Xu Xia, Wang Daoquan, Hou Ningxin, Zhou Hongmin, Li Jun, Tian Liang
Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurosurgery, Taikang Tongji (Wuhan) Hospital, Wuhan, China.
Front Surg. 2022 Feb 11;8:813970. doi: 10.3389/fsurg.2021.813970. eCollection 2021.
To evaluate the in-hospital and later outcomes of thoracic endovascular aortic repair (TEVAR) for type B intramural hematoma (TBIMH) combined with an aberrant subclavian artery (aSCA).
In the period from January 2014 to December 2020, 12 patients diagnosed with TBIMH combined with aSCA and treated by TEVAR were enrolled in this retrospective cohort study, including 11 patients with the aberrant right subclavian artery (ARSA) and 1 with an aberrant left subclavian artery (ALSA). A handmade fenestrated stent-graft or chimney stent or hybrid repair was performed when the proximal landing zone was not enough.
The mean age of all the patients was 59.2 ± 7.6 years, and 66.7% of patients were men. There were 4 patients with Kommerell's diverticulum (KD). The procedures in all 12 patients were technically successful. There was one case each of postoperative delirium, renal impairment, and type IV endoleak after TEVAR. During follow-up, 1 patient died of acute pancreatitis 7 months after TEVAR. The overall survival at 1, 3, and 5 years for the patients was 90.9, 90.9, and 90.9%, respectively. KD was excluded in 2 patients, and the handmade fenestrated stent-graft was applied in the other 2 patients to preserve the blood flow of the aSCA. No neurological complications developed and no progression of KD was observed during the follow-up.
Thoracic endovascular aortic repair for patients with aSCA and TBIMH is promising. When KD was combined, we could exclude KD or preserve the blood flow of aSCA with regular follow-up for the diverticulum according to the size of the KD.
评估腔内修复术（TEVAR）治疗B型主动脉壁内血肿（TBIMH）合并迷走锁骨下动脉（aSCA）的院内及远期疗效。
回顾性队列研究纳入2014年1月至2020年12月期间12例诊断为TBIMH合并aSCA并接受TEVAR治疗的患者，其中11例为迷走右锁骨下动脉（ARSA），1例为迷走左锁骨下动脉（ALSA）。当近端锚定区不足时，采用自制开窗支架型人工血管、烟囱支架或杂交修复术。
所有患者的平均年龄为59.2±7.6岁，66.7%为男性。4例患者合并Kommerell憩室（KD）。12例患者手术均获成功。TEVAR术后分别出现1例谵妄、1例肾功能损害和1例IV型内漏。随访期间，1例患者在TEVAR术后7个月死于急性胰腺炎。患者1年、3年和5年的总生存率分别为90.9%、90.9%和90.9%。2例患者排除KD，另2例患者应用自制开窗支架型人工血管以保留aSCA血流。随访期间未出现神经系统并发症，KD未进展。
TEVAR治疗aSCA合并TBIMH患者疗效良好。合并KD时，可根据KD大小排除KD或保留aSCA血流，并对憩室进行定期随访。
