Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China.
Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, People's Republic of China.
J Vasc Surg. 2018 Mar;67(3):704-711. doi: 10.1016/j.jvs.2017.07.124. Epub 2017 Oct 6.
To report our single-center experience of the hybrid procedure for type B aortic dissection (TBAD) with an aberrant right subclavian artery (ARSA) and the early to midterm outcomes in these patients.
From December 2011 to February 2016, 16 patients (12 males; median age, 51 years; range, 40-66 years) underwent thoracic endovascular aortic repair and extraanatomic bypass hybrid procedure for TBAD with an ARSA in our center. Demographics, coexisting medical conditions, imaging features, operation details, and follow-up outcomes of these patients were collected retrospectively and analyzed.
Duration from onset to hybrid procedure ranged from 5 to 57 days, with a median duration of 17 days. The median duration of stay in the intensive care unit and duration of in-hospital stay was 126 hours (range, 14-450 hours) and 21 days (range, 11-31 days), respectively. The overall technique success rate was 100%. No perioperative death, major stroke, or spinal cord ischemia was registered. Immediate type Ia endoleak was detected in three patients (18.8%) and immediate type II endoleak was detected in one patient (6.3%). One access-related complication occurred, which was a femoral artery pseudoaneurysm requiring compression bandage. Brachial plexus injury was observed in two patients (12.5%) with weakness of the upper extremity. The median follow-up was 33 months (range, 11-59 months). During follow-up, a retrograde type A aortic dissection was found in one patient (6.3%) 3 months after procedure. The occlusion of left common carotid artery to left subclavian artery bypasses were confirmed by computed tomography angiography in two patients (12.5%). They were left untreated for no symptoms. Reintervention was required in one patient (6.3%) for persistent type II endoleak by using Amplatzer plugs to seal the origin of the ARSA 20 months after the operation. There was no recorded death or stroke during the study period.
Our limited experience demonstrates that a hybrid procedure is a viable and relatively safe treatment strategy for patients with TBAD and an ARSA. A larger series of cases with a longer follow-up is needed to substantiate these results.
报告我们中心治疗伴有右位锁骨下动脉（ARSA）的 B 型主动脉夹层（TBAD）的杂交手术经验，并评估这些患者的早期至中期结果。
自 2011 年 12 月至 2016 年 2 月，我们中心对 16 例伴有 ARSA 的 TBAD 患者进行了胸主动脉腔内修复术和体外旁路杂交手术。回顾性收集这些患者的人口统计学、并存的医学状况、影像学特征、手术细节和随访结果，并进行分析。
从发病到杂交手术的时间为 5 至 57 天，中位数为 17 天。入住重症监护病房的中位时间和住院时间分别为 126 小时（范围为 14 至 450 小时）和 21 天（范围为 11 至 31 天）。总体技术成功率为 100%。无围手术期死亡、大卒中或脊髓缺血发生。3 例（18.8%）患者即刻出现 I 型内漏，1 例（6.3%）患者即刻出现 II 型内漏。发生 1 例血管入路相关并发症，即股动脉假性动脉瘤需加压包扎。2 例（12.5%）患者出现臂丛神经损伤，上肢无力。中位随访时间为 33 个月（范围为 11 至 59 个月）。随访期间，1 例患者（6.3%）术后 3 个月发现逆行性 A 型主动脉夹层。2 例（12.5%）患者通过 CT 血管造影证实左颈总动脉至左锁骨下动脉旁路闭塞。由于无任何症状，故未予治疗。1 例患者（6.3%）术后 20 个月因持续性 II 型内漏，使用 Amplatzer 封堵器封堵 ARSA 起源处，需再次干预。研究期间无死亡或卒中发生。
我们的有限经验表明，杂交手术是治疗伴有 ARSA 的 TBAD 患者的一种可行且相对安全的治疗策略。需要更大系列的病例和更长时间的随访来证实这些结果。
