Laser in situ fenestration with thoracic endovascular aortic repair in treatment of aortic dissection involving arch branches: short-term result and complications

doi:10.16139/j.1007-9610.2022.04.010

Abstract

Abstract:

Objective To evaluate the surgical effect and complication of laser in situ fenestration with thoracic endovascular aortic repair (TEVAR) in the patients with aortic dissection involving arch branches. Methods From December 2018 to December 2020, 181 patients with aortic dissection involving arch branches admitted to our hospital were analyzed retrospectively among whom 172 patients had laser in situ fenestration with TEVAR. The inclusion criteria were dissection involved aortic arch and the process of TEVAR required reconstruction of the branched vessels in arch. Patients both with aortic dissection lesions less than 15 mm from the coronary ostium and the diameter of ascending aorta more than 45 mm were excluded. Results All cases underwent laser in situ fenestration with TEVAR including 37 cases (21.51%) in acute stage and 135 cases (78.49%) in subacute stage and 165 cases (95.93%) with success of reconstruction of branch vessels. In-hospital death occurred in 6 cases (3.49%), stroke in 2 cases (1.16%), paraplegia in 4 cases (2.33%), proximal stent-graft induced new entry (SINE) in 2 cases (1.16%), and without distal SINE. A total of 168 cases (97.67%) were followed-up. There were 311 branch vessels reconstructed. Follow-up CT angiography was done(10.6±5.4) months which showed that 295 branch vessels were patency with patency rate 94.86%. The partial or complete false lumen thrombosis of thoracic aorta was found in 152 cases (88.37%). Conclusions Laser in situ fenestration with TEVAR was performed with high success rate and low complication rate for the patients with aortic dissection involving arch branches. Long-term follow-up and large sample studies are needed for long-term clinical effects.

Key words: Aortic dissection, Endovascular repair, Reconstruction of branched vessel, Laser in situ fenestration, Complication

CLC Number:

R543.1

WANG Ruihua, QIU Peng, LIU Junchao, WU Xiaoyu, QIN Jinbao, YE Kaichuang, LI Weimin, LIU Xiaobing, YIN Minyi, HUANG Xintian, LU Xinwu. Laser in situ fenestration with thoracic endovascular aortic repair in treatment of aortic dissection involving arch branches: short-term result and complications[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 324-329.

References 42

[1]	Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery(EACTS) and the European Society for Vascular Surgery(ESVS)[J]. Eur J Cardiothorac Surg, 2019, 55(1):133-162. doi: 10.1093/ejcts/ezy313 URL
[2]	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection[J]. J Am Coll Cardiol, 2015, 66(4):350-358. doi: 10.1016/j.jacc.2015.05.029 URL
[3]	Nauta FJ, Tolenaar JL, Patel HJ, et al. Impact of retrograde arch extension in acute type B aortic dissection on management and outcomes[J]. Ann Thorac Surg, 2016, 102(6):2036-2043. doi: 10.1016/j.athoracsur.2016.05.013 URL
[4]	Valentine RJ, Boll JM, Hocking KM, et al. Aortic arch involvement worsens the prognosis of type B aortic dissections[J]. J Vasc Surg, 2016, 64(5):1212-1218. doi: S0741-5214(16)30295-6 pmid: 27397897
[5]	Leone A, Beckmann E, Martens A, et al. Total aortic arch replacement with frozen elephant trunk technique: results from two European institutes[J]. J Thorac Cardiovasc Surg, 2020, 159(4):1201-1211. doi: 10.1016/j.jtcvs.2019.03.121 URL
[6]	Tsai TT, Evangelista A, Nienaber CA, et al. Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD)[J]. Circulation, 2006, 114(1 Suppl):I350-I356.
[7]	Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: surgical experience in 104 patients over a 12-year period[J]. J Thorac Cardiovasc Surg, 2016, 151(6):1581-1592. doi: 10.1016/j.jtcvs.2015.11.056 URL
[8]	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch?[J]. Circulation, 2011, 123(9):971-978. doi: 10.1161/CIRCULATIONAHA.110.015081 URL
[9]	Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial[J]. Circulation, 2009, 120(25):2519-2528. doi: 10.1161/CIRCULATIONAHA.109.886408 URL
[10]	Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial[J]. Circ Cardiovasc Interv, 2013, 6(4):407-416. doi: 10.1161/CIRCINTERVENTIONS.113.000463 URL
[11]	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections[J]. J Vasc Surg, 2020, 71(3):723-747. doi: S0741-5214(19)32649-7 pmid: 32001058
[12]	Qin YL, Wang F, Li TX, et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection[J]. J Am Coll Cardiol, 2016, 67(24):2835-2842. doi: 10.1016/j.jacc.2016.03.578 URL
[13]	Wang L, Zhao Y, Zhang W, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: incidence, time trends and risk factors[J]. Semin Thorac Cardiovasc Surg, 2021, 33(3):639-653. doi: 10.1053/j.semtcvs.2020.11.010 URL
[14]	Jing Z, Lu Q, Feng J, et al. Endovascular repair of aortic dissection involving the left subclavian artery by castor stent graft: a multicentre prospective trial[J]. Eur J Vasc Endovasc Surg, 2020, 60(6):854-861. doi: 10.1016/j.ejvs.2020.08.022 URL
[15]	Li X, Li W, Dai X, et al. Thoracic endovascular repair for aortic arch pathologies with surgeon modified fenestrated stent grafts: a multicentre retrospective study[J]. Eur J Vasc Endovasc Surg, 2021, 62(5):758-766. doi: 10.1016/j.ejvs.2021.07.017 URL
[16]	Qin J, Zhao Z, Wang R, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch du-ring thoracic endovascular aortic repair[J]. J Am Heart Assoc, 2017, 6(4):e004542.
[17]	Zhao Z, Qin J, Yin M, et al. In situ laser stent graft fe-nestration of the left subclavian artery during thoracic endovascular repair of type B aortic dissection with limited proximal landing zones: 5-year outcomes[J]. J Vasc Interv Radiol, 2020, 31(8):1321-1327. doi: 10.1016/j.jvir.2020.02.025 URL
[18]	Li Y, Hu Z, Wang J, et al. Endovascular chimney technique for aortic arch pathologies treatment: a systematic review and meta-analysis[J]. Ann Vasc Surg, 2018, 47:305-315. doi: 10.1016/j.avsg.2017.09.006 URL
[19]	Sachs T, Pomposelli F, Hagberg R, et al. Open and endovascular repair of type B aortic dissection in the nationwide inpatient sample[J]. J Vasc Surg, 2010, 52(4):860-866. doi: 10.1016/j.jvs.2010.05.008 URL
[20]	Chikwe J, Cavallaro P, Itagaki S, et al. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality[J]. Ann Thorac Surg, 2013, 95(5):1563-1569. doi: 10.1016/j.athoracsur.2013.02.039 URL
[21]	Patel VI, Mukhopadhyay S, Ergul E, et al. Impact of hospital volume and type on outcomes of open and endovascular repair of descending thoracic aneurysms in the United States Medicare population[J]. J Vasc Surg, 2013, 58(2):346-354. doi: 10.1016/j.jvs.2013.01.035 URL
[22]	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[J]. 中国普外基础与临床杂志, 2011, 18(10):1039-1042.
[23]	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识[J]. 中国循环杂志, 2020, 35(2):124-130.
[24]	Wilson A, Zhou S, Bachoo P, et al. Systematic review of chimney and periscope grafts for endovascular aneurysm repair[J]. Br J Surg, 2013, 100(12):1557-1564. doi: 10.1002/bjs.9274 pmid: 24264776
[25]	舒畅, 王暾. 烟囱技术用于主动脉夹层腔内治疗的现状与思考[J]. 中华外科杂志, 2015, 53(11):809-811.
[26]	Anthony Lee W. Status of branched grafts for thoracic aortic arch endovascular repair[J]. Semin Vasc Surg, 2016, 29(1-2):84-89. doi: S0895-7967(16)30011-4 pmid: 27823595
[27]	Riambau V. Application of the bolton relay device for thoracic endografting in or near the aortic arch[J]. Aorta (Stamford), 2015, 3(1):16-24. doi: 10.12945/j.aorta.2015.14-050 URL
[28]	Patel HJ, Dake MD, Bavaria JE, et al. Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the gore thoracic branch endoprosthesis[J]. Ann Thorac Surg, 2016, 102(4):1190-1198. doi: 10.1016/j.athoracsur.2016.03.091 URL
[29]	Yokoi Y, Azuma T, Yamazaki K. Advantage of a precurved fenestrated endograft for aortic arch disease: simplified arch aneurysm treatment in Japan 2010 and 2011[J]. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl):S103-S109.
[30]	Wang ZG, Li C. Single-branch endograft for treating Stanford type B aortic dissections with entry tears in proximity to the left subclavian artery[J]. J Endovasc Ther, 2005, 12(5):588-593. doi: 10.1583/05-1539.1 URL
[31]	Sobocinski J, d′Utra G, O′Brien N, et al. Off-the-shelf fenestrated endografts: a realistic option for more than 70% of patients with juxtarenal aneurysms[J]. J Endovasc Ther, 2012, 19(2):165-172. doi: 10.1583/11-3772.1 pmid: 22545880
[32]	Inoue K, Hosokawa H, Iwase T, et al. Aortic arch reconstruction by transluminally placed endovascular branched stent graft[J]. Circulation, 1999, 100(19 Suppl): Ⅱ 316-Ⅱ 321.
[33]	Maurel B, Mastracci TM, Spear R, et al. Branched and fenestrated options to treat aortic arch aneurysms[J]. J Cardiovasc Surg (Torino), 2016, 57(5):686-697.
[34]	刘晓兵, 陆信武. 激光原位开窗技术重建弓部分支的技术难点及评价[J]. 中国实用外科杂志, 2018, 38(12):1373-1376. doi: 10.19538/j.cjps.issn1005-2208.2018.12.08
[35]	Qin J, Zhao Z, Liu G, et al. In situ diode laser fenestration of aortic arch stent grafts during thoracic endovascular aortic repair of Stanford type A aortic dissection[J]. EuroIntervention, 2019, 14(18):e1854-e1860.
[36]	张省, 秦金保, 李维敏, 等. 半导体激光原位开窗术在胸主动脉腔内修复术治疗主动脉弓部疾病中的应用价值[J]. 中华消化外科杂志, 2017, 16(11):1118-1122.
[37]	Li F, Wu X, Zhang X, et al. Clinical outcomes of distal tapered restrictive covered stent applied in endovascular treatment of aortic dissection involving zone 0[J]. Eur J Vasc Endovasc Surg, 2021, 61(3):413-421. doi: 10.1016/j.ejvs.2020.11.037 URL
[38]	Canaud L, Gandet T, Sfeir J, et al. Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection[J]. J Vasc Surg, 2019, 69(5):1610-1614. doi: 10.1016/j.jvs.2018.07.086 URL
[39]	Feng J, Lu Q, Zhao Z, et al. Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection[J]. J Vasc Surg, 2013, 57(2 Suppl):44S-52S.
[40]	Zhao Y, Yin H, Chen Y, et al. Restrictive bare stent prevents distal stent graft-induced new entry in endovascular repair of type B aortic dissection[J]. J Vasc Surg, 2018, 67(1):93-103. doi: 10.1016/j.jvs.2017.04.066 URL
[41]	苏奕明, 魏立春, 侯培勇, 等. 脑脊液引流防治胸腹主动脉瘤腔内修复术后脊髓损伤疗效及安全性的系统评价和Meta分析[J]. 中国普通外科杂志, 2019, 28(6):687-695.
[42]	Zhang Z, Zhou Y, Lin S, et al. Systematic review and meta-analysis of association of prophylactic cerebrospinal fluid drainage in preventing spinal cord ischemia after thoracic endovascular aortic repair[J]. J Vasc Surg, 2022, 75(4):1478-1489. doi: 10.1016/j.jvs.2021.10.050 URL