Strategies of Endovascular Repair for Complicated Stanford Type B Aortic Dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHENGJiang-hua , CHENKai , ZHUYan-bin , WANGHai-fei , CHENZhi-long , YONGXi

Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

ZHENGJiang-hua, Email: zhengjianghua@126.com

Keywords：

Complicated Stanford type B; Aortic dissection; Endovascular repair; Strategy

DOI：

10.7507/1007-9424.20150249

Video：

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Objective To investigate the therapeutic strategies of endovascular repair for complicated Stanford type B aortic dissection. Method The clinical data of 36 patients with complicated Stanford type B aortic dissection treated by endovascular repair were analyzed retrospectively. Results Thirty-six patients with complicated Stanford type B aortic dissection were treated successfully by endovascular repair. Twenty-two cases were treated by endovascular repair combined with covering left subclavian artery (LSA). Ten cases were treated by endovascular repair combined with chimney technique. Two cases were treated by endovascular repair combined with vascular prosthesis bypass from left common carotid artery to LSA. Two cases were treated by endovascular repair combined with vascular prosthesis bypass from right common carotid artery to left common carotid artery, whose proximal part were ligated. The viscera artery and lower extremity artery supply were restored gradually. No complication such as endoleak occurred. Conclusion For endovascular repair of complicated Stanford type B aortic dissection, strategies combined with covering LSA, chimney technique, and hybrid operation of small incision could extend anchor zone, expand the range of endovascular repair of aortic dissection, improve curative effect, reduce complications.

Citation： ZHENGJiang-hua, CHENKai, ZHUYan-bin, WANGHai-fei, CHENZhi-long, YONGXi. Strategies of Endovascular Repair for Complicated Stanford Type B Aortic Dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(8): 958-961. doi: 10.7507/1007-9424.20150249 Copy

1.	Genoni M, Von Segesser LK, Carrel T, et al. Type B aortic dissec-tions:surgical technique and results. Helv Chir Acta, 1994, 60(6):1151-1157.
2.	Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26):1729-1734.
3.	蒋俊豪, 季瀛豪, 郭大乔, 等.急性Stanford B型主动脉夹层腔内修复术的指征和治疗时机选择.中华外科杂志, 2009, 47(23):1784-1786.
4.	Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissec-tion after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5):735-741.
5.	Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg, 1988, 7(2):199-209.
6.	舒畅, 李全明, 姜晓华, 等.复杂型主动脉夹层的腔内治疗.中国普通外科杂志, 2006, 15(12):897-900.
7.	Dake MD, Miller DC, Mitchell RS, et al. The "first Generation" of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg, 1998, 116(5):689-704.
8.	Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta:a 4-year experience. J Vasc Surg, 2002, 36(6):1121-1128.
9.	Chung J, Kasirajan K, Veeraswamy RK, et al. Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death. J Vasc Surg, 2011, 54(4):979-984.
10.	Manninen H, Tulla H, Vanninen R, et al. Endangered cerebral blood supply after closure of left subclavian artery:postmortem and clinical imaging studies. Ann Thorac Surg, 2008, 85(1):120-125.
11.	竺挺, 符伟国, 王玉琦.复杂主动脉瘤及主动脉夹层的腔内治疗策略.中华外科杂志, 2011, 49(6):491-494.
12.	司逸, 符伟国, 王玉琦, 等.胸主动脉腔内修复术封堵左锁骨下动脉的前瞻性研究.中华外科杂志, 2009, 47(24):1868-1872.
13.	Criado FJ. Chimney grafts and bare stents:aortic branch preserva-tion revisited. J Endovasc Ther, 2007, 14(6):823-824.
14.	Xue Y, Sun L, Zheng J, et al. The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg, 2015, 47(4):623-629.
15.	Ohrlander T, Sonesson B, Ivancev K, et al. The chimney graft:a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther, 2008, 15(4):427-432.
16.	Pamler RS, Kotsis T, Gorich J, et al. Complications after endovas-cular repair of type B aortic dissection. J Endovasc Ther, 2002, 9(6):822-828.
17.	Sze DY, Van Den Bosch MA, Dake MD, et al. Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. Circ Cardiovasc Interv, 2009, 2(2):105-112.
18.	Zhu Y, Guo W, Liu X, et al. The single-centre experience of the supra-arch chimney technique in endovascular repair of type B aortic dissections. Eur J Vasc Endovasc Surg, 2013, 45(6):633-638.

1. Genoni M, Von Segesser LK, Carrel T, et al. Type B aortic dissec-tions:surgical technique and results. Helv Chir Acta, 1994, 60(6):1151-1157.
2. Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26):1729-1734.
3. 蒋俊豪, 季瀛豪, 郭大乔, 等.急性Stanford B型主动脉夹层腔内修复术的指征和治疗时机选择.中华外科杂志, 2009, 47(23):1784-1786.
4. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissec-tion after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5):735-741.
5. Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg, 1988, 7(2):199-209.
6. 舒畅, 李全明, 姜晓华, 等.复杂型主动脉夹层的腔内治疗.中国普通外科杂志, 2006, 15(12):897-900.
7. Dake MD, Miller DC, Mitchell RS, et al. The "first Generation" of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg, 1998, 116(5):689-704.
8. Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta:a 4-year experience. J Vasc Surg, 2002, 36(6):1121-1128.
9. Chung J, Kasirajan K, Veeraswamy RK, et al. Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death. J Vasc Surg, 2011, 54(4):979-984.
10. Manninen H, Tulla H, Vanninen R, et al. Endangered cerebral blood supply after closure of left subclavian artery:postmortem and clinical imaging studies. Ann Thorac Surg, 2008, 85(1):120-125.
11. 竺挺, 符伟国, 王玉琦.复杂主动脉瘤及主动脉夹层的腔内治疗策略.中华外科杂志, 2011, 49(6):491-494.
12. 司逸, 符伟国, 王玉琦, 等.胸主动脉腔内修复术封堵左锁骨下动脉的前瞻性研究.中华外科杂志, 2009, 47(24):1868-1872.
13. Criado FJ. Chimney grafts and bare stents:aortic branch preserva-tion revisited. J Endovasc Ther, 2007, 14(6):823-824.
14. Xue Y, Sun L, Zheng J, et al. The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg, 2015, 47(4):623-629.
15. Ohrlander T, Sonesson B, Ivancev K, et al. The chimney graft:a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther, 2008, 15(4):427-432.
16. Pamler RS, Kotsis T, Gorich J, et al. Complications after endovas-cular repair of type B aortic dissection. J Endovasc Ther, 2002, 9(6):822-828.
17. Sze DY, Van Den Bosch MA, Dake MD, et al. Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. Circ Cardiovasc Interv, 2009, 2(2):105-112.
18. Zhu Y, Guo W, Liu X, et al. The single-centre experience of the supra-arch chimney technique in endovascular repair of type B aortic dissections. Eur J Vasc Endovasc Surg, 2013, 45(6):633-638.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Strategies of Endovascular Repair for Complicated Stanford Type B Aortic Dissection

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