Comparison Of Long-Term Effects Of Left Subclavian Artery Reconstruction In Different Ways With Anchorage Area Deficient B-Type Aortic Dissection

Objective: To study the influence of different subclavian vascular reconstruction methods on the prognosis of patients with insufficient aortic dissection in the anchoring area through long-term follow-up,so as to explore the best management method for aortic dissection in the anchoring area.Methods:Clinical data of patients with insufficient aortic dissection in the proximal anchorated area were collected from the Department of Cardiac Macrovascular Surgery of Linyi Central Hospital from March 1,2019 to March 1,2022.They were classified according to left subclavian vascular reconstruction.Among them,30 cases were in the operation group of "chimney" stent.Fenestration operation group: 12 cases;Hybrid operation group 8 cases;Castor branch stent implantation group 16 cases.The general information before operation,the occurrence of postoperative complications,operation time,blood loss and postoperative recovery were compared in each group.The postoperative efficacy and prognosis of each group were evaluated.Results: Sixty-six patients with aortic dissection in the short anchoring area were admitted,and the success rate was 100%.There was no statistical difference in the basic data of each group.Postoperative follow-up was(12±2)months.There were 8 cases(12.1%)of postoperative complications in each group,and no serious complications such as dissection reverse tear and aortic rupture,including 5 cases(16.7%)of complications in the "chimney stent" operation group,3 cases of immediate postoperative internal leakage,1 case of internal leakage during long-term follow-up,and 1 case of left subclavicular artery stent stenosis during follow-up.In the fenestrated operation group,internal leakage occurred in 1 case(8.3%);Postoperative incision infection occurred in 1case(12%)of the hybrid operation group.In Castor stent operation group,there were 2complications(12.5%): postoperative incision infection occurred in 1 case,and mild renal insufficiency occurred in 1 case.In addition,the postoperative recovery time and operation time of patients in the hybrid surgery group were significantly increased than those in the other groups,the use of contrast agent and fluoroscopy time in the Castor stent group were significantly longer than those in the other groups,and there was no statistical significance in postoperative mortality in each group.Conclusion: The "chimney" stent technique,the window technique,the hybridization technique,and the Castor coated stent technique can all be used for the interventional treatment of the deficient type B aortic dissection in the anchoring area and achieve the ideal efficacy.However,the Castor branch stent technology has a higher patency rate,fewer postoperative complications,and easier operation than the other three groups,making it a better choice for type B aortic dissection with insufficient anchoring area.