The Effects Of Different Methods For Left Cubclavian Artery During The Thoracic Aortic Endovascular Repair Of Aortic Dilatation Diseases

Objection:To study the effects of different methods for left subclavian artery during the Thoracic aortic endovascular repair of aortic dilatation diseases.Methods:A total of 64 cases were chosen from the patients of The First Affiliated Hospital of Guangxi Medical University between January 2008 and May 2015, with diagnosed as thoracic aortic dissection, thoracic aortic aneurysm, thoracic Intramural aortic hematoma, and thoracic aortic ulcer, and received the thoracic endovascular aneurysm repair procedures. According to the different methods of the left subclavian artery, the cases with the distance proximal break away from the left subclavian artery< 15 mm were divided into the bypass group (3 cases), the plugging group (11 cases), and the chimney graft group (10 cases).40 cases with the proximal break away from the left subclavian artery> 15 mm is the group of keeping the left subclavian artery open. All the 64 cases received preoperative treatments, the thoracic endovascular aneurysm repair, and postoperative treatments. During the thoracic endovascular aneurysm repair, the left subclavian arteries are separately processed in different methods as bypass, plugging, chimney graft, and reserving. Clinical data including basic indicators, complications, the patency of left subclavian artery, quality of life of each group were compared when pre-operation, post-operation, and 1 month,3 months,6 months, and 12 months after the procedures. Results:64 operations were successful. The chimney graft group had an advantage over the bypass group and the plugging group.4 cases in the plugging group and 1 case in the chimney group showed subclavian steal on postoperative CTA. Only one of the 4 cases in the plugging group occurred the subclavian artery steal syndrome. "Chimney" vascular and bypass vascular patency rates are good. The results of different ways of handling the left subclavian artery did not get a significant statistical difference. The W values of the QWB scale showed that the chimney group and reserving group had an significant improvement on the quality of life. Conclusion:Reconstructing the left subclavian artery can expand the indications of thoracic endovascular aneurysm repair. Bilateral axillary artery bypass, plugging, and chimney grafts are safe and effective methods to handle the LSA during TEVAR. And the chimney grafts are better.