Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGXue-gang , BAIDou , WUShao-hui , ZHANGXiao-jie ,  JIANGLan-shan

Department of Vascular Surgery, Mianyang Central Hospital, Mianyang 621000, Sichuan, P. R. China;

Corresponding?author：

JIANGLan-shan, Email: 422242431@qq.com

Keywords：

Aortic dissection; Covered graft; Endovascular repair; Visceral artery

DOI：

10.7507/1007-4848.20150040

Video：

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Objective To investigate the improvement of visceral arterial blood supply after thoracic endovascular aortic repair (TEVAR) for patients with Stanford type B aortic dissection (AD). Methods We retrospectively analyzed clinical data of 35 patients with Stanford type B AD undergoing TEVAR in Mianyang Central Hospital from January 2013 to March 2014. There were 30 male and 5 female patients with their age of 45-82(62.5±10.0) years. Among the 140 main visceral arteries (celiac artery, superior mesenteric artery, left and right renal arteries) of the 35 patients, blood supply of 79 arteries were compromised, including 36 arteries with stenosis and blood supply via the true lumen, 18 arteries with blood supply via both true and false lumen, 18 arteries with blood supply via the false lumen, and 7 arteries without blood supply. Improvement of blood supply of main visceral arteries was analyzed. Results All the operations were successfully performed without in-hospital death. Operation time was 97.8 (68-147) minutes, length of ICU stay was 12-34 h, and length of hospital stay was 10-21 days. None of the patients had cerebral infarction, acute renal failure, AD rupture or stent migration after TEVAR. Blood supply of the compromised visceral arteries showed improvement in various degrees. Conclusion For the treatment of Stanford type B AD, TEVAR can not only successfully block the rupture of AD, but also improve blood supply of main visceral arteries, avoid or reduce the complications resulting from compromised visceral arterial blood supply and visceral ischemia.

Citation： WANGXue-gang, BAIDou, WUShao-hui, ZHANGXiao-jie, JIANGLan-shan. Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 143-145. doi: 10.7507/1007-4848.20150040 Copy

1.	郭偉, 蓋魯粵, 劉小平, 等. Stanford B型主動脈夾層腔內修復術前后內臟動脈供血形式的變化.中華外科雜志, 2003, 41(12):924-927.
2.	景在平, 馮翔, 包俊敏, 等.腔內隔絕術治療Stanford B型主動脈夾層——116例臨床分析.中國胸心血管外科臨床雜志, 2003, 13(1):14-17.
3.	趙珺.對腔內修復Stanford B型主動脈夾層手術范圍的質疑——應將"遠端曠置"改為"全程修復".中國胸心血管外科臨床雜志, 2014, 21(2):141-143.
4.	王深明, 主編.血管外科學.北京:人民衛生出版社, 2011. 316.
5.	劉維永.胸主動脈瘤及主動脈夾層外科治療進展.中國胸心血管外科臨床雜志, 2003, 13(1):50-53.
6.	Walker PJ, Sarris GE, Miller DC. Peripheral vascular manifestations of acute aortic dissection. Vascular Surgery. 4th ed. Philadephia:WB Saunders, 1995. 1087-1102.
7.	Kieffer E. Dissection of the descending thoracic aorta. In Rutherford Vascular Surgery. 5th ed. Philadephia:WB Saunders, 2000. 1326-1344.
8.	朱崢嶸, 陳小東, 羅燦華, 等.帶膜血管內支架腔內隔絕治療對ⅢB型主動脈夾層內臟動脈血流的影響.中國組織工程研究與臨床康復, 2008, 12(52):10263-10267.
9.	李長青, 楊建.覆膜支架主動脈腔內修復術在Stanford B型主動脈夾層中的應用.中國胸心血管外科臨床雜志, 2014, 21(3):364-366.
10.	張明宇, 夏洪遠, 董玉梅, 等.腔內隔絕術治療Stanford B型胸主動脈夾層18例.哈爾濱醫科大學學報, 2011, 45(3):286-288.
11.	Shiiya N, Matsuzaki K, Kunihara T, et al. Management of vital organ malperfusion in acute aortic dissection:proposal of a mechanism-specific approach. Gen Thorac Cardiovasc Surg, 2007, 55(3):85-90.
12.	Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20):1546-1552.
13.	Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med, 1999, 340(20):1539-1545.
14.	Kato N, Hirano T, Shimono T, et al. Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement:preliminary results. J Vasc Interv Radiol, 2001, 12(7):835-840.
15.	Palma JH, de Souza JA, Rodrigues Alves CM, et al. Self-expandable aortic stent-graft for treatment of descending aortic dissections. Ann Thorac Surg, 2002, 73(4):1138-1141.
16.	Kato N, Shimono T, Hirano T, et al. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear:the complication-specific approach. J Thorac Cardiovasc Surg, 2002, 124(2):306-312.
17.	黃連軍, 孫立忠, 朱俊明, 等.帶膜血管內支架置入治療胸主動脈夾層.中華心血管病雜志, 2004, 32(2):141-143.
18.	陳偉, 楊建勇, 莊文權, 等.腔內隔絕術治療胸主動脈夾層.中華放射學雜志, 2013, 37(11):1007-1011.

1. 郭偉, 蓋魯粵, 劉小平, 等. Stanford B型主動脈夾層腔內修復術前后內臟動脈供血形式的變化.中華外科雜志, 2003, 41(12):924-927.
2. 景在平, 馮翔, 包俊敏, 等.腔內隔絕術治療Stanford B型主動脈夾層——116例臨床分析.中國胸心血管外科臨床雜志, 2003, 13(1):14-17.
3. 趙珺.對腔內修復Stanford B型主動脈夾層手術范圍的質疑——應將"遠端曠置"改為"全程修復".中國胸心血管外科臨床雜志, 2014, 21(2):141-143.
4. 王深明, 主編.血管外科學.北京:人民衛生出版社, 2011. 316.
5. 劉維永.胸主動脈瘤及主動脈夾層外科治療進展.中國胸心血管外科臨床雜志, 2003, 13(1):50-53.
6. Walker PJ, Sarris GE, Miller DC. Peripheral vascular manifestations of acute aortic dissection. Vascular Surgery. 4th ed. Philadephia:WB Saunders, 1995. 1087-1102.
7. Kieffer E. Dissection of the descending thoracic aorta. In Rutherford Vascular Surgery. 5th ed. Philadephia:WB Saunders, 2000. 1326-1344.
8. 朱崢嶸, 陳小東, 羅燦華, 等.帶膜血管內支架腔內隔絕治療對ⅢB型主動脈夾層內臟動脈血流的影響.中國組織工程研究與臨床康復, 2008, 12(52):10263-10267.
9. 李長青, 楊建.覆膜支架主動脈腔內修復術在Stanford B型主動脈夾層中的應用.中國胸心血管外科臨床雜志, 2014, 21(3):364-366.
10. 張明宇, 夏洪遠, 董玉梅, 等.腔內隔絕術治療Stanford B型胸主動脈夾層18例.哈爾濱醫科大學學報, 2011, 45(3):286-288.
11. Shiiya N, Matsuzaki K, Kunihara T, et al. Management of vital organ malperfusion in acute aortic dissection:proposal of a mechanism-specific approach. Gen Thorac Cardiovasc Surg, 2007, 55(3):85-90.
12. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20):1546-1552.
13. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med, 1999, 340(20):1539-1545.
14. Kato N, Hirano T, Shimono T, et al. Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement:preliminary results. J Vasc Interv Radiol, 2001, 12(7):835-840.
15. Palma JH, de Souza JA, Rodrigues Alves CM, et al. Self-expandable aortic stent-graft for treatment of descending aortic dissections. Ann Thorac Surg, 2002, 73(4):1138-1141.
16. Kato N, Shimono T, Hirano T, et al. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear:the complication-specific approach. J Thorac Cardiovasc Surg, 2002, 124(2):306-312.
17. 黃連軍, 孫立忠, 朱俊明, 等.帶膜血管內支架置入治療胸主動脈夾層.中華心血管病雜志, 2004, 32(2):141-143.
18. 陳偉, 楊建勇, 莊文權, 等.腔內隔絕術治療胸主動脈夾層.中華放射學雜志, 2013, 37(11):1007-1011.

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Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

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