ObjectiveTo evaluate the short-and long-term results of hybrid procedures in the treatment for aortic arch lesions. MethodsFrom October 2002 to March 2011, 28 patients with thoracic aortic aneurysms or dissections involving the aortic arch were treated with hybrid endovascular treatment in our center. Twenty-two males and 6 females were in the series. The mean age of the patients was 68 years old. Of 28 patients, 15 were atherosclerotic thoracic aortic aneurysms and 13 were thoracic aortic dissection. Follow-up protocol consisted of computed tomography (CT) angiograms or ultrasound was performed in 3, 6, and 12 months, and annually thereafter. The main goal was to evaluate the operative mortality, morbidity, and the longterm survival of these patients. ResultsHybrid procedures included 12 totalarch transpositions, 3 left common carotid artery (LCCA)left subclavian artery (LSA) bypass, 11 right common carotid artery (RCCA)LCCA-LSA bypass, 2 RCCA-LCCA bypass. The technical success rate was 92.9% (26/28). The complications occurred in 10 patients (35.7%). Operative mortality was 7.1% (2/28). The apoplexia rate was 7.1% (2/28). The time of followup was (36±3) months. The patency rates of 1-year, 3-year, and 5-year were 100%, 92.9% (26/28), and 85.7% (24/28), respectively. The survival rates of 1-year, 3-year, and 5-year were 89.3% (25/28), 71.4% (20/28), and 60.7% (17/28), respectively. ConclusionsThe short-and long-term results with hybrid procedures in the treatment for aortic arch diseases are satisfactory. Further reducing the complications is the key to increase the survival rate.
ObjectiveTo evaluate the feasibility and security of endovascular repair of abdominal aorta using branched stent graft in a novel in vitro vascular model. MethodsThe branched stent graft for the abdominal aorta was designed. The novel in vitro vascular model was established to test this stent graft. Attempts were made to optimize the procedure of stent graft and to evaluate the feasibility of this device. The branched stent graft for abdominal aorta was tested by a novel in vitro vascular model. The number of stent graft released and expanded was recorded respectively. The pressure and situation of branch vessels were assessed before and after stent graft released. The endoleak during releasing process was observed by digital subtraction angiography (DSA). ResultsThe stent graft was successfully deployed in the novel in vitro vascular model. The releasing process was all properly achieved (100%, 30/30). The pressure changes of branch vessels were no statistical significances (P > 0.05) between before and after stent graft released. The stent grafts were well landed, and were fully expanded and properly positioned by DSA. No endoleak occurred. ConclusionThe branched stent graft for abdominal aorta in a novel in vitro vascular model is safe and feasible.
Objective To evaluate the importance of "one-stop" hybrid operating room in the individualized treatment of aortic pathology. Method We retrospectively analyzed the clinical data of 247 patients of aortic pathology who were operated in the hybrid operating room in our hospital from January 2013 through December 2014. There were 193 males and 54 females at age of 24-83(54±12) years. Results Thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) was applied in 132 patients, including 122 simple patients and 10 complexes. Fenestrated TEVAR was applied in 61 patients. Hybrid operation was done in 54 patients. Perioperative death occurred in 9 patients (3.6%). Perioperative complication rate was 11.7% (29/247) . The patients were followed up for one year. During follow-up, five patients were dead. The one-year survival rate was 98.0% (242/247) . Conclusions "One-stop" individualized treatment of aortic pathology shows its advantage, yet long-term result still needs to be followed up.
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.
ObjectiveTo evaluate the initial results of hybrid procedure without sternotomy for aortic arch dissection, and also report our initial experience in performing this procedure. MethodsFrom January 2011 to September 2014, 17 patients diagnosed with aortic arch dissection by CT angiography undergoing the hybrid procedure (thoracic endovascular aortic repair combined with supra-arch branch vessel bypass) in the department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command. There were 12 males and 5 females aged from 46 to 71 years. Their clinical data, including the imaging findings, treatment, and prognosis were retrospectively analyzed. ResultsLeft common carotid artery (LCCA) to left subclavian artery (LSA) bypass (n=4), right common carotid artery (RCCA) to LCCA to LSA bypass (n=3), RCCA to LCCA bypass merger covered LSA (n=3) were performed. All operations were successful. Laryngeal recurrent nerve injury occurred in one patient. All patients were followed up on the postoperative day 7, 30 and one year. All patients were followed up for 12 to 53 months till September 2015. There was no death, and no complications such as endoleak after the hybrid procedure, stenosis or blockage of the bypass graft during the follow-up period. ConclusionInitial results suggest that the hybrid procedure without sternotomy is a suitable therapeutic option for high risk aortic arch dissection patients in poor general condition with little tolerance to aortic arch replacement．
ObjectiveTo investigate the improvement of visceral arterial blood supply after thoracic endovascular aortic repair (TEVAR) for patients with Stanford type B aortic dissection (AD). MethodsWe retrospectively analyzed clinical data of 35 patients with Stanford type B AD undergoing TEVAR in Mianyang Central Hospital from January 2013 to March 2014. There were 30 male and 5 female patients with their age of 45-82(62.5±10.0) years. Among the 140 main visceral arteries (celiac artery, superior mesenteric artery, left and right renal arteries) of the 35 patients, blood supply of 79 arteries were compromised, including 36 arteries with stenosis and blood supply via the true lumen, 18 arteries with blood supply via both true and false lumen, 18 arteries with blood supply via the false lumen, and 7 arteries without blood supply. Improvement of blood supply of main visceral arteries was analyzed. ResultsAll the operations were successfully performed without in-hospital death. Operation time was 97.8 (68-147) minutes, length of ICU stay was 12-34 h, and length of hospital stay was 10-21 days. None of the patients had cerebral infarction, acute renal failure, AD rupture or stent migration after TEVAR. Blood supply of the compromised visceral arteries showed improvement in various degrees. ConclusionFor the treatment of Stanford type B AD, TEVAR can not only successfully block the rupture of AD, but also improve blood supply of main visceral arteries, avoid or reduce the complications resulting from compromised visceral arterial blood supply and visceral ischemia.
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.
ObjectiveTo assess the causes and risk factors of multiple-intervention in endovascular aortic repair (EVAR) for type B aortic dissection (TBAD). MethodsWe retrospectively analyzed the clinical data of 347 TBAD patients initially treated with EVAR in our hospital between January 1999 and December 2013. The patients were stratified into a multiple-intervention group (34 patients) and a single-intervention group (313 patients). We analyzed the differences of clinical data of the two groups. ResultsThere were 9 patients with endoleak, 10 patients with new dissection, 8 patients with incomplete thrombosis of the false lumen, 4 patients with new aneurysm, 2 patients with retrograde dissection, and 1 patient with iliac artery occlusion in the multiple-intervention group. Higher proportions of chronic dissection and smoking occurred in the multiple-intervention group (79.4% versus 50.8%, 61.8% versus 40.3%, P=0.002, 0.018, respectively). Both of the degree and proportion of hyperglycemia were higher in the multiple-intervention group (6.9±2.3 mmol/L versus 5.7±1.8 mmol/L, P=0.027; 44.1% versus 22.7%, P=0.011). There were statistical differences in oversizing rate of grafts (14.6%±3.2% versus 11.3%±2.5%, P<0.001), operation time (172 min versus 82 min, P<0.001), and blood loss (280 ml versus 100 ml, P=0.006) between the two groups. ConclusionEndoleak, new dissection, and incomplete thrombosis of the false lumen are the main causes of multiple-intervention. While in chronic phase, smoking, hyperglycemia, too big oversizing, and complicated lesion or operation are the potential risk factors.
Objective To introduce the experience of treating 85 cases of stanford type B aortic dissection by endovascular implantment of stent-grafts，to provide more clinical evidence for endovascular repairment for stanford B type aortic dissections.Methods Imaging examination by computed tomography angiography （CTA） were done to obtain anatomical detail of dissection. Stent-grafts were implanted under the guide of DSA in all cases. The patients were followed-up for 3 months，6 months，12 months，and then annually by CTA examination to observe the complications and morphological changes of the aneurysm.Results The technical success rate was 95.3%（81/85），and the clinical success rate was 91.8%（78/85）. Eight patients died after operation in hospital，who were all in acute phase，and no patients of chronic phase died，there had statistic differences （P＜0.05）. The perioperative complications’ incidence of endovascular repair which happened in patients of acute phase was higher than that patients of chronic phase （38.2% vs.13.3%，P＜0.05）. Left subclavian artery were covered completely for 13 cases，and partially covered for 22 cases，there was no obvious cerebralvascular insufficiency. There were 41 patients of whom other tears which were not covered during operation exsited at abdominal aortic and one year following-up showed that at those section thromblization of false cavity was not clear. The rest of patients whose abdominal aortic didn’t exist tears hadn’t new tears appeared.Conclusions Regardless in the acute or chronic stage，endovascular therapy is an effective mathod of treating stanford type B dissection. However，implanting stent-grafts have a higher security in chronic period than doing that in acute period. If the right carotid artery，vertebra and Willis ring are smoothly，there is little need to set up a by-pass to left subclavian artery before endovascular repairment. For those patients that other uncovered tears exited，following-up should be a must，and further strategy should be studied and prepared in advance.
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