Efficacy of extracorporeal prefenestration versus type Ⅳ hybrid technique in the treatment of type B aortic dissection involving the left subclavian artery

Abstract

Objective To explore the difference in efficacy between two techniques for reconstructing the left subclavian artery in the treatment of type B aortic dissection involving the left subclavian artery extracorporeal prefenestration and type Ⅳ hybrid shunt (left common carotid artery - left subclavian artery bypass). Methods A retrospective analysis was conducted on the clinical data of 51 patients with type B aortic dissection involving the left subclavian artery, treated in the Department of Cardiothoracic Surgery at Huai ‘an First People’s Hospital from December 2021 to January 2024. Of these, 29 patients underwent extracorporeal prefenestration combined with thoracic endovascular aortic repair (TEVAR), as the prefenestration group; 22 patients received type Ⅳ hybrid shunt [carotid subclavian bypass (CSB) ] combined with TEVAR, as the CSB group. The efficacy and safety of the two groups were compared. Results The surgical success rate in both groups was 100.0%, with no deaths at 30 days post-operation or during a 30-day follow-up. No endoleak was observed immediately after surgery or at the 3-monthfollow-up in either group. The operation time in the prefenestration group was shorter than that in the CSB group [ (1.8± 0.6) h vs (2.8±0.9) h, t=4.127, P<0.01]. Postoperative indicators showed no significant difference in left upper limb blood pressure between the prefenestration group and CSB group [ (113.8±11.5) mmHg vs (108.6±12.7) mmHg, t= 1.529, P=0.133]. No patients in either group developed left upper limb ischemia, dizziness, or hoarseness postoperatively. Conclusion Both techniques for left subclavian artery reconstruction are safe and effective. The prefenestration technique has the advantage of reducing surgical trauma, while the type Ⅳ hybrid shunt provides better forward flow to the left subclavian artery