Prognostic analysis of thoracic endovascular aortic repair combined with left subclavian artery revascularization for Stanford type B aortic dissection patients with insufficient proximal landing zone_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Xin ¹ , DAI Shilin ² ,  SHANG Yuqiang ²

1. Medical School of Jianghan University, Wuhan, 430113, P. R. China;
2. Department of Cardiac Surgery, The Central Hospital of Wuhan, Wuhan, 430014, P. R. China;

Corresponding author：

SHANG Yuqiang, Email: syq027@163.com

Keywords：

Stanford type B aortic dissection; endovascular repair; left subclavian artery; left subclavian artery revascularization technique

DOI：

10.7507/1007-4848.202311003

Video：

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Objective To analyze the clinical efficacy of left subclavian artery (LSA) revascularization combined with thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection with insufficient proximal landing zone. Methods A retrospective analysis was conducted on the clinical data of patients with Stanford type B aortic dissection and insufficient proximal landing zone who underwent TEVAR combined with LSA revascularization or TEVAR alone at the Central Hospital of Wuhan from 2017 to 2021. Patients were divided into a revascularization group and a simple stent group based on the surgical approach. Perioperative data of the two groups were compared. Results A total of 144 patients were included. In the simple stent group, there were 113 patients, including 85 males and 28 females, with a median age of 56.0 (48.0, 68.0) years. In the revascularization group, there were 31 patients, including 23 males and 8 females, with a median age of 54.0 (48.2, 59.7) years. There were statistical differences in operation time, hospital stay, preoperative lesion diameter, and preoperative and postoperative right vertebral artery diameter between the two groups (P<0.05). The simple stent group had 12 (10.6%) patients of complications, which was lower than the revascularization group (9 patients, 29.0%) postoperatively. At three months postoperatively, the most common complication in the simple stent group was endoleak (5 patients), while in the revascularization group it was hoarseness (2 patients). There was no death in the two groups within 1 year postoperatively. Conclusion Both different surgical approaches have good effects on the treatment of type B aortic dissection with insufficient proximal landing zone, but further validation is needed through multicenter, large-sample, and long-term follow-up studies.

Citation： HUANG Xin, DAI Shilin, SHANG Yuqiang. Prognostic analysis of thoracic endovascular aortic repair combined with left subclavian artery revascularization for Stanford type B aortic dissection patients with insufficient proximal landing zone. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(4): 515-520. doi: 10.7507/1007-4848.202311003 Copy

1.	Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg, 2001, 33(6): 1185-1192.
2.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
3.	Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
4.	Maldonado TS, Dexter D, Rockman CB, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg, 2013, 57(1): 116-124.
5.	Cooper DG, Walsh SR, Sadat U, et al. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: A systematic review and meta-analysis. J Vasc Surg, 2009, 49(6): 1594-1601.
6.	Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg, 2009, 50(6): 1255-1264.
7.	van der Weijde E, Saouti N, Vos JA, et al. Surgical left subclavian artery revascularization for thoracic aortic stent grafting: A single-centre experience in 101 patients. Interact Cardiovasc Thorac Surg, 2018, 27(2): 284-289.
8.	Cinà CS, Safar HA, Laganà A, et al. Subclavian carotid transposition and bypass grafting: Consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
9.	Nienaber CA, Kische S, Akin I, et al. Strategies for subacute/chronic type B aortic dissection: The Investigation of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S101-S108.
10.	Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
11.	Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
12.	Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
13.	Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
14.	Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
15.	Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱendoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.
16.	Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for typeⅡ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

1. Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg, 2001, 33(6): 1185-1192.
2. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
3. Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
4. Maldonado TS, Dexter D, Rockman CB, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg, 2013, 57(1): 116-124.
5. Cooper DG, Walsh SR, Sadat U, et al. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: A systematic review and meta-analysis. J Vasc Surg, 2009, 49(6): 1594-1601.
6. Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg, 2009, 50(6): 1255-1264.
7. van der Weijde E, Saouti N, Vos JA, et al. Surgical left subclavian artery revascularization for thoracic aortic stent grafting: A single-centre experience in 101 patients. Interact Cardiovasc Thorac Surg, 2018, 27(2): 284-289.
8. Cinà CS, Safar HA, Laganà A, et al. Subclavian carotid transposition and bypass grafting: Consecutive cohort study and systematic review. J Vasc Surg, 2002, 35(3): 422-429.
9. Nienaber CA, Kische S, Akin I, et al. Strategies for subacute/chronic type B aortic dissection: The Investigation of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S101-S108.
10. Kotelis D, Geisbüsch P, Hinz U, et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg, 2009, 50(6): 1285-1292.
11. Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
12. Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
13. Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
14. Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
15. Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱendoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.
16. Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for typeⅡ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

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Prognostic analysis of thoracic endovascular aortic repair combined with left subclavian artery revascularization for Stanford type B aortic dissection patients with insufficient proximal landing zone

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