The Application Of The Modified Cheese Wire Technique In The Treatment Of Complicated Pathological Changes Of Chronic Aortic Dissection

Purpose:To explore the efficacy and safety of the modified cheese wire technique in the treatment of complicated pathological changes of chronic aortic dissection.Methods:Between June 2016 and February 2017,six consecutive patients(median age 62.5(47.5,67.5)years;range 36–69 years)with complicated pathological changes of chronic supra-renal aortic dissection underwent endovascular aneurysm repair(EVAR)following guidewire septectomy to prompt true and false lumen form a big lumen combined chimney technique to create a suitable proximal aortic landing zone.Technical success was evaluated by angiography performed at the end of the procedure.Through the follow-up of patients with postoperative computer tomography angiography(CTA)compared patients with visceral zone branch level vessels have abdominal aorta true and false lumen diameter without expand or narrow,symptoms,physical signs and by observation of CTA with and without leakage,major blood vessels of adverse events,rupture,death,and so on in order to evaluate the safety and effectiveness of this technology.Results: Efficacy:six patients with chronic suprarenal aortic dissection,compared to preoperative,postoperative 1 month,3 months,6 months,1 year,the diameter of the aortic(including true and false lumen)of branch vessel level in the visceral area was not increased significantly(P>0.05).Compared to preoperative,postoperative 1 month,3 months,6 months,1 year,the diameter of the aortic(including false lumen)of distal renal artery level in the visceral area was obviously reduced(P<0.05).Compared to preoperative,postoperative 1 month,3 months,6 months,1 year,the diameter of the aortic(including true and false lumen)of branch vessel(Coeliac trunk,Superior mesenteric artery)level in the remaining visceral area was not increased significantly(P>0.05).All the six patients had severe lumbar abdominal pain,preoperative and postoperative 1,3,6,12 months VAS respectively 9(8,9),3(2,3.5),3(2,3.5),3(2,3.5),3(2,3.5)(P < 0.027),the symptoms have statistical significance.Safety:Preoperative,1 month,3 months,6 months,1 year without aortic rupture.Postoperative median 4(2.75,2.75)days in hospital,no endoleak,intra-stent thrombosis and stent displacement,no major blood vessels of adverse events,no death.:Conclusions:the modified cheese wire technique is a technique that has the potential advantage,which is feasible,safe,minimally invasive and effective in the treatment of complicated pathological changes of chronic aortic dissection.The technique to create an anatomically suitable proximal neck for successful EVAR,and makes the fluid biomechanical model simplification,but larger clinical studies and longer-term follow-up data are needed for further verification.