The feasibility study of endovascular reconstruction of aortic arch with modular branched stent-graft system in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair.</p><p><b>METHODS</b>After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed.</p><p><b>RESULTS</b>Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and artery rupture of left subclavian respectively during operation. In the eight successful cases, two proximal type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed.</p><p><b>CONCLUSION</b>It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.</p>

Treatment of left subclavian artery in endovascular repair of thoracic aortic aneurysm and thoracic aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD).</p><p><b>METHODS</b>In 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover.</p><p><b>RESULTS</b>DSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg.</p><p><b>CONCLUSIONS</b>EVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.</p>