ObjectiveTo evaluate the effect of fast track surgery (FTS) on clinical parameters and postoperative complications in patients with abdominal aortic aneurysm (AAA). MethodFifty Patients with AAA treated in our hospital between December 2009 and May 2015 were enrolled in this study. Ten patients between December 2009 and December 2012 received conventional standard care (conventional group), while 50 between January 2013 and May 2015 received FTS (FTS group). The first exhaust time, the first time of off-bed activities, the duration of hospital stays, and the complications after AAA surgery were analyzed. ResultsThe first exhaust time of patients in the FTS group and conventional group was (2.5±0.9) and (4.0±1.1) days; the first time of off-bed activities was (2.9±1.0) and (4.1±0.9) days; and the duration of hospital stays was (13.5±2.1) and (17.9±2.8) days. All those differences were significant (P<0.05). The incidences of incision infection, renal inadequacy, lower limb swelling, and weakened gastric function in the FTS group were significantly lower than those in the conventional group (P<0.05). On the third day after surgery, C-reactive protein in the FTS and conventional group was respectively (57.5±9.0) and (65.0±13.1) mg/L, and interleukin-6 was respectively (10.2±3.9) and (15.5±5.1) pg/L, both of which were significantly different between the two groups (P<0.05). ConclusionsFast track surgery is effective and safe in patients with abdominal aortic aneurysm, and it may lower trauma stress after surgery and incidence of postoperative complications.
Objective To review the progress of artificial intelligence (AI) and radiomics in the study of abdominal aortic aneurysm (AAA). Method The literatures related to AI, radiomics and AAA research in recent years were collected and summarized in detail. Results AI and radiomics influenced AAA research and clinical decisions in terms of feature extraction, risk prediction, patient management, simulation of stent-graft deployment, and data mining. Conclusion The application of AI and radiomics provides new ideas for AAA research and clinical decisions, and is expected to suggest personalized treatment and follow-up protocols to guide clinical practice, aiming to achieve precision medicine of AAA.
目的 总结肾动脉下腹主动脉瘤腔内修复术的初步经验。 方法 对我院2006年8月至2009年3月期间收治的10例肾动脉下腹主动脉瘤患者在全麻下采用单侧或双侧股动脉入路置入带膜支架行腔内修复术。 结果 10例肾动脉下腹主动脉瘤采用腔内修复治疗，带膜支架置入顺利，立即DSA 7例动脉瘤体消失，Ⅰ型内瘘2例，经支架附着点球囊扩张后内瘘即刻消失。随访3～30个月(平均10个月)，2例术后切口淋巴瘘，经换药痊愈。全部患者肢体血运正常。1例发生Ⅱ型内瘘，未经治疗，随访2个月后消失。 结论 腔内修复术对肾动脉下腹主动脉瘤是一种创伤小、恢复快及效果好的治疗方法。
ObjectiveTo summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.MethodsA case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.ResultsThe clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.ConclusionsFor patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
ObjectiveTo understand risk factors of abdominal aortic aneurysm (AAA) rupture and the latest progress.MethodThe domestic and foreign related literatures on risk factors affecting AAA rupture were retrieved and reviewed.ResultsBesides some definite risk factors of AAA rupture, including age, gender, hypertension, smoking, family history, complications (such as diabetes mellitus, hypertension, dyslipidemia, etc.), the biomechanical factor was the crucial factor of AAA rupture, including the aortic compliance, aortic wall peak value of pressure, aortic wall calcification, and hemodynamics. The latest imaging methods such as the high resolution ultrasound, function and molecular imaging, and phase contrast magnetic resonance imaging could provide technical supports for the prediction of AAA rupture.ConclusionsThere are many risk factors affecting AAA rupture. Clinicians might prevent and make individualize treatment for AAA rupture according to its risk factors, and risks of AAA rupture could be more accurately assessed with help of new medical imaging examination.
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 observe the effects of sarpogrelate hydrochloride in prevention and treatment for ischemia of gluteal and limb following endovascular repair of abdominal aortic aneurysm （EVAR）. Methods Clinical data were analyzed in 174 patients with abdominal aortic aneurysm （AAA） who underwent EVAR from January 2006 to January 2011. The patients’ mean age was （71.8±8.2）years old （male： 148 cases， female： 26 cases）. The diameter of abdominal aortic aneurysm was （55.2±12.9） mm. AAA involving common iliac artery was in 52 （29.9%） patients. Bifurcated endografts and aorto-uni-iliac （AUI） endografts with crossover bypass were used in 169 patients （97.1%） and 5 patients （2.9%）， respectively. Sarpogrelate hydrochloride were used in 39 patients with gluteal and limb ischemia due to exclusion of bilateral and unilateral internal iliac arteries among 174 patients. Sarpogrelate hydrochloride， 100 mg， three times daily，was taken for 2-4 weeks. Symptoms of gluteal and limb ischemia were followed-up.Results All of patients with AAA was repaired by EVAR successfully and no conversion to open repair. General anesthesia 〔50.6%（88/174）〕， epidural anesthesia 〔30.0%（52/174）〕， and local anesthesia 〔19.5%（34/174）〕 were used. Blood loss was （125.2±43.1） ml and no blood transfusion during operation. Operative time was （145.5±38.7） min, ICU stay time was （14.7±5.2） h， and postoperative fasting time was （7.2±4.3） h. The duration of postoperative hospital stay was （9.1±2.7） d. The perioperative complication rate was 12.6% （22/174）. The 30-day mortality rate was 1.1% （2/174）. Gluteal and limb claudication occurred in 2 paients and 5 patients respectively among 29 patients with EVAR due to exclusion of unilateral internal iliac artery， intermittent claudication distance was 100-200 meters. Gluteal muscle pain and limb claudication for less than 200 meters occurred in 4 patients due to exclusion of bilateral internal iliac artery. The symptoms were relieved after Sarpogrelate hydrochloride， 100 mg， three times daily， was taken for 2-4 weeks. No gluteal gangrene occurred and claudication distances were more than 500 meters when walking， no any interventional and surgical procedures were required， all of them were doing well for median 16.1 months follow-up period. Conclusions Sarpogrelate hydrochloride has definite effects on prevention and treatment for gluteal and limb ischemia following endovascular repair of abdominal aortic aneurysm，especially for exclusion of bilateral and unilateral internal iliac arteries during EVAR
Objective To discuss feasibility and effectivity of intraoperative ultrasound (US) during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods A radiographic contrast nephropathy patient of abdominal aortic aneurysm and left internal iliac artery aneurysm was treated by EVAR without iodine contrast media assisted by US. Then summarized the data of this patient. Results The precise placement of the stent-graft was performed for abdominal aortic aneurysm. The left internal iliac artery aneurysm was successfully treatment with the stent-graft and coils. Intraoperative Ⅱ type endoleak from inferior mesenteric artery and Ⅰ b type endoleak from right iliac stent were identified by using US. The operative duration was 120 min and the blood loss was only 20 mL. Ⅱ type endoleak was still detected and the Ⅰ b type of endoleak was loss on postoperative a week. Conclusion Intraoperative US-assisted EVAR in patients with infrarenal abdominal aortic aneurysm represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents.