Comparison Of The Effects Of In Situ Fenestration And Single-Branched Stent Graft For Patients With Type B Aortic Dissections Involving The Left Subclavian Artery

Objective:To summarize the data of patients with Stanford type B aortic dissection involving the left subclavian artery(LSA).Comparing the efficacy of In Situ Fenestration(ISF)and Single-Branched Stent Graft(SBSG),and provide a reference for the selection of surgical methods for such patients.Methods:Analyse the clinical data of patients with type B aortic dissection involving the LSA in the Department of Vascular Surgery,Second Affiliated Hospital of Nanchang University from October 2017 to March 2019.Of these,57 patients underwent ISF surgery and 34 patients underwent SBSG surgery.Recording the hospitalization information of these patients,including general conditions,past history,intraoperative conditions,postoperative to discharge,and follow-up.Using statistical methods to quantitatively analyze the above data and compare the efficacy of two surgical methods.Results:All cases were successfully completed in situ fenestration(ISF)and single branch stent implantation(SBSG),and there were no perioperative deaths.Of the 57 cases in the ISF group,9 were lost to follow-up and 48 were finally collected.Among the 34 cases in the SBSG group,2 were lost to follow-up and 32 were finally collected.Among the general information items,the ISF group and the SBSG group had statistically significant differences in the time of onset,and the other items were not significantly different.All surgical techniques had a 100% success rate in the two groups.Compared with SBSG group,the operation time and fluoroscopy time of ISF were longer,and the amount of contrast material and bleeding was more.The difference was statistically significant.There was no statistical difference in the incidence of intraoperative and perioperative complications.Follow-up: The median follow-up time was 15 months(12-24 months)in the ISF group and 17 months(12-26 months)in the SBSG group.During the follow-up,there was no significantdifference in the incidence of complications between the two groups.One-year follow-up CTA showed that 38 cases of thoracic aortic false lumen thrombosis were completely absorbed in the ISF group,and 10 cases were partially absorbed,while in the SBSG group,26 cases of thoracic aortic false lumen thrombosis were completely absorbed and 6 cases were partially absorbed.The difference was not statistically significant.Conclusions:1.ISF technology and SBSG technology are both effective and feasible surgical methods,and both can expand the range of application of thoracic aortic repair.2.When aortic dissection patients need emergency surgery,ISF has more advantages in comprehensive stent selection,and SBSG technology has advantages in reducing surgical time and standardizing surgical procedures.3.Compared with other perioperative and follow-up complications such as endoleak and stenosis of stent graft,there is no significant difference between the ISF group and the SBSG group.Larger data and longer follow-up studies are needed.