The application of reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with unfavourable proximal landing zone / 中国医师杂志

ABSTRACT

Objective To explore the preliminary results of application of reserving the left subclavian artery by fenestration of domestic stent graft in the thoracic endovascular aortic repair (TEVAR) of type B dissection with unfavourable proximal landing zone.Methods From October 2015 to January 2018,a total of 13 patients with type B aortic dissection without healthy proximal landing zones underwent TEVAR using fenestration of domestic stent graft in our hospital.Computed tomography angiography (CTA) data were measured before surgery.Digital subtraction angiography (DSA) was conducted after surgery.All patients underwent CTA or ultrasound examination during follow-up.Operation success rate,survive rate,patency of left subclavian artery and complications were analyzed.Results All the patients were deployed fenestrated endografts successfully.No proximal endoleak happened during perioperative period.Delirium occurred in 1 case during 7 postoperative days and fully recovered with the medical treatment.The mean follow-up period was (9.8 ± 9.5) months (range,1-29 months).11 patients underwent CTA and 2 patients underwent ultrasound examination during follow-up.During period of following up,no patients died,no proximal endoleak appeared,and all the left subclavian arteries reserving by fenestration.Conclusions Reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with hostile proximal sealing zone is economical,safe and feasible,which expand the indication of TEVAR for aortic dissection,and the long-term outcomes of this technique need to be assessed in the future.