ABSTRACT
Objective To explore the technology and curative effect of thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 85 patients with Stanford type B aortic dissection,who were admitted to authors' hospital during the period from January 2010 to April 2016 to receive TEVAR,were retrospectively analyzed.Conventional left brachial artery puncture and straight incision of right femoral artery were employed in all 85 patients,and DSA of ascending aorta was performed to find out the position of rupture,the position of the true and false lumens,and their relationship with the vascular openings of important organs.Endovascular covered stent was implanted to seal off the primary rupture;reexamination of ascending aorta angiography was adopted to check the sealing-off condition of the proximal rupture and the changes of blood flow in the aortic branches as well as in the true and false lumens.Results Successful TEVAR was accomplished in 84 patients.One patient died of sudden rupture of aortic dissection during preoperative anaesthesia.The technical success rate was 100％.In 9 patients the covered stent partially overlapped the left subclavian artery,in one patient the left subclavian artery “chimney” stem completely obstructed both the left common carotid artery and the left subclavian artery,and bypass surgery between left common carotid artery and left subclavian artery was carried out in 2 patients.After the treatment,internal leakage of type Ⅰ was detected in 2 patients.No death occurred during hospitalization period.After the surgery the patients were followed up for 3 months to 3 years,and all patients survived.New rupture at the distal site occurred in 2 patients.Conclusion For the treatment of Stanford type B aortic dissection,TEVAR is safe and effective.Strict observance of surgical indications,careful operative manipulation,and strengthening postoperative management after discharge from hospital are the key points to ensure a successful surgery as well as to improve the long-term survival rate.
ABSTRACT
Objective To evaluate the early and mid-term clinical efficacy and safety of endovascular re-pair for Stanford B aortic dissection. Methods Fifty-seven patients with Stanford B aortic dissection from July 2012 to July 2016 were selected.Based on the preoperative CTA image data,the appropriate stent grafts were cho-sen,and then endovascular graft exclusion was performed under the DSA perspective. The complications and mor-tality 3,6,12 and 24 months after the operation were observed,and the clinical features,curative effect and follow-up results were analyzed.Results The success rate of operation reached 100% and the average length of hospital-ization was 11 d.There were 1 case of postoperative 3 d leakage,1 postoperative 7 d death and 1 of recurrent dis-section 13 months later.Postoperative follow-up of 3 to 24 months showed that there were no postoperative paraple-gia,no dislocated and regressive stents and no occurrence of transposition and breakage of stent. Conclusions Covered stent in the treatment of Stanford B aortic dissection has the advantages of less trauma,safety,rapid recov-ery,simple operation,high success rate,less complications,definite curative effect in early-and middle-term and low fatality rate.
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Objective To summarize clinical outcomes of interventional therapy on children with common congenital heart diseases(CHD).Methods A retrospective study was conducted.One hundred and fourteen patients with CHD were selected as our subjects,who underwent catheter interventional therapy in the Second Affiliated Hospital of Zhengzhou University from Jan.2004 and Dec.2012.The size of occluder was chose according to intraoperative echocardiography or cardiac imaging measurements,and occluder was released under assisted monitoring by subtraction angiography or cardiac ultrasound.Results There are all together 112 patients got the therapy successfully,2 cases failed(occluder detachment),and the success rate of operation was 98.2％.After the success of interventional,echocardiography examination showed that 11 cases were with star point across shunt,but the function of the around valve was not affected.One months after operation,echocardiography examination showed star point across shunt of 11 cases were disappeared,and no occluder was shifted as well as no thrombosis formed.Three months after operation,chest radiograph showed pulmonary congestion decreases and heart shadow was shrink.Thirty-eight cases were with three tricuspid regurgitation before operation and 32 cases were without reflux at 3 months after operation,and 6 cases relieved significantly.The patients were followed up for 6 months or 3 years,activity endurance was significantly improved than that before operation.No occluder was shiftand hemolysis and arrhythmia occurred.Meanwhile,No thrombosis or embolism occurred.Conclusion Interventional treatment for children with congenital heart disease is proved as a safe,effective methods and it have broad prospects in clinical application.