Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Shaoxiong ,  YANG Jiansheng

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

Corresponding author：

YANG Jiansheng, Email: jianson@163.com

Keywords：

Aortic dissection; chimney technique; fenestration; bypass; endovascular repair; treatment

DOI：

10.7507/1007-4848.202004064

Video：

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Objective To investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.Methods From January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.Results The operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).Conclusion In situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.

Citation： JIN Shaoxiong, YANG Jiansheng. Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1020-1024. doi: 10.7507/1007-4848.202004064 Copy

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2.	邱家伟, 赵锐, 王德, 等. 杂交全主动脉弓修复术治疗不同年龄段 Stanford A 型主动脉夹层的临床疗效分析. 中国胸心血管外科临床杂志, 2020, [Epub ahead of print].
3.	张科, 侯培勇, 李祺熠, 等. 体外转流联合多种原位开窗技术在主动脉弓部疾病腔内修复的应用. 中国微创外科杂志, 2019, 19(10): 874-877, 881.
4.	庞桦进, 陈勇, 何晓峰, 等. Amplatzer 血管塞联合 Interlock 可解脱弹簧圈栓塞治疗 B 型主动脉夹层 TEVAR 联合颈动脉烟囱支架治疗术后高流量 Ⅰa 型内漏. 实用医学杂志, 2019, 35(9): 1496-1499.
5.	陈文, 叶仕高, 张迎春, 等. “杂交”技术治疗特殊腹髂主动脉病变的应用观察. 微创医学, 2018, 13(4): 37-39.
6.	Maynar M, Rostagno R, Zander T, <italic>et al</italic>. Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection. J Endovasc Ther, 2005, 12(1): 103-109.
7.	蔡丽生, 蔡铭智, 陈秋贤, 等. Stanford B 型主动脉夹层 52 例报告. 中国微创外科杂志, 2013, 13(10): 41-44.
8.	Canaud L, Ozdemir BA, Patterson BO, <italic>et al</italic>. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
9.	Fujiyoshi T, Koizumi N, Nishibe T, <italic>et al</italic>. Direct repair of localized aortic dissection with critical malperfusion of the left main trunk. Ann Thorac Cardiovasc Surg, 2018, 24(6): 320-323.
10.	DeSart K, Scali ST, Feezor RJ, <italic>et al</italic>. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair. J Vasc Surg, 2013, 58(3): 635-642.
11.	Bouassida I, Meyrignac O, Marcheix B, <italic>et al</italic>. Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug Ⅱ in chronic aortic arch dissection: A case report. J Thorac Cardiovasc Surg, 2018, 155(1): e7-e10.
12.	Kouchoukos NT, Kulik A, Castner CF, <italic>et al</italic>. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S125-S129.
13.	Bavaria J, Vallabhajosyula P, Moeller P, <italic>et al</italic>. Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3): S85-S90.
14.	丘俊涛, 张良, 罗新锦, 等. 主动脉夹层手术时机对预后的影响. 中华胸心血管外科杂志, 2018, 34(1): 26-31.
15.	寇镭, 陈忠, 唐小斌, 等. 腹主动脉瘤腔内修复术后Ⅱ型内漏的诊断和治疗. 心肺血管病杂志, 2016, 35(11): 875-879.
16.	Preventza O, Aftab M, Coselli JS. Hybrid techniques for complex aortic arch surgery. Tex Heart Inst J, 2013, 40(5): 568-571.
17.	郑智, 刘赋斌, 潘友民, 等. 个体化开窗策略在主动脉疾病腔内修复术中的应用. 中国医师杂志, 2015, 17(11): 1686-1689.
18.	Tolenaar JL, van Keulen JW, Trimarchi S, <italic>et al</italic>. The chimney graft, a systematic review. Ann Vasc Surg, 2012, 26(7): 1030-1038.
19.	Nauta FJ, Conti M, Kamman AV, <italic>et al</italic>. Biomechanical changes after thoracic endovascular aortic repair in type B dissection: A systematic review. J Endovasc Ther, 2015, 22(6): 918-933.

1. leischman F, Elsayed RS, Cohen RG, <italic>et al</italic>. Selective aortic arch and root replacement in repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 105(2): 505.
2. 邱家伟, 赵锐, 王德, 等. 杂交全主动脉弓修复术治疗不同年龄段 Stanford A 型主动脉夹层的临床疗效分析. 中国胸心血管外科临床杂志, 2020, [Epub ahead of print].
3. 张科, 侯培勇, 李祺熠, 等. 体外转流联合多种原位开窗技术在主动脉弓部疾病腔内修复的应用. 中国微创外科杂志, 2019, 19(10): 874-877, 881.
4. 庞桦进, 陈勇, 何晓峰, 等. Amplatzer 血管塞联合 Interlock 可解脱弹簧圈栓塞治疗 B 型主动脉夹层 TEVAR 联合颈动脉烟囱支架治疗术后高流量 Ⅰa 型内漏. 实用医学杂志, 2019, 35(9): 1496-1499.
5. 陈文, 叶仕高, 张迎春, 等. “杂交”技术治疗特殊腹髂主动脉病变的应用观察. 微创医学, 2018, 13(4): 37-39.
6. Maynar M, Rostagno R, Zander T, <italic>et al</italic>. Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection. J Endovasc Ther, 2005, 12(1): 103-109.
7. 蔡丽生, 蔡铭智, 陈秋贤, 等. Stanford B 型主动脉夹层 52 例报告. 中国微创外科杂志, 2013, 13(10): 41-44.
8. Canaud L, Ozdemir BA, Patterson BO, <italic>et al</italic>. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
9. Fujiyoshi T, Koizumi N, Nishibe T, <italic>et al</italic>. Direct repair of localized aortic dissection with critical malperfusion of the left main trunk. Ann Thorac Cardiovasc Surg, 2018, 24(6): 320-323.
10. DeSart K, Scali ST, Feezor RJ, <italic>et al</italic>. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair. J Vasc Surg, 2013, 58(3): 635-642.
11. Bouassida I, Meyrignac O, Marcheix B, <italic>et al</italic>. Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug Ⅱ in chronic aortic arch dissection: A case report. J Thorac Cardiovasc Surg, 2018, 155(1): e7-e10.
12. Kouchoukos NT, Kulik A, Castner CF, <italic>et al</italic>. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S125-S129.
13. Bavaria J, Vallabhajosyula P, Moeller P, <italic>et al</italic>. Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3): S85-S90.
14. 丘俊涛, 张良, 罗新锦, 等. 主动脉夹层手术时机对预后的影响. 中华胸心血管外科杂志, 2018, 34(1): 26-31.
15. 寇镭, 陈忠, 唐小斌, 等. 腹主动脉瘤腔内修复术后Ⅱ型内漏的诊断和治疗. 心肺血管病杂志, 2016, 35(11): 875-879.
16. Preventza O, Aftab M, Coselli JS. Hybrid techniques for complex aortic arch surgery. Tex Heart Inst J, 2013, 40(5): 568-571.
17. 郑智, 刘赋斌, 潘友民, 等. 个体化开窗策略在主动脉疾病腔内修复术中的应用. 中国医师杂志, 2015, 17(11): 1686-1689.
18. Tolenaar JL, van Keulen JW, Trimarchi S, <italic>et al</italic>. The chimney graft, a systematic review. Ann Vasc Surg, 2012, 26(7): 1030-1038.
19. Nauta FJ, Conti M, Kamman AV, <italic>et al</italic>. Biomechanical changes after thoracic endovascular aortic repair in type B dissection: A systematic review. J Endovasc Ther, 2015, 22(6): 918-933.

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Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery

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