Clinical Investigative Of Hybrid Arch Repair For Thoracic Aortic Pathologies Involving The Aortic Arch

Background:Thoracic endovascular aortic repair(TEVAR)is widely used in thoracic aortic diseases,such as thoracic aortic aneurysm,aortic dissection,intramural hematoma,penetrating ulcer and traumatic aortic disease,etc.The anatomy of the aortic arch is complex.It includes the innominate artery,left common carotid artery and left subclavian artery.Occlusion of these vessels causes the stroke,spinal cord ischemia and limb ischemia,etc.Therefore,TEVAR alone cannot solve all aortic arch lesions.In order to solve this problem,a series of auxiliary techniques including hybrid arch repair,parallel stent technique,fenestrated stent-graft,and branching stent-graft have been gradually adopted in clinical practice.This investigative retrospectively analyzed the clinical data of hybrid arch repair for aortic arch lesions and evaluated its clinical effects.Objective:To evaluate the clinical feasibility,safety and efficacy of hybrid arch repair for thoracic aortic pathologies involving the aortic arch.Methods:This retrospectively investigative was based on 21 patients cohort with thoracic aortic diseases treated byhybrid arch repair from January 1st 2014 to December 31 th 2018.Data of basic characteristic,surgical methods,imaging,and prognosis were collected.During follow-up period,quality of life and blood pressure were assessed,and imaging data were collected through telephone interview and in person review at outpatient department.The clinical effects and complications of different surgical methods and different kinds of the stents during hospitalization and follow-up were analyzed.Results:Hybridization arch repair was successfully performed in all 21 patients.Aortic angiography showed one case(4.8%)with type II internal leakage was occurred.The stent was well shaped and no internal leakage was found among the rest of patients.The postoperative ICU monitoring time was 3 ±1.2 days and the average hospital stay was 18.6 ±6.2days.Among theses paitients,1 case died(4.8%),1 case had stroke(4.8%),5 cases had pulmonary infection(23.8%),3 cases had pleural effusion(14.3%),and no paraplegia was observed.The follow-up time was 3 to 63 months.During follow-up period,there was no death,stent displacement,new internal leakage,and retrograde dissection occurred,and the blood flows smoothly in artificial blood vessels.Conclusion:Hybrid arch repair for thoracic aortic pathologies involving the aortic arch is a minimally invasive,safe and effective.The early and medium-term outcomes were well,but the long-term effect of hybridization arch repair is needed to be confirmed in further studies with longer follow-up period.