Supra-arch branch vessel bypass and thoracic endovascular aortic repair for treating type B1C aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CUI Cong , ZHANG Li , GAO Xia , ZHANG Xianghui , SUN Kexiong , XIAO Changbo , WU Gang , MA Shen , CHEN Yuxin , WANG Pingfan

Henan Province Chest Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

CUI Cong, Email: conghuicui@163.com

Keywords：

Type B1C aortic dissection; supra-arch branch vessel bypass; hybrid procedure; stent graft

DOI：

10.7507/1007-4848.201805006

Video：

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Objective To evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection.Methods In our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair (TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass (n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass (n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass (n=2) were performed.Results Early mortality rate was 2.0% (1/49). Forty-eight patients survived postoperatively. The follow-up rate was 100.0% (48/48). The patients were followed up for 6 to 47 (26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia.Conclusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.

Citation： CUI Cong, ZHANG Li, GAO Xia, ZHANG Xianghui, SUN Kexiong, XIAO Changbo, WU Gang, MA Shen, CHEN Yuxin, WANG Pingfan. Supra-arch branch vessel bypass and thoracic endovascular aortic repair for treating type B1C aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(2): 121-124. doi: 10.7507/1007-4848.201805006 Copy

1.	饶从亮, 胡何节, 王晓天, 等. 亚急性期 Stanford B 型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素. 中国普通外科杂志, 2017, 26(12): 1547-1554.
2.	Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9(Suppl 2): I98-I105.
3.	冯俊波, 葛圣林, 周汝元, 等. " 一站式”杂交手术及单纯腔内隔绝术治疗 Stanford B 型主动脉夹层. 安徽医学, 2015, 36(4): 476-478.
4.	Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
5.	范海伦, 汤凯丰, 胡凡果, 等. 体外开窗 TEVAR 技术治疗不良近端锚定区 Stanford B 型主动脉夹层的近期疗效分析. 血管与腔内血管外科杂志, 2016, 2(5): 415-419.
6.	舒畅, 王暾. " 烟囱”技术治疗累及弓部分支动脉病变中远期疗效研究. 中国实用外科杂志, 2014, 34(12): 1163-1166.
7.	Yuri K, Yokoi Y, Yamaguchi A, et al. Usefulness of fenestrated stent grafts for thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2013, 44(4): 760-767.
8.	Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier: review of current applications and directions of thoracic endovascular aortic repair (TEVAR). Can J Cardiol, 2014, 30(1): 52-63.
9.	Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010, 140(3): 590-597.
10.	Sood V, Patel HJ, Williams DM, et al. Open and endovascular repair of the nontraumatic isolated aortic arch aneurysm. J Vasc Surg, 2014, 60(1): 57-63.
11.	Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S85-S90.
12.	Ozsvath KJ, Roddy SP, Darling RC 3rd, et al. Carotid-carotid crossover bypass: is it a durable procedure? J Vasc Surg, 2003, 37(3): 582-585.
13.	魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18(2): 99-103.
14.	Grabenwöger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2012, 42(1): 17-24.
15.	Pepper J. Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection (TAAD)-the European experience. Ann Cardiothorac Surg, 2016, 5(4): 360-367.
16.	Preventza O, Coselli JS. Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience. Ann Cardiothorac Surg, 2016, 5(4): 352-359.
17.	Dijkstra ML, Vainas T, Zeebregts CJ, et al. Editor’s choice - spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair: review of preventive strategies. Eur J Vasc Endovasc Surg, 2018, 55(6): 829-841.
18.	Bozso SJ, White A, Nagendran J, et al. Hybrid aortic arch and frozen elephant trunk reconstruction: bridging the gap between conventional and total endovascular arch repair. Expert Rev Cardiovasc Ther, 2018, 16(3): 209-217.
19.	Ullery BW, Cheung AT, Fairman RM, et al. Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair. J Vasc Surg, 2011, 54(3): 677-684.
20.	Jayia P, Constantinou J, Hamilton H, et al. Temporary perfusion branches to decrease spinal cord ischemia in the endovascular treatment of thoraco-abdominal aortic aneurysms: based on a presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA). Aorta (Stamford), 2015, 3(2): 56-60.

1. 饶从亮, 胡何节, 王晓天, 等. 亚急性期 Stanford B 型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素. 中国普通外科杂志, 2017, 26(12): 1547-1554.
2. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9(Suppl 2): I98-I105.
3. 冯俊波, 葛圣林, 周汝元, 等. " 一站式”杂交手术及单纯腔内隔绝术治疗 Stanford B 型主动脉夹层. 安徽医学, 2015, 36(4): 476-478.
4. Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
5. 范海伦, 汤凯丰, 胡凡果, 等. 体外开窗 TEVAR 技术治疗不良近端锚定区 Stanford B 型主动脉夹层的近期疗效分析. 血管与腔内血管外科杂志, 2016, 2(5): 415-419.
6. 舒畅, 王暾. " 烟囱”技术治疗累及弓部分支动脉病变中远期疗效研究. 中国实用外科杂志, 2014, 34(12): 1163-1166.
7. Yuri K, Yokoi Y, Yamaguchi A, et al. Usefulness of fenestrated stent grafts for thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2013, 44(4): 760-767.
8. Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier: review of current applications and directions of thoracic endovascular aortic repair (TEVAR). Can J Cardiol, 2014, 30(1): 52-63.
9. Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010, 140(3): 590-597.
10. Sood V, Patel HJ, Williams DM, et al. Open and endovascular repair of the nontraumatic isolated aortic arch aneurysm. J Vasc Surg, 2014, 60(1): 57-63.
11. Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S85-S90.
12. Ozsvath KJ, Roddy SP, Darling RC 3rd, et al. Carotid-carotid crossover bypass: is it a durable procedure? J Vasc Surg, 2003, 37(3): 582-585.
13. 魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18(2): 99-103.
14. Grabenwöger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2012, 42(1): 17-24.
15. Pepper J. Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection (TAAD)-the European experience. Ann Cardiothorac Surg, 2016, 5(4): 360-367.
16. Preventza O, Coselli JS. Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience. Ann Cardiothorac Surg, 2016, 5(4): 352-359.
17. Dijkstra ML, Vainas T, Zeebregts CJ, et al. Editor’s choice - spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair: review of preventive strategies. Eur J Vasc Endovasc Surg, 2018, 55(6): 829-841.
18. Bozso SJ, White A, Nagendran J, et al. Hybrid aortic arch and frozen elephant trunk reconstruction: bridging the gap between conventional and total endovascular arch repair. Expert Rev Cardiovasc Ther, 2018, 16(3): 209-217.
19. Ullery BW, Cheung AT, Fairman RM, et al. Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair. J Vasc Surg, 2011, 54(3): 677-684.
20. Jayia P, Constantinou J, Hamilton H, et al. Temporary perfusion branches to decrease spinal cord ischemia in the endovascular treatment of thoraco-abdominal aortic aneurysms: based on a presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA). Aorta (Stamford), 2015, 3(2): 56-60.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Supra-arch branch vessel bypass and thoracic endovascular aortic repair for treating type B1C aortic dissection

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