|Objective: To summarize the data of Stanford type B aortic dissection patients with insufficient proximal anchoring area treated by left subclavian artery (LSA) revascularization combined with Thoracic endovascular aortic repair (TEVAR) in our hospital. Comparative analysis on the effectiveness and safety of the Hybrid technique (HT), chimney graft (CG), single-branched stent graft (SBSG) and In vitro fenestration (IVF) methods was made, so as to provide clinical basis for the selection of LSA revascularization methods in such patients.
Methods: A total of 105 patients with type B aortic dissection treated by TEVAR combined with LSA revascularization in our hospital from March 2013 to March 2020 were statistically analyzed. According to the method of LSA revascularization, they were divided into four groups: HT group (41 cases), CG group (29 cases), SBSG group (21 cases), IVF group (14 cases). General information, perioperative, postoperative and follow-up data of the four groups of patients were collected, statistical methods were used to compare the above data between groups.
Results: The success rate of the four groups of patients was 100%, there was statistical difference in the application rate of the four techniques in emergency surgery of type B AD (P<0.05). And the HT group had the highest rate of emergency surgery. Intraoperative blood loss, contrast agent usage, fluoroscopy time, operative time, total hospitalization cost, and incidence of LSA ischemia symptoms during follow-up in the four groups were significantly different (P<0.05). Pairwise comparison among groups showed that the intraoperative blood loss and operative time in HT group were highest (adjusted P<0.0083;P<0.05). According to the amount of intraoperative contrast medium and the duration of fluoroscopy, SBSG group>IVF group>CG group>HT group. The total hospitalization cost of SBSG group was significantly higher than that of the other three groups (P<0.05), the incidence of LSA ischemia symptoms was the highest in the IVF group during the follow-up period. The incidence of complications (except LSA ischemia symptoms) during the perioperative period and the follow-up period among the four groups were similar (P>0.05), the median follow-up time of HT group, CG group, SBSG group and IVF group was significantly different (P<0.05), and HT group had the longest follow-up time.
Conclusion: All the four LSA revascularization techniques could effectively restore LSA perfusion, and all of them could expand the application range of TEVAR in Type B AD. The application of SBSG technique in emergency Type B AD surgery was poor, but the short-term prognosis of patients was good. The HT, CG and IVF technique was comparable. However, both the operative time and intraoperative blood loss of HT were longer than those of other luminal LSA revascularization techniques, and the postoperative LSA patency of patients with IVF technique was poor. Each of the four LSA revascularization techniques has its own advantages and disadvantages, and this study still needs to be further verified in large-sample, multi-center randomized controlled studies.
Keywords: Type B aortic dissection, Endovascular repair, Left subclavian artery, Revascularization