Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.
ObjectiveTo analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). MethodsThe clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. ResultsAll 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. ConclusionFrom analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.
ObjectiveTo explore the efficacy of using a single branch stent-graft to treat primary intramural hematoma located at the distal arch or descending aorta in Stanford A type aortic intramural hematoma. MethodsFrom July 2020 to November 2022, 10 patients with primary intramural hematoma of Stanford A type aortic intramural hematoma were treated with endovascular repair using a single branch stent-graft in the Department of Cardiovascular Surgery at The University of Hong Kong-Shenzhen Hospital. There were 9 males and 1 female, aged from 32 to 66 years, with a mean age of (47.0±10.4) years. All patients had intramural hematoma involving the ascending aorta and aortic arch, diagnosed as type A intramural hematoma, with the tear located in the descending aorta. Among them, 6 patients were complicated by ulceration of the descending aorta with intramural hematoma, and 4 patients had changes of the descending aortic dissection. All patients underwent endovascular stent repair, with 8 patients undergoing emergency surgery (≤14 days) and 2 patients undergoing subacute surgery (15 days to 3 months). Results There were no neurological complications, paraplegia, stent fracture or displacement, or limb or visceral ischemia during the perioperative period in all patients. One patient had continuous chest pain after surgery, and the stent had a new tear at the proximal end, requiring ascending aorta and partial arch replacement. As of the latest follow-up, all patients had obvious absorption or complete absorption of the intramural hematoma in the ascending aorta and aortic arch compared with before the operation. ConclusionSingle branch stent-graft treatment of retrograde ascending aortic intramural hematoma is safe and effective, with good short-term results.
ObjectiveTo summarize the mid-term follow-up results and postoperative aortic remodeling of treating blunt aortic injuries (BAI) with thoracic endovascular aortic repair (TEVAR).MethodsA retrospective study was conducted on BAI patients treated with TEVAR, who were admitted into the Department of Vascular Surgery in Zhongshan Hospital, Affiliated to Fudan University between September 2003 and December 2015. There were 15 males and 9 females at an average age of 45.6±14.0 years. The mechanism of BAI was mainly auto car crash. Totally 25 entry tears were detected and most of them were located at the aortic isthmus.ResultsTwenty-four BAI patients survived and eventually went through TEVAR. One patient died of pulmonary embolism 1 week post-TEVAR. Rate of technical success, clinical success and perioperative mortality was 100.0%, 95.8%, and 4.2%, respectively. Nineteen patients were followed up with a mean time of 35.1(13-87) months. All of them survived this period. Based on the follow-up imaging of CTA, 18 of them revealed no endoleak or stent migration, and 1 patient of transection still had perfusion of distal false lumen at the abdominal aorta. None of the aortic segments measured in this study showed expansion of ≥5 mm during follow-up. The aorta remodeled well in 94.7% of them.ConclusionTEVAR for treating BAI appears feasible with high rates of technical and clinical success rates. The mid-term follow-up results seems satisfying, but the long-term results are yet to be assessed with further follow-up.
ObjectiveTo explore the technique experience and short- term and long-term effect of endovascular treatment on aorioiliac artery occlusive disease.MethodsClinical data of 131 patients were admitted for aorioiliac artery occlusive disease in the Department of Vascular Surgery of Beijing Chaoyang Hospital Affiliated to Capital Cedical University in recent years were analyzed.ResultsAll the 131 patients underwent surgical operation, including 5 cases of pure catheterization (CDT); 94 cases of balloon dilatation and stent implantation; 23 cases which combind CDT, balloon dilatation, and stent implantation; 3 cases of pure balloon dilatation and 6 complicated cases of hybrid surgery. The mean operative time was 90 minutes, mean hospitaliztion time was 5 days. There were 6 cases occurred complications during perioperative period, including 3 cases of hematoma, 1 case of retroperitoneal hematoma, 1 case of acute transient ischemic attacks (TIA), and 1 case of pulmonary infection. There were 113 patients were followed-up for 1–32 months, and the median time was 16 months, the follow-up rate was 86.3% (113/131). During the follow-up period, 2 patients died, 1 died of myocardial infarction and 1 died of multi-organ failure. The one-year patency rate was 89.3% (100/112). During the follow-up period, 13 patients relapsed, including 5 patients who underwent secondary stent implantation, 1 patient who underwent CDT and percutaneous transluminal angioplasty (PTA), and 7 patients who received conservative treatment due to mild symptoms.ConclusionsThe treatment of aorioiliac artery occlusive disease still needs to choose reasonable measures according to the lesions, and even several measures should be combined to simplify the lesions, lower risk and receive better effect.
Objective To explore the effectiveness and predictive value of computer simulated thoracic endovascular aortic repair (TEVAR). Methods The clinical data of the patients with Stanford type B aortic dissection who underwent TEVAR from February 2019 to February 2022 in our hospital was collected. According to whether there was residual false cavity around the stent about 1 week after TEVAR, the patients were divided into a false cavity closure group and a false cavity residual group. Based on computer simulation, personalized design and three-dimensional construction of the stent framework and covering were carried out. After the stent framework and membrane were assembled, they were pressed and placed into the reconstructed aortic dissection model. TEVAR computer simulation was performed, and the simulation results were analyzed for hemodynamics to obtain the maximum blood flow velocity and maximum wall shear stress at the false lumen outlet level at the peak systolic velocity of the ventricle, which were compared with the real hemodynamic data of the patient after TEVAR surgery. The impact of hemodynamics on the residual false lumen around the stent in the near future based on computer simulation of hemodynamic data after TEVAR surgery was further explored. Results Finally a total of 28 patients were collected, including 24 males and 4 females aged 53.390±11.020 years. There were 18 patients in the false cavity closure group, and 10 patients in the false cavity residual group. The error rate of shear stress of the distal decompression port of the false cavity after computer simulation TEVAR was 6%-25%, and the error rate of blood flow velocity was 3%-31%. There was no statistical difference in age, proportion of male, history of hypertension, history of diabetes, smoking history, prothrombin time or activated partial thromboplatin time at admission between the two groups (all P>0.05). The blood flow velocity and shear stress after TEVAR were statistically significant (all P<0.05). The maximum shear stress (OR=1.823, P=0.010) of the false cavity at the level of the distal decompression port after simulated TEVAR was an independent risk factor for the residual false cavity around the stent. Receiver operating characteristic curve analysis showed that the area under the curve corresponding to the maximum shear stress of false cavity at the level of distal decompression port after simulated TEVAR was 0.872, the best cross-sectional value was 8.469 Pa, and the sensitivity and specificity were 90.0% and 83.3%, respectively. Conclusion Computers can effectively simulate TEVAR and perform hemodynamic analysis before and after TEVAR surgery through simulation. Maximum shear stress at the decompression port of the distal end of the false cavity is an independent risk factor for the residual false cavity around the stent. When it is greater than 8.469 Pa, the probability of residual false cavity around the stent increases greatly.
The current finite element analysis of vascular stent expansion does not take into account the effect of the stent release pose on the expansion results. In this study, stent and vessel model were established by Pro/E. Five kinds of finite element assembly models were constructed by ABAQUS, including 0 degree without eccentricity model, 3 degree without eccentricity model, 5 degree without eccentricity model, 0 degree axial eccentricity model and 0 degree radial eccentricity model. These models were divided into two groups of experiments for numerical simulation with respect to angle and eccentricity. The mechanical parameters such as foreshortening rate, radial recoil rate and dog boning rate were calculated. The influence of angle and eccentricity on the numerical simulation was obtained by comparative analysis. Calculation results showed that the residual stenosis rates were 38.3%, 38.4%, 38.4%, 35.7% and 38.2% respectively for the 5 models. The results indicate that the pose has less effect on the numerical simulation results so that it can be neglected when the accuracy of the result is not highly required, and the basic model as 0 degree without eccentricity model is feasible for numerical simulation.
The treatment of chronic thoracoabdominal aortic dissection aneurysm remains a major challenge in aortic surgery. Open surgery is the mainstream treatment at present. New devices for endovascular treatment of chronic thoracoabdominal aortic dissection are gradually applied in clinical practice. The hybrid procedure is a combination of open and endovascular procedures. The appropriate treatment should be selected according to the patient's age, anatomy, genetic aortic disease, and comorbidities.
Transcatheter aortic valve replacement and endovascular abdominal aortic repair have now become the first-line treatment options for aortic stenosis and abdominal aortic disease, respectively. For patients with both diseases, combined procedures have been reported in a few domestic and foreign publications. However, all the procedures were performed under general anesthesia. Here, we reported a case of simultaneous minimalist transfemoral transcatheter aortic valve replacement and endovascular repair of the abdominal aorta for a 78-year-old male patient with aortic stenosis and abdominal aortic ulcer, and the surgical results were satisfactory.
ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.