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Comparison of Chimney Technique and Single-Branched Stent Graft for Treating Patients with Type B Aortic Dissections that Involved the Left Subclavian Artery

  • Honggang Zhang
  • He Huang
  • Yepeng Zhang
  • Zhao Liu
  • Tong Qiao
  • Xiwei Zhang
  • Changjian Liu
  • Yuanyong JiaoEmail author
  • Min ZhouEmail author
Clinical Investigation Arterial Interventions
  • 69 Downloads
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Objective

To compare the short-term efficiency of two different endovascular repairs for type B aortic dissection involving the left subclavian artery.

Methods

From February 2013 to March 2016, a cohort of 43 patients with TBADs involving the LSA underwent thoracic endovascular aortic repair (TEVAR) in two departments, consisting of 22 (Group A) with chimney grafts (CGs) and 21 (Group B) with single-branched stent graft (SBSG). Results of the two groups in perioperative and follow-up period (≥ 3 months) were comparatively analyzed, especially on aortic remodeling.

Results

Endoluminal repair of the two groups was successfully carried out. The median follow-up period was 19 months (range, 3–43 months) in Group A and 12 months in Group B (range, 6–32 months). During the TEVAR, one CG compression occurred in Group A and one type I endoleak in Group B. During follow-up, four complications occurred in Group A (two CGs occlusion, one type I endoleak and one death from dissecting aneurysm rupture), compared with two occurred in Group B (one sidearm graft twist and one death from myocardial infarction). Complete thrombosis of the false lumen (FL) in thoracic aorta was revealed in 83.3% (15/18) cases in Group A and 89.5% (17/19) in Group B. Partial thrombosis of the FL was revealed in 16.7% (3/18) cases in Group A and 10.5% (2/19) in Group B. In the abdominal aorta, complete thrombosis of the FL was noted in 23.1% (3/13) cases in Group A and 36.4% (4/11) in Group B. Partial thrombosis of the FL was revealed in 76.9% (10/13) cases in Group A and 63.6% (7/11) in Group B. Significant true lumen re-expansion and false lumen regression were observed in different levels of the descending aorta by computed tomography angiography (CTA) in both Groups A and B (P < 0.05). No significant diametric changes of abdominal aorta were found during follow-up in both groups.

Conclusions

For patients with TBADs involving the LSA, the chimney technique and the SBSG revealed comparable results. Further evaluation of more patients with longer follow-up is needed to substantiate these results.

Keywords

Type B aortic dissection Thoracic endovascular aortic repair Chimney technique Single-branched stent graft Left subclavian artery 

Abbreviations

LSA

Left subclavian artery

TBADs

Type B aortic dissection

TEVAR

Thoracic endovascular aortic repair

CGs

Chimney grafts

SBSG

Single-branched stent graft

FL

False lumen

TL

True lumen

CTA

Computed tomography angiography

CFA

Common femoral artery

Notes

Compliance with Ethical Standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Honggang Zhang
    • 1
    • 3
  • He Huang
    • 1
    • 3
  • Yepeng Zhang
    • 1
  • Zhao Liu
    • 1
  • Tong Qiao
    • 1
  • Xiwei Zhang
    • 2
  • Changjian Liu
    • 1
  • Yuanyong Jiao
    • 2
    Email author
  • Min Zhou
    • 1
    Email author
  1. 1.Department of Vascular SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingPeople’s Republic of China
  2. 2.Department of Vascular SurgeryThe First Affiliated Hospital of Nanjing Medical UniversityNanjingPeople’s Republic of China
  3. 3.Department of Vascular SurgeryThe First People’s Hospital of LianyungangLianyungangPeople’s Republic of China

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