Comparison of curative effect and cost between domestic and imported covered stents in the treatment of non-complex Stanford type B aortic dissection / 国际外科学杂志

Objective:To compare the curative effect and cost of domestic and imported covered stents in the treatment of non-complex Stanford type B aortic dissection.Methods:A retrospective case-control study was used to analyze the clinical data of 93 patients with non-complex Stanford B aortic dissection who underwent thoracic endovascular aortic repair (TEVAR) in Taizhou Second People's Hospital from September 2016 to September 2021.Ninty-three patients were divided into two groups according to the use of different covered stents during the operation, of which 47 patients were treated with domestic covered stents (observation group) and 46 patients were treated with imported covered stents (control group). Overall response rate, rate of complication, treatment cost and cost-effectiveness ratio of the two groups were compared and sensitivity analysis was performed in the two groups.The measurement datas conforming to the normal distribution were expressed as mean ± standard deviation( ± s), and the inter-group comparison was conducted by t test.The comparison of counting datas between groups was conducted by Chi-square test or Fisher exact probability method. Results:The overall response rate of the observation group and the control group were 93.62% and 97.83%, with no significant difference ( P>0.05); The incidence of complications was 6.38% and 2.17%, with no significant difference ( P>0.05). The cost of covered stent [(62 155.49±10 231.08) yuan] and the total cost of treatment [(95 063.66±20 042.34) yuan] in the observation group were lower than those in the control group [(93 825.37±16 577.04) yuan and (126 035.89±26 186.18) yuan]( P<0.05). There was no significant difference in other direct costs between the observation group [(32 908.17±9 811.26) yuan] and the control group [(32 210.52±9 609.14) yuan] ( P >0.05). The cost-effectiveness ratio of the observation group and the control group were 1 015.42 and 1 288.31, and the incremental cost-effectiveness ratio of the control group was 7 356.82. After the cost-effectiveness sensitivity analysis and adjusting the cost of the covered stent to decrease by 10% of the two groups, the cost-effectiveness ratio of the observation group and the control group were 949.03 and 1 192.41, and the incremental cost-effectiveness ratio of control group was 6 604.61. Conclusions:Both domestic and imported covered stents are effective in the treatment of non-complex Stanford type B aortic dissection with fewer complications. Compared with the imported covered stent, the domestic covered stent has lower treatment cost and more advantages of cost-effectiveness, which is more in line with diagnosis related groups reform.

Hemodynamic Analysis of Redissection after Endovascular Repair for One Stanford Type B Aortic Dissection Case / 医用生物力学

Objective Based on hemodynamic analysis, to investigate the cause of distal re-entry tear in Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods A patient with type B aortic dissection was reexamined regularly with computed tomography angiography (CTA) at 1st month, 6th month, 12th month and 24th month after TEVAR. Based on the CTA images in each period, three-dimensional (3D) aorta models were reconstructed to perform morphological analysis and hemodynamic simulation.Results Compared with the diameter at 1st month after TEVAR, the diameter of true lumen at 12 months after TEVAR increased by 1.8 times and the global distortion of aorta increased by 16.67%. At postoperative 1st, 6th and 12th month, the maximum blood velocities at the new entry tear in systole were 69.6%, 33.7% and 92.1% higher than the average ones at distal landing zone, and the maximum wall shear stresses (WSSs) were 2.52, 2.32 and 3.52 times of the average WSSs respectively. In addition, the maximum time-averaged WSS (TAWSS) at 1st, 6th and 12th month after TEVAR were 1.88, 2.53 and 3.62 times of the mean TAWSS respectively.ConclusionsThe morphology of the aorta remodeled after TEVAR, and a sudden change in the diameter of true lumen occurred at distal anchoring zone and continued to increase. As a result, the blood flow velocity in this area accelerated, and the intima was continuously exposed to high WSS, leading to the redissection.

Thoracic Endovascular Aortic Repair Following Axillo-Femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Renal Ischemia / 日本心臓血管外科学会雑誌

A 71-year-old male was admitted to our institution because of right leg pain and paleness, accompanied by sudden chest-back pain. The right femoral artery was not palpable. The reticulated cyanosis appeared on the right leg. Contrast enhanced computed tomography (CT) revealed an acute type B aortic dissection (TBAD) extending from the descending thoracic aorta to the left common iliac artery and right external iliac artery. The intimal tear was located at thoraco-abdominal aorta. There was a severe stenosis of the true lumen at bilateral common iliac arteries because of the dynamic compression caused by the extended false lumen. Blood to the right leg was not supplied from the dissected iliac artery, the peripheral circulation was maintained by collateral flow. The patient was diagnosed acute TBAD complicated with lower limb ischemia. An emergent right axillary artery-bifemoral arteries bypass was carried out for malperfusion of lower extremities. The symptoms in the lower limbs disappeared immediately. The bilateral femoral arteries were well palpated. However, 4 days later, uncontrollable severe hypertension and anuria appeared suddenly. Contrast enhanced CT revealed the stenosis of true lumen at bilateral renal arteries and an exacerbation of stenosis of true lumen at abdominal aorta. Emergent thoracic endovascular aortic repair (TEVAR) for entry closure was performed to improve the renal function and prevent mesenteric ischemia. Postoperative contrast enhanced CT revealed the complete closure of the entry tear and dilatation of the true lumen at the descending and abdominal aorta. At the bilateral renal arteries, the blood flow improved. The renal function recovered and mesenteric ischemia did not occurred. In this report, we presented a case of acute TBAD complicated with lower limbs ischemia and late onset acute ischemic renal failure. We first performed the right axillary artery-bifemoral arteries bypass grafting, after that we had to perform TEVAR to close the entry tear. One-stage emergent TEVAR should be considered for acute TBAD with the dynamic compression at the level of abdominal aorta in future.

Analysis of clinical characteristics and prognostic risk factors in patients with Stanford type B aortic dissection complicated with hypertension / 中华危重病急救医学

Objective:To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension.Methods:Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients.Results:Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [ OR and 95% CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [ OR and 95% CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. Conclusions:The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.

Effectiveness of in vitro fenestration versus bypass surgery for type B aortic dissection involving the left subclavian artery / 中国胸心血管外科临床杂志

@#Objective    To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR). Methods    Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared. Results    The surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups. Conclusion    The two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.

A Case of Staged Hybrid Repair for Subacute Type B Aortic Dissection in a Patient with Shaggy Aorta / 日本心臓血管外科学会雑誌

In aortic surgery involving shaggy aorta, surgical strategy to avoid embolism is crucial for each case. We applied the frozen elephant trunk technique to a patient with shaggy aorta. A 79-year-old man was admitted to our hospital for conservative treatment of acute Type B aortic dissection. Dissecting aneurysms of the aortic arch and descending aorta were shown to have rapidly dilated according to CT three weeks later. Preoperative contrast CT showed an ulcerated shaggy aorta from the aortic arch to the mid portion of the descending aorta. To utilize the benefit of the stent compared with the classical elephant trunk technique, we proposed that the frozen elephant trunk technique would be helpful in prevention of embolism. We therefore planned total arch replacement with the frozen elephant trunk technique and performed thoracic endovascular aortic repair. We employed the frozen elephant trunk technique in the first operation and balloon protection of the superior mesenteric artery and the renal artery in the second operation. The patient had an uneventful postoperative course without thromboembolism. The frozen elephant trunk technique may be helpful for patients with shaggy aorta to avoid thromboembolic events.

Arc of Buhler: A lifesaving anatomic variation. A case report / Arco de Buhler: uma variação anatômica que salva vidas - relato de caso

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

Resumo A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.

Pathogenesis Analysis of Type-B Aortic Dissection Based on Morphological and Hemodynamic Parameters / 医用生物力学

Objective To investigate the pathogenesis of type-B aortic dissection by using morphological analysis and computational fluid dynamics (CFD) method, so as to provide evidence for the effective prediction of type-B aortic dissection. Methods Six primary type-B dissection cases scanned by CT (dissection group) and six normal cases applied to black-blood MRI (control group) were included in this study and patient-specific three-dimensional (3D) models of aorta were established through image segmentation and 3D reconstruction. The pre-type-B dissection aortas were constructed by applying the scaling algorithm to shrink the dissection and then compared with subjects in control group. The differences between morphological parameters and hemodynamic parameters of the two groups were compared. Results Compared with the normal cases, the area of the descending aorta increased dramatically in dissection group ［(892.03±263.78) mm2 vs (523.67±64.10) mm2, P=0.036］. A significant decrease in angle of the left subclavian artery occurred (66.62°±20.11° vs 100.40°±15.35°, P=0.036). The tortuosity of the aorta also had an obvious increase (0.37°±0.07° vs 0.21°±0.51°, P=0.011). The time-averaged wall shear stress (TAWSS) in dissection group was obviously higher than that in control group; the flow in the dissection region was vortex flow at low speed and the oscillating shear index (OSI) was higher. Conclusions The results of this study can be used to provide guidance for the early diagnosis and treatment of type-B aortic dissection.

Stent Graft Implantation into a False Lumen of a Chronic Type B Aortic Dissection after Surgical Abdominal Aortic Fenestration / 日本心臓血管外科学会雑誌

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

Radiomics technique for Type B aortic dissection:Feasibility and potential clinical utility / 中国实用外科杂志

Radiomics has recently emerged as a promising tool for analyzing digital medical images.Radiomics is defined as extracting innumerable,quantitative,and mineable features from medical images,by high-throughout computing.The technique has been initiated and now is typically used in oncology studies,buthas not been reported in aortic diseases.The use of imaging omics technology to assist the prognosis of type B aortic dissection has great feasibility,but it still needs to be further explored in the aspects of image acquisition standardization,automatic mechanization segmentation and new feature development of imaging omics.

The beneficial enlightenment of thoracic endovascular aortic repair for traumatic type B aortic dissection with long-term follow-up of single center / 中华胸心血管外科杂志

Objective To evaluate the long-term clinical effect of Thoracic endovascular aortic repair (TEVAR) for traumatic Type B aortic dissection,and to provide a reference for the next stage treatment.Methods Twenty-one patients with traumatic Stanford type B aortic dissection treated in our center from December 1999 to June 2012 were retrospectively analyzed for the treatment effectiveness and follow-up results.The average age of 21 Traumatic Type B aortic dissection patients was 42.7 years (range:19 to 67 years).Men accounted for 85.7％ (18/21).80.9％ (17/21) of the dissection were caused by car accident,4 were due to falling accident from high places.There were 7 cases of hypertension,4 cases of diabetes,4 cases of hyperlipidemia,2 cases of chronic ischemic heart disease,14 cases of pneumothorax,8 cases of rib fracture,3 cases of craniocerebral trauma / neuropsychiatric symptoms,and 1 patient with shock.The median time from onset to treatment was 5 days (range:1-73 days).There were 16 cases (≤14 days) in the acute phase,2 cases (15-60 days) in the subacute phase,and 3 cases (＞ 60 days) in the chronic phase.There was no patient in super acute phase in the study group (0-24 hour).Results The perioperative mortality was 9.52％ (2/21) for the patients traumatic type B aortic dissection,4.76％ (1/21)for those with postoperative endoleaks;2-year and 5-year survival rates were 90.48％ and 85.71％.Conclusion Intracavitary treatment of traumatic Stanford B type aortic dissection is effective and has good long-term clinical benefit,which provides a guidance for future clinical treatment of traumatic type B aortic dissection.

Advances in treatment for Stanford type B aortic dissection / 基础医学与临床

Type B aortic dissection(TBAD)is a life-threatening aortic disease.Complicated TBAD patients require emergency surgical procedure to prevent death caused by rupture or severe complication.The development of endo-vascular repair has shifted the management from extensive open surgical to minimally less invasive endovascular strategy.Thoracic endovascular aortic repair(TEVAR)may promote aortic remodeling and prevent late aneurysmal dilatation,more and more evidences show that TEVAR is effective in the treatment of uncomplicated TBAD.

Intensive care to patients with traumatic type B aortic dissection caused by traffic accidents / 现代临床护理

Objective To report care strategies for 4 patients undergoing thoracic endovascular aortic repair (TEVAR) of traumatic type B aortic dissection caused by traffic accidents.Methods From December 2009 to December 2016,4 patients underwent TEVAR for traumatic type B aortic dissection caused by traffic accidents. The care strategies included sedative analgesia, control of blood pressure and heart rate and treatment of complications.Results All patients underwent TEVAR.The length of hospital stay was 14~25 days.The examinations by thoracicaorta computer tomography (CT)3 months after operation showed that a satisfactory closure of intimal tear,decreased false lumen diameter,increased true lumen diameter and the stent in good position.Conclusion The systematic care strategy plays an important role in the control of rapid progressing in traumatic aortic dissection,gains time for operation so as to reduce the mortality rate and promote successful operation and recovery of the disease.

Chimney technique combined with thoracic endovascular aortic repair in treatment of type B aortic dissection / 局解手术学杂志

Objective To observe the clinical effects of chimney technique combined with thoracic endovascular aortic repair(TEVAR) in the treatment of type B aortic dissection.Methods The clinical datas of 56 patients with type B aortic dissection in our hospital were analyzed retrospectively.According to the surgical intervention method,they were divided into observation group (22 cases,TEVAR + chimney technique) and control group (34 cases,TEVAR alone).Surgery related indicators,incidence of postoperative short-term complications and mortality between the two groups were compared.Results The success rates in both groups were 100％,and the surgical time in observation group was longer than that in control group (P ＜ 0.05).There were no significant differences in blood loss,eating time,off-bed time and hospitalization time between the two groups(P ＞ 0.05).The incidence of complications of observation group and control group within 2 weeks after operation were 18.2％ and 5.8 ％ respectively,the difference was not significant(P ＞ 0.05),as well as mortality and incidence of longterm complications during the followed period (P ＞ 0.05).Conclusion The perioperative indexes of single endovascular repair and its combination with chimney technique for the treatment of type B aortic dissection are similar.Chimney technique can reconstruct important branch flows,especially for patients with insufficiency of landing zone.However,particular attention needs to be paid to postoperative complications to avoid negative effect on the prognosis of patients.

Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection.

We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an interesting case of a 65‑year‑old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the implantation of a stent‑graft which occluded the left subclavian artery due to its extension to the aortic arch. This event required a carotid‑subclavian artery bypass due to ischemia of the left arm. An aneurysm in the innominate artery also detected, was treated with another stent‑graft implantation 3 months later. At 5‑year follow‑up, an aneurysm of the thyreocervical trunk was found while the stent‑graft of the aorta was well‑tolerated without endoleak and the carotid‑subclavian graft was patent. The aneurysm was asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to isolate the aneurysm. An 8‑mm Dacron graft was anastomosed end‑to‑end to the distal part of subclavian artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize the postoperative complications in complex cardiovascular pathology. We also discuss the international bibliography about the thyreocervical trunk aneurysm and the treatment options.

Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis

This study aimed to evaluate the long-term survival and risk factors of traditional open surgical repair (OSR) vs thoracic endovascular aneurysm repair (TEVAR) for complicated type-B aortic dissection (TBAD). A total of 118 inpatients (45 OSR vs 73 TEVAR) with TBAD were enrolled from January 2004 to January 2015. Kaplan-Meier curves and Cox proportional hazards analysis were performed to identify the long-term survival rate and independent predictors of survival, respectively. Meta-analysis was used to further explore the long-term efficacy of OSR and TEVAR in the eight included studies using Review Manager 5.2 software. An overall 10-year survival rate of 41.9% was found, and it was similar in the two groups (56.7% OSR vs 26.1% TEVAR; log-rank P=0.953). The risk factors of long-term survival were refractory hypertension (OR=11.1; 95%CI=1.428-86.372; P=0.021] and preoperative aortic diameter >55 mm (OR=4.5; 95%CI=1.842-11.346; P=0.001). Long-term survival rate did not differ significantly between OSR and TEVAR (hazard ratio=0.87; 95%CI=0.52-1.47; P=0.61). Compared with OSR, TEVAR did not show long-term advantages for patients with TBAD. Refractory hypertension and total aortic diameter >55 mm can be used to predict the long-term survival of TBAD in the Chinese Han population.

A Patient with an Aberrant Right Subclavian Artery Who Underwent Endovascular Aortic Repair for Stanford Type B Acute Aortic Dissection / 日本心臓血管外科学会雑誌

<p>Case : A 75-year-old man was brought to our hospital by ambulance with dorsal pain. Contrast-enhanced computed tomography (CT) revealed acute communicating aortic dissection (Stanford type B) complicated by an aberrant right subclavian artery (ARSCA). Under a diagnosis of type B dissection, conservative treatment by hypotensive therapy and resting was performed. One month after onset, contrast-enhanced CT showed the expansion of the false lumen, and intermittent abdominal pain persisted. To close the entry of the distal arch and reconstruct the ARSCA route, right common carotid artery-right axillary artery bypass, thoracic endovascular aortic repair (TEVAR), and coil embolization of the ARSCA were performed. Five days after surgery, contrast-enhanced CT revealed the expansion of a false abdominal lumen. Abdominal endovascular aortic repair (EVAR) was additionally conducted, leading to the disappearance of false lumen blood flow. ARSCA is a congenital arch vessel abnormality. It may cause obstruction of the esophagus/trachea, aortic aneurysm/dissection of an adjacent area, or aneurysmal changes/rupture of the ARSCA. Various techniques have been reported ; reconstruction of the ARSCA route and closure of the false lumen by de-branch TEVAR may be effective for acute communicating aortic dissection with an ARSCA.</p>

Endovascular Treatment for Ruptured Chronic Type B Dissecting Aneurysm Using the Candy Plug Technique / 日本心臓血管外科学会雑誌

<p>We report a case of ruptured chronic type B aortic dissecting aneurysm that was successfully treated with the Candy plug technique to exclude a false lumen. A 57-year-old man had undergone abdominal fenestration for complicated acute type B aortic dissection previously. He then underwent debranching TEVAR for an impending rupture because of a dilated thoracic aortic dissecting aneurysm in 2014. After one year, the aneurysm was ruptured because of continuous distal flow of the false lumen. We performed TEVAR using the Candy plug technique, and he was discharged on the 11th postoperative day. The false lumen diameter was reduced. TEVAR using the Candy plug technique for chronic type B aortic dissection was thought to be useful in high-risk patients, but we need more careful observation.</p>

Mid-term Results of Endovascular Treatment for Type B Aortic Dissection / 日本心臓血管外科学会雑誌

<b>Background</b> : Endovascular treatment of the thoracic aorta (TEVAR) for type B aortic dissection is reported to be effective if the interval between the onset and the procedure is relatively short. However, the optimal timing for TEVAR is still controversial. <b>Method</b> : From December 2008 to April 2015, we experienced 46 TEVARs for type B aortic dissection. The interval between onset and TEVAR was within 3 months in 15 cases (Group A), from 3 months to 1 year in 10 cases (Group B), and more than 1 year in 21 cases (Group C). <b>Result</b> : Primary success was obtained in all cases, and no new intimal tear was formed during the procedure. There was no hospital death. At the time of discharge, disappearance of ULP or thrombosed thoracic false lumen occurred significantly more frequently in Group A (93%) than in Group B (50%) and Group C (43%) (<i>p</i><0.05). At 6 months, the rate of the patients with reduced aneurysm diameter more than 5 mm was significantly higher in Group A (87%) and Group B (70%) than in Group C (19%) (<i>p</i><0.05). Three cases of Group C had enlargement of the aneurysm despite of TEVAR, and graft replacement of thoracoabdominal aorta was performed in one of the cases. <b>Conclusion</b> : For type B aortic dissection, TEVAR is more effective if performed within 3 months from the onset.

Diagnosis and management of Stanford B aortic dissection / 国际外科学杂志

Type B aortic dissection is a life-threatening aortic disease.With the development of clinical classification and diagnostic method,the mortality of type B aortic dissection has been greatly decreased.In respect of treatment,endovascular repair due to minimally invasive advantages become the first choice for the treatment of complicated type B aortic dissection.For non-complicated type B aortic dissection,endovascular repair also gradually replace drug treatment,and showed good efficacy.Open surgery is only available for patients who ate not suitable for endovascular repair or repair failure or patients with connective tissue disease.