Xing Yue, Zhu Zhengrong, Zou Lan, Wu Jiayu, Xu Guojian, Xu Yiding, He Zhijian, Cao Jianqiang, Luo Canhua
Department of Vascular Surgery, The First People's Hospital of Foshan, Foshan, China.
Cardiovasc Diagn Ther. 2024 Jun 30;14(3):367-376. doi: 10.21037/cdt-23-449. Epub 2024 Jun 17.
Single-branched stent grafts and the chimney technique are widely used in the treatment of type B aortic dissection (TBAD). The main objective of this study was to compare the outcomes of single-branched stent grafts and the chimney technique in the treatment of TBAD.
From January 2019 to December 2021, the retrospective cohort study contained a cohort of 91 patients with TBAD undergoing thoracic endovascular aortic repair (TEVAR) using single-branched stent grafts and the chimney technique. Group A included 55 patients treated with single-branched covered stents, and Group B included 36 patients treated with the chimney technique. We compared the effects of the procedures on peri-/post-operative outcomes between the two groups. The primary endpoint is clinical death, and the secondary endpoints include the patency of branch stents, the incidence of cerebral infarction, false lumen thrombosis, and the proportion of paraplegia.
For the baseline data, the two groups of patients show no differences in terms of age, gender, and associated symptoms. All procedures were successfully performed in both groups. The median follow-up period was 17.6 months (range, 10-34 months). During TEVAR, 5 (9.1%) type I endoleaks occurred in group A, and 11 (30.6%) occurred in group B (P<0.05). During follow-up, there were 2 cases (3.6%) of paraplegia and 1 case (1.8%) of cerebral infarction in Group A, while Group B had 1 case (2.8%) of paraplegia. Three patients in group B reported retrograde type A aortic dissection (RTAD), and 1 of them died (2.8%); however, there were no RTAD cases in group A. Complete thrombosis of the false lumen in the thoracic aorta was observed in 45.5% (25/55) of patients in group A and in 41.7% (15/36) in group B (P=0.72). No significant difference in the thrombosis-volume ratio in the whole false lumen was found during follow-up between group A (81.0%±2.9%) and group B (81.8%±2.6%; P=0.23).
Branched stent grafts can be used in cases with insufficient proximal landing zones and reduce the occurrence of type 1 endoleak compared to the chimney technique. This may help to prevent RTAD. Further research, including more cases and longer follow-up periods, is needed to substantiate these results.
单分支支架型血管移植物和烟囱技术广泛应用于B型主动脉夹层（TBAD）的治疗。本研究的主要目的是比较单分支支架型血管移植物和烟囱技术治疗TBAD的疗效。
2019年1月至2021年12月，这项回顾性队列研究纳入了91例行胸主动脉腔内修复术（TEVAR）治疗TBAD的患者，采用单分支支架型血管移植物和烟囱技术。A组包括55例接受单分支覆膜支架治疗的患者，B组包括36例接受烟囱技术治疗的患者。我们比较了两组手术对围手术期/术后结局的影响。主要终点是临床死亡，次要终点包括分支支架通畅情况、脑梗死发生率、假腔血栓形成及截瘫比例。
就基线数据而言，两组患者在年龄、性别及相关症状方面无差异。两组手术均成功完成。中位随访期为17.6个月（范围10 - 34个月）。TEVAR术中，A组发生5例（9.1%）I型内漏，B组发生11例（30.6%）（P<0.05）。随访期间，A组有2例（3.6%）发生截瘫，1例（1.8%）发生脑梗死；B组有1例（2.8%）发生截瘫。B组有3例患者报告发生逆行性A型主动脉夹层（RTAD），其中1例死亡（2.8%）；而A组未发生RTAD病例。A组45.5%（25/55）的患者胸主动脉假腔完全血栓形成，B组为41.7%（15/36）（P = 0.72）。随访期间，A组（81.0%±2.9%）和B组（81.8%±2.6%；P = 0.23）整个假腔的血栓体积比无显著差异。
与烟囱技术相比，分支支架型血管移植物可用于近端锚定区不足的病例，并减少I型内漏的发生。这可能有助于预防RTAD。需要进一步研究，包括纳入更多病例和更长随访期，以证实这些结果。
