Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGXue-gang , BAIDou , WUShao-hui , ZHANGXiao-jie ,  JIANGLan-shan

Department of Vascular Surgery, Mianyang Central Hospital, Mianyang 621000, Sichuan, P. R. China;

Corresponding author：

JIANGLan-shan, Email: 422242431@qq.com

Keywords：

Aortic dissection; Covered graft; Endovascular repair; Visceral artery

DOI：

10.7507/1007-4848.20150040

Video：

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Objective To investigate the improvement of visceral arterial blood supply after thoracic endovascular aortic repair (TEVAR) for patients with Stanford type B aortic dissection (AD). Methods We retrospectively analyzed clinical data of 35 patients with Stanford type B AD undergoing TEVAR in Mianyang Central Hospital from January 2013 to March 2014. There were 30 male and 5 female patients with their age of 45-82(62.5±10.0) years. Among the 140 main visceral arteries (celiac artery, superior mesenteric artery, left and right renal arteries) of the 35 patients, blood supply of 79 arteries were compromised, including 36 arteries with stenosis and blood supply via the true lumen, 18 arteries with blood supply via both true and false lumen, 18 arteries with blood supply via the false lumen, and 7 arteries without blood supply. Improvement of blood supply of main visceral arteries was analyzed. Results All the operations were successfully performed without in-hospital death. Operation time was 97.8 (68-147) minutes, length of ICU stay was 12-34 h, and length of hospital stay was 10-21 days. None of the patients had cerebral infarction, acute renal failure, AD rupture or stent migration after TEVAR. Blood supply of the compromised visceral arteries showed improvement in various degrees. Conclusion For the treatment of Stanford type B AD, TEVAR can not only successfully block the rupture of AD, but also improve blood supply of main visceral arteries, avoid or reduce the complications resulting from compromised visceral arterial blood supply and visceral ischemia.

Citation： WANGXue-gang, BAIDou, WUShao-hui, ZHANGXiao-jie, JIANGLan-shan. Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 143-145. doi: 10.7507/1007-4848.20150040 Copy

1.	郭伟, 盖鲁粤, 刘小平, 等. Stanford B型主动脉夹层腔内修复术前后内脏动脉供血形式的变化.中华外科杂志, 2003, 41(12):924-927.
2.	景在平, 冯翔, 包俊敏, 等.腔内隔绝术治疗Stanford B型主动脉夹层——116例临床分析.中国胸心血管外科临床杂志, 2003, 13(1):14-17.
3.	赵珺.对腔内修复Stanford B型主动脉夹层手术范围的质疑——应将"远端旷置"改为"全程修复".中国胸心血管外科临床杂志, 2014, 21(2):141-143.
4.	王深明, 主编.血管外科学.北京:人民卫生出版社, 2011. 316.
5.	刘维永.胸主动脉瘤及主动脉夹层外科治疗进展.中国胸心血管外科临床杂志, 2003, 13(1):50-53.
6.	Walker PJ, Sarris GE, Miller DC. Peripheral vascular manifestations of acute aortic dissection. Vascular Surgery. 4th ed. Philadephia:WB Saunders, 1995. 1087-1102.
7.	Kieffer E. Dissection of the descending thoracic aorta. In Rutherford Vascular Surgery. 5th ed. Philadephia:WB Saunders, 2000. 1326-1344.
8.	朱峥嵘, 陈小东, 罗灿华, 等.带膜血管内支架腔内隔绝治疗对ⅢB型主动脉夹层内脏动脉血流的影响.中国组织工程研究与临床康复, 2008, 12(52):10263-10267.
9.	李长青, 杨建.覆膜支架主动脉腔内修复术在Stanford B型主动脉夹层中的应用.中国胸心血管外科临床杂志, 2014, 21(3):364-366.
10.	张明宇, 夏洪远, 董玉梅, 等.腔内隔绝术治疗Stanford B型胸主动脉夹层18例.哈尔滨医科大学学报, 2011, 45(3):286-288.
11.	Shiiya N, Matsuzaki K, Kunihara T, et al. Management of vital organ malperfusion in acute aortic dissection:proposal of a mechanism-specific approach. Gen Thorac Cardiovasc Surg, 2007, 55(3):85-90.
12.	Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20):1546-1552.
13.	Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med, 1999, 340(20):1539-1545.
14.	Kato N, Hirano T, Shimono T, et al. Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement:preliminary results. J Vasc Interv Radiol, 2001, 12(7):835-840.
15.	Palma JH, de Souza JA, Rodrigues Alves CM, et al. Self-expandable aortic stent-graft for treatment of descending aortic dissections. Ann Thorac Surg, 2002, 73(4):1138-1141.
16.	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. J Thorac Cardiovasc Surg, 2002, 124(2):306-312.
17.	黄连军, 孙立忠, 朱俊明, 等.带膜血管内支架置入治疗胸主动脉夹层.中华心血管病杂志, 2004, 32(2):141-143.
18.	陈伟, 杨建勇, 庄文权, 等.腔内隔绝术治疗胸主动脉夹层.中华放射学杂志, 2013, 37(11):1007-1011.

1. 郭伟, 盖鲁粤, 刘小平, 等. Stanford B型主动脉夹层腔内修复术前后内脏动脉供血形式的变化.中华外科杂志, 2003, 41(12):924-927.
2. 景在平, 冯翔, 包俊敏, 等.腔内隔绝术治疗Stanford B型主动脉夹层——116例临床分析.中国胸心血管外科临床杂志, 2003, 13(1):14-17.
3. 赵珺.对腔内修复Stanford B型主动脉夹层手术范围的质疑——应将"远端旷置"改为"全程修复".中国胸心血管外科临床杂志, 2014, 21(2):141-143.
4. 王深明, 主编.血管外科学.北京:人民卫生出版社, 2011. 316.
5. 刘维永.胸主动脉瘤及主动脉夹层外科治疗进展.中国胸心血管外科临床杂志, 2003, 13(1):50-53.
6. Walker PJ, Sarris GE, Miller DC. Peripheral vascular manifestations of acute aortic dissection. Vascular Surgery. 4th ed. Philadephia:WB Saunders, 1995. 1087-1102.
7. Kieffer E. Dissection of the descending thoracic aorta. In Rutherford Vascular Surgery. 5th ed. Philadephia:WB Saunders, 2000. 1326-1344.
8. 朱峥嵘, 陈小东, 罗灿华, 等.带膜血管内支架腔内隔绝治疗对ⅢB型主动脉夹层内脏动脉血流的影响.中国组织工程研究与临床康复, 2008, 12(52):10263-10267.
9. 李长青, 杨建.覆膜支架主动脉腔内修复术在Stanford B型主动脉夹层中的应用.中国胸心血管外科临床杂志, 2014, 21(3):364-366.
10. 张明宇, 夏洪远, 董玉梅, 等.腔内隔绝术治疗Stanford B型胸主动脉夹层18例.哈尔滨医科大学学报, 2011, 45(3):286-288.
11. Shiiya N, Matsuzaki K, Kunihara T, et al. Management of vital organ malperfusion in acute aortic dissection:proposal of a mechanism-specific approach. Gen Thorac Cardiovasc Surg, 2007, 55(3):85-90.
12. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20):1546-1552.
13. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med, 1999, 340(20):1539-1545.
14. Kato N, Hirano T, Shimono T, et al. Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement:preliminary results. J Vasc Interv Radiol, 2001, 12(7):835-840.
15. Palma JH, de Souza JA, Rodrigues Alves CM, et al. Self-expandable aortic stent-graft for treatment of descending aortic dissections. Ann Thorac Surg, 2002, 73(4):1138-1141.
16. 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. J Thorac Cardiovasc Surg, 2002, 124(2):306-312.
17. 黄连军, 孙立忠, 朱俊明, 等.带膜血管内支架置入治疗胸主动脉夹层.中华心血管病杂志, 2004, 32(2):141-143.
18. 陈伟, 杨建勇, 庄文权, 等.腔内隔绝术治疗胸主动脉夹层.中华放射学杂志, 2013, 37(11):1007-1011.

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Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

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