| Objective:To assess whether the angle of the left subclavian artery(LSA)to the aortic arch has an impact on the prognosis of patients with parallel stent reconstruction of the supra-aortic arch branches and to provide a clinical basis for future individualized supra-arch reconstruction protocols.Methods:A retrospective analysis of patients with aortic disease who underwent LSA reconstruction using parallel stents(chimney stents)at the Department of Vascular Surgery,Chengde Medical College Hospital from September2016 to December 2021 was performed to collect clinical data and aortic anatomical data from patients.Patients were divided into complication and non-complication groups based on whether they developed complications(such as endoleak,stent stenosis,cerebral infarction,left upper limb ischemia,and death,etc.)after surgery.The two groups were subjected to univariate analysis,and the univariate factors with significant differences in comparison between groups were included in binary logistic regression analysis to screen for independent risk factors leading to the development of postoperative complications.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of the model.Results:A total of 45 patients met the inclusion criteria,and the success rate of surgery was 100%.The mean follow-up time was 25.6±14.0 months.There were 12 cases in the complication group and 33 cases in the non-complication group,with a ratio of 0.36:1.The complications group included 1 case of endoleak combined with cerebral infarction,8 cases of endoleak and 3 cases of stent stenosis.The stent patency rate was 93.3%.Univariate analysis showed statistically significant differences in parallel stent type and the angle of the LSA to the aortic arch between the two groups(P < 0.05).Multifactorial logistic regression analysis showed that the angle of the LSA to the aortic arch(OR=1.159,95% CI=1.013 to 1.326,P=0.032)and the use of bare stents(OR=6.074,95% CI=1.027 to 35.92,P=0.047)were independent risk factors for the development of complications after parallel stent reconstruction for LSA(P<0.05).The area under the curve of the joint prediction model in the ROC curve was 0.8169,(95%CI: 0.652 to 0.981,P=0.001),with a sensitivity of 75.0% and a specificity of 84.8%,and the accuracy of the model in evaluating the generation of postoperative complications was high,the area under the angle of the LSA to the aortic arch was 0.7437,(95%CI: 0.588～0.899,P=0.013),sensitivity was 75%,specificity was 60.6%,the best truncation value of the angle of the LSA to the aortic arch was 42.45°.The area under the curve of bare stent was0.7348,(95%CI:0.539～0.870,P=0.038),sensitivity was 83.3%,specificity was 57.6%.Conclusions:1.The angle of the LSA to the aortic arch and the use of bare stent are risk factors for the development of complications after parallel stent reconstruction of branches on the aortic arch.When the angle of the LSA to the aortic arch is greater than 42.45° or when a bare stent is used,the complication rate after parallel stent reconstruction of the LSA is higher.2.When aortic disease involves the supra-arch branches,preoperative assessment of the anatomy of the aortic arch and screening of patients who are not suitable for parallel stenting technique can reduce the incidence of postoperative complications,and the coverd stent should be used for parallel stent reconstruction of the supra-arch branches. |
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