Analysis of the effect of bare stent combined with endovascular aortic repair in the treatment of distal descending aortic dissection

Xiang Chaohu; Hu Kai; Wang Hao; Yan Yu; Zheng Tian; Xie Yan; Lai Yinglong; Liu Yong

doi:10.3760/j.issn.1673-4777.2025.04.008

Abstract：Objective To investigate the efficacy of bare metal stent combined with endovascular aortic repair in the treatment of distal descending aortic dissection.Methods Six patients who underwent bare metal stent combined with endovascular aortic repair in the Department of Cardiovascular and Vascular Surgery,Affiliated Hospital of North Sichuan Medical College from April 2023 to April 2024 were selected.Among them,4 patients were Stanford type B aortic dissection,and 2 patients were Stanford type A aortic dissection treated after operation.All the 6 patients had thoracoabdominal aortic dissection,with obvious collapse of true lumen and malperfusion of distal organs.The clinical data of the patients were retrospectively analyzed.Methods,postoperative complications and vascular remodeling of distal descending aorta before and after bare-metal stent combined with endovascular aortic repair were analyzed.Results The operation was successfully completed in all 6 patients.The operation time was(113±28)min.There was no perioperative death.Three patients with Stanford type B dissection were treated with 1 covered stent and 1 bare metal stent.One patient diagnosed as aortic root aneurysm with type B aortic dissection was implanted with Fabulous stent system.In the 2 patients with Stanford type A aortic dissection,1 bare stent was reattached to the distal end of the stent during the first stage operation,and 1 covered stent and 1 bare metal stent were implanted in the other patient,without endoleak and stent migration.Follow-up CT angiog-raphy showed that the maximum diameter of the descending aorta was significantly decreased after operation,and the ratio of false lumen to true lumen was significantly decreased after operation(both P＜0.05).The true lumen of the distal descending aorta was dilated obviously,the vascular remodeling effect was satisfactory,and the poor perfusion of the distal organs was recovered.Conclusion Bare-metal stent combined with endovascular aortic repair is safe and feasible for the treatment of distal descending aortic dissection.The effect of vascular remodeling of the distal descending aorta is good,and it can effectively improve the distal organ malperfusion and reduce the incidence of postoperative adverse events.The early follow-up results are satisfactory.