Spot stenting combined with false lumen endovascular occlusive repair in treatment of postoperative aortic dissecting aneurysm

doi:10.16139/j.1007-9610.2022.05.015

Abstract

Abstract: Objective To retrospectively evaluate the mid-term outcome of spot stenting combined with false lumen endovascular occlusive repair(SS-FLEVOR) in the treatment of postoperative aortic dissection aneurysm. Methods Both perioperative and follow-up data of the patients with aortic dissection aneurysm after thoracic endovascular aortic repair (TEVAR) who underwent SS-FLEVOR from October 2016 to October 2020 were collected and analyzed. The preoperative and postoperative largest diameters of both thoracic aortic true lumen and abdominal aortic true lumen were analyzed combined with the thrombus in false lumen and stents patency of visceral arteries. Results A total of 17 cases were enrolled with an average age of (54.5±14.5) years and 3 cases female. SS-FLEVOR was all successful. Mean operative time was (151.4±37.9) min with follow-up time of (24.9±20.7) months. During the follow-up period, the stents in visceral arteries were all patent. Thrombus was formed in thoracoabdominal aortic false lumen 10 cases and in thoracic false lumen 3 cases. Partial blood flow was found 4 cases in thoracoabdominal aortic false lumen. The sac size did not increase due to decreasing in blood flow of the false lumen gradually and secondary intervention was not needed. The true lumens diameter increased compared with those of preoperative for thoracic aorta [(2.1±0.6) cm vs. (1.7±0.7) cm, P=0.001] and for abdominal aorta [(1.4±0.6) cm vs. (1.1±0.4) cm, P=0.001]. The diameter of true lumen decreased in 1 case after six months post operation (1.3 cm vs. 1.7 cm) due to the compression caused by the stent-graft in false lumen. There was no stent displacement, paraplegia, infection, visceral artery stent occlusion and other complications occured during the period of follow-up. Conclusions SS-FLEVOR might be relatively safe, effective and feasible with satisfied results for specific cases.

Key words: Thoracic endovascular aortic repair, Chronic aortic dissecting aneurysm, Distal tear, False lumen embolization

CLC Number:

R543.1

YUAN Ye, ZHOU Min, WANG Enci, LI Zheyun, ZHANG Yuchong, LIN Peng, MO Fandi, GUO Daqiao, FU Weiguo, WANG Lixin. Spot stenting combined with false lumen endovascular occlusive repair in treatment of postoperative aortic dissecting aneurysm[J]. Journal of Surgery Concepts & Practice, 2022, 27(05): 458-462.

Figures/Tables 3

References 19

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病例	内脏动脉重建情况	假腔内支架数	假腔内弹簧圈辅助栓塞	髂动脉破口位置
1	右肾动脉	1枚主动脉支架	栓塞支架近端	右髂动脉
2	左肾动脉	无	单纯假腔栓塞	左髂动脉
3	左肾动脉	1枚主动脉支架	栓塞支架近端	双髂动脉
4	右肾动脉	1枚主动脉支架	栓塞支架近端	左髂动脉
5	左肾动脉	1枚主动脉支架	栓塞支架两端	左髂动脉
6	右肾动脉	1枚主动脉支架	无	右髂动脉
7	无	1枚主动脉支架	栓塞支架近端	左髂动脉
8	无	1枚袖套支架（Cuff）	无	无
9	左肾动脉	1枚主动脉支架	栓塞支架近端	左髂动脉
10	无	1枚主动脉支架	无	双髂动脉
11	左肾动脉	1枚主动脉支架	栓塞支架近端	左髂动脉
12	右肾动脉	无	单纯假腔栓塞	无
13	右肾动脉	无	单纯假腔栓塞	无
14	左肾动脉	无	单纯假腔栓塞	无
15	右肾动脉	无	单纯假腔栓塞	右髂动脉
16	无	1枚髂动脉支架	栓塞支架近端	右髂动脉
17	无	2枚主动脉支架	栓塞支架近端	右髂动脉

测量部位	术前	随访结果	P值
胸主动脉最大径	4.6±2.4	4.8±2.3	0.486
胸主动脉真腔最大径	1.7±0.7	2.1±0.6	0.001
胸主动脉假腔最大径	3.4±2.0	3.3±2.4	0.665
腹主动脉最大径	4±1.6	3.9±1.5	0.683
腹主动脉真腔最大径	1.1±0.4	1.4±0.6	0.001
腹主动脉假腔最大径	3.1±1.7	2.7±1.8	0.097