Volume 20 Issue 1
Jan.  2022
Turn off MathJax
Article Contents
Article Navigation >  Chinese Journal of General Practice  > 2022  >  20(1): 59-61,133
BEN Chen, CHEN Lei, YANG Da-bin, SHI Chao. Surgical treatment for complex type-B aortic dissection involving the arch[J]. Chinese Journal of General Practice, 2022, 20(1): 59-61,133. doi: 10.16766/j.cnki.issn.1674-4152.002276
Citation: BEN Chen, CHEN Lei, YANG Da-bin, SHI Chao. Surgical treatment for complex type-B aortic dissection involving the arch[J]. Chinese Journal of General Practice, 2022, 20(1): 59-61,133. doi: 10.16766/j.cnki.issn.1674-4152.002276
shu

Surgical treatment for complex type-B aortic dissection involving the arch

doi: 10.16766/j.cnki.issn.1674-4152.002276
  • 1.

    Department of Cardiothoracic Surgery, Huaibei Coal Miners General Hospital Affiliated to Bengbu Medical College, Huaibei, Anhui 235000, China

Funds:

 1804h08020280

 2020byzd280

  • Received Date: 2021-05-01
    Available Online: 2022-03-03
    Abstract
  •   Objective  To evaluate the efficacy of intraoperative stenting combined with left subclavian artery-left common carotid artery diversion for the treatment of complex type-B aortic dissection involving the distal aortic arch.  Methods  From November 2018 to April 2020, six patients with Stanford type-B aortic dissection involving the distal aortic arch received intraoperative stenting combined with left subclavian artery-left common carotid artery diversion in the Department of Cardiothoracic Surgery, Huaibei Coal Miners General Hospital. All patients were males with an average age of 51 years old and had a definite diagnosis of hypertension. The maximum diameter of the arch was greater than 40 mm, and the rupture was located in the distal aortic arch, less than 1.5 cm away from the opening of the left subclavian artery. The cardiopulmonary bypass time, intraoperative block time, selective cerebral perfusion time, ventilator-assisted time, perioperative mortality, incidence of postoperative cerebral infarction, paraplegia, and secondary thoracotomy haemostasis were analysed. All patients were followed up. Aortic CTA was reviewed 1 week, 3 months, and 12 months after surgery.  Results  The average duration of CPB was (145±37) min, from 80 to 207 min. The average duration of intraoperative occlusion was 34.5 min, and the average duration of selective cerebral perfusion was 12 min. The duration of postoperative ventilator assistance exceeded 24 h in 3 patients (41, 44, 26 h, respectively). The average ventilator-assisted time was 16.48 h. No symptoms of dizziness and no cerebral infarction were observed. No incidence of paraplegia, secondary thoracotomy haemostasis, and perioperative death were found. Follow-up time ranged within 3-18 months. All patient lived well. Postoperative aortic CTA showed 100.0% (6/6) occlusion rate at the distal end of the stent.  Conclusion  The application of intraoperative stenting combined with left subclavian artery-left common carotid artery diversion in the treatment of patients with complex Stanford type-B dissection is safe and efficient. However, the number of patients in this group is small and the follow-up time is short, so the long-term clinical effect requires further evaluation through long-term follow-up.

     

    • FullText(HTML)
  • loading
    • References(23)
  • [1]
    梁凯, 崔明哲, 马金辉, 等. 急性Stanford B型主动脉夹层患者行TEVAR术介入治疗的疗效研究[J]. 中华全科医学, 2020, 18(9): 1477-1479, 1533. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202009014.htm
    [2]
    马祥云, 赵根尚. Stanford B型主动脉夹层覆膜支架腔内修复术近中期的疗效[J]. 实用医学杂志, 2017, 33(23): 3942-3945. doi: 10.3969/j.issn.1006-5725.2017.23.023
    [3]
    周子凡, 王龙飞, 董松坡, 等. 胸主动脉腔内覆膜支架修复术联合外科转流术或"烟囱"支架置入术对Stanford B型主动脉夹层术后并发症的影响[J]. 中国医药, 2018, 13(10): 1481-1484. doi: 10.3760/j.issn.1673-4777.2018.10.011
    [4]
    陈晨, 郭小梅. 高血压致主动脉夹层机制研究及治疗进展[J]. 医药导报, 2018, 37(2): 171-177. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB201802010.htm
    [5]
    严文俊, 韩冬, 薛东明, 等. 单纯主动脉腔内隔绝术治疗累及弓部Stanford B型主动脉夹层的效果观察[J]. 中西医结合心血管病电子杂志, 2018, 6(22): 4-5. doi: 10.3969/j.issn.2095-6681.2018.22.003
    [6]
    吴怡锦, 熊卫萍, 曾嵘, 等. 孙氏手术治疗急、慢性Stanford A型主动脉夹层疗效的病例对照研究[J]. 中国胸心血管外科临床杂志, 2018, 25(5): 401-405. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX201805010.htm
    [7]
    韩磊, 万珊杉, 王家平, 等. 不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究[J]. 介入放射学杂志, 2016, 25(11): 958-961. doi: 10.3969/j.issn.1008-794X.2016.11.006
    [8]
    刘子豪, 郗二平. Stanford B型主动脉夹层腔内修复术中左锁骨下动脉处理的研究进展[J]. 中国普通外科杂志, 2017, 26(6): 781-788. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201706020.htm
    [9]
    中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志, 2017, 33(11): 641-654. doi: 10.3760/cma.j.issn.1001-4497.2017.11.001
    [10]
    丁焕宇, 江敏纯, 胡孜阳, 等. 杂交技术治疗B型主动脉夹层258例预后分析[J]. 中国心血管病研究, 2019, 17(12): 1062-1067. doi: 10.3969/j.issn.1672-5301.2019.12.002
    [11]
    DING H, LIU Y, XIE N, et al. Outcomes of chimney technique for preservation of the left subclavian artery in type B aortic dissection[J]. Eur J Vase Endovasc Surg, 2019, 57(3): 374-381. doi: 10.1016/j.ejvs.2018.09.005
    [12]
    HE X, LIU W, LI Z, et al. Hybrid approach to management of complex aortic arch pathologies: A single-center experience in China[J]. Ann Vase Suig, 2016, 31: 23-29. doi: 10.1016/j.avsg.2015.09.019
    [13]
    丁焕宇, 刘媛, 罗建方. "烟囱"技术在主动脉弓部重建中的应用与思考[J]. 岭南心血管病杂志, 2018, 24(2): 232-234. doi: 10.3969/j.issn.1007-9688.2018.02.29
    [14]
    彭栋, 阿拉法特·艾尔肯, 沙尔娜. Stanford B型主动脉夹层腔内修复术后再干预的危险因素研究[J]. 中国血管外科杂志(电子版), 2021, 13(1): 17-20. doi: 10.3969/j.issn.1674-7429.2021.01.005
    [15]
    KANAOKA Y, OHKI T, MAEDA K, et al. Analysis of risk factors for early type Ⅰ endoleaks after thoracic endovascular aneurysm repair[J]. J Endovasc Ther, 2017, 24(1): 89-96. doi: 10.1177/1526602816673326
    [16]
    QIN J, ZHAO Z, WANG R, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair[J]. J Am Heart Assoc, 2017, 6(4): e004542.
    [17]
    周洋, 赵飞, 郑波, 等. 不同左锁骨下动脉重建方式在Stanford B型主动脉夹层腔内修复术中的应用[J]. 中国医刊, 2021, 56(4): 408-411. doi: 10.3969/j.issn.1008-1070.2021.04.015
    [18]
    吴江滨, 李明亮, 蔡小碧, 等. Stanford B型主动脉夹层累及主动脉弓分支血管治疗进展[J]. 医学理论与实践, 2021, 34(14): 2398-2400. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202114011.htm
    [19]
    里程楠, 朱俊明, 齐瑞东, 等. 左锁骨下动脉-左颈总动脉转流术联合支架象鼻治疗慢性Stanford B型主动脉夹层累及远端弓的临床经验[J]. 中国医药, 2018, 13(12): 1818-1821. doi: 10.3760/j.issn.1673-4777.2018.12.014
    [20]
    齐瑞东, 朱俊明, 陈雷, 等. 左锁骨下动脉-左颈总动脉转流术联合支架象鼻术治疗主动脉弓远端病变[J]. 中国胸心血管外科临床杂志, 2018, 25(1): 49-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX201801012.htm
    [21]
    杨龙. 主动脉弓远端病变患者以支架象鼻术联合左锁骨下动脉-左颈总动脉转流术治疗的临床疗效[J]. 中国医学工程, 2021, 29(7): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC202107021.htm
    [22]
    马中原, 李明, 吴先志. 支架"象鼻"手术在复杂性Stanford B型主动脉夹层中的应用[J]. 新疆医学, 2017, 47(3): 279-281. doi: 10.3969/j.issn.1009-5551.2017.03.003
    [23]
    田振宇, 李聪, 李豪威. 不同脑灌注方式对Stanford A型主动脉夹层患者的脑保护作用[J]. 中华全科医学, 2021, 19(5): 727-730. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202105007.htm
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (255) PDF downloads(0) Cited by()
    Proportional views
    Related

    Address：No. 287, Changhuai Road, Bengbu, Anhui Province, 233004, P.R.ChinaphoneNo：0552-3066635； 0552-3051890Email：zhqkyx@163.com

    Copyright © Chinese Journal of General Practice皖ICP备2020018345号-2

    Supported by: Beijing Renhe Information Technology Co., Ltd.    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return