Abstract
BackgroundEndovascular repair involving branches of the aorta is still difficult in clinical treatment. A new type of blood flow regulator has been used in thoracic endovascular aortic repair/endovascular aortic repair in our centre, and the effects were followed and analysed.MethodsFrom March 2014 to January 2015, 14 patients with Stanford type B aortic dissection or penetrating ulcers and aortic arch pseudoaneurysms were consecutively enrolled. All patients were evaluated and underwent endovascular repair. The average age of these patients was 59 ± 14 years (34–76 years old, median 62 years), and there were 12 males and 2 females. The blood flow regulator was a self-expanding membrane-supported artificial blood vessel. The film was made from polyester that was formed into a mesh 1 mm2 in size. The metal stent used was made of nickel-titanium alloy.ResultsThe success rate for the technique was 100%. All patients underwent postoperative aortic CTA and had type III endoleak. There were no deaths and no instances of stroke, transient ischemic attack (TIA), hemiplegia, paraplegia or other central nervous system complications, and there were no left upper limb ischaemia symptoms in the group. The average follow-up time was 14.7 ± 3.6 months. One patient died of sudden death 4 months after the operation. One patient died due to abdominal aortic aneurysm rupture, and the other 12 patients survived. The survival rate was 86%. The blood flow regulator covered a total of 19 branch vessels (the intercostal artery was not counted), of which 18 experienced smooth blood flow. One patient continued to have a type III endoleak after the operation, and the endoleak disappeared after endovascular repair.ConclusionsThis clinical case series of 14 patients with percutaneous transluminal stents indicates that the blood flow regulator is safe and feasible in TEVAR surgery, providing a promising new technology.
Highlights
Endovascular repair involving branches of the aorta is still difficult in clinical treatment
The blood flow regulator is a self-expanding membrane-supported artificial blood vessel, the film is made of polyester, the polyester radial and the weft are formed into a mesh 1 mm2 in size, and the metal stent is a nickel-titanium alloy
There were 10 cases of Stanford type B aortic dissection (TBAD) in 14 patients: 6 primary intimal tears were located in the descending thoracic aorta and 4 in the abdominal aorta
Summary
Endovascular repair involving branches of the aorta is still difficult in clinical treatment. The operation involved in aortic branch vessels is difficult and traumatic; it is not appropriate to perform open surgery in elderly patients or high-risk patients with multiple complications. One of the major challenges of thoracic endovascular aortic repair (TEVAR) is that it is difficult to have an appropriate anchoring area when the lesion is located next to a large branch of blood vessels. We designed a new type of blood flow regulator based on the concept of a multilayer bare stent. This blood flow regulator can achieve results of a proper landing zone and can preserve the normal flow of branches of the aorta.
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