The Clinical Study Of Thoracic Aortic Dissection Treated By Thoracic Aortic Stent Repair

Objective:To summarize the surgical treatment experience of acute Stanford type B aortic dissection in our center,and to discuss the effect of surgical treatment and the choice of appropriate surgical method.Methods:From sep 2016 to 2018 were retrospectively analyzed in December,a total of 68 patients with aortic dissection were receiving Thoracic aortic lumen prosthesis(Thoracic endovascular aortic repair TEVAR),the clinical data of 64 cases of male,female 4 cases,aged 25 to 87,an average of 51 ±13.6 years of age,hypertension,44 cases traumatic merger pleural effusion in 4 cases,3 cases with diabetes mellitus,merge coronary heart disease in 4 cases,5 cases,apnea syndromeOne case was proximal avulsion after B-type interlayer intracavitary isolation.Smoking history was 30 cases,drinking history was 21 cases.In 27 cases,the dissected aneurysm was located in the left subclavian artery at the far side,32 cases were located in the far side of the left subclavian artery at the far side,3 cases involved the opening of the left subclavian artery,and 6 cases were located in the abdominal aorta.Postoperative follow-up was conducted to observe the effect of early treatment.With Microsoft Excel worksheet for data classification,first through cases input statistics,using SPSS 22.0 software(SPSSincorporate,Chicago,IL,USA)for patient data for statistical analysis.Measurement data were expressed as mean standard deviation.Results:All the 68 patients successfully completed the surgery and were implanted with a covered stent.Angiography confirmed the accurate positioning of stent implantation after stent implantation.The true lumen blood flow of aortic dissection was restored to normal,the bypass blood flow was unobstructed,and the cure rate was 95.55%.Among them,1 patient suffered from reverse tear to form type A dissection within 4h after surgery,1 patient died 3 days after surgery,1 patient suffered from postoperative multiple organ failure,2 patients suffered from postoperative renal dysfunction(early stage),and the remaining patients had no death or serious complications during the perioperative period.Conclusion : TEVAR has the advantages of small trauma,simple operation,quick recovery and high cure rate.Meanwhile,for some complex type B aortic dissection involving the arch vessels,endovascular isolation combined with window opening technology and chimney technology can enable the reconstruction of the arch vessels.Moreover,the fenestration and chimney techniques can effectively prevent the occurrence of stolen blood syndrome in patients with left vertebral artery dominance or inadequate Willis ring compensation.Compared with the surgical vascular bypass technique,the left subclavian artery "chimney" and fenestration techniques are simpler and less invasive.Although the requirements of windowing technology and chimney technology are higher,with the development of intracavitary technology and the accumulation of experience,more restricted areas of the aorta can be broken through,and the long-term results continue to be closely followed up.