ObjectiveTo assess the causes and risk factors of multiple-intervention in endovascular aortic repair (EVAR) for type B aortic dissection (TBAD). MethodsWe retrospectively analyzed the clinical data of 347 TBAD patients initially treated with EVAR in our hospital between January 1999 and December 2013. The patients were stratified into a multiple-intervention group (34 patients) and a single-intervention group (313 patients). We analyzed the differences of clinical data of the two groups. ResultsThere were 9 patients with endoleak, 10 patients with new dissection, 8 patients with incomplete thrombosis of the false lumen, 4 patients with new aneurysm, 2 patients with retrograde dissection, and 1 patient with iliac artery occlusion in the multiple-intervention group. Higher proportions of chronic dissection and smoking occurred in the multiple-intervention group (79.4% versus 50.8%, 61.8% versus 40.3%, P=0.002, 0.018, respectively). Both of the degree and proportion of hyperglycemia were higher in the multiple-intervention group (6.9±2.3 mmol/L versus 5.7±1.8 mmol/L, P=0.027; 44.1% versus 22.7%, P=0.011). There were statistical differences in oversizing rate of grafts (14.6%±3.2% versus 11.3%±2.5%, P<0.001), operation time (172 min versus 82 min, P<0.001), and blood loss (280 ml versus 100 ml, P=0.006) between the two groups. ConclusionEndoleak, new dissection, and incomplete thrombosis of the false lumen are the main causes of multiple-intervention. While in chronic phase, smoking, hyperglycemia, too big oversizing, and complicated lesion or operation are the potential risk factors.
Objective To summarize the cl inical experience of vascular bypass grafting combined with endovascularaortic repair (EVAR) for aortic dilatation disease. Methods Between January 2008 and August 2011, 12 patients with aorticdilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 wasfemale, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA),including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 casesof abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwentfemoral artery bypass grafting after EVAR. Results After operation, pulmonary infection occurred in 3 patients, renalinsufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groinwound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVARof the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation,and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak,no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and12 months after operation. Conclusion Vascular bypass grafting combined with EVAR can expand the indications forendovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifiesthe surgical procedure, and reduces the difficulty of endovascular treatment.
ObjectiveThis paper aimed to summarize the new progress in surgical indications regarding as maximum diameter from evidence-based medical evidence and morphological rupture-risk assessment of abdominal aortic aneurysms (AAA) and its clinical application value.MethodThe rupture-risk and its mechanism of AAA in specific population and morphological characteristics were reviewed.ResultsAsymptomatic patients in specific subgroups may also benefit from AAA repair by lowering the intervention threshold. Besides the maximum diameter of aneurysm, other morphological factors, such as the true geometric shape, the wall thickness, and mural thrombus also had important predictive value for AAA rupture risk.ConclusionRupture-risk assessment based on the actual individual situation of AAA patients can further facilitate the clinical diagnosis and treatment.
腔内隔绝术（endovascular exclusion, EVE）最早用于治疗腹主动脉瘤，1994年Dake报道将其用于B型主动脉夹层（aortic dissection, AD）的治疗，国内自1998年开展。在EVE治疗AD的10余年历史中，内漏的预防和处理始终是一个备受关注的问题，现结合笔者的经验讨论AD术后内漏相关的问题。......
Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.