Clinical Report Of Branched Stent On Repairing Stanford Type B Aortic Dissection Involving The Left Subclavian Artery

Objective: The study was undertaken to prove that branched stent is safe,stable and effective by comparing the geometric data of true and false lumen of each plane of aorta before and after thoracic endovascular aortic repair,the false lumen thrombotic state and the internal diameter of left subclavian artery on the basis of the results of clinical follow-up.Methods: From November 2017 to May 2020,123 patients with type B aortic dissection,diagnosed in our hospital,were selected,among which 51 cases involved the left subclavian artery and 22 cases of Castor were treated with branched stent implantation.Five planes were measured,middle stent(plane B),distal stent(plane C),celiac trunk(plane D),left renal artery(plane E)and the end of abdominal aorta(plane F).The diameter and area of true and false lumen after operation were compared with those before operation.The aortic remodeling was evaluated based on the postoperative thrombotic state of false lumen and the change of blood supply source of each branch of abdominal aorta.The internal diameter of left subclavian artery before and after operation indicates whether there were complications such as left arm ischemia,stroke and paraplegia,so as to evaluate the effect of left subclavian artery revascularization.The short-term safety,stability and effectiveness of branched stent could be detected by finding out whether there were major complications such as perioperative death,internal leakage,interlayer rupture,stent deformation and displacement..Results: The success rate of the operation was 100%.There were no complications such as postoperative death,dissection rupture,stroke,paraplegia,left arm ischemia,internal leakage,stent deformation and displacement.Through the comparison of data,the internal diameter of left subclavian artery after operation was significantly larger than that before operation(P < 0.001).In the six designated aortic planes,there were morphological changes in 5planes after operation,and the total inner diameter of plane A was significantly changed(P<0.05),the true lumen was enlarged and the false lumen was significantly reduced in plane B,C and D(P<0.001).The true lumen in E plane was enlarged,but there was no significant change in false lumen(P>0.05).The change of true and false lumen in F plane was not statistically significant(P>0.05).Among the 20 patients who met the criteria of this study,in the thoracic aortic segment,18 cases were in basic thrombotic state,2 cases in partial thrombotic state,0 cases without thrombosis,and in abdominal aortic segment,16 cases were in basic or partial thrombotic state,and 4 cases were not thrombotic.Conclusion: For type B aortic dissection involving the left subclavian artery,branch stent can not only solve the problem of blood supply of the left subclavian artery,but also extend the anchorage area and promote aortic remodeling,which is a safe,stable and effective treatment.