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Methods:From Jan 2019 to Nov 2021, 20 patients underwent 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the EVAR at the three hospitals. The clinical data patients were collected and analyzed.Results:All the 20 cases underwent 3D printed template assisted pre-fenestration of stent graft according to the data of pre-operative the computed tomographic angiography (CTA). EVAR was successfully performed in all patients(included 2 cases with one fenestration,5 cases with 2 fenestration,10 cases with 3 fenestration and 3 cases with 4 fenestration). Fifty-four reinforced fenestrations (20 in right renal artery, 18 in left renal artery, 13 in superior mesenteric artery and 3 in celiac artery) were performed. During the follow-up period (mean 14.6 months), 1 case died, and the one-stage patency rate of splanchnic artery branch stent was 98.1%. Four patients had endoleak, 1 patient died of intracranial hemorrhage during postoperative period. None of patients had postoperative paraplegia or organ ischemia.Conclusions:3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique is feasible for EVAR in the treatment of complex abdominal aortic aneurysms and dissections. The technique is capable to reinforce the blood supply of visceral arteries with satisfied short-term effectiveness.Ojective:To evaluate 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the endovascular aortic aneurysm repair (EVAR).
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Objective:To explore the safety and efficacy of Castor branched stent-graft exclusion in the treatment of aortic dissection and aneurysm involving left subclavian artery.Methods:The clinical and imaging data of 88 patients with aortic dissection or aneurysm involving left subclavian artery diagnosed by CTA or DSA in our hospital from December 2017 to December 2019 were collected retrospectively, including 67 aorta dissections, 7 thoracic aortic aneurysms and 14 aorta penetrating ulcer. All patients were treated with branched stent-graft under the guidance of DSA. The postoperative curative effect and complications were observed. The paired t test was used to compare the maximum aortic diameter of the lesion before and 6 months after the operation. Results:Eighty-eight patients were successfully treated with integrated stent, the success rate of operation was 100%, and the disease-related symptoms of all patients were basically or completely relieved. The mortality rate within 1 month after the operation was 2.7% (2/88). The two deaths were complicated with other serious diseases before the operation, and the cause of death was not related the operation. All patients were followed up except 4 patients who lost contact after discharge. During the follow-up, there were 1 case of retrograde type A dissection, 1 case of new aneurysm of aortic arch, 2 cases of in-stent stenosis of left subclavian artery branch, 3 cases of mild stroke, no persistent endoleak and no death or other serious complications. The mean maximum aortic diameter at 6 months after operation [(34±4)mm] was significantly lower than that before operation [(38±6 mm)] ( t=6.63, P<0.05). Conclusion:Castor branched stent-graft is simple, mini-invasive and effective in the treatment of aortic dissection and aneurysms involving the left subclavian artery.
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Objective:To explore the therapeutic value of interventional methods for hemorrhage caused by mandibular arteriovenous malformations.Methods:The clinical data of 7 patients (3 males and 4 females) with mandibular arteriovenous malformations treated by interventional therapy from January 2012 to January 2018 in the First Affiliated Hospital, Zhengzhou University were retrospectively analyzed. Of all patients, 4 patients suffered from sudden massive hemorrhage and 3 patients suffered from spontaneous repeated bleeding. The age ranged from 8.0 to 13.0 (10.6±1.7) years. Of the 7 patients, 3 underwent interventional embolization via arteries and veins, and 4 underwent embolization only via arteries. The embolic materials were polyvinyl alcohol granules and coils. The follow-up period was 9—18 months and the curative effect was observed.Results:Among the 7 patients, 4 cases of acute massive hemorrhage were effectively controlled after interventional operation, 3 cases of chronic bleeding disappeared after interventional operation. No recurrence of bleeding occurred during the follow-up period, only 1 patient presented with oral infection and gingival swelling and hyperplasia. The symptoms were effectively controlled after anti-infection and debridement. No severe complications occurred in all patients.Conclusion:Interventional therapy for ateriovenous malformation with hemorrhage is effective, safe and feasible, which is worthy of clinical application.
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Objective@#To explore the therapeutic value of interventional methods for hemorrhage caused by mandibular arteriovenous malformations.@*Methods@#The clinical data of 7 patients (3 males and 4 females) with mandibular arteriovenous malformations treated by interventional therapy from January 2012 to January 2018 in the First Affiliated Hospital, Zhengzhou University were retrospectively analyzed. Of all patients, 4 patients suffered from sudden massive hemorrhage and 3 patients suffered from spontaneous repeated bleeding. The age ranged from 8.0 to 13.0 (10.6±1.7) years. Of the 7 patients, 3 underwent interventional embolization via arteries and veins, and 4 underwent embolization only via arteries. The embolic materials were polyvinyl alcohol granules and coils. The follow-up period was 9—18 months and the curative effect was observed.@*Results@#Among the 7 patients, 4 cases of acute massive hemorrhage were effectively controlled after interventional operation, 3 cases of chronic bleeding disappeared after interventional operation. No recurrence of bleeding occurred during the follow-up period, only 1 patient presented with oral infection and gingival swelling and hyperplasia. The symptoms were effectively controlled after anti-infection and debridement. No severe complications occurred in all patients.@*Conclusion@#Interventional therapy for ateriovenous malformation with hemorrhage is effective, safe and feasible, which is worthy of clinical application.
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Objective To evaluate the feasibility and clinical outcomes of interventional treatment of Budd-Chiari syndrome (BCS) associated with simultaneous upper gastrointestinal hemorrhage.Methods The clinical data of 32 patients of BCS with upper gastrointestinal hemorrhage from October 2015 to April 2008 in First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Variceal embolization and inferior vena cave (IVC) and/or hepatic veins (HV) angioplasty were performed simultaneously.Perioperative complications were observed.Portal vein pressures were measured through catheterization preand post-operation.Restenosis of IVC and HV,upper gastrointestinal hemorrhage were observed on followup.Results Percutaneous transluminal balloon angioplasty were successfully carried out in all patients:16 patients with IVC and 17 patients with HV stenosis underwent angioplasty without stent placement.Portography indicated one esophageal and gastric varices in 17 patients and two in 15 patients.All the varices were embolized successfully.The portal vein pressure reduced from (35.7±2.9) cmH2O to (31.2±2.5) cmH2O (P ＜ 0.05,1 cmH2O =0.098 kPa).Portal vein pressure reduced from (35.8± 3.0) cmH2O to (30.7±2.3) cmH2O in HV type BCS post-operation,and reduce from (35.6±3.0) cmH2O to (31.8±2.6) cmH2O in HV and IVC involved type,which indicated that portal vein pressure decreased more obviously after HV recanalization.On follow-up for 3 to 32 months (mean 11.7 ±7.8 months),7 patients with IVC and 5 patients with HV stenosis developed restenosis.Transluminal balloon angioplasty was performed.No upper gastrointestinal hemorrhage occurred during the follow-up period.Conclusion One-stage interventional treatment of BCS with upper gastrointestinal hemorrhage was safe and effective,and had satisfactory mediumlong term outcomes.
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Objective To explore the efficacy and safety of percutaneous transhepatic portal vein or transjugular intrahepatic portosystemie shunt (TIPS)to implant the portal vein metallic stent in treatment of cavernous transformation of portal vein (CTPV).Methods Clinical and imaging data of 8 patients with CTPV were retrospectively analyzed who were treated in our hospital.All patients were treated with metallic stent implantation in portal vein including 3 patients by TIPS and 5 by percutaneous transhepatic portal vein.Results All patients were successful in the stent implantation without any occurrence of serious complications such as intra-abdominal hemorrhage and so on.Intraoperative angiography showed blood circulated freely in these stents.1 day-2 weeks later,the patients symptoms of abdominal pain and gastrointestinal bleeding were obviously relieved or disappeared.Follow up 1 month-3 years,1 patient with stent occlusion after one year of operation,the blood flow recovery after stent reimplantation,and the remaining patients,color doppler ultrasound reflected patency of blood flows in their stents.No one suffered from gastrointestinal bleeding or abdominal pain again.Conclusion Implantation of portal vein metallic stent via percutaneous transhepatic portal vein or via TIPS in treatment of cavernous transformation of portal vein is safe and effective.
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The onset of hepatocelluar carcinoma, one of the serious complications of primary Budd-Chiari syndrome, is associated with poor prognosis.Although so, the diagnosis and treatment of such disease has still not been standardized at recent.In this paper, we overviewed the recent advances on Budd-Chiari syndrome associated with hepatocelluar carcinoma.