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.
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 compare the effectiveness between conventional open repair (OR) and endovascular repair (EVRAR) for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases (OR group) or by EVRAR in 8 cases (EVRAR group). There was no significant difference in age, sex, the neck length (less than 2 cm), the neck angulation of aneurysm (more than60°), il iac severe tortuosity, preoperative systol ic pressure, and preoperative comorbidity between 2 groups (P gt; 0.05). The blood transfusion volume, operation time, intensive care unit (ICU) stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups (P gt; 0.05). EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay (P lt; 0.05), but OR group was significantly better than EVRAR group in reinterventions and graftrelated complications (P lt; 0.05). Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.
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。......