ObjectiveTo investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.MethodsFrom January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.ResultsThe operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).ConclusionIn situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
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 etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for 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.
Objective To evaluate the safety and efficacy of the femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair (TEVAR). Methods From January 2013 to September 2016, TEVAR was performed on 40 patients with Standford type B aortic dissection. There were 34 males and 6 females aged 57.9±10.4 years. According to the surgical procedure, they were divided into a purse-string group (20 patients, 16 males, 4 females, aged 58.1±10.3 years), in which the patients received femoral arterial preclosure by purse-string suture and a convention group (20 patients, 18 males, 2 females, aged 57.7±10.8 years), in which the patients underwent conventional femoral cutdown. The outcomes and complications of two groups were evaluated. Results There was no in-hospital death and no paraplegia event. There was significantly shorter operation time (70.4±24.0 min vs. 100.8±35.6 min, P=0.003) and less blood loss (39.5±29.8 ml vs. 83.5±86.5 ml, P=0.038) in the purse-string group than those in the convention group. Femoral artery stenosis was observed in 3 patients (15.0%) in the convention group and none in the purse-string group during the follow-up of 1-36 (17.2±11.5) months with no statistical difference (P=0.231). Conclusion Using the femoral arterial preclosure by purse-string suture for TEVAR can save operation time, reduce intraoperative bleeding and decrease the approach-associated complications.
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.
目的 总结腔内修复术治疗主动脉夹层的经验。方法 选择2011年7月至2013年1月期间我院住院的胸主动脉夹层患者15例，术前均采用CTA评估，全部行腔内修复术。结果 15例患者采用腔内修复手术全部成功，手术时间95～165min，（120±26） min；失血量30～160mL，（68±34） mL。10例采用经股动脉入路，5例采用经股动脉及肱动脉入路。13例单一破口者各植入支架1枚，手术全部成功。15例患者未发生截瘫，无一椎基底动脉缺血症状，无下肢缺血改变，无伤口感染及腹股沟区淋巴瘘。2例存在Ⅱ型内漏，未经处理自行闭合。随访胸腹主动脉CTA扫描显示覆膜支架均未移位，未发现植入支架后并发近端夹层者。结论 腔内修复术治疗主动脉夹层是一种有效的治疗方法，具有安全性高、术后并发症少、治疗效果好等优点。
Aortic dissection is a disease with high mortality rates. Due to the urgency of time, the diagnosis, treatment processes, and strategies of acute aortic dissection follow specific guidelines. However, patients with chronic aortic dissection are often neglected. Choosing the best medication therapy and surgical interventions remains challenging, and there is still a lack of guideline recommendations. With the improvement of imaging diagnostic methods for aortic diseases, the progress of endovascular surgical techniques, and the development of new endovascular graft devices in recent years, clinical data of the treatment of chronic aortic dissection is also gradually increasing. This article summarized the current new technologies and clinical research results for the diagnosis and treatment of chronic aortic dissection, aiming to provide new suggestions for the diagnosis and treatment of chronic aortic dissection.