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.
Non-valvular atrial fibrillation has a high morbidity. Cox Ⅲ surgery is the gold standard for treating all kinds of atrial fibrillation. However, which needs to be performed with cardiopulmonary bypass (CPB) and the trauma caused by it is severe. It is placed emphasis on minimal invasion, safety and efficacy for contemporary surgery so as to minimally invasive intervention is important in the treating non-valvular atrial fibrillation. Although the results of epicardial ablation with video-assisted thoracoscopic surgery (VATS) are better than that of transcatheter ablation, it also has some disadvantages and shortages under certain circumstance. Epicardial ablation with VATS combined with transcatheter ablation is complemantary which becomes the hot spot for treatment of novalvular atrial fibrillation.
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.
Surgical intervention for chronic thoracoabdominal aortic dissecting aneurysms (cTAADA) is regarded as one of the most challenging procedures in the field of vascular surgery. For nearly six decades, open repair predominantly utilizing prosthetic grafts has been the treatment of choice for cTAADA. With advances in minimally invasive endovascular technologies, two novel surgical approaches have emerged: total endovascular stent-graft repair and hybrid procedures combining retrograde debranching of visceral arteries with endovascular stent-graft repair (abbreviated as hybrid procedure). Although total endovascular stent-graft repair offers reduced trauma and quicker recovery, limitations persist in clinical application due to hostile anatomical requirements of the aorta, high costs, and the lack of universally available stent-graft products. Hybrid repair, integrating the minimally invasive ethos of endovascular repair with visceral artery debranching techniques, has increasingly become a significant surgical modality for managing thoracoabdominal aneurysms, especially in cases unsuitable for open surgery or total endovascular treatment due to anatomical constraints such as aortic tortuosity or narrow true lumens in dissections. Recent enhancements in hybrid surgical approaches include ongoing optimization of visceral artery reconstruction strategies based on hemodynamic analyses, and exploration of the comparative benefits of staged versus concurrent surgical interventions.
Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P＞0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.
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.
Kommerell's diverticulum is a rare congenital abnormal aortic development. The diverticulum can occur in both left and right aortic arches, from which an aberrant subclavian artery rises to the contralateral side. Only a small number of patients with Kommerell's diverticulum present symptoms. Dysphagia, dyspnea, chest discomfort and upper extremity blood pressure difference are common in adult patients. The risk of aortic dissection or aortic aneurysm rupture is higher in such patients than that in patients with normal aorta. Early surgical intervention is recommended to improve the prognosis. Treatment options include open surgical repair, hybrid operation and total endovascular repair. The choice of surgical method depends on the specific anatomy of patients, the patients' state and the preference of surgeons. This paper reviewed and summarized the surgical methods and early results of the treatment of Kommerell's diverticulum reported in the literature from 2015 to 2020.
Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD). Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared. Results All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%. Conclusion For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.
Objective To evaluate the immediate and mid-term effectiveness of hybrid procedures (combined open surgery and endovascular therapy) for multilerel femoral and popliteal artery occlusive disease. Methods Between June 2009 and June 2012, 22 cases of severe femoral and popliteal artery occlusive disease were treated by hybrid surgery. There were 15 men and 7 women with an age range of 52-78 years (mean, 66.2 years) and with a disease duration of 6 months to 5 years (mean, 1.5 years). Of 22 patients, 13 had a history of smoking; 8 were classified as Fontaine III and 14 as Fontaine IV. The complications included diabetes (8 patients), hypertension (16 patients), hyperlipemia (10 patients), coronary heart disease (11 patients), and chronic kidney failure (1 patient). Patency analyses were performed using Kaplan-Meier life tables and log-rank test. Results All patients underwent successfully procedures. The time of operation was 70-160 minutes (mean, 137 minutes). Acute myocardial infarction, hematoma of incision, fracture of stent, and stent thrombosis occurred in 1 case, respectively. At 6 months after surgery, the ankle brachial index (ABI), the transcutaneous oxygen pressure (TcpO2), and the average intermittent claudication distance were significantly increased when compared with preoperative ones [0.79 ± 0.33 vs. 0.32 ± 0.18, (42.7 ± 15.7) kPa vs. (17.6 ± 11.6) kPa, and (420 ± 80) m vs. (160 ± 54) m, P lt; 0.05]. The patients were followed up 6-24 months (mean, 14.5 months). The primary patency rate, primary assisted patency rate, and second patency rate were 77.3% (17/22), 90.9% (20/22), and 95.5% (21/22) respectively, showing no significant difference among them (P gt; 0.05). No significant difference was found in various-stage patency rates between patients at Fontaine III and IV (P gt; 0.05). Conclusion Hybrid procedures provide an effective treatment of multilevel femoral artery and popliteal artery disease while there is good outflow.