Clinical effect of <i>in vitro</i> fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Donglin , CHEN Lufeng , LI Rongbin ,  CAI Xudong

The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, P. R. China;

Corresponding author：

CAI Xudong, Email: 714889404@qq.com

Keywords：

Aortic dissection; in vitro fenestration; chimney technique; endovascular treatment; left subclavian artery

DOI：

10.7507/1007-4848.202103133

Video：

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Objective To investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection.Methods A total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups.Results The operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05).Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.

Citation： LI Donglin, CHEN Lufeng, LI Rongbin, CAI Xudong. Clinical effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 403-409. doi: 10.7507/1007-4848.202103133 Copy

1.	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
2.	Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg, 2019, 67(1): 59-65.
3.	Norton EL, Williams DM, Kim KM, et al. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg, 2020, 160(5): 1151-1161.
4.	韩啸, 宋来春, 符竣, 等. 杂交手术治疗Stanford B型复杂型主动脉夹层的近中期效果. 中国心血管病研究, 2015, 13(8): 744-746.
5.	Brescia AA, Patel HJ, Likosky DS, et al. Volume-outcome relationships in surgical and endovascular repair of aortic dissection. Ann Thorac Surg, 2019, 108(5): 1299-1306.
6.	周小彪, 宋曼, 郭宏伟, 等. 胸主动脉腔内修复术治疗B型主动脉夹层的早中期结果. 中华血管外科杂志, 2020, 5(3): 175-180.
7.	Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
8.	金少雄, 杨建胜. 原位开窗联合烟囱技术治疗累及左侧颈总动脉的主动脉夹层的疗效分析. 中国胸心血管外科临床杂志, 2020, 27(9): 1020-1024.
9.	Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
10.	胡凡果, 朱杰昌, 戴向晨, 等. 体外预开窗腔内修复治疗非健康锚定区及短锚定区B型主动脉夹层的前瞻性单中心研究. 中华普通外科杂志, 2020, 35(7): 536-539.
11.	高伟, 刘燊, 丘俊涛, 等. 主动脉弓降部病变患者胸主动脉腔内治疗同期左锁骨下动脉血流重建的近中期效果. 中华胸心血管外科杂志, 2017, 33(10): 587-590.
12.	Liu Z, Zhang Y, Liu C, et al. Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection. J Int Med Res, 2017, 45(5): 1574-1584.
13.	朱水波, 朱健, 郗二平, 等. 不开胸“杂交”手术治疗主动脉弓部夹层的近中期随访研究. 中国胸心血管外科临床杂志, 2016, 23(10): 988-991.
14.	Wang M, Dong D, Yuan H, et al. Hybrid versusin vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone. Vascular, 2020, 28(1): 42-47.
15.	张省, 秦金保, 李维敏, 等. 拓展近端锚定区对Stanford B型主动脉夹层腔内修复术预后的影响. 中华外科杂志, 2018, 56(10): 760-763.
16.	陈凯, 景在平, 张磊, 等. 主动脉夹层腔内隔绝术后再干预的原因及危险因素分析. 中国胸心血管外科临床杂志, 2016, 23(5): 425-429.
17.	李树春, 周庆, 潘俊, 等. Stanford B型主动脉夹层腔内修复术后并发A型夹层的外科治疗. 中国胸心血管外科临床杂志, 2019, 26(8): 826-828.
18.	Davidovic L, Sladojevic M, Koncar I, et al. Late complication after thoracic endovascular aortic repair: What is the role of an open surgical conversion? Ann Vasc Surg, 2018, 47: 238-246.
19.	高永山, 郭曦, 吴文辉, 等. 急性Stanford B型主动脉夹层行腔内隔绝术后的主动脉重塑. 中华胸心血管外科杂志, 2017, 33(12): 725-728.
20.	Veger HTC, Pasveer EH, Visser MJT. Where to fenestrate in aortic dissection type B? An ex vivo study. Ann Vasc Surg, 2017, 43: 296-301.

1. Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
2. Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg, 2019, 67(1): 59-65.
3. Norton EL, Williams DM, Kim KM, et al. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg, 2020, 160(5): 1151-1161.
4. 韩啸, 宋来春, 符竣, 等. 杂交手术治疗Stanford B型复杂型主动脉夹层的近中期效果. 中国心血管病研究, 2015, 13(8): 744-746.
5. Brescia AA, Patel HJ, Likosky DS, et al. Volume-outcome relationships in surgical and endovascular repair of aortic dissection. Ann Thorac Surg, 2019, 108(5): 1299-1306.
6. 周小彪, 宋曼, 郭宏伟, 等. 胸主动脉腔内修复术治疗B型主动脉夹层的早中期结果. 中华血管外科杂志, 2020, 5(3): 175-180.
7. Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
8. 金少雄, 杨建胜. 原位开窗联合烟囱技术治疗累及左侧颈总动脉的主动脉夹层的疗效分析. 中国胸心血管外科临床杂志, 2020, 27(9): 1020-1024.
9. Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
10. 胡凡果, 朱杰昌, 戴向晨, 等. 体外预开窗腔内修复治疗非健康锚定区及短锚定区B型主动脉夹层的前瞻性单中心研究. 中华普通外科杂志, 2020, 35(7): 536-539.
11. 高伟, 刘燊, 丘俊涛, 等. 主动脉弓降部病变患者胸主动脉腔内治疗同期左锁骨下动脉血流重建的近中期效果. 中华胸心血管外科杂志, 2017, 33(10): 587-590.
12. Liu Z, Zhang Y, Liu C, et al. Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection. J Int Med Res, 2017, 45(5): 1574-1584.
13. 朱水波, 朱健, 郗二平, 等. 不开胸“杂交”手术治疗主动脉弓部夹层的近中期随访研究. 中国胸心血管外科临床杂志, 2016, 23(10): 988-991.
14. Wang M, Dong D, Yuan H, et al. Hybrid versusin vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone. Vascular, 2020, 28(1): 42-47.
15. 张省, 秦金保, 李维敏, 等. 拓展近端锚定区对Stanford B型主动脉夹层腔内修复术预后的影响. 中华外科杂志, 2018, 56(10): 760-763.
16. 陈凯, 景在平, 张磊, 等. 主动脉夹层腔内隔绝术后再干预的原因及危险因素分析. 中国胸心血管外科临床杂志, 2016, 23(5): 425-429.
17. 李树春, 周庆, 潘俊, 等. Stanford B型主动脉夹层腔内修复术后并发A型夹层的外科治疗. 中国胸心血管外科临床杂志, 2019, 26(8): 826-828.
18. Davidovic L, Sladojevic M, Koncar I, et al. Late complication after thoracic endovascular aortic repair: What is the role of an open surgical conversion? Ann Vasc Surg, 2018, 47: 238-246.
19. 高永山, 郭曦, 吴文辉, 等. 急性Stanford B型主动脉夹层行腔内隔绝术后的主动脉重塑. 中华胸心血管外科杂志, 2017, 33(12): 725-728.
20. Veger HTC, Pasveer EH, Visser MJT. Where to fenestrate in aortic dissection type B? An ex vivo study. Ann Vasc Surg, 2017, 43: 296-301.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection

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