Comparison Of The Clinical Efficacy Of Different Surgical Procedures For The Treatment Of Type B Aortic Dissection With Insufficient Proximal Anchoring Zone

Objective:To analyze the data of patients with Stanford B aortic dissection with insufficient proximal anchoring area,to explore the treatment of the left subclavian artery in different surgical procedures,and to summarize the treatments for the treatment of Stanford B aortic dissection with insufficient proximal anchoring area.Methods:A retrospective analysis of the clinical data of Stanford B aortic dissection patients with insufficient proximal anchoring area admitted to the Department of Vascular Surgery,Jinan Central Hospital Affiliated of Shandong University from June 2017 to June 2020.Divided into 3 groups according to the reconstruction method of the left subclavian artery during TEVAR,including 30 cases in the in-situ fenestration group,12 cases in the physician-modified fenestration group,and 9 cases in the chimney stent group.follow-up with CTA at 3,6,and 12 months.Recording the basic information of patients,including preoperation,Intraoperative,and postoperative.Using statistical methods to analyze the data and comparing the clinical effects of different surgical procedures are evaluated.result:1.After screening according to the admission criteria,in this study 51 patients were included,including 34 males and 17 females,aged from 32 to 80 years old,with an average age of(59.7±12.0)years old.Between three types of LSA reconstruction method,there was no significant difference in baseline data of the patients,in terms of gender,age,smoking history,drinking history,main clinical symptoms,and past disease history.2.The overall success rate was 96.1%(49/51),the success rate of the in-situ fenestration group was 93.3%,the technical success rate of the physician-modified fenestration group was 100%,and the technical success rate of the chimney stent group was 100%.In the chimney stent group,the incidence of endoleak was 33.3%,which was higher than the other two groups.The difference was statistically significant.One case died during the intraoperative period,and the overall all-cause mortality rate was 2%(1/51),of which the all-cause mortality rate of the in-situ fenestration group was 3.3%,and the other groups was 0%.The aortic-related mortality were both 0%in all of the group.There was no statistical difference in the incidence of intraoperative complications.3.Follow-up:The follow-up time is 6 to 36 months,of which the in-situ fenestration group was followed up for an average of 18.43 ± 8.97 months,the physician-modified fenestration group was followed up for an average of 17.33 ±9.85 months,and the chimney group was followed up for an average of 18.44±10.62 Months,the overall average follow-up was 18.18±9.32 months,and there was no statistically significant difference in follow-up time.During the follow-up,there was no statistically significant difference in the occurrence of complications among the three groups.Follow-up CTA for 6 months after operation showed that the true lumen diameter was enlarged and the false lumen was reduced in the LSA plane and the pulmonary artery bifurcation plane after the operation in the three groups,and the difference was statistically significant(P<0.01)compared with the preoperative plane.The abdominal trunk plane was true.The changes of lumen and false lumen were not statistically significant compared with preoperatively.The thrombosis rate of false lumen after thoracic aortic segment was higher than that of abdominal aorta,and there was no statistical difference between the three groups.conclusion:1.For aortic dissections with insufficient proximal anchoring areas,in-situ fenestration technology,the physician-modified fenestration,and "chimney"stent technology are all safe and effective surgical methods.2.The incidence of endoleak in the "chimney" technique is relatively high,but there is no statistically significant difference in the incidence of complications between the three groups,and the long-term efficacy still needs follow-up.3.The aortic remodeling of the thoracic aorta segment after the three groups was better than that of the abdominal aortic segment,and there was no statistically significant difference in aortic remodeling between the three groups.