Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Halimulati·MUERTIZHA , Haerman·AJIHAN ,  Sailike·MAGAOWEIYA , Baoerjiang·ASIHAER , Qiamixi·BIEZIERJIAN

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R.China;

Corresponding author：

Sailike·MAGAOWEIYA, Email: sairike@126.com

Keywords：

complex aortic dissection; hybrid surgery; endovascular exclusion; chimney technique

DOI：

10.7507/1007-9424.201608086

Video：

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Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.

Citation： Halimulati·MUERTIZHA, Haerman·AJIHAN, Sailike·MAGAOWEIYA, Baoerjiang·ASIHAER, Qiamixi·BIEZIERJIAN. Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 469-473. doi: 10.7507/1007-9424.201608086 Copy

1.	韩啸, 宋来春, 符竣, 等. 杂交手术治疗Stanford B型复杂型主动脉夹层的近中期效果. 中国心血管病研究, 2015, 13(8): 744-746.
2.	Kuratani T. Best surgical option for arch extension of type B dissection: the endovascular approach. Ann Cardiothorac Surg, 2014, 3(3): 292-299.
3.	Hogendoorn W, Schlösser FJ, Moll FL, et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg, 2013, 58(2): 502-511.
4.	Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties. Eur J Vasc Endovasc Surg, 2009, 38(3): 255-261.
5.	韩向军, 徐克. B型主动脉夹层腔内修复治疗的荟萃分析. 介入放射学杂志, 2011, 20(7): 530-533.
6.	Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
7.	Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174-179.
8.	鲍春荣, 梅举, 丁芳宝, 等. 27例主动脉弓部病变患者一期杂交技术治疗的早中期结果. 中华胸心外科杂志, 2015, 31(5): 293-296.
9.	魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18(2): 99-103.
10.	丁盛, 张近宝, 张立平, 等. 杂交手术治疗累及弓部的主动脉夹层的临床研究. 生物医学工程与临床, 2012, 16(5): 434-437.
11.	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: Ⅱ98-105.
12.	张勇, 王胜, 梁家立. 杂交手术在治疗B型主动脉夹层中的应用. 中国结合临床, 2013, 29(1): 87-89.
13.	Fujikawa T, Yamamoto S, Sekine Y, et al. Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg, 2015, 50(6): 738-743.
14.	Bell D, Bassin L, Neale M, et al. A review of the endovascular management of thoracic aortic pathology. Heart Lung Circ, 2015, 24(12): 1211-1215.
15.	Lu Q, Feng J, Zhou J, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg, 2015, 150(6): 1631-1638. e5.
16.	张宏鹏, 郭伟, 刘小平, 等. 杂交技术治疗主动脉弓部病变的近远期结果. 中国普外基础与临床杂志, 2011, 18(10): 1039-1042.
17.	Zhang T, Jiang W, Lu H, et al. Thoracic endovascular aortic repair combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. Ann Vasc Surg, 2016, 32: 88-97.
18.	Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg, 2015, 63(2): 97-112.
19.	Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
20.	Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.

1. 韩啸, 宋来春, 符竣, 等. 杂交手术治疗Stanford B型复杂型主动脉夹层的近中期效果. 中国心血管病研究, 2015, 13(8): 744-746.
2. Kuratani T. Best surgical option for arch extension of type B dissection: the endovascular approach. Ann Cardiothorac Surg, 2014, 3(3): 292-299.
3. Hogendoorn W, Schlösser FJ, Moll FL, et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg, 2013, 58(2): 502-511.
4. Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties. Eur J Vasc Endovasc Surg, 2009, 38(3): 255-261.
5. 韩向军, 徐克. B型主动脉夹层腔内修复治疗的荟萃分析. 介入放射学杂志, 2011, 20(7): 530-533.
6. Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
7. Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174-179.
8. 鲍春荣, 梅举, 丁芳宝, 等. 27例主动脉弓部病变患者一期杂交技术治疗的早中期结果. 中华胸心外科杂志, 2015, 31(5): 293-296.
9. 魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18(2): 99-103.
10. 丁盛, 张近宝, 张立平, 等. 杂交手术治疗累及弓部的主动脉夹层的临床研究. 生物医学工程与临床, 2012, 16(5): 434-437.
11. 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: Ⅱ98-105.
12. 张勇, 王胜, 梁家立. 杂交手术在治疗B型主动脉夹层中的应用. 中国结合临床, 2013, 29(1): 87-89.
13. Fujikawa T, Yamamoto S, Sekine Y, et al. Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg, 2015, 50(6): 738-743.
14. Bell D, Bassin L, Neale M, et al. A review of the endovascular management of thoracic aortic pathology. Heart Lung Circ, 2015, 24(12): 1211-1215.
15. Lu Q, Feng J, Zhou J, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg, 2015, 150(6): 1631-1638. e5.
16. 张宏鹏, 郭伟, 刘小平, 等. 杂交技术治疗主动脉弓部病变的近远期结果. 中国普外基础与临床杂志, 2011, 18(10): 1039-1042.
17. Zhang T, Jiang W, Lu H, et al. Thoracic endovascular aortic repair combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. Ann Vasc Surg, 2016, 32: 88-97.
18. Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg, 2015, 63(2): 97-112.
19. Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
20. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique

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