Objective To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for 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.
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.
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.
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.
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.
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.
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。