Abstract：Objective This study aims to evaluate the efficacy and safety of hybrid surgery in Stanford type B aortic dissection (TBAD) involving arch. Methods A prospective descriptive design was adopted. Patients with TBAD involving arch who were diagnosed in the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2020 to September 2021 were included. The patients comprised 16 males and 5 females, with average age of 32–81 (59.7±12.9) years. All patients were treated with a new hybrid surgery designed in combination with surgical bypass and thoracic endovascular aortic repair. The observation targets were operation time, intraoperative bleeding, patency of intraoperative blood vessels, type Ⅰ internal leakage, postoperative bed time, hospitalization expense, postoperative hospitalization time, postoperative complications, and death. The patients were followed up for stent displacement, reintervention, in-stent thrombosis, in-stent restenosis, graft infection, various types of internal leakage, patency of bypass vessels, and patency of true lumen. Results All patients were operated successfully, and no type Ⅰ internal leakage occurred during the operation. The operation time was (156.5±19.7) min, the amount of intraoperative bleeding was (70.2±25.6) mL, and the postoperative bed rest time was (4.3±1.7) d. Eleven patients underwent bypass surgery with artificial blood vessels. The postoperative hospital stay was (9.6±3.1) d, and the hospital cost was (166±38) thousand yuan. The 10 other cases used autologous great saphenous vein, the postoperative hospital stay was (14.1±6.3) d, and the hospitalization cost (excluding 2 cases of left carotid artery stent implantation) was (130±12) thousand yuan. Except for lacunar cerebral infarction in only one patient after the operation, the other patients did not have complications such as visceral ischemia, lower limb ischemia, acute cardiac insufficiency, stroke, pulmonary embolism, cerebral infarction, pulmonary infection, and acute renal injury. The postoperative follow-up time of 21 patients was 6–12 (10.9±2.4) months. All patients had no stent deviation, no internal leakage, excellent morphology of aorta in stent segment, and smooth blood flow in true lumen and vascular bypass. No re-intervention, stent thrombosis, stent restenosis, and graft infection occurred. Conclusion In the short- and medium-term efficacy observation, hybrid surgery is safe and effective for treatment of Stanford B thoracic aortic dissection involving the arch.
余朝文, 任天才, 聂中林, 陈世远, 宋涛, 高涌. 杂交手术治疗累及弓部的Stanford B型主动脉夹层的疗效分析[J]. 中华解剖与临床杂志, 2022, 27(3): 175-180.
Yu Chaowen, Ren Tiancai, Nie Zhonglin, Chen Shiyuan, Song Tao, Gao Yong. Effect of hybrid surgery on Stanford type B aortic dissection involving arch. Chinese Journal of Anatomy and Clinics, 2022, 27(3): 175-180.
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2022, Vol. 27 
