Comparison Of The Therapeutic Effects On Endovascular Aortic Repair With Different Treatment Methods Of Left Subclavian Artery

Objective: To retrospectively analyze the data of patients with Stanford type B aortic dissection with lesions involving Left Subclavian Artery and with insufficient Landing Zone,and compare the therapeutic effects on endovascular aortic repair with different treatment methods of Left Subclavian Artery,namely,pure TEVAR completely covering the LSA opening,chimney technique or hybrid surgery to reconstruct LSA,explore the advantages and disadvantages of the three surgical methods and surgical indications,so as to provide certain reference for clinical treatment.Methods: From September 2012 to July 2019,54 patients with type B aortic dissection with lesions involving LSA and anchoring areas less than 1.5cm were admitted to the Department of Cardiac Surgery of the First Affiliated Hospital of Guangxi Medical University.According to different treatments of LSA,they were divided into complete coverage group,chimney technique group,and hybrid surgery group.Among them,32 cases received pure TEVAR that completely covered the LSA opening,10 cases received LSA chimney stent +TEVAR,and 12 cases received artificial vascular bypass + Hybrid surgery of TEVAR;retrospectively analyze the hospitalization data of these patients,including general conditions,past history,intraoperative conditions,postoperative and discharge conditions,etc.,and follow up the post-discharge conditions in the outpatient department,and use statistical methods to quantitatively analyze the above data,To compare the curative effects of three surgical methods: stent graft implantation,chimney technique,and hybrid surgery.Results: All 54 patients successfully completed the operation,1 case had immediate endoleak during the operation,4 cases had endoleak after operation,2 cases of new type A dissection after operation,3 cases of new fracture at the distal end of the stent,and no perioperative operation Death cases.There was no statistically significant difference in the incidence of endoleak,new type A dissection or distal rupture among the three groups.3 cases were treated conservatively,and 6 cases needed surgical intervention again.There was no endoleak in the later follow-up.There is no statistically significant difference in the general information;in terms of hospitalization data,the operation time of the complete group was significantly shorter than that of the other two groups.(P<0.05),the hospitalization time of the chimney group was significantly shorter than that of the other two groups(P<0.05),and the hospitalization cost of the hybrid group was significantly higher than that of the other two groups(P<0.05).The incidence of left upper limb ischemia in the complete group was significantly higher than that of the other two groups(P<0.05).There was no statistically significant difference in the occurrence of other complications during the operation,perioperative period,and follow-up after discharge.Conclusion:Three different LSA treatment methods: covered stents completely cover LSA,artificial vascular bypass and chimney technology,all of which can achieve the effect of expanding the proximal Landing Zone of the Complex Type B Aortic Dissection,and the surgical treatment effect is exact and equivalent.Hybrid surgery and chimney technology can be used as the preferred treatment options for Complex Type B Aortic Dissection.