Exploration Of Simplified Intraluminal TEVAR Technique For The Treatment Of Aortic Arch Disease:Clinical Research And Practice

Part ? The position relationship between the opening of three branches of aortic arch and the aortic arch axis in normal people OBJECTIVES:Using image workstation,the position relationship between the three branches of the aortic arch was observed by measuring the related data of the three branches of the aortic arch of normal people,which provided data support for the customization of aortic arch stent and simplified intraluminal treatment.METHODS: 1?From January 2018 to December 2018,120 patients who underwent thoracic aorta CTA examination in General Hospital of Tianjin Medical University were collected according to exclusion criteria.2?Using GE AW4.6 workstation,after the aortic arch was straightened,the relationship between the tri-branch opening and the corresponding cross-sectional aortic axis was compared by measuring the ratio of the distance(from the midpoint of the tri-branch opening to the anterior wall)to the cross-sectional diameter of the aortic arch.Finally,the position relationship between the three branch openings is obtained,and the data are analyzed by statistical software.RESULTS: 1?The three branches opening of the aortic arch is not in a straight line.The left subclavian artery(LSA)opening is closer to the anterior wall of the aortic arch,the left common carotid artery(LCCA)opening is closer to the anterior wall of the aortic arch,and the opening of the brachiocephalic trunk(BCT)was closer to the posterior wall of the aortic arch.There was no significant difference in the location of the central opening of the three branches between the sexes(P > 0.05).There was no significant difference in the following age groups(P>0.05):<40 years old,41-60 years old and >61 years old.The position relationship between the three branches openings is divided into 4 types: Type I: Three-branch opening's center-line is approximately parallel to the aortic arch axis.Type II: LSA,LCCA central line parallel to aortic arch axis is defined as type IIA,and LCCA,BCT central connection parallel to aortic arch axis is defined as type IIB.Type III: LSA,BCT central line parallel to aortic arch axis is defined as type III,in which LCCA near the anterior wall of aortic arch is defined as type IIIA,and near the posterior wall is defined as type IIIB.Type IV: There is no parallel relationship between the three branch openings and the aortic arch axis.Type I: 71 cases(59.2%);Type II:29 cases(31.7%);Type III: 10 cases(8.3%);Type IV:1 cases(0.8%).There was no statistical difference between the above four types and sex and age(P>0.05),and there was no statistical difference between the four types and traditional aortic arch classification.CONCLUSIONS: There are certain rules for the position relation of three branches,and we divide it into four types.By measuring the opening position of the three branches,we can better understand the position relationship between the three branches,so as to provide a theoretical basis for the design of intraluminal stents and the simplified intracavity TEVAR technology.Part ? Clinical effect of Fenestrated-TEVAR in the treatment of thoracic aortic lesionsOBJECTIVES: As a new technique,fenestrated-TEVAR technology is currently used in clinical practice to solve some of the diseases involving the arch.The emergence of this technology further broadens the adaptability of TEVAR.It simplifies the traditional complicated treatments involving arch lesions,such as “chimney” or “hybrid operation”.This technique is relatively simple and beneficial to clinical promotion.It can reduce the possible complications during operation.Clinical data are collected and its clinical efficacy is analyzed.METHODS: 1?According to exclusion criteria,51 patients who underwent fenestrated-TEVAR were collected.Clinical data include general basic information,main clinical manifestations,smoking history,past history,related aortic parameters,postoperative complications,etc.2?2 weeks,1 month,3 months,6 months and 1 year after operation and after discharge,the patients were reexamined by total aortic contrast-enhanced angiography(Aortic CTA).Follow-up was conducted to observe whether the patients had any special discomfort,blood pressure of both upper limbs and complications after operation.Postoperative follow-up including: CTA stent leakage,displacement,lesion progression,false lumen thrombosis and so on.The short-term efficacy of fenestrated-TEVAR technique was obtained by analysis.RESULTS: 1?51 cases of patients underwent fenestrated-TEVAR.All patients underwent LSA single grooving or fenestration.14 cases of fenestration and 37 cases of grooving.Among them,37 cases had type B dissection,2 cases had pseudoaneurysm,3 cases had aortic rupture and 9 cases had penetrating ulcer,44 lesions were located at the far or small curved side of the LSA orifice,7 lesions involved the LSA orifice,29 lesions or cuts were located on the small curved side,and 22 on the large curved side.There were 1 case of failed alignment,1 case of perioperative death,and 6 cases of endoleak,of which 4 cases were type I endoleak: Among them,1 case had more proximal leakage,and the stent was occluded again;1 case had distal leakage and the stent was occluded again;2 cases of membrane leakage were untreated,and the results were good.2?Follow-up 1 to 20 months after surgery,during the follow-up,6 cases were absent and 1 case died.Type I endoleak was increased in 1 case,which was sealed by occluder.Re-examination of CTA showed that the aortic stent was in good shape,no stent displacement,and the blood flow in stent was unobstructed.CONCLUSIONS:For thoracic aortic lesions close to LSA,fenestrated-TEVAR technology simplifies the minimally invasive treatment of arch lesions.It can effectively prolong the anchorage area and keep LSA unobstructed.It can safely expand the indications for endovascular treatment of thoracic aortic lesions and achieve the goal of minimally invasive,safe and effective.