One-stage Hybrid Surgery for Complex Stanford Type B Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIURi-hui ,  YANGJun-bo , CHENJia-jun , NIERong-hua

Department of Cardiothoracic Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei College of Arts and Sciences, Xiangyang 441021, Hubei, P. R. China;

Corresponding?author：

YANGJun-bo, Email: ctsxfs@163.com

Keywords：

Hybrid technique; Endovascular repair; Vascular bypass; Aortic dissection; Basic-level hospital

DOI：

10.7507/1007-4848.20140096

Video：

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Objective To review clinical techniques and outcomes of one-stage hybrid surgery for complex Stanford type B aortic dissection (AD), and explore the feasibility of this surgery in basic-level hospitals. Methods Seven patients with complex Stanford type B AD underwent one-stage hybrid surgery from December 2010 to March 2013 in Department of Cardiothoracic Surgery of Xiangyang Central Hospital. There were 2 males and 5 females with a mean age of 50.0±8.3 years. Preoperative computed tomography angiography (CTA)found that the distance between breach and left subclavian artery opening was less than 15 mm in 4 patients, and left subclavian artery root were involved in 3 patients. One patient had several calcification sites of the thoracic aorta and coronary arterial stenosis near the middle segment of anterior descen-ding coronary artery by about 70%. All the patients received general anesthesia and endotracheal intubation. Firstly, bypass surgery of the branches of the aortic arch was performed via neck incision in the operating room, then endovascular aortic repair (EVAR)using femoral artery incision was performed in the catheter room. The patient with coronary artery disease received concomitant stenting of the anterior descending artery. Results All the patients successfully received the operation and EVAR. Postoperatively, 1 patient had mild type Ⅰ endoleaks. No death or severe complication occurred in this group. Intraoperative angiography showed that blood flow in true lumen of AD became normal, all the bypass grafts were unobs-tructed, the positioning of stent grafts was accurate, and no stent displacement was found. All the 7 patients were followed-up for 3-24 (12.0±3.6)months, and all the patients were alive and resumed normal life during follow-up. In 6 patients, CTA at 3 months, 1 year or 2 years after the operation showed no stent graft translocation, endoleak, bypass or graft obstruction. In 1 patient with typeⅠendoleaks, CTA at 3 months after the operation showed contrast agent in the false lumen, but partial thrombosis occurred, the size and scope of false lumen were smaller than preoperative values, and the true lumen significantly became larger. CTA at 6 months after the operation showed that leakage had disappeared. None of the patients had any sign of brain or limb ischemia. Conclusion One-stage hybrid surgery is safe and effective for the treatment of complex Stanford type B AD, expands the treatment indications of EVAR, and is worthy of widely application in basic-level hospitals.

Citation： LIURi-hui, YANGJun-bo, CHENJia-jun, NIERong-hua. One-stage Hybrid Surgery for Complex Stanford Type B Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 352-355. doi: 10.7507/1007-4848.20140096 Copy

1.	Eggebrecht H, Nienaber CA, Neuhauser M, et al. Endovascular stent-graft placement in aortic dissection:a meta-analysis. Eur Heart J, 2006, 27 (4):489-498.
2.	郭偉, 蓋魯粵, 劉小平, 等.血管腔內移植物治療Stanford B型夾層的探討.中國實用外科雜志, 2002, 22 (3):151-153.
3.	李智, 倪才方, 金泳海, 等.覆膜支架腔內修復術治療Stanford B型主動脈夾層.蘇州大學學報:醫學版, 2011, 31 (6):981-983.
4.	舒暢, 方坤.復雜性Stanford B型主動脈夾層的腔內治療.中國血管外科雜志:電子版, 2012, 4 (4):212-213, 217.
5.	Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comp-arison of strategies for type B aortic dissection:the investigation of stent grafts in Aortic Dissection (INSTEAD)trial. Circulation, 2009, 120 (25):2519-2528.
6.	Lansman SL, Hagl C, Fink D, et al. Acute type B aortic dissection:surgical therapy. Ann Thorac Surg, 2002, 74 (5):S1833-S1835, S1857-1863.
7.	楊發, 劉雪梅, 方俊平, 等.主動脈夾層的早期診斷與首診誤診分析.中華急診醫學雜志, 2007, 16 (10):1089-1090.
8.	White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53 (4):1082-1090.
9.	Kim EK, Choi ER, Song BG, et al. Presence of simple renal cysts is associated with increased risk of aortic dissection:a common manifestation of connective tissue degeneration? Heart, 2011, 97 (1):55-59.
10.	Dake MD, Miller DC, Mitchell RS, et al. The "first generation" of endovascular stent grafts for patients with aneurysms of descending thoracic aortic. J Thorac Cardiovasc Surg, 1998, 116 (5):689-704.
11.	Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta:a 4-year experience. J Vasc Surg, 2002, 36 (6):1121-1128.
12.	孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):1171-1176.
13.	孫立忠, 趙海鵬, 朱俊明, 等. Stanford B型主動脈夾層的外科治療.中華胸心血管外科雜志, 2012, 28 (6):321-323.
14.	韓輝. Stanford B型主動脈夾層118例臨床分析.中國急救醫學, 2010, 30 (2):144-146.
15.	Fattori R, Tsai TT, Myrmel T, et al. Complicated acute type B dissection:is surgery still the best option?:a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv, 2008, 1 (4):395-402.
16.	李濱, 孫立忠, 常謙, 等.全弓替換加支架象鼻技術治療復雜Stanford B型主動脈夾層的臨床觀察.中華醫學雜志, 2010, 90 (5):323-326.
17.	Dias RR, Mejia OA, Fiorelli AI, et al. Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction. Rev Bras Cir Cardiovasc, 2010, 25 (4):491-499.
18.	程光存, 朱正艷, 嚴中亞.外科雜交技術在主動脈弓疾病中的應用進展.中華心胸血管外科雜志, 2011, 27 (10):625-626.
19.	張振龍, 邱罕凡, 陳良萬, 等.主動脈弓部病變的腔內治療.臨床心血管病雜志, 2012, 28 (12):931-933.
20.	Noor N, Sadat U, Hayes PD, et al. Management of the left subcl-avian artery during endovascular repair of the thoracic aorta. J Endovasc Ther, 2008, 15 (2):168-176.
21.	魏以楨, 常謙, 于存濤, 等.一期雜交手術治療累及主動脈弓遠端的降主動脈病變.中國胸心血管外科臨床雜志, 2011, 18 (2):99-102.
22.	丁盛, 張近寶, 歐陽輝, 等.不同雜交方式治療累及弓部的主動脈夾層.中國胸心血管外科臨床雜志, 2012, 19 (4):435-437.
23.	孫益峰, 梅運清, 蔡建志, 等.腔內隔絕術、聯合血管旁路移植術治療主動脈夾層動脈瘤.中國胸心血管外科臨床雜志, 2008, 15 (1):64-65.
24.	Chen X, Huang F, Xu M, et al. The stented elephant trunk proce-dure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11 (5):594-598.
25.	Yamashiro S, Kuniyoshi Y, Arakaki K, et al. Total arch replacement for distal enlargement after ascending aortic replacement for acute type A aortic dissection.Ann Thorac Cardiovasc Surg, 2009, 15 (5):318-323.

1. Eggebrecht H, Nienaber CA, Neuhauser M, et al. Endovascular stent-graft placement in aortic dissection:a meta-analysis. Eur Heart J, 2006, 27 (4):489-498.
2. 郭偉, 蓋魯粵, 劉小平, 等.血管腔內移植物治療Stanford B型夾層的探討.中國實用外科雜志, 2002, 22 (3):151-153.
3. 李智, 倪才方, 金泳海, 等.覆膜支架腔內修復術治療Stanford B型主動脈夾層.蘇州大學學報:醫學版, 2011, 31 (6):981-983.
4. 舒暢, 方坤.復雜性Stanford B型主動脈夾層的腔內治療.中國血管外科雜志:電子版, 2012, 4 (4):212-213, 217.
5. Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comp-arison of strategies for type B aortic dissection:the investigation of stent grafts in Aortic Dissection (INSTEAD)trial. Circulation, 2009, 120 (25):2519-2528.
6. Lansman SL, Hagl C, Fink D, et al. Acute type B aortic dissection:surgical therapy. Ann Thorac Surg, 2002, 74 (5):S1833-S1835, S1857-1863.
7. 楊發, 劉雪梅, 方俊平, 等.主動脈夾層的早期診斷與首診誤診分析.中華急診醫學雜志, 2007, 16 (10):1089-1090.
8. White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53 (4):1082-1090.
9. Kim EK, Choi ER, Song BG, et al. Presence of simple renal cysts is associated with increased risk of aortic dissection:a common manifestation of connective tissue degeneration? Heart, 2011, 97 (1):55-59.
10. Dake MD, Miller DC, Mitchell RS, et al. The "first generation" of endovascular stent grafts for patients with aneurysms of descending thoracic aortic. J Thorac Cardiovasc Surg, 1998, 116 (5):689-704.
11. Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta:a 4-year experience. J Vasc Surg, 2002, 36 (6):1121-1128.
12. 孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):1171-1176.
13. 孫立忠, 趙海鵬, 朱俊明, 等. Stanford B型主動脈夾層的外科治療.中華胸心血管外科雜志, 2012, 28 (6):321-323.
14. 韓輝. Stanford B型主動脈夾層118例臨床分析.中國急救醫學, 2010, 30 (2):144-146.
15. Fattori R, Tsai TT, Myrmel T, et al. Complicated acute type B dissection:is surgery still the best option?:a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv, 2008, 1 (4):395-402.
16. 李濱, 孫立忠, 常謙, 等.全弓替換加支架象鼻技術治療復雜Stanford B型主動脈夾層的臨床觀察.中華醫學雜志, 2010, 90 (5):323-326.
17. Dias RR, Mejia OA, Fiorelli AI, et al. Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction. Rev Bras Cir Cardiovasc, 2010, 25 (4):491-499.
18. 程光存, 朱正艷, 嚴中亞.外科雜交技術在主動脈弓疾病中的應用進展.中華心胸血管外科雜志, 2011, 27 (10):625-626.
19. 張振龍, 邱罕凡, 陳良萬, 等.主動脈弓部病變的腔內治療.臨床心血管病雜志, 2012, 28 (12):931-933.
20. Noor N, Sadat U, Hayes PD, et al. Management of the left subcl-avian artery during endovascular repair of the thoracic aorta. J Endovasc Ther, 2008, 15 (2):168-176.
21. 魏以楨, 常謙, 于存濤, 等.一期雜交手術治療累及主動脈弓遠端的降主動脈病變.中國胸心血管外科臨床雜志, 2011, 18 (2):99-102.
22. 丁盛, 張近寶, 歐陽輝, 等.不同雜交方式治療累及弓部的主動脈夾層.中國胸心血管外科臨床雜志, 2012, 19 (4):435-437.
23. 孫益峰, 梅運清, 蔡建志, 等.腔內隔絕術、聯合血管旁路移植術治療主動脈夾層動脈瘤.中國胸心血管外科臨床雜志, 2008, 15 (1):64-65.
24. Chen X, Huang F, Xu M, et al. The stented elephant trunk proce-dure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11 (5):594-598.
25. Yamashiro S, Kuniyoshi Y, Arakaki K, et al. Total arch replacement for distal enlargement after ascending aortic replacement for acute type A aortic dissection.Ann Thorac Cardiovasc Surg, 2009, 15 (5):318-323.

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One-stage Hybrid Surgery for Complex Stanford Type B Aortic Dissection

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