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International Society For Minimally Invasive Cardiothoracic Surgery

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Preprocedural Fenestrated Thoracic Endovascular Aortic Repairfor Stanford B Dissection And Endoleak Treatment
Zanxin Wang, Minxin Wei
Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China

Background:Traditional thoracic endovascular aortic repair (TEVAR) can’t be made branch reconstruction. Preprocedural fenestrated thoracic endovascular aortic repair (PF-TEVAR) is a minimally invasive method for reconstructing the partial branch vessels of the arch. This study investigated the safety and efficiency of PF-TEVAR in treating Stanford type B aortic dissections (TBADs).Methods:Clinical data of 106 patients with TBADs who underwent PF-TEVAR from April 2017 to December 2018 were recorded. All patients suffered Stanford B dissection Results of the perioperative and follow-up periods (12 months) were analyzed, especially those of aortic remodeling.Results: 106 patients underwent PF-TEVAR to preserve the LSA in the treatment of Stanford type B aortic dissection were recruited. The mean follow-up period was 14±5 months (range, 1-24 months). No cardiovascular accident, paraplegia, reverse tear A type dissection, and other complications were reported in these patients during the perioperative period. One patient suffered sudden cardiac arrest within 24h after weaning the ventilator,finally died after 3 days. The head CT indicated a large cerebral infarction, while ultrasound confirmed that there was no blood in the thoracic cavity. Type I endoleak occurred in 6 patients after surgery, accounting for 5.7% of the total number of patients as shown in Table 1. Angiography revealed obvious proximal endoleak after the release of the stent in one patient, which was located at the level of the LSA. The endoleak disappeared after the placement a cuff at the proximal end. A small amount of proximal endoleak was observed in 2 patients during the postoperative follow-up at 1 month, which disappeared 3 months later without any special treatment (Fig. 1a). At reexamination 1 month after surgery, an obvious proximal endoleak was found in one patient, which was confirmed to be located near to the LSA by aortography and was successfully blocked using a vascular occluder (Fig. 1b-e). In the other 2 patients, the distal stent endoleak (Fig. 1f) disappeared after the stent was extended to the level of the celiac trunk. Intraoperative type IV endoleak occurred in 3 patients, which disappeared without any special treatment at reexamination a month later and also showed a good thrombosis of the false lumen.Conclusion: In this study, the pre-fenestration TEVAR technique was used to retain LSA in patients with poor anchoring area, and a good short-term effect was obtained. The results reflect the short-term safety of the pre-fenestration technology, but long-term follow-up results and a large number of case data are needed to confirm the long-term effect of this technology.

Six cases of Type I endoleak
No.GenderAge (yrs)DiseaseStentPreprocedural fenestrated sizeTreatment
1Male45Stanford type B dissectionMedtronic3434200Hole, Ø=1.0 cmSmall endoleak with no further treatment. It disappeared 3 months after surgery
2Female65Stanford type B dissectionMedtronic3030200Groove, 1.8*1.5 cmSmall endoleak with no further treatment .It disappeared 3 months after surgery
3Male60Stanford type B dissectionMedtronic3838200Hole, Ø=0.8 cmType Ib endoleak. One more stent (Medtronic 3832160) was put above the celiac trunk
4Male44Stanford type B dissectionMedtronic3030200Groove, 2.0*1.5 cmType Ib endoleak. One more stent (Medtronic 3026160) was put above the celiac trunk
5Male43Stanford type B dissectionMedtronic3030200Groove, 1.5*1.5 cmOne more cuff stent (303080) was used to cover the LSA
6Male52Stanford type B dissectionMedtronic3030200Groove, 2.0*1.2 cmRupture was occluded by block

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