ObjectiveTo analyze the risk factors relevant retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection and provide a reference for its prevention and management. MethodsA retrospective analysis was conducted on patients with Stanford type B aortic dissection who underwent TEVAR at the First Affiliated Hospital of Chongqing Medical University from January 2017 to June 2023. The patients met the inclusion and exclusion criteria were included in the study. The multivariate logistic regression was used to analyze the risk factors for RTAD, with a test level of α=0.05. ResultsA total of 176 patients were included, among whom 7 developed RTAD, with an occurrence rate of 3.98%. The multivariate logistic regression analysis revealed that the larger τ angle between the centerline of the aorta [OR (95%CI)=1.195 (1.032, 1.384)] and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) [OR (95%CI)=0.756 (0.572, 0.999)], the higher probability of RTAD after TEVAR (P＜0.05). ConclusionsFrom the results of this study, it can be seen that for patients with Stanford B-type aortic dissection underwent TEVAR treatment, careful preoperative evaluation of morphological characteristics of the aortic arch (particularly the τ angle of the aorta centerline and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) is crucial for reducing the occurrence of RTAD after TEVAR in patients with Stanford type B aortic dissection.
Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, aortic dissection, surgical duration, intubation time, and ICU stay may be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer surgical and intubation times are associated with an increased risk of delirium in patients undergoing TEVAR. No significant factors influencing delirium are identified in patients undergoing EVAR.
Transcatheter aortic valve replacement and endovascular abdominal aortic repair have now become the first-line treatment options for aortic stenosis and abdominal aortic disease, respectively. For patients with both diseases, combined procedures have been reported in a few domestic and foreign publications. However, all the procedures were performed under general anesthesia. Here, we reported a case of simultaneous minimalist transfemoral transcatheter aortic valve replacement and endovascular repair of the abdominal aorta for a 78-year-old male patient with aortic stenosis and abdominal aortic ulcer, and the surgical results were satisfactory.
Objective To summarize the advantages and key points of external fenestration in the treatment of aortic dissection involved visceral branch arteries after endovascular aortic repair (EVAR), and to explore the application effect of external fenestration in aortic dissection involved visceral branch arteries. Methods A patient with abdominal aortic aneurysm resulting in abdominal aortic dissection and involving multiple visceral arteries after EVAR was treated in Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu. The surgical procedure of this patient was summarized, and the current status of total lumen technique in the treatment of such diseases was discussed and analyzed. Results The operation was successful, and it took only five hours, the intraoperative blood loss was about 100 mL, the patient was kept in ICU for one day and discharged one week after surgery and no serious postoperative complications occurred (such as spinal cord ischemia, liver and kidney insufficiency, infection, lower limb ischemia, puncture pseudoaneurysm, etc.). Aortic CT angiography was reexamined in three months after surgery, and the three-dimensional reconstruction showed that the aortic stent was stable, the blood flow of visceral branch arteries was smooth, and the aortic dissection was well isolated. Conclusion Endovascular repair of aortic dissection involving branch arteries of important organs can be achieved by external fenestration technique, it is a new treatment for aortic lesions involved visceral branch arteries.
ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.
Objective To assess the efficacy and safety of ascending aorta banding technique combined with typeⅠhybrid aortic arch repair for the aortic arch diseases. Methods The clinical data of patients undergoing ascending aorta banding technique combined with type Ⅰ hybrid arch repair for aortic arch diseases from March 2019 to March 2022 in Beijing Anzhen Hospital were retrospectively analyzed. The technical success, perioperative complications and follow-up results were evaluated. Results A total of 44 patients were collected, including 35 males and 9 females, with a median age of 63.0 (57.5, 64.6) years. The average EuroSCORE Ⅱ score was 8.4%±0.7%. The technical success rate was 100.0%. All patients did not have retrograde type A aortic dissection and endoleaks. One patient died of multiple organ failure 5 days after operation, the in-hospital mortality rate was 2.3%, and the remaining 43 patients survived and were discharged from hospital. The median follow-up period was 14.5 (6-42) months with a follow-up rate of 100.0%. One patient with spinal cord injury died 2 years after hospital discharge. One patient underwent thoracic endovascular aortic repair at postoperative 3 months due to new entry tears near to the distal end of the stent. Conclusion Ascending aorta banding combined with typeⅠhybrid arch repair for the aortic arch diseases does not need cardio-pulmonary bypass. Ascending aorta banding technique strengthens the proximal anchoring area of the stent to avoid risks such as retrograde type A dissection, endoleak and migration. The operation owns small trauma, rapid recovery, low mortality and a low rate of reintervention, which may be considered as a safe and effective choice in the treatment of the elderly, high-risk patients with complex complications.
Objective To compare the advantages and disadvantages between double Perclose ProGlide crossing suture and traditional suture for the closure of 20F or 22F access points so as to provide a basis for selecting appropriate approach to repair the puncture points in endovascular aortic repair. Methods Between June 2007 and May 2011, 103 patients (115 common femoral arteries) underwent endovascular aortic repair using sheaths of 20F or 22F (outer diameter); double Perclose ProGlide crossing suture was performed for closure of puncture sites in 57 cases (64 common femoral arteries) (double Perclose group) and traditional suture in 46 cases (51 common femoral arteries) (traditional group). There was no significant difference in age, gender, or disease duration between 2 groups (P gt; 0.05). Results The operation time, blood loss, and hospitalization days of double Perclose group were significantly better than those of traditional group (P lt; 0.05). Ecchymoma in inguinal region and lymphatic leakage occurred in 5 cases (5 common femoral arteries) and 2 cases (2 common femoral arteries) of double Perclose group respectively, in 2 cases (2 common femoral arteries) and 6 cases (8 common femoral arteries) of traditional group respectively; no significant difference was found in the rate of the early complication between double Perclose group and traditional group (7.8% vs. 15.7%, χ2=1.76, P=0.19). The technique success rate of double Perclose group was 96.9% (62/64), and was 100% (51/51) in traditional group, showing no significant difference (χ2=0.31, P=0.50). All patients were followed up, 2-19 months (mean, 15 months) in double Perclose group and 2-18 months (mean, 14 months) in traditional group. Pseudoaneurysm occurred in the puncture region at 3 months in 1 case (1 common femoral artery) of double Perclose group, and incision and suture therapy was performed; no arteriostenosis or pseudoaneurysm occurred in other cases; and the rate of mid-term complication was 1.6% (1/64) in double Perclose group and was 0 in traditional group, showing no significant difference (P=1.000). Conclusion Double Perclose ProGlide crossing suture has the same effectiveness to traditional surture in repairing the puncture point with 20F or 22F, but it is superior to traditional suture in reducing operation time, blood loss, and hospitalization days.
Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P＞0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.