Kang Mengyang, Qin Hao, Meng Yan, Ma Qiang, Zhang Junbo, Tian Hongyan
Department of Peripheral Vascular Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, China.
Eur J Med Res. 2024 Dec 31;29(1):638. doi: 10.1186/s40001-024-02247-y.
The optimal treatment of complicated type B aortic dissection (cTBAD) involving arch anomalies remain unclear.
We consecutively enrolled patients with cTBAD involving arch anomalies who underwent endovascular repair using a single-branched stent graft (SBSG) at our medical center between January 2020 and January 2023. The demographics, clinical manifestation, operation detail, and follow-up outcomes of these patients were retrospectively collected and analyzed.
A total of 16 patients (14 men; 55.8 ± 11.7 years) were enrolled, including isolated left vertebral artery (ILVA) (n = 6), aberrant right subclavian artery (ARSA) (n = 7), and right aortic arch and aberrant left subclavian artery (ALSA) with Kommerell's diverticulum (KD) (n = 3). Among them, six patients with multi-branched arch anomalies. The endovascular management strategies of patients were diverse based on their aortic morphology. The early outcome demonstrated that one patient experienced an immediate intraoperative type I endoleak, which was resolved by balloon dilation, and two patients exhibited bird-beak configuration. After a median of follow-up of 910 (743-1023) days, the long-term outcome revealed that two patients developed endoleak. No death, retrograde type A aortic dissection (RTAD), paraplegia, stent graft-induced new entry tear (SINE), or branch section stenosis of SBSG were observed during the follow-up.
Our limited experience suggests that endovascular repair with a SBSG appears to be a relatively safe, feasible, and effective treatment option for patients with cTBAD and arch anomalies.
累及主动脉弓异常的复杂性B型主动脉夹层（cTBAD）的最佳治疗方法仍不明确。
我们连续纳入了2020年1月至2023年1月期间在我们医疗中心接受单分支支架移植物（SBSG）血管腔内修复的累及主动脉弓异常的cTBAD患者。回顾性收集并分析这些患者的人口统计学资料、临床表现、手术细节和随访结果。
共纳入16例患者（14例男性；年龄55.8±11.7岁），包括孤立左椎动脉（ILVA）（n = 6）、迷走右锁骨下动脉（ARSA）（n = 7）以及合并Kommerell憩室（KD）的右主动脉弓和迷走左锁骨下动脉（ALSA）（n = 3）。其中，6例患者存在多分支主动脉弓异常。根据患者的主动脉形态，其血管腔内治疗策略各不相同。早期结果显示，1例患者术中即刻出现I型内漏，经球囊扩张后解决，2例患者出现鸟嘴样畸形。中位随访910（743 - 1023）天后，长期结果显示2例患者出现内漏。随访期间未观察到死亡、逆行性A型主动脉夹层（RTAD）、截瘫、支架移植物引起的新破口（SINE）或SBSG分支段狭窄。
我们有限的经验表明，对于cTBAD和主动脉弓异常患者，采用SBSG进行血管腔内修复似乎是一种相对安全、可行且有效的治疗选择。
