Effectiveness of <i>in vitro</i> fenestration <i>versus</i> bypass surgery for type B aortic dissection involving the left subclavian artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Hao , LIU Xiaobin , DU Xinling , JIANG Xionggang , WU Long ,  DONG Nianguo

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, P.R.China;

Corresponding author：

DONG Nianguo, Email: hhdongnianguo@aliyun.com

Keywords：

Left subclavian artery; type B aortic dissection; in vitro fenestration; bypass surgery

DOI：

10.7507/1007-4848.202011099

Video：

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Objective To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR).Methods Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared.Results The surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups.Conclusion The two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.

Citation： HONG Hao, LIU Xiaobin, DU Xinling, JIANG Xionggang, WU Long, DONG Nianguo. Effectiveness of in vitro fenestration versus bypass surgery for type B aortic dissection involving the left subclavian artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 788-791. doi: 10.7507/1007-4848.202011099 Copy

1.	Joseph G, Premkumar P, Thomson V, et al. Externalized guidewires to facilitate fenestrated endograft deployment in the aortic arch. J Endovasc Ther, 2016, 23(1): 160-171.
2.	Zhu J, Zhao L, Dai X, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Vasc Endovasc Surg, 2018, 55(2): 170-176.
3.	Clough RE, Spear R, Van Calster K, et al. Patient series of aortic arch disease treated with branched stent-grafts. Br J Surg, 2018, 105(4): 358-365.
4.	Mangialardi N, Lachat M, Esposito A, et al. The "Open Branch" technique: New way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm. Catheter Cardiovasc Interv, 2016, 87(4): 773-780.
5.	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.
6.	Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
7.	Tsilimparis N, Heidemann F, Rohlffs F, et al. Outcome of surgeon modified fenestrated/branched stent-grafts for symptomatic complex aortic pathologies or contained rupture. J Endovasc Ther, 2017, 24(6): 825-832.
8.	Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
9.	Pearce BJ, Scali ST, Beck AW. The role of surgeon modified fenestrated stent grafts in the treatment of aneurysms involving the branched visceral aorta. J Cardiovasc Surg (Torino), 2017, 58(6): 861-869.
10.	Canaud L, Baba T, Gandet T, et al. Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions. J Endovasc Ther, 2017, 24(4): 542-548.
11.	Georgiadis GS, van Herwaarden JA, Antoniou GA, et al. Systematic review of off-the-shelf or physician-modified fenestrated and branched endografts. J Endovasc Ther, 2016, 23(1): 98-109.
12.	Cochennec F, Kobeiter H, Gohel M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(5): 583-592.
13.	Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2019, 23: 300060519870903.
14.	Touma J, Verscheure D, Majewski M, et al. Parallel grafts used in combination with physician-modified fenestrated stent grafts for complex aortic aneurysms in high-risk with hostile anatomies. Ann Vasc Surg, 2018, 46: 265-273.
15.	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.

1. Joseph G, Premkumar P, Thomson V, et al. Externalized guidewires to facilitate fenestrated endograft deployment in the aortic arch. J Endovasc Ther, 2016, 23(1): 160-171.
2. Zhu J, Zhao L, Dai X, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Vasc Endovasc Surg, 2018, 55(2): 170-176.
3. Clough RE, Spear R, Van Calster K, et al. Patient series of aortic arch disease treated with branched stent-grafts. Br J Surg, 2018, 105(4): 358-365.
4. Mangialardi N, Lachat M, Esposito A, et al. The "Open Branch" technique: New way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm. Catheter Cardiovasc Interv, 2016, 87(4): 773-780.
5. 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.
6. Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
7. Tsilimparis N, Heidemann F, Rohlffs F, et al. Outcome of surgeon modified fenestrated/branched stent-grafts for symptomatic complex aortic pathologies or contained rupture. J Endovasc Ther, 2017, 24(6): 825-832.
8. Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
9. Pearce BJ, Scali ST, Beck AW. The role of surgeon modified fenestrated stent grafts in the treatment of aneurysms involving the branched visceral aorta. J Cardiovasc Surg (Torino), 2017, 58(6): 861-869.
10. Canaud L, Baba T, Gandet T, et al. Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions. J Endovasc Ther, 2017, 24(4): 542-548.
11. Georgiadis GS, van Herwaarden JA, Antoniou GA, et al. Systematic review of off-the-shelf or physician-modified fenestrated and branched endografts. J Endovasc Ther, 2016, 23(1): 98-109.
12. Cochennec F, Kobeiter H, Gohel M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(5): 583-592.
13. Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2019, 23: 300060519870903.
14. Touma J, Verscheure D, Majewski M, et al. Parallel grafts used in combination with physician-modified fenestrated stent grafts for complex aortic aneurysms in high-risk with hostile anatomies. Ann Vasc Surg, 2018, 46: 265-273.
15. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness of in vitro fenestration versus bypass surgery for type B aortic dissection involving the left subclavian artery

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