Clinical application of left common carotid artery-left subclavian artery bypass technique in thoracic endovascular aortic repair
Xie Wei, Xue Yunxing, Li Shuchun, Jin Min, Zhou Qing, Wang Dongjin
Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
Abstract:Objective This study aimed to investigate the clinical experience of left common carotid artery (LCCA)-left subclavian artery (LSA) bypass in thoracic endovascular aortic repair (TEVAR) for the treatment of thoracic aortic diseases when the proximal anchoring area is insufficient. Methods In this study, a retrospective study design was used. From January 2016 to December 2019, 83 patients with thoracic aortic diseases underwent LCCA-LSA bypass during TEVAR in Nanjing Drum Tower Hospital. A total of 76 males and 7 females were identified. The age of the patients ranged from 27 to 82, with a mean age of (55.3±12.0) years. Indications for TEVAR included 70 cases of type B aortic dissection, 2 cases of thoracic aortic aneurysm, 5 cases of aortic ulcers, and 5 cases of aortic intramural hematoma. All patients were treated with LCCA-LSA bypass during TEVAR. The operation time, the number of stents placed, and whether coil embolization of the LSA was performed during the operation were observed. The incidence of death, cerebral infarction, and causes of reoperation were observed during the perioperative period. After discharge, the patients were followed up to observe the death of the patients and the incidence of cerebral infarction; aortic CTA was examined to observe the patency of the bypass vessel, the condition of branch vessels of the arch, and the presence or absence of stent displacement. Results The operation was successful for all patients. The operation time was 1.0-7.0(3.2±1.0) h. The number of thoracic aortic stents placed during TEVAR was one in 64 cases, two in 17 cases, and three in 2 cases. Contrast agent leakage at the root of the LSA was observed in four patients, and the leakage disappeared after coil embolization. No patient died during the perioperative period. Two patients (2.4%, 2/83) needed reoperation, including one with partial occlusion of the LCCA and one with retrograde aortic dissection, which returned to safety after corresponding treatment. One (1.2%, 1/83) patient developed transient cerebral infarction with a transient decrease in muscle strength of the left limb after surgery, who was discharged after conservative treatment. All 83 patients were followed up for 8 to 46 months, with an average of 25.3 months. Five (6.0%, 5/83) patients died during the follow-up period. Three (3.6%, 3/83) patients developed cerebral infarction during follow-up, which improved after conservative treatment. During the follow-up period, the patient underwent reexamination of aortic CTA, and no patients showed failure in primary patency or stent displacement during follow-up. Conclusion LCCA-LSA bypass can provide an adequate proximal landing zone in the setting of TEVAR, which is a safe and effective surgical method for the treatment of thoracic aortic diseases.
谢伟, 薛云星, 李树春, 金珉, 周庆, 王东进. 左颈总动脉-左锁骨下动脉转流技术在胸主动脉腔内修复术中的临床应用[J]. 中华解剖与临床杂志, 2022, 27(8): 558-562.
Xie Wei, Xue Yunxing, Li Shuchun, Jin Min, Zhou Qing, Wang Dongjin. Clinical application of left common carotid artery-left subclavian artery bypass technique in thoracic endovascular aortic repair. Chinese Journal of Anatomy and Clinics, 2022, 27(8): 558-562.
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