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 review and compare the literatures on studying endoleak via intra-sac pressure (Psac) measurement in order to reveal the characters of all types of endoleak. Methods Measured the intra-sac pressure with miscellaneous pressure transducers in vitro and in vivo endoleak models or patients afflicted with endoleak. Compared the difference of Psac among no endoleak and all types of endoleak. Results Psac＞0 but was obviously lower than Psys in no endoleak. Psac approached Psys in type Ⅰ and type Ⅳ endoleaks. Some researches showed that Psac in type Ⅱ endoleak was higher than that in no endoleak and even approached Psys, however the other researches showed that Psac in type Ⅱ endoleak was lower than that in no endoleak. Conclusion Postoperative Psac dropping greatly eliminated the risk of aneurysm rupture, which symbolized the success of endovascular therapy. Even if the type Ⅰ endoleak of small size might lead to obvious elevation of Psac, which necessitates management. The impairment and management tactics of type Ⅱ endoleak remained equivocal, which required further study.
Objective To investigate pathogenesis and therapeutic prospect of abdominal aortic aneurysm (AAA). Methods Relevant literatures about pathogenesis and ways of treatment for AAA in recent years were reviewed. Results The formation of AAA are associated with heredity, anatomy, environment and biochemistry and other factors. All factors influence and interact with each other. The metabolic disequilibrium of aortic intermediate extracellular matrix plays an important role in the pathogenesis of AAA. The main reasons for the formation of AAA may be the increase of activity of matrix metalloproteinases and the disequilibrium of genetic expressions of elastin and collagen. The therapy of AAA includes surgical and medical treatment. The methods of medical treatment are still in the process of exploration and research. Conclusion The formation of AAA is a synergistical result of multiple factors, and medical treatment is an important supplement of surgical treatment.
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 summarize the current advancement of peroxisome proliferator activated receptors (PPARs) participating in formation of abdominal aortic aneurysm (AAA) and to find out the potential treatment strategy of AAA. MethodsRelevant literatures about PPARs and formation of AAA were reviewed. ResultsAAA involved inflammation of all the layers of aorta, and the formation of AAA needed many kinds of inflammatory cells and cytokines. Many researches in vitro or in vivo had shown that PPARs could reduce the expression of inflammatory cytokines, to reduce formation of AAA. However, PPARγ was also confirmed to participate in the formation of AAA and the mechanism might be the transformation of macrophage from type 1 macrophage (M1) to type 2 macrophage (M2). According to the existing studies, the assumption could be that PPARγ can suppress the inflammatory function of M1 to reduce formation of AAA at the initiating stage, and promote formation of AAA by inducing the transform of macrophage to M2 at the late stage. ConclusionPPARs may be a potential targeting point for the prevention of AAA. More studies are needed to show the feasibility and to decide the application timing.