Endovascular repair of proximal descending aortic disease with insufficient proximal landing zone in patients with concomitant severe coronary heart disease
Objective: To investigate the strategies and attention points for endovascular repair of proximal descending aortic disease with an insufficient proximal landing zone in patients with concomitant severe coronary heart disease who have undergone or were soon likely to receive coronary artery bypass grafting surgery requiring preservation of the left subclavian artery. Methods: The clinical data of 9 patients with proximal descending aortic disease, who had concomitant severe coronary heart disease and insufficient proximal landing zone, undergoing thoracic endovascular aortic repair in Vascular Surgery Center of Fuwai Hospital from April 2016 to July 2016 were retrospectively analyzed. Of the patients, 7 cases were male and 2 cases were female, with an average age of 60 (37–76) years. All patients underwent thoracic endovascular aortic repair, with preservation of the left subclavian artery for preserving the left internal mammary artery that was the best choice for bypass of the diseased left anterior descending coronary artery. Results: The surgical success rate was 100%, no surgical death occurred, and the left subclavian artery was preserved in all patients. Type I endoleak occurred in one patient (11.1%) after operation, which disappeared 3 months later, and one patient (11.1%) underwent percutaneous coronary angioplasty 4 months after operation due to stenosis of the left circumflex coronary artery. All patients received follow-up by outpatient visits or telephone. The clinical symptoms disappeared or were significantly alleviated, the quality of life was improved in all patients and no death occurred during the follow-up period for an average of 6 (4–7) months. Conclusion: In patients who have undergone coronary artery bypass grafting with left internal mammary artery to the left anterior descending artery, or will undergo coronary artery bypass surgery soon, the left subclavian artery can be preserved by personalized measures during thoracic endovascular aortic repair, and thereby to preserve the left internal mammary artery. Adjunctive techniques such as chimney-stenting can be used when necessary.