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Effectiveness and Safety of Endovascular Aortic Repair and Open Operation in Treatment of Acute Stanford Type B Aortic Dissection

Objective　To systematic evaluate the efficacy and safety of the endovascular aortic repair （endovascular stent placement） and open operation in treatment of acute Stanford type B aortic dissection. Methods　The literatures about clinical controlled trials of endovascular aortic repair and open operation in treatment of acute Stanford type B aortic dissection that were included in CNKI， Wanfang data， VIP， Cochrane Central Register of Controlled Trials of the Cochrane Library， OVID， Pubmed Medline， EBSCO， EMBASE， Springer Link，Science Direct， and other databases from January 1991 to January 2013 were retrieved by computer. RevMan 5.1 software were used to analyze the clinical trial data. Results　Eight trials （5 618 patients with acute Stanford type B aortic dissection） were included in the analysis.There was statistically significant difference of the 30 d mortality after operation between the endovascular repair group and the open operation group， which endovascular repair group was significantly better than the open operation group〔OR=0.55，95% CI （0.46-0.65）， P＜0.000 01〕. In addition， there were significant difference between the incidence of stroke 〔OR=0.57， 95% CI （0.39-0.84）， P=0.005〕， respiratory failure 〔OR=0.64， 95% CI （0.53-0.78）， P＜0.000 01〕， and cardiac complications 〔OR=0.49，95% CI （0.38-0.64），P＜0.000 01〕，which endovascular repair group was better than the open operation group. However，endovascular repair could not improve the postoperative outcomes of paraplegia〔OR=1.30，95% CI （0.82-2.05），P=0.26〕 and acute renal failure 〔OR=0.86，95% CI （0.41-1.80），P=0.69〕. Conclusion　Endovascular repair for treatment acute Stanford type B aortic dissection is preferred method.

降主动脉“逆行”去分支与主动脉腔内修复术杂交治疗 Stanford A 型主动脉夹层

Clinical study on noninfectious fever of endovascular aortic repair

Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and explore the management strategy. Methods We reviewed 468 patients who received endovascular aortic repair from January 2021 to October 2023. The patients who were selected were classified into a febrile group and an afebrile group according the fever after operation. The fever data were analyzed, and the demographics, operative data were researched to sieve out the correlation factors. Logistic regression analysis was conducted for the risk factors of postoperative fever if the P value≤0.05 in the univariate analysis, and receiver operating characteristic curve (ROC) was used to analyze the predictive indexes of postoperative noninfectious fever. Results75.08% (229/305) patients had noninfectious fever after aortic repair and 98.25% of them had fever within 2 days. There were 229 patients in the febrile group, mean age 65 (53.0,73.0) years (83.4% males , and 76 patients in the afebrile group, mean age 71(65.0,76.7) years(84.2% males). Univariate analysis showed that the number of patients with coronary heart disease, using statins before operation and aortic aneurysm in the febrile group were significantly lower than those in the afebrile group, and patients were younger in the febrile group. The logistic regression showed that age, surgical site, type of disease, preoperative hyperthermia, type of stent were positively correlated with noninfectious fever, while statin use was negatively associated with noninfectious fever. And age, surgical site, preoperative hyperthermia and stent type were analyzed by means of ROC curve (P<0.01). Conclusion Noninfectious fever is very common after aortic repair. The relationship between fever and infection should be comprehensively judged according to the risk factors of noninfectious fever and the disease status to promote rational use of antibiotics.

COMPARISON OF EARLY EFFECTIVENESS BETWEEN TOTAL PERCUTANEOUS ENDOVASCULAR ANEURYSM REPAIR AND SURGICAL FEMORAL CUTDOWN ENDOVASCULAR ANEURYSM REPAIR FOR ASYMPTOMATIC ABDOMINAL AORTIC ANEURYSM

Objective To investigate the early effectiveness of total percutaneous endovascular aneurysm repair (TPEVAR) in treating asymptomatic abdominal aortic aneurysm (AAAA) by comparing with surgical femoral cutdown endovascular aneurysm repair (SFCEVAR). Methods Between January 2010 and May 2011, 41 cases of AAAA were treated with TPEVAR in 26 cases (TPEVAR group) and with SFCEVAR in 15 cases (SFCEVAR group). The maximum tumor diameter ranged from 3.5 to 9.2 cm (mean, 5.7 cm) in TPEVAR group, and ranged from 3.5 to 10.0 cm (mean, 6.9 cm) in SFCEVAR group. There was no significant difference in gender or age between 2 groups (P gt; 0.05). Results All patients underwent EVAR successfully. The patients were followed up 6-23 months (mean, 13.5 months). No significant difference was found in the outer diameters of the delivery system for main body and iliac leg, operation time, contrast media dosage, hospitalization days, or postoperative hospitalization days between 2 groups (P gt; 0.05). The patients of SFCEVAR group had more bleeding volume and longer ICU stay than patients of TPEVAR group (P lt; 0.05). The incidence of minor complication was 7.7% (2/26) in TPEVAR group and 33.3% (5/15) in SFCEVAR group, showing no significant difference between 2 group (χ2=4.42, P=0.08); the incidence of major complication in SFCEVAR group (20.0%, 3/15) was significantly higher than that in TPEVAR group (0) (χ2=5.61, P=0.02). Conclusion TPEVAR shows safer and more effective than SFCEVAR in treating AAAA.

Experiences of Endovascular Repair in Treatment for Aortic Dissecting Aneurysm（Report of 15 Cases）

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。

对腔内修复Stanford B型主动脉夹层手术范围的质疑——应将“远端旷置”改为“全程修复”

Advancements in the treatment of chronic thoracoabdominal aortic dissection

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.

主单髂支架植入联合股股动脉转流复合技术治疗复杂腹主动脉病变

目的总结主单髂支架植入联合股股动脉转流复合技术治疗复杂腹主动脉病变的疗效。 方法2004年1月－2012年9月，采用主单髂支架植入联合股股动脉转流复合技术治疗复杂腹主动脉病变12例。其中男9例，女3例；年龄36～79岁，平均61.7岁。病程4h～30d，中位时间10d。腹主动脉下腔静脉瘘2例，多发性腹主动脉及髂动脉瘤1例，腹主动脉瘤合并一侧髂动脉严重狭窄3例，腹主动脉瘤合并一侧髂动脉严重扭曲1例，腹主动脉瘤合并远端瘤颈夹层1例，Schumacher分型为Ⅱa型腹主动脉瘤且远端瘤颈狭窄2例，急诊腹主动脉瘤破裂2例。 结果患者均痊愈出院，未出现手术并发症。12例均获随访，随访时间3个月～7年，中位时间52个月。腹主动脉CT血管造影检查示支架位置良好，动静脉瘘消失，动脉瘤瘤体隔绝良好，无内漏，双侧股动脉转流吻合口通畅、无狭窄。随访期间无再发腹主动脉瘤及动静脉瘘，双下肢血供正常。 结论主单髂支架植入联合股股动脉转流复合技术治疗复杂腹主动脉病变具有较好的手术安全性和成功率，临床疗效满意。

CUFF 预开窗技术治疗胸主动脉腔内修复术后近端内漏

目的探讨胸主动脉腔内修复手术中即时造影提示覆膜支架近端出现Ⅰ型内漏，通过追加植入体外预开窗的支架延长段（CUFF）以延长锚定区，并消除Ⅰ型内漏的手术方式的安全性、有效性及其技术要点。方法2016～2017 年阜外医院血管外科中心实施胸主动脉腔内修复手术 623 例，其中 6 例患者在第 1 枚覆膜支架植入后，采取了追加植入 1 枚体外预开窗 CUFF 的方法处理了近端Ⅰ型内漏并保留了弓部分支动脉。6 例患者平均年龄 63.3（54～76）岁，男 4 例、女 2 例，其中 Stanford B 型主动脉夹层 2 例，胸主动脉假性动脉瘤 1 例，主动脉穿通性溃疡 3 例，全部接受经股动脉途径的胸主动脉腔内修复术治疗。结果本组手术成功率 100.0%，预开窗技术分支动脉保留成功率 100.0%，预开窗平均时间 10.3（6～17）min。5 例保留了左锁骨下动脉，1 例同时保留了左颈总动脉和左锁骨下动脉，后者经开窗向左颈总动脉植入覆膜支架 1 枚。本组锁骨下动脉均未植入支架。Ⅰ型内漏消除率 83.3%（5/6），1 例患者术后仍有微少量内漏，未予进一步处理。所有患者均获得门诊或电话随访，随访时间 10.3（3～25）个月，即时造影残留微少量内漏患者于术后 3 个月随访时内漏完全消失，所有患者生活质量改善，无死亡患者。结论对于腔内修复治疗术中出现近端Ⅰ型内漏的主动脉弓降部疾病患者，采取追加植入体外预开窗 CUFF 的方法，可在延长近端锚定区的同时成功保留弓上分支动脉。

Diagnosis and Management of Endoleak after Endovascular Aneurysm Repair in Abdominal Aortic Aneurysm

腹主动脉瘤（AAA）腔内修复术（EVAR）是目前大动脉病变腔内治疗最成熟的技术之一。AAA EVAR术后内漏指支架型血管置入后，在支架型血管腔外、被旷置的瘤体及邻近血管腔内出现持续性血流的现象［1~3］。内漏是AAA EVAR术后最为常见、对疗效影响很大的并发症，其发生率大约15%～50%［4］。内漏可导致瘤体进一步增大甚至破裂。目前，内漏的机理尚不完全明确，诊断与治疗方面也存在争议。现根据我院临床经验，结合近年来相关文献报道探讨AAA EVAR术后内漏的诊治。......