Li Yuejin, Zhao Yiman, Li Rougang, Li Yu, Liu Yu, Li Guosan, Gong Kunmei
Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6792-6805. doi: 10.21037/qims-23-1705. Epub 2024 Aug 27.
With the advances in medical technology and materials, thoracic endovascular aortic repair has become the mainstay of treatment for aortic dissection. In situ fenestration (ISF) and single-branch stent graft (SBSG) implantation are commonly used methods, with each having its own advantages and disadvantages. The study aimed to compare the perioperative outcomes and one-year follow-up results of patients who underwent ISF or SBSG in the treatment of acute Stanford type B aortic dissection involving the left subclavian artery (LSA).
From January 2018 to December 2022, consecutive patients with Stanford type B aortic dissection were retrospectively recruited and divided into ISF group and SBSG group according to the type of surgery. The patient's aortic physiology was evaluated by computed tomography angiography at 1, 3, 6, and 12 months after discharge.
This study included 67 patients in the SBSG group and 21 patients in the ISF group. The baseline and preoperative indices were similar between the groups. The success rate of perioperative treatment was 100%, and no adverse consequences occurred in either group. No spinal cord ischemia, stroke, or paraplegia occurred in either group during the one-year follow-up. The rate of endoleak in the SBSG group was significantly lower (3%, all type I endoleaks) than that in the ISF group (9.5% type I and 14.3% type II endoleaks) (P=0.005). Type II endoleak mainly occurred in the LSA. In addition, complete thrombosis of the false lumen was achieved in 95.5% of the SBSG group versus 81.0% of the ISF group, but this was not a significant difference (P=0.091). The maximum diameter of the true lumen increased significantly in the ISF (P<0.001) and SBSG (P<0.001) groups. Meanwhile, the maximum diameter of the false lumen was significantly reduced in the ISF (P<0.001) and SBSG (P<0.001) groups, but the difference in the maximum diameter change of the true or false lumen between the two groups was not statistically significant (P>0.05).
SBSG was associated with a significantly lower incidence of endoleak than was ISF. However, there were no differences observed in complete thrombosis of the false lumen. Further studies with larger sample sizes are needed to definitively establish which treatment is superior in terms of complete thrombosis of the false lumen.
随着医学技术和材料的进步，胸主动脉腔内修复术已成为主动脉夹层治疗的主要手段。原位开窗术（ISF）和单分支支架移植物（SBSG）植入是常用的方法，各有其优缺点。本研究旨在比较接受ISF或SBSG治疗累及左锁骨下动脉（LSA）的急性Stanford B型主动脉夹层患者的围手术期结局和一年随访结果。
回顾性纳入2018年1月至2022年12月连续收治的Stanford B型主动脉夹层患者，根据手术方式分为ISF组和SBSG组。出院后1、3、6和12个月通过计算机断层扫描血管造影评估患者的主动脉生理情况。
本研究纳入SBSG组67例患者和ISF组21例患者。两组的基线和术前指标相似。围手术期治疗成功率为100%，两组均未发生不良后果。在一年随访期间，两组均未发生脊髓缺血、中风或截瘫。SBSG组的内漏发生率显著低于ISF组（3%，均为I型内漏）（ISF组：I型内漏9.5%，II型内漏14.3%）（P=0.005）。II型内漏主要发生在LSA。此外，SBSG组95.5%实现了假腔完全血栓形成，ISF组为81.0%，但差异无统计学意义（P=0.091）。ISF组（P<0.001）和SBSG组（P<0.001）真腔最大直径均显著增加。同时，ISF组（P<0.001）和SBSG组（P<0.001）假腔最大直径均显著减小，但两组真腔或假腔最大直径变化的差异无统计学意义（P>0.05）。
与ISF相比，SBSG的内漏发生率显著更低。然而，在假腔完全血栓形成方面未观察到差异。需要更大样本量的进一步研究来明确哪种治疗在假腔完全血栓形成方面更具优势。
