Early and Midterm Follow-Up Results of Endovascular Repair of Stanford Type B Aortic Dissection：Report of 85 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHI Tianxiong , XIE Xiaozhang.

General Surgical Department 2，Zhongshan City People’s Hospital，Zhongshan 528403，Guangdong Province，China;

Corresponding author：

SHI Tianxiong, Email: tianxiongshi@yahoo.com.cn

Keywords：

Aortic dissection; Endovascular repair; Stent-graft

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Objective 　To introduce the experience of treating 85 cases of stanford type B aortic dissection by endovascular implantment of stent-grafts，to provide more clinical evidence for endovascular repairment for stanford B type aortic dissections.
Methods 　Imaging examination by computed tomography angiography （CTA） were done to obtain anatomical detail of dissection. Stent-grafts were implanted under the guide of DSA in all cases. The patients were followed-up for 3 months，6 months，12 months，and then annually by CTA examination to observe the complications and morphological changes of the aneurysm.
Results 　The technical success rate was 95.3%（81/85），and the clinical success rate was 91.8%（78/85）. Eight patients died after operation in hospital，who were all in acute phase，and no patients of chronic phase died，there had statistic differences （P＜0.05）. The perioperative complications’ incidence of endovascular repair which happened in patients of acute phase was higher than that patients of chronic phase （38.2% vs.13.3%，P＜0.05）. Left subclavian artery were covered completely for 13 cases，and partially covered for 22 cases，there was no obvious cerebralvascular insufficiency. There were 41 patients of whom other tears which were not covered during operation exsited at abdominal aortic and one year following-up showed that at those section thromblization of false cavity was not clear. The rest of patients whose abdominal aortic didn’t exist tears hadn’t new tears appeared.
Conclusions 　Regardless in the acute or chronic stage，endovascular therapy is an effective mathod of treating stanford type B dissection. However，implanting stent-grafts have a higher security in chronic period than doing that in acute period. If the right carotid artery，vertebra and Willis ring are smoothly，there is little need to set up a by-pass to left subclavian artery before endovascular repairment. For those patients that other uncovered tears exited，following-up should be a must，and further strategy should be studied and prepared in advance.

Citation： SHI Tianxiong,XIE Xiaozhang.. Early and Midterm Follow-Up Results of Endovascular Repair of Stanford Type B Aortic Dissection：Report of 85 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(1): 66-71. doi: Copy

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13.	Wang ZG， Li C.Single-branch endograft for treating Stanford type B aortic dissections with entry tears in proximity to the left subclavian artery[J].J Endovasc Ther， 2005， 12(5)：588-593.
14.	Chuter TA， Schneider DB， Reilly LM， et al.Modular branched stent graft for endovascular repair of aortic arch aneurysm and dissection[J].J Vasc Surg， 2003， 38(4)：859-863.
15.	Erbel R， Alfonso F， Boileau C， et al.Diagnosis and management of aortic dissection[J].Eur Heart J， 2001， 22(18)：1642-1681.
16.	Nienaber CA， Fattori R， Lund G， et al.Nonsurgical Reconstruction of thoracic aortic dissection by stent-graft placement[J].N Engl J Med， 1999， 340(20)：1539-1545.
17.	Xu SD， Huang FJ， Yang JF， et al.Endovascular repair of acute type B aortic dissection：early and mid-term results[J].J Vasc Surg， 2006， 43(6)：1090-1095.
18.	Kusagawa H， Shimono T， Ishida M， et al.Changes in false lumen after transluminal stent-graft placement in aortic dissections：six years’ experience[J].Circulation， 2005， 111(22)：2951-2957.
19.	Bortone AS， De Cillis E， D’Agostino D， et al.Endovasculartreatment of thoracic aortic disease：four years of experience[J].Circulation， 2004， 110(11 Suppl 1)：Ⅱ262-Ⅱ267.
20.	Eggebrecht H， Nienaber CA， Neuhäuser M， et al.Endovascular stent-graft placement in aortic dissection：a meta-analysis[J].Eur Heart J， 2006， 27(4)：489-498.
21.	Kato N， Shimono T， Hirano T， et al.Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear：the complication-specific approach[Z]， 2002：306-312.
22.	Chen S， Yei F， Zhou L， et al.Endovascular stent-grafts treatment in acute aortic dissection (type B)：clinical outcomes during early，late，or chronicphases[J].Catheter Cardiovasc Interv， 2006(68)：319-325.
23.	Jing QM， Han YL， Wang XZ， et al.Endovascular stent-grafts for acute and chronic type B aortic dissection：comparison of clinical outcomes[J].Chin Med J (Engl)， 2008， 121(22)：2213-2217.
24.	Eggebrecht H， Herold U， Kuhnt O， et al.Endovascular stent-graft treatment of aortic dissection：determinants of post-interventional outcome[J].Eur Heart J， 2005， 26(5)：489-497.
25.	李梓伦，王丽萍，常光其.中国血管腔内支架植入术治疗Stanford B 型主动脉夹层：Meta分析[J].中华普通外科学文献：电子版， 2009， 3(4)：334-341．.

1. 　Mészáros I， Mórocz J， Szlávi J， et al.Epidemiology and clinicopathology of aortic dissection[J].Chest， 2000， 117(5)： 1271-1278.
2. Dake MD， Miller DC， Semba CP， et al.Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms[J].N Engl J Med， 1994， 331(26)：1729-1734.
3. 鞠衍松. 46 例主动脉夹层诊治体会[J].山东医药， 2009， 49( 27) ：116．.
4. 周艳红，贾立静，计达.急诊主动脉夹层临床特征研究[J].山东医药， 2010， 50(20)：19-21．.
5. 朱锐，关思虞.主动脉夹层78例临床分析[J].疑难病杂志， 2008， 7(2)：104-105．.
6. Criado FJ， Clark NS， Barnatan MF.Stent graft repair in the aortic arch and descending thoracic aorta：a 4-year experience[J].J Vasc Surg， 2002， 36(6)：1121-1128.
7. Czermak BV， Waldenberger P， Fraedrich G， et al.Treatment of stanford type B aortic dissection with stent-grafts：preliminary results[J].Radiology， 2000， 217(2)：544-550.
8. Hausegger KA， Tiesenhausen K， Schedlbauer P， et al.Treatment of acute aortic type B dissection with stent-grafts[J].Cardiovasc Intervent Radiol， 2001， 24(5)：306-306.
9. Hausegger KA， Oberwalder P， Tiesenhausen K， et al.Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition[J].J Endovasc Ther， 2001， 8(5)：472-476.
10. 戎建杰，李晓强，钱爱民，等.主动脉夹层动脉瘤的血管腔内治疗[J].苏州大学学报：医学版， 2009， 29(3)：530-532．.
11. Fu WG， Dong ZH， Wang YQ， et al.Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair[J].Chin Med J， 2005， 118(13)：1066-1071.
12. 景在平，冯翔，包俊敏，等. 腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤146例临床分析[J].中华外科杂志， 2003， 41(7)：483-486．.
13. Wang ZG， Li C.Single-branch endograft for treating Stanford type B aortic dissections with entry tears in proximity to the left subclavian artery[J].J Endovasc Ther， 2005， 12(5)：588-593.
14. Chuter TA， Schneider DB， Reilly LM， et al.Modular branched stent graft for endovascular repair of aortic arch aneurysm and dissection[J].J Vasc Surg， 2003， 38(4)：859-863.
15. Erbel R， Alfonso F， Boileau C， et al.Diagnosis and management of aortic dissection[J].Eur Heart J， 2001， 22(18)：1642-1681.
16. Nienaber CA， Fattori R， Lund G， et al.Nonsurgical Reconstruction of thoracic aortic dissection by stent-graft placement[J].N Engl J Med， 1999， 340(20)：1539-1545.
17. Xu SD， Huang FJ， Yang JF， et al.Endovascular repair of acute type B aortic dissection：early and mid-term results[J].J Vasc Surg， 2006， 43(6)：1090-1095.
18. Kusagawa H， Shimono T， Ishida M， et al.Changes in false lumen after transluminal stent-graft placement in aortic dissections：six years’ experience[J].Circulation， 2005， 111(22)：2951-2957.
19. Bortone AS， De Cillis E， D’Agostino D， et al.Endovasculartreatment of thoracic aortic disease：four years of experience[J].Circulation， 2004， 110(11 Suppl 1)：Ⅱ262-Ⅱ267.
20. Eggebrecht H， Nienaber CA， Neuhäuser M， et al.Endovascular stent-graft placement in aortic dissection：a meta-analysis[J].Eur Heart J， 2006， 27(4)：489-498.
21. Kato N， Shimono T， Hirano T， et al.Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear：the complication-specific approach[Z]， 2002：306-312.
22. Chen S， Yei F， Zhou L， et al.Endovascular stent-grafts treatment in acute aortic dissection (type B)：clinical outcomes during early，late，or chronicphases[J].Catheter Cardiovasc Interv， 2006(68)：319-325.
23. Jing QM， Han YL， Wang XZ， et al.Endovascular stent-grafts for acute and chronic type B aortic dissection：comparison of clinical outcomes[J].Chin Med J (Engl)， 2008， 121(22)：2213-2217.
24. Eggebrecht H， Herold U， Kuhnt O， et al.Endovascular stent-graft treatment of aortic dissection：determinants of post-interventional outcome[J].Eur Heart J， 2005， 26(5)：489-497.
25. 李梓伦，王丽萍，常光其.中国血管腔内支架植入术治疗Stanford B 型主动脉夹层：Meta分析[J].中华普通外科学文献：电子版， 2009， 3(4)：334-341．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Early and Midterm Follow-Up Results of Endovascular Repair of Stanford Type B Aortic Dissection：Report of 85 Cases

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