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Finite element simulation of stent implantation and its applications in the interventional planning for hemorrhagic cardio-cerebrovascular diseases

Numerical simulation of stent deployment is very important to the surgical planning and risk assess of the interventional treatment for the cardio-cerebrovascular diseases. Our group developed a framework to deploy the braided stent and the stent graft virtually by finite element simulation. By using the framework, the whole process of the deployment of the flow diverter to treat a cerebral aneurysm was simulated, and the deformation of the parent artery and the distributions of the stress in the parent artery wall were investigated. The results provided some information to improve the intervention of cerebral aneurysm and optimize the design of the flow diverter. Furthermore, the whole process of the deployment of the stent graft to treat an aortic dissection was simulated, and the distributions of the stress in the aortic wall were investigated when the different oversize ratio of the stent graft was selected. The simulation results proved that the maximum stress located at the position where the bare metal ring touched the artery wall. The results also can be applied to improve the intervention of the aortic dissection and the design of the stent graft.

The Treatment of Traumatic Carotid Cavernous Fistula with Covered Stent

目的：探讨覆膜支架治疗外伤性颈内动脉海绵窦瘘（TCCF）的临床治疗经验。方法：11例TCCF经血管内介入治疗，1例外伤性颈内动脉海绵窦瘘患者复发，压迫颈总动脉无效，行球囊闭塞颈内动脉及瘘口。结果：术后杂音立即消失，数天后结膜水肿消退，造影见瘘口完全闭塞，10例TCCF患者颈内动脉保持通畅。1例患者颈内动脉闭塞。无操作所产生的并发症出现。结论：覆膜支架是处理TCCF的有效手段；瘘口再通可能与支架移位、贴壁不良有关。压迫颈总动脉对再通瘘口的治疗无效。

主动脉覆膜支架腔内隔绝术治疗成人巨大动脉导管未闭

目的总结主动脉覆膜支架腔内隔绝术治疗成人巨大动脉导管未闭（ PDA）的经验，并对其疗效进行评价。方法回顾性分析 2010年 9月至 2011年 8月青海省心脑血管病专科医院 8例 PDA患者行主动脉覆膜支架腔内隔绝术治疗的临床资料，其中男 5例，女 3例；年龄（30.4±9.3）岁。主动脉造影显示 PDA最窄内径为（21.0±3.0）mm；肺动脉收缩压（ 76.6±9.4）mm Hg。结果 8例患者中 7例一次性隔绝成功。术后即刻血管造影显示 6例动脉导管完全封闭， 2例残余少量左向右分流。术后 2周超声心动图及大血管 CT血管造影显示：残余分流消失，肺动脉收缩压（ 43.5±7.2）mm Hg，显著降低。术后左心室舒张期末内径较术前明显减小［（52.0±5.2） mm vs.（69.0±11.1）mm］。随访 8例，随访时间 1～ 11（7.2±1.1）个月，随访期间胸部 X线示：肺血明显减少，心胸比率明显减小。结论应用主动脉覆膜支架腔内隔绝术治疗成人巨大 PDA是一种安全、有效的方法。

The feasibility study of transjugular extrahepatic portacaval shunt

Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.

三分支覆膜支架行主动脉弓重建治疗 Stanford A 型主动脉夹层效果的临床随访

目的通过长期随访采用三分支覆膜支架重建主动脉弓治疗 Stanford A 型主动脉夹层患者的临床治疗效果，评价三分支覆膜支架行主动脉弓重建的安全性和可行性。方法纳入 2009 年 3 月至 2014 年 6 月我院心脏大血管外科应用三分支覆膜支架治疗的 Stanford A 型主动脉夹层患者 17 例，其中男 11 例、女 6 例，年龄 35～72 岁。观察其临床疗效及并发症发生率以及术后 CT 随访结果。结果三分支主动脉弓覆膜支架治疗组患者随访期间死亡 1 例。术后不同随访时间 64 排 CT 血管造影结果显示支架血管位置满意，支架打开完全，无扭曲及内漏发生。主动脉各分支血管血流通畅，无狭窄及闭塞。3 个月后随访观察到有 8 例假腔血栓形成闭塞，6 个月后随访观察到所有患者假腔全部血栓闭塞。3 年后随访观察到支架稳定，未发生支架扭曲、变形或者断裂情况，假腔消失。结论三分支覆膜支架重建主动脉弓治疗 A 型主动脉夹层临床效果可靠，值得推广应用。

胸腹主动脉瘤Ⅳ型行外科及腔内微创术围手术期护理

【摘要】　目的　总结对胸腹主动脉瘤IV型行血管外科和腔内微创术治疗患者的护理要点及经验。　方法　2007年11月-2008年1月对收治的1例胸腹主动脉瘤IV型行血管外科和腔内微创术患者，术前做好心理护理，控制血压，完善术前相关检查等；术后做好生命体征的监测、预防术后吻合口出血、支架移位、内漏、肠坏死、肾功能衰竭等并发症发生的各项护理工作。　结果　患者无并发症发生，痊愈出院，治疗和护理效果满意。　结论　围手术期实施正确恰当的护理是保证手术和治疗效果的关键。

Observation and Care of Endovascular Covered Stent Graft in Treating Abdominal Aortic Aneurysm

【摘要】　目的　总结血管腔内覆膜支架植入术治疗腹主动脉瘤患者围手术期并发症的预防、观察和临床护理要点。　方法　对2008年1-8月行血管腔内覆膜支架植入术治疗的27例腹主动脉瘤患者的临床资料进行回顾性分析。　结果　27例手术均获成功，术后未发生严重并发症，治疗及护理效果良好。　结论　有效的护理措施是保证治疗成功的重要因素。【Abstract】　Objective　To summarize and analyze the prevention, observation and clinical care of perioperative complications in patients with abdominal aortic aneurysm (AAA).　Methods　We retrospectively analyzed the clinical data of 27 patients with AAA who underwent endovascular covered stent grafting surgery in our hospital from January to August 2008.　Results　With appropriate treatment and good care, all grafting surgeries were successful without any severe postoperative complications.　Conclusion　Effective care measures are an important factor to ensure successful treatment.

创伤性主动脉夹层并发肾功能衰竭一例

Exploring the impact of stanford type B aortic dissection complicated by an isolated left vertebral artery on the prognosis after thoracic endovascular aortic repair

ObjectiveTo investigate the impact of anatomical variations of the isolated left vertebral artery (ILVA) on clinical outcomes and imaging outcomes in patients with Stanford type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair. MethodsThe clinical data of patients with TBAD in West China Hospital, Sichuan University from January 2016 to December 2023 were collected, and the differences of clinical outcomes and imaging outcomes between patients with and without ILVA were compared. ResultsBased on the inclusion criteria and the result of propensity score-based matching, 82 patients with TBAD were included, including 17 patients with ILVA (ILVA group) and 65 patients without ILVA (control group). There was no significant difference between the two groups in terms of the radiological and surgical information (P>0.05). The median time of the follow-up for these 82 patients were 37 months, during which there were no significant differences in aortic-related death, aortic event, stroke, adverse aortic remodeling, type Ⅰ A endoleak, and retrograde progression between the two groups (P>0.05). Compared with the control group, the re-intervention rate [HR=2.56, 95%CI (1.55, 8.11), P=0.03] and the incidence of type Ⅱ internal leakage [OR=1.36, 95%CI (1.08, 2.11), P=0.04] in the ILVA group were higher. ConclusionsNo significant differences were observed for ILVA patients in terms of serious adverse events such as aortic-related death and retrograde progression, comparing with the patients with normal aortic arch. However, the patients with ILVA were more susceptible to complications such as reintervention and type Ⅱ endoleak, which warranted the necessity of intensive postoperative follow-up for these patients.

Supra-arch branch vessel bypass and thoracic endovascular aortic repair for treating type B1C aortic dissection

ObjectiveTo evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection.MethodsIn our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair (TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass (n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass (n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass (n=2) were performed.ResultsEarly mortality rate was 2.0% (1/49). Forty-eight patients survived postoperatively. The follow-up rate was 100.0% (48/48). The patients were followed up for 6 to 47 (26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia.ConclusionInitial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.