Early Outcome Of The Treatment Of Complicated Stanford B Dissection With Surgeon-modified Endografts
Minxin Wei, Zanxin Wang, Rong Ren, Junmin Wen, Weixin Chen.
Shenzhen Sun Yat-sun Cardiovascular Hospital, Shenzhen, China.
Background: Surgeon-modified fenestrated endovascular aortic repair (sm-fEVAR) is a good option to patients with acute Stanford B dissection, especially in the emergent cases. This technique has increased rapidly in this decade. The present research was to evaluate the early results of sm-fEVAR in complicated Stanford B dissection. Methods: Fifteen consecutive patients who underwent sm-fEVAR were retrospectively reviewed. The modality of sm-fEVAR technique was assessed, peri -operative clinical data were recorded. Diameters of total aortic, true and false lumen were measured at different anatomic locations: the left subclavia artery, the carina and the celiac artery. True lumen index (true lumen/total aortic diameter, goal=1) was calculated to evaluate the impact of reintervention on remodeling of the descending aorta. Results: The median patient age was 44 years old (range, 34 -78years), and 14 of the 15 patients were male. Indications were complicated Stanford B dissection with inadequate proximal landing zone. There were no death, stroke or spinal cord injury happened. All the cases were deployed Medtronic Valiant stent. Mean operatiion time was 109 ±43 minutes. Mean duration of hospital stay was 7 ±3 days (range, 3-10 days). During follow up, no postoperative complications occurred, all target vessels remained patent and no fenestration-related endoleak. False lumen was absorbed at left subclavia artery level, carina level in all patients. True lumen index increased significantly at the level of celiac artery (P < 0.05).Conclusions: Surgeon-modified fenestrated endograft could be a good alternative for patients with complicated Stanford B dissection with unfavorable proximal landing zones, when patients are in urgent condition.
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