Objective：To investigate the techniques and effectiveness of endovascular repair for treating Stanford type B thoracic aortic dissection.
Methods：The clinical data of 78 patients with Stanford type B thoracic aortic dissection were retrospectively analyzed. All patients were evaluated before surgery by CT angiography (CTA) or magnetic resonance angiography (MRA). A vascular prosthesis (membrane-covered stent) was introduced via the femoral artery into the dissected thoracic aorta under digital subtraction angiography (DSA) guidance to exclude the proximal primary entry tear. DSA examination was carried out immediately after the stent placement procedure to confirm the exclusion of the dissection. Follow-up CTA was performed at 1, 3 and 6 months after surgery, and then every one year thereafter. The survival status, endoleak types, true and false lumen diameter of the residual dissection of the patients were recorded.
Results：Intraoperative angiography revealed 6 cases of type I endoleak following endovascular repair. Of these patients, the endoleak in 2 cases disappeared after cuff insertion, the proximal endoleak in 2 cases disappeared after the balloon expansion, and another 2 cases with small leak as evidenced by less contrast material in the false lumen received no treatment. A persistent endoleak was only found in 1 case, but no enlargement of the false lumen diameter 3 months later. Type II endoleak occurred in 2 cases who received no treatment due to small amount of blood leakage. Of the 2 cases, endoleak spontaneously closed in 1 case, and persisted without enlargement of the false lumen diameter 6 months later in the another one. Of the 78 patients, 15 cases underwent intentional occlusion of the left subclavian artery during surgery, of whom, 2 cases presented the steal syndrome of left upper limb accompanied by debilitating fatigue, 2 cases suffered cerebral infarction after 2 years, and 1 case, after 6 months, developed Stanford type A aortic dissection, that underwent ascending aorta replacement. No severe complications (such as, heart, lung and renal function failure or paraplegia) occurred in the rest of the patients.
Conclusions：Our brief follow-up study suggests that endovascular repair for Stanford type B thoracic aortic dissection is safe and effective treatment. Endoleak is the major complication after endovascular treatment.