ObjectiveTo determine the influence of proximal aneurysm neck anatomy on typeⅠA endoleak follo-wing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm. MethodsFrom September 2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR. The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of typeⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. ResultsThe recurrence of typeⅠA endo-leak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren't related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. ConclusionsThe complicated proximal aneurysm neck anatomy is a major cause for the typeⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The applica-tion of EVAR depends largely on the shape of the proximal aneurysm neck.
Objective To study the major postoperative complications of abdominal aortic aneurysm （AAA） repair in high-risk patients， analyze its causes， and suggest the prevention methods. Methods From January 2009 to September 2011， 57 cases of high-risk AAA patients underwent AAA repair in our hospital were analyzed retrospectively. High-risk patients were defined as age≥60 years，the American Society of Anesthesiologists grade three or four，and at least one of complications about heart， lung， and kidney. Major postoperative complications were rated， and preoperative cardiac，pulmonary， and renal condition，anesthesia and surgical impact were taken into account while evaluating the risk factors of major postoperative complications. Results Forty-one of 57 high-risk patients with AAA were repaired by endovascular repair，16 of 57 high-risk patients with AAA were repaired by traditional open surgery. The early mortality （within 30d） was 1.8% （1/57）. The major postoperative complications rate of AAA repair was 19.3% （11/57） in total，and 8.8% （5/57），8.8% （5/57），and 1.8% （1/57） for cardiac complication，pulmonary complication， and acute renal failure，respectively. The patients with coronary heart disease had a higher cardiac complication rate 〔19.0% （4/21） versus 2.8% （1/36），χ2=4.387，P＜0.05〕 ， while with hypertension had no such effect for that〔10.3% （4/39） versus 5.6% （1/18），χ2=0.340，P＞0.05〕. Patients with abnormal pulmonary function was responsible for postoperative respiratory complications 〔20.0% （4/20） versus 5.6% （1/18）， χ2=4.387， P＜0.05〕 ， while with chronic obstructive pulmonary disease history was not responsible for that 〔13.2% （5/38） versus 0 （0/19），χ2=2.740，P＞0.05〕．Patients with preoperative renal function was not related to postoperative acute renal failure 〔0 （0/4） versus 1.9% （1/53）， χ2=0.077，P＞0.05〕. Compared with traditional open surgery，endovascular repair could effectively reduce the incidence of postoperative complications 〔12.2% （5/41） versus 37.5% （6/16）， χ2=3.980，P＜0.05〕. The incidence of postoperative respiratory complications in the local anesthesia patients was less than that in the general anesthesia patients 〔0（0/20）versus 19.0% （4/21），χ2=4.221，P＜0.05〕. Conclusions Cardiac and pulmonary complications are commonly seen after AAA repair in high-risk patients．Preoperative cardiac，pulmonary condition，anesthesia and surgical aspects greatly influence the major postoperative complications. Exhaustively assessment of each system before surgery，appropriate anesthesia and surgical options，postoperative active and effective symptomatic，and supportive treatment are the key to reducing the 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.
Objective To compare the effectiveness between conventional open repair (OR) and endovascular repair (EVRAR) for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases (OR group) or by EVRAR in 8 cases (EVRAR group). There was no significant difference in age, sex, the neck length (less than 2 cm), the neck angulation of aneurysm (more than60°), il iac severe tortuosity, preoperative systol ic pressure, and preoperative comorbidity between 2 groups (P gt; 0.05). The blood transfusion volume, operation time, intensive care unit (ICU) stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups (P gt; 0.05). EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay (P lt; 0.05), but OR group was significantly better than EVRAR group in reinterventions and graftrelated complications (P lt; 0.05). Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.
This paper interprets clinical practice guideline for abdominal aortic aneurysm of American Society for Vascular Surgery in 2018.
Objective To explore the diagnosis and treatment for ruptured abdominal aortic aneurysm （RAAA）. Methods The clinical data of 20 patients with RAAA from January 2000 to December 2010 were analyzed retrospectively．Results There were 18 males and 2 females．The age was 31-82 years with an average 65.4 years．All the patients were abdominal pain and （or） back pain．Eleven cases had low blood pressure or shock．Seven cases had a history of abdominal aortic aneurysm．All the cases were accurately diagnosed by CTA，Doppler ultrasonography or operation．Nineteen cases were treated by conventional operation，1 by endovascular aortic repair．Survival of 16 cases recovered smoothly. Perioperative death occurred in 4 cases，mortality rate was 20% in 20 patients with RAAA．The causes of death included circulatory failure in 1 case and multiple organ dysfunction syndrome in 3 cases．Conclusions Surgery treatment is an effective treatment for RAAA．Early diagnosis and urgent surgical repair are crucial to reduce the mortality of RAAA．
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.
The phenomenon of sex differences exists in patients who have abdominal aortic aneurysms (AAA). The occurrence rate of AAA is higher in male, while the rates of rupture and postoperative mortality are higher for female. This phenomenon of sex differences would affect the diagnosis, treatment and postoperative rehabilitation for AAA patients. This article reviewed the recent research status of sex differences on AAA, and explored the phenomenon of sex differences from the aspects of threshold determination, biomechanics and mechanobiology. This review points out that the sex differences on AAA could ascribe to the differences of biomechanical environment and biological properties induced by the vascular size, anatomy structure and structure components of abdominal aortic artery. The comprehensive investigations of the sex differences on AAA could help to optimize the diagnosis, treatment and device design, patient care and rehabilitation strategy of AAA based on sex differences phenomenon.
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。