title: [Efficacy of personalized endovascular repair using two stent-grafts for patients with Stanford B aortic dissection].
abstract: OBJECTIVE
  To observe the feasibility and clinical efficacy of thoracic endovascular aortic repair (TEVAR) for patients with Stanford B aortic dissection using personalized two stent-grafts implantation (TSI).
  
  
  METHODS
  This retrospective review included 56 patients who underwent TSI during TEVAR for Stanford B aortic dissection from Jan 2012 to May 2013 in Beijing Anzhen hospital. There were 8 patients in acute phase (within 2 weeks from onset of symptoms), 11 patients in chronic phase (greater than 2 months following initial dissection) and 37 patients in subacute phase (between 2 weeks and 2 months from onset of symptoms). Infrarenal aorta was involved in 34 patients (60.7%) and suprarenal aorta involved in 22 patients (39.3%), the mean aortic lesion length was (226 ± 13)mm. Thoracic and abdominal aortic angiography was performed during operation to measure aortic diameters of proximal and distal landing zone, and the distance between them. The proximal stent-grafts were implanted in distal aorta to the origin of left subclavian artery with oversize rate of 10%-15% according to proximal landing zone according to procedural guideline. Then the distal newly customized large tapered stent-grafts were sequentially deployed according to the diameters of both the distal end of proximal stent and distal landing zone (aortic true lumen), and overlapping length of the two stent-grafts was more than 30 mm. Patients were followed-up at 3 months, 6 months, and yearly thereafter post operation.
  
  
  RESULTS
  TSI procedure was successful in all patients and 122 stent-grafts were implanted. The mean length of implanted stent-grafts was (197.6 ± 20.3)mm. The mean diameter taper span was (7.5 ± 1.8)mm with proximal oversize rate of (12.8 ± 3.4)% and distal oversize rate of (11.2 ± 4.1)%. The mean angle between the distal end of stent and aorta was (2.3 ± 1.3)°. The diameter of proximal and distal landing zone, and angle between the distal end of stent and aorta remained unchanged during follow up (mean: (10.0 ± 4.0) months). The total thrombosis rate of the false lumen was 98.2% (55/56), thrombosis rate of stent segment was 82.1% (46/56) . Stent-related complications were observed in 2 patients (3.6%) , including acute spinal cord ischemia due to paraplegia (n = 1) and malposition of distal stent (n = 1).
  
  
  CONCLUSIONS
  Encouraging short-term outcomes are obtained from current personalized two stent-grafts implantation strategy for patients with Stanford B aortic dissection. Further prospective clinical studies are warranted to evaluate the long-term efficacy of this procedure.
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Xiaoyong
authors: X
authors: Huang
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Lianjun
authors: L
authors: Huang
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. Email: huanglianjun2008@163.com.
authors: Xi
authors: X
authors: Guo
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Yuguo
authors: Y
authors: Xue
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Peng
authors: P
authors: Li
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Wenhui
authors: W
authors: Wu
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Guangrui
authors: G
authors: Liu
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Tiezheng
authors: T
authors: Li
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Mingliang
authors: M
authors: Peng
authors: Department of Interventional Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors: Qinglong
authors: Q
authors: Zeng
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection; D001011:Aorta; D001014:Aortic Aneurysm; D017545:Aortic Aneurysm, Thoracic / Q000628:therapy*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery; D013927:Thrombosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome