Objective To assess the efficacy and safety of ascending aorta banding technique combined with typeⅠhybrid aortic arch repair for the aortic arch diseases. Methods The clinical data of patients undergoing ascending aorta banding technique combined with type Ⅰ hybrid arch repair for aortic arch diseases from March 2019 to March 2022 in Beijing Anzhen Hospital were retrospectively analyzed. The technical success, perioperative complications and follow-up results were evaluated. Results A total of 44 patients were collected, including 35 males and 9 females, with a median age of 63.0 (57.5, 64.6) years. The average EuroSCORE Ⅱ score was 8.4%±0.7%. The technical success rate was 100.0%. All patients did not have retrograde type A aortic dissection and endoleaks. One patient died of multiple organ failure 5 days after operation, the in-hospital mortality rate was 2.3%, and the remaining 43 patients survived and were discharged from hospital. The median follow-up period was 14.5 (6-42) months with a follow-up rate of 100.0%. One patient with spinal cord injury died 2 years after hospital discharge. One patient underwent thoracic endovascular aortic repair at postoperative 3 months due to new entry tears near to the distal end of the stent. Conclusion Ascending aorta banding combined with typeⅠhybrid arch repair for the aortic arch diseases does not need cardio-pulmonary bypass. Ascending aorta banding technique strengthens the proximal anchoring area of the stent to avoid risks such as retrograde type A dissection, endoleak and migration. The operation owns small trauma, rapid recovery, low mortality and a low rate of reintervention, which may be considered as a safe and effective choice in the treatment of the elderly, high-risk patients with complex complications.
ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
Objective To compare the advantages and disadvantages between double Perclose ProGlide crossing suture and traditional suture for the closure of 20F or 22F access points so as to provide a basis for selecting appropriate approach to repair the puncture points in endovascular aortic repair. Methods Between June 2007 and May 2011, 103 patients (115 common femoral arteries) underwent endovascular aortic repair using sheaths of 20F or 22F (outer diameter); double Perclose ProGlide crossing suture was performed for closure of puncture sites in 57 cases (64 common femoral arteries) (double Perclose group) and traditional suture in 46 cases (51 common femoral arteries) (traditional group). There was no significant difference in age, gender, or disease duration between 2 groups (P gt; 0.05). Results The operation time, blood loss, and hospitalization days of double Perclose group were significantly better than those of traditional group (P lt; 0.05). Ecchymoma in inguinal region and lymphatic leakage occurred in 5 cases (5 common femoral arteries) and 2 cases (2 common femoral arteries) of double Perclose group respectively, in 2 cases (2 common femoral arteries) and 6 cases (8 common femoral arteries) of traditional group respectively; no significant difference was found in the rate of the early complication between double Perclose group and traditional group (7.8% vs. 15.7%, χ2=1.76, P=0.19). The technique success rate of double Perclose group was 96.9% (62/64), and was 100% (51/51) in traditional group, showing no significant difference (χ2=0.31, P=0.50). All patients were followed up, 2-19 months (mean, 15 months) in double Perclose group and 2-18 months (mean, 14 months) in traditional group. Pseudoaneurysm occurred in the puncture region at 3 months in 1 case (1 common femoral artery) of double Perclose group, and incision and suture therapy was performed; no arteriostenosis or pseudoaneurysm occurred in other cases; and the rate of mid-term complication was 1.6% (1/64) in double Perclose group and was 0 in traditional group, showing no significant difference (P=1.000). Conclusion Double Perclose ProGlide crossing suture has the same effectiveness to traditional surture in repairing the puncture point with 20F or 22F, but it is superior to traditional suture in reducing operation time, blood loss, and hospitalization days.
Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.
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.
Objective To evaluate the safety and efficacy of treating type Ⅱ endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms with coil embolization. Methods A retrospective review of patients with type Ⅱ endoleaks treated with coil embolization was performed. Data regarding the technical, clinical, and imaging outcomes during perioperation and followed-up were collected. Results The technical success rate and the initial clinical success rate of treating type Ⅱ endoleaks with coil embolization were 100% (14/14). The mean operating time was (124.3±11) min, a mean of (127±15) mL contrast agent and a mean of (7±2) coils were used. During perioperation, one patient suffered left limb paralysis, all the patients were discharged with no perioperative mortality. Twelve patients were followed-up. During the period of 3 to 57 months of followed-up (average: 17.3 months), Type Ⅱ endoleaks reoccurred in one patient with coil embolization of the feeding vessels alone and two patients with coil embolization of the aneurysm sac alone. Since the aneurysms did not enlarge during the followed-up, these 3 patients continued followed-up without reinterventions. Conclusion Treating type Ⅱ endoleaks with coil embolization appears to be safe, and it can prevent aneurysm sac enlargement effectively. Because of the high risk of reoccurrence, follow-up after embolization is important.
Objective To summarize the clinical experience of capture technology in the large diameter of abdominal aortic aneurysm in endovascular repair of abdominal aortic aneurysm(EVAR). Methods We retrospectively analyzed clinical data of 6 patients with abdominal aortic aneurysm (maximum diameter of 6.0 cm or bigger) in our hospital between July 2013 and May 2014.There were 3 males and 3 females at age of 76.2(73–81) years. Two patients of ruptured abdominal aortic aneurysm, in EVAR, established orbit using the capture technology successfully. Results The capture technology made the thread through the proximal tumor neck smoothly, successful repaired. One patient of rupture of abdominal aortic aneurysm was dead after 10 hours. One patient was lost to follow-up. Four patients were followed up for 3 to 11 months. The four patients had not occurred bracket displacement, internal leakage, thrombosis, or other serious complications. Conclusion For the patients with larger abdominal aortic aneurysm, capture technology may be used to the thread through the proximal tumor neck, to build a convey or track easily, to shorten the operation time, to improve the success rate of surgery.
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 evaluate the feasibility and security of endovascular repair of abdominal aorta using branched stent graft in a novel in vitro vascular model. MethodsThe branched stent graft for the abdominal aorta was designed. The novel in vitro vascular model was established to test this stent graft. Attempts were made to optimize the procedure of stent graft and to evaluate the feasibility of this device. The branched stent graft for abdominal aorta was tested by a novel in vitro vascular model. The number of stent graft released and expanded was recorded respectively. The pressure and situation of branch vessels were assessed before and after stent graft released. The endoleak during releasing process was observed by digital subtraction angiography (DSA). ResultsThe stent graft was successfully deployed in the novel in vitro vascular model. The releasing process was all properly achieved (100%, 30/30). The pressure changes of branch vessels were no statistical significances (P > 0.05) between before and after stent graft released. The stent grafts were well landed, and were fully expanded and properly positioned by DSA. No endoleak occurred. ConclusionThe branched stent graft for abdominal aorta in a novel in vitro vascular model is safe and feasible.