Zaiping Jing1, Qingsheng Lu2, Jiaxuan Feng3, Jian Zhou3, Rui Feng3, Zhiqing Zhao3, Junmin Bao3, Weiliang Jiang4, Xiwei Zhang5, Chang Shu6, Weiguo Fu7, Changjian Liu8, Wei Guo9, Xiaoming Zhang10, Zhong Chen11, Changwei Liu12, Xinwei Han13. 1. Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: xueguanky@163.com. 2. Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: luqs@xueguan.net. 3. Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. 4. Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China. 5. Department of Vascular Surgery, People's Hospital of Jiangsu Province, Jiangsu, China. 6. Department of Vascular Surgery, Second Xiangya Hospital of Central South University, Hunan, China. 7. Department of Vascular Surgery, Zhongshan Affiliated Hospital of Fudan University, Shanghai, China. 8. Department of Vascular Surgery, Gulou Affiliated Hospital of Nanjing University, Jiangsu, China. 9. Department of Vascular Surgery, General Hospital of the People's Liberation Army, Beijing, China. 10. Department of Vascular Surgery, People's Affiliated Hospital of Peking University, Beijing, China. 11. Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China. 12. Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China. 13. Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China.
Abstract
OBJECTIVE: The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS: From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS: The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION: For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
OBJECTIVE: The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS: From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS: The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION: For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
Authors: Antonio Rizza; Francesco Negro; Stefano Palermi; Cataldo Palmieri; Michele Murzi; Giovanni Credi; Sergio Berti Journal: Int J Environ Res Public Health Date: 2022-04-15 Impact factor: 4.614