Endovascular repair combined with assistant techniques for the treatment of Stanford Type B aortic dissection involving aortic arch / 中华普通外科杂志

ABSTRACT

Objective To evaluate endovascular repair combined with assistant techniques for the treatment of Stanford type B aortic dissection involving aortic arch.Method From July 2002 to June 2010,46 patients of aortic arch dissection with the primary entry tear next to the orifice of left subclavian artery,were treated with endovascular repair.Left subclavian arteries were covered with TEVAR in 43 cases.PDA occludes were used in 6 patients.Nine patients received extrathoracic supra-aortic branches bypass.Double-barrel technique was performed in 8 patients.Fenestrated stent graft was used in 1 patient.Result All patients survived and were followed up for 2 to 76 months.No severe neurological complications happened.All synthetic grafts and carotid artery stents were patent.Type Ⅱ endoleak occurred in 10 patients,among them 6 received PDA occlude implantation in the left subclavian artery,and 2 patients recovered by conservative treatment.Nine patients suffered from ischemia of the left upper extremity,and 8 of them were treated with conservative method,one received bilateral subclavian artery bypass because of severe ischemia after endovascular treatment.In follow-up,all of the stent-grafts and grafts were patent.In the descending aorta,the diameter of true lumen increased significantly and the diameter of false lumen shrank gradually.Conclusions Endovascular aortic repair combined with extrathoracic supra-aortic branches bypass,PDA occlude,double-barrel technique and fenestrated technique is a safe and effective method for Stanford Type B aortic dissection involving aortic arch.