The clinical effect of three dimensional print guided F/B-TEVAR vascular endoluminal repair of anastomotic leaks after open surgery for type A aortic dissection
10.3760/cma.j.cn112139-20241106-00495
- VernacularTitle:三维打印技术辅助预开窗分支支架腔内修复术治疗A型夹层开放术后吻合口漏的临床效果
- Author:
Yu ZHOU
1
;
Yuexue HAN
;
Jianhang HU
;
Tao TANG
;
Lili SUN
;
Wendong LI
;
Nan HU
;
Chen LIU
;
Jun SHAO
;
Hao YU
;
Zhao LIU
Author Information
1. 南京大学附属鼓楼医院血管外科，南京 210008
- Publication Type:Journal Article
- Keywords:
Surgical stomas;
Anastomotic leak;
Printing, three-dimensional;
Fenestration/branch stent;
Thoracic aortic dissection;
Stanford A aortic dissection;
Total e
- From:
Chinese Journal of Surgery
2025;63(9):836-841
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.
