| Objective: To retrospectively analyze the effect of in situ fenestration and chimney technique on reconstruction of left subclavian artery in endovascular repair of Stanford B type aortic dissection.Method:We choost 45 cases of Clinical case data of patients with Stanford B aortic dissection undergoing intraoperative reconstruction of the left subclavian artery and was performed by TEVAR during January 1,2015 to December 31,2019.Multi-level spiral CT angiography(Computed Tomography Angiography CTA)was performed in our hospital before operation,and digital subtraction angiography(Digital Subtraction Angiography DSA)was used for intracavitary repair.the 45 patients were divided into in situ windowing group(17 cases)and chimney group(28 cases)according to the reconstruction LSA method.the clinical data of the patients were compared,including TEVAR days before operation,operation time,success rate of operation technique,postoperative complications and hospitalization expenses.Follow-up time was 1 year,including stent patency,complications(internal leakage,paraplegia),re-operation in the treatment of intracavitary surgery.Results: There was no statistical difference between the two groups in the analysis of age,sex and hypertension data.The technical success rate was 100% in the whole group.The average preoperative days were 15.47 ± 10.35 days in the in situ window-opening group and 5.39 ± 3.71 days in the chimney group.The average operating cost of open windows in situ was 115972.91 ± 51192.60 yuan,and the operating cost of chimney technical group was 92976.62 ± 29277.01 yuan,The difference between the two groups was statistically significant.The duration of in situ fenestration was 206.94±73.30 min,and that of chimney was 152.04±66.78,The difference between the two groups was statistically significant.The success rate of operation was 100% in both groups.Intraoperative angiography showed successful closure of aortic dissection,including 2 cases of I type internal leakage(11.76%)in in in situ window opening group and 2 cases of I type internal leakage(7.14%)in chimney technical group.There was no statistical difference 。 Paraplegia(5.88%)occurred in 1 case after in situ windowing,paraplegia(3.57%)in 1 case of chimney technique,stroke in 3 cases,in situ windowing in 2 cases and chimney technique in 1case.Other postoperative complications included pulmonary infection(2 cases with in situ fenestration,3 cases with chimney technique)and myocardial infarction in the in situ fenestration group 。 All stent patency(100%),no stent displacement and deformation were CTA after operation。One case died of myocardial infarction during follow-up of in situ fenestration group.There were 7 cases of I type internal leakage during the follow-up of chimney technical group,2 of which were due to large internal leakage,enlarged false cavity and Combined with chest pain and other symptoms,one which was performed Intra-lumen treatment for sealing leakage after 2 months leter and one was performed Intra-lumen treatment for sealing leakage after 3 months leter.Others patients CTA suggest a small amount of internal leakage with no clinical symptoms,was to be closely followed up.Conclusion :1.There was no significant difference in the incidence of early postoperative complications(paraplegia,stroke,pulmonary infection)between the two groups,regardless of chimney technique or in situ fenestration technique.Considering the small number of cases in this study,a large sample of data is still needed to confirm.2.Chimney technique is shorter than in situ window opening.For patients who can not tolerate long time operation,it may be more advantageous to choose chimney technique to reconstruct the left subclavian artery,and it is also a good choice for intracavitary remedial surgery.However,with the development of window opening technology,the time of window opening operation is greatly shortened,and chimney technology will no longer have an advantage in this respect.3.The incidence of internal leakage of chimney technology is higher than that of in-situ window opening group,and in-situ window opening technology is more effective to prevent internal leakage.4.In situ fenestration technique changed the original design structure of the stent,and long-term follow-up was needed to observe the stability of the stent and its effect on aortic remodeling.5.Subacute intracavitary repair has a lower incidence of postoperative complications than acute intracavitary repair,and more high-quality prospective studies are needed for the selection of treatment timing... |
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