| Objective To evaluate the difference between the safety and effectiveness of fenestration thoracic aortic endovascular repair(TEVAR)technology and branched TEVAR technology in revascularizing the left subclavian artery(LSA)for aortic disease,and to screen for indications for different endovascular techniques.Methods To collect preoperative,intraoperative and postoperative clinical data of 79 patients with aortic lesions requiring revascularization of LSA from November 25,2015 to October 30,2019 in the Department of Vascular Surgery,General Hospital of Tianjin Medical University.According to the different LSA revascularization methods,they are divided into a f TEVAR group(abbreviated as f group)and a b TEVAR group(abbreviated as b group)for comparative analysis.The operation success rate,intraoperative and postoperative complication rate,mortality rate,and secondary surgery intervention rate were compared between the two groups.The image data of preoperative and postoperative follow-up were reconstructed with professional software to observe the patency of the branch artery and measure the area change of the true and false lumen in each plane of the aorta.Compare the patency of the branch artery and the remodeling of the aorta between the two groups.Results A total of 50 patients in group f and 29 patients in group b were included.The average age of the two groups(57.3 ± 12.5 vs 53.14 ± 14.06)and other preoperative clinical baseline data were not significantly different(p > 0.05).In the selection of anatomical indications,the length of landing zone in group f was significantly greater than that in group b(10.4 ± 6.0 vs 5.2 ± 7.5,p = 0.039).Intraoperative results: The aneurysms or dissections in group B and group B were effectively occluded,and there was no significant difference in surgical success rate(100% vs 100%)(p > 0.05).All patients were revascularized with LSA.2 early cases in group f were transferred to the chimney technique due to inaccurate positioning,but the success rate of stent release(96% vs 100%)between the two groups was not significantly different(p > 0.05).In group f,1 case of trace type Ia endoleak was found after operation(untreated),but the incidence of type Ia endoleak(2.0% vs 0%)in the two groups was not significantly different(p > 0.05).There was no significant difference in the incidence of intraoperative aortic stent-related complications(2.0% vs 0%)and mortality(0% vs 0%)between group f and group b(p > 0.05).The operation time in group f(123.0 ± 40.7min)was significantly longer than that in group b(84.2 ± 16.3min,P <0.05).Perioperative results: There was no significant difference in the average hospital stay between group f and group b(14.9 ± 5.0 vs 14.6 ± 8.7 days)(p = 0.857).The operation cost of group b(162005.7 ± 4990.9 yuan)was significantly higher than that of group f(142995.6 ± 11017.8 yuan,p <0.05).In group f,a small amount of type Ia endoleak disappeared after operation.The incidence of new type I endoleak in group f and group b(0% vs 0%),the incidence of type III endoleak(2.0% vs 0%),the incidence of dissection reverse tear(0% vs 3.5%)There was no significant difference in the rate of acute cerebral embolism(2.0% vs 0%)and the incidence of approach complications(2.0% vs 3.5%)(p > 0.05).1 patient in group f was re-operated one week after the operation to successfully occlude type III endoleak with an occluder and a coil,and 1 patient underwent reoperation and repair of the left brachial artery pseudoaneurysm.In group b,1 patient underwent secondary open surgery due to the dissection of the reverse tear one week after surgery,and 1 patient underwent reoperation for the left brachial artery pseudoaneurysm resection and repair.Significant difference(p > 0.05).Both groups of LSA remained unobstructed and there were no deaths.Short-term(6-12months)follow-up period results: Between group f and group b,the complication rate(8.0%vs13.8%),stent-related complications rate(6.0%vs3.5%),endoleak rate(0% vs 0%),the rate of neurological complications such as new cerebral spinal cord ischemia(0% vs 0%)and the rate of aneurysm formation in the distal stent(6.0% vs 0%)were not significantly different(p > 0.05).There was no significant difference in the LSA patency rate(100%vs96.6%)and stent displacement rate(0% vs 0%)in group f and group b(p > 0.05).There was 1case of LSA occlusion in group b,and stenting was performed in the second operation.There was no significant difference between the two groups in the intervention rate(0% vs 3.5%)(p > 0.05).There was no significant difference in stent-related mortality(0% vs 0%)and all-cause mortality(4.0% vs 3.5%)between the two groups(p > 0.05).A total of 24 patients in group f and 15 patients in group b received effective measurement data.After surgery,the true lumen of the stent segment increased and the false lumen decreased.The increase of the true lumen in group b was significantly higher than that of group f(p <0.05),and the decrease of false lumen in group b was also higher than that of group f,but no significant difference(p > 0.05).The overall change trend of the non-stent segment is similar to that of the stent segment,but some have a decrease in true cavity and an increase in false cavity after surgery,and there is no significant difference between the two groups(p > 0.05).The aortic stent segment has better postoperative remodeling effect than the non-stent segment.Conclusion 1.The f TEVAR technique and the b TEVAR technique revascularize LSA have good safety and effectiveness in the treatment of aortic disease.2.The two techniques have achieved good results in the stent segment aortic remodeling recently,and the b TEVAR technique is slightly superior to the in f TEVAR technique.The mid-to long-term results are yet to be evaluated.3.The operation time of the b TEVAR technology is shorter,the impact on the patient’s general condition is smaller,and the safety is higher.4.The b TEVAR technique does not destroy the stent’s structure,and has higher effectiveness for lesions with shorter landing zone.5.The f TEVAR technology supplies are cheaper and more economical. |
PDF Full Text Request