Short- and medium-term efficacy of combining the reconstruction of left subclavian artery with thoracic endovascular aortic repair to treat Stanford type B aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Xin ¹ , DAI Shilin ² ,  SHANG Yuqiang ²

1. Medical School in Jianghan University, Wuhan, 430113, P. R. China;
2. Department of Cardiac Surgery, Wuhan Central Hospital in Hu bei Province, 430014, P. R. China;

Corresponding author：

SHANG Yuqiang, Email: syq027@163.com

Keywords：

Stanford B aortic dissection; endovascular repair; left subclavian artery; left subclavian artery reconstruction technique

DOI：

10.7507/1007-4848.202311003

Video：

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Objective To analyze the clinical efficacy of left subclavian artery (LSA) revascularization combined with thoracic endovascular repair (TEVAR) in the treatment of Stanford type B aortic dissection (AD). Methods A retrospective analysis was conducted on patients treated with TEVAR combined with LAS reconstruction surgery at Wuhan Central Hospital in Hubei Province from 2017 to 2021. The patients were divided into a reconstruction group and a simple stent group. The reconstruction group was subdivided into a hybrid reconstruction group and a chimney reconstruction group according to the different methods of reconstruction surgery. Perioperative data of different groups were compared. A total of 144 patients were included, including 108 males and 36 females. There were 113 patients in the simple group and 31 patients in the reconstruction group. There were statistically significant differences in surgical time, hospital stay, preoperative lesion area diameter, and postoperative right vertebral artery diameter between the reconstruction group and the simple group (P<0.05). There was no statistically significant difference in postoperative complications between the simple group and the reconstruction group within 1 year (P>0.05). There was no statistically significant difference in surgical time between different surgical procedures in the reconstruction group (P>0.05). During the follow-up period, there were no deaths. A total of 12 (10.6%) patients in the simple group experienced complications, which was lower than that in the reconstruction group (8 patients, 25.8%). Among them, the most common complication in the follow-up of patients in the simple group was internal leakage (5 patients), and there was no statistical difference compared to patients in the reconstruction group (2 patients). The most common complication in the follow-up of patients in the reconstruction group was hoarseness (2 patients), while in the simple group, 1 patient occurred. Conclusion Both different surgeries have good effects on the treatment of type B aortic dissection, and multi center, large sample, and long-term studies are needed.

1.	Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg, 2001, 33(6): 1185-1192.
2.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
3.	Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
4.	Maldonado TS, Dexter D, Rockman CB, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg, 2013, 57(1): 116-124.
5.	Cooper DG, Walsh SR, Sadat U, et al. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: A systematic review and meta-analysis. J Vasc Surg, 2009, 49(6): 1594-1601.
6.	Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg, 2009, 50(6): 1255-1264.
7.	van der Weijde E, Saouti N, Vos JA, et al. Surgical left subclavian artery revascularization for thoracic aortic stent grafting: A single-centre experience in 101 patients. Interact Cardiovasc Thorac Surg, 2018, 27(2): 284-289.
8.	Cinà CS, Safar HA, Laganà A, et al. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
9.	Nienaber CA, Kische S, Akin I, et al. Strategies for subacute/chronic type B aortic dissection: the Investigation Of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S101-S108.
10.	Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
11.	Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
12.	Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
13.	Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
14.	Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
15.	Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱendoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.994-996.
16.	Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for typeⅡ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

1. Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg, 2001, 33(6): 1185-1192.
2. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
3. Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
4. Maldonado TS, Dexter D, Rockman CB, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg, 2013, 57(1): 116-124.
5. Cooper DG, Walsh SR, Sadat U, et al. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: A systematic review and meta-analysis. J Vasc Surg, 2009, 49(6): 1594-1601.
6. Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg, 2009, 50(6): 1255-1264.
7. van der Weijde E, Saouti N, Vos JA, et al. Surgical left subclavian artery revascularization for thoracic aortic stent grafting: A single-centre experience in 101 patients. Interact Cardiovasc Thorac Surg, 2018, 27(2): 284-289.
8. Cinà CS, Safar HA, Laganà A, et al. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
9. Nienaber CA, Kische S, Akin I, et al. Strategies for subacute/chronic type B aortic dissection: the Investigation Of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S101-S108.
10. Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
11. Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
12. Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
13. Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
14. Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
15. Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱendoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.994-996.
16. Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for typeⅡ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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