Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA). The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.</p><p><b>METHODS</b>Between March 2011 and May 2012, nine male patients (mean age, (79.6 ± 8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography (CTA) was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter.</p><p><b>RESULTS</b>Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was (8.9 ± 1.4) days, mean blood loss was (360.5 ± 46.8) ml, and mean iodinated contrast volume was (230.6 ± 58.3) ml. The mean follow-up time was (7.6 ± 4.2) months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up.</p><p><b>CONCLUSIONS</b>The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.</p>

Hybrid procedures for thoracoabdominal aortic aneurysms and dissections / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients.</p><p><b>METHODS</b>Between September 1998 and May 2012, 32 high-risk TAAA patients (five females, median age 61.5 years) underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients' conditions. Follow-up computed tomography angiography (CTA) was routinely performed before discharge and at 6, 12 months and annually thereafter.</p><p><b>RESULTS</b>Procedural success was achieved in all cases. The median hospital stay was (21.5 ± 2.3) days, and the median procedure time was (420 ± 31) minutes. Blood loss averaged (2100 ± 261) ml. A total of 124 visceral artery bypasses was performed. Two patients (6.3%) died within 30 days. One patient exhibited complete paraplegia (3.1%). The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1, 2, 3 and 5 years, respectively.</p><p><b>CONCLUSIONS</b>The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.</p>

Early and midterm results of covered Cheatham-Platinum stent for treatment of aortic coarctation: a report of 9 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm results of covered Cheatham-Platinum (CP) stent for treatment of aortic coarctation (CoA) in adolescents and adults.</p><p><b>METHODS</b>From January 2007 to June 2011, 9 consecutive cases of CoA underwent covered CP stent implantation. There were 4 male and 5 female patients, aging from 13 to 44 years with a mean of (24 ± 11) years. The covered CP stent and balloon-in-balloon catheter were selected according to digital subtraction angiography measurements. The covered CP stents were expanded to appropriate diameter by inflation of the inner balloon and outer balloon successively. The systolic pressure gradient across the stenosis and narrowest degree of the stenotic vessels were compared before and after the procedure.</p><p><b>RESULTS</b>After the procedure, the systolic pressure gradient across the stenosis decreased from (66 ± 21) mmHg to (9 ± 4) mmHg (1 mmHg = 0.133 kPa, t = 9.13, P = 0.000) and the narrowest degree of CoA decreased from 79% ± 12% to 17 ± 4% (t = 16.65, P = 0.000). During a mean follow-up of (33 ± 22) months (ranging 4 to 54 months), no intrastent restenosis were found and systolic pressure gradient from upper to low extremity was not more than 15 mmHg in each case.</p><p><b>CONCLUSIONS</b>Covered CP stent implantation is safe and effective for treatment of CoA in adolescents and adults. The early and midterm results are encouraging, but long term results require further follow-up and observation.</p>

Recanalization of superficial femoral artery occlusions with Outback LTD catheter / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate immediate- and median-term outcomes from subintimal recanalization of superficial femoral arteries (SFA) chronic total occlusions (CTO) with the Outback LTD catheter.</p><p><b>METHODS</b>From January 2010 to May 2011, 35 legs in 30 patients with CTO of the SFA and proximal popliteal artery were treated by Outback LTD catheter. There were 20 male and 10 female patients. The mean age of the patients was 68 years. Clinical presentation was severe intermittent claudication (Rutherford category 3, 10/35, 28.6%), rest pain (Rutherford category 4, 13/35, 37.1%), and minor ulceration (Rutherford category 5, 12/35, 34.3%). In all cases, the true lumen could not be entered by using standard antegrade catheter and guide wire techniques. Technical success, complications, procedure times, clinical outcomes and cumulative patency rates in follow-up were evaluated.</p><p><b>RESULTS</b>Median lesion length was (210 ± 15) mm. Recanalization of the arterial occlusion was successful in 34 of 35 treated lesions (97.1%). None of the 30 patients showed any procedure-related complications during or after treatment. The mean follow-up was (7.2 ± 0.3) months. Cumulative primary patency rates after 3, 6, and 12 months were 90.9%, 84.8% and 50.6%. Three minor toe amputations and one major below-the-knee amputation were observed in patients with critical limb ischemia.</p><p><b>CONCLUSIONS</b>The Outback LTD catheter is a safe and effective device to recanalize challenging superficial femoral arteries CTO. The technique could reduce radiation exposure time and raise the technique success rate.</p>

Endovascular aneurysm repair in high-surgical-risk abdominal aortic aneurysm patients: initial and long-term results / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients.</p><p><b>METHODS</b>From July 1997 to July 2011, 120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry. There were 96 male and 24 female patients, aged from 52 to 95 years with a mean of 74 years. Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3, 6, 9, 12 months, and annually thereafter. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement.</p><p><b>RESULTS</b>Mean aneurysm diameter was (57 ± 8) mm. Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five type I endoleaks, twenty-five type II endoleaks and one type III endoleak occurred during the perioperative period. The technical success rate was 95%. Operative mortality was 2.5%. The survival rates at 1-, 3- and 5-year were 92%, 75% and 43% respectively. The mean follow up was (36 ± 3) months. Primary and secondary patency rates at 3 year were respectively 97% and 100%. Secondary intervention rate was 10% (12/120) at 5 year. The reasons included endoleaks for 7 patients, stent-grafts fracture for 2 patients, stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients.</p><p><b>CONCLUSIONS</b>Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.</p>

Total percutaneous endovascular abdominal aortic aneurysm repair / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the safety and efficacy of total percutaneous endovascular abdominal aortic aneurysm repair using the Perclose ProGlide suture-mediated closure system.</p><p><b>METHODS</b>From May 2008 to April 2010, 36 abdominal aortic aneurysm patients were undergone total percutaneous endovascular repair. There were 30 male and 6 female patients with a mean age of 68 years. Endografts used included 3 Endurant endografts, 13 Talent endografts, and 20 Zenith endografts. Prior to insertion of the introducer sheath, two ProGlides were pre-set to 18 to 24 F access sites and one to 14 to 16 F access sites. At last, suture the arteriotomy by tying down knots of the ProGlide following removal of the sheath. Technical success, complications, and procedure and access closure times were evaluated. Follow-up protocol consisted of computed tomography angiograms performed at 3, 6, 9, 12 months, and annually thereafter.</p><p><b>RESULTS</b>Twenty patients were operated under local anesthesia and 16 patients under general anesthesia. A total of 68 femoral arteries were closed with 128 devices. Thirty-eight vessels were with 2 devices, while 8 arteries required 3 devices and 2 arteries required 4 devices for hemostasis and an additional 20 vessels only required a single device. Sixty-three (63/68, 92.6%) vessels were closed successfully. Two vessels converted to open closure. Three vessels complicated with hematomas without surgical procedure. The mean follow-up was (12±3) months. There was one asymptomatic femoral artery dissection 3 months after operation.</p><p><b>CONCLUSIONS</b>Total percutaneous endovascular abdominal aortic aneurysm repair is safe and effective. But it should be performed at hybrid operating room where can convert to open procedure if necessary.</p>

Foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective randomized controlled trial / 中华外科杂志

<p><b>OBJECTIVE</b>to compare the clinical outcome of foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery.</p><p><b>METHODS</b>as a prospective randomized controlled trial, 60 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups, treated by SFJ ligation and either foam sclerotherapy or standard stripping of the GSV. There were 26 male and 34 female with a median age of 49 years (ranging 37 to 66 years). Primary end points were patient recovery period, postoperative pain, quality of life and recurrence rate. Secondary end points were frequency of complications on the two arms of the trial.</p><p><b>RESULTS</b>all treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group than the standard stripping (43 min vs. 65 min, P < 0.01). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group compared to the surgical group (3 d vs. 6 d, P < 0.01). After 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups (P < 0.01). After 6 months, in the foam sclerotherapy group, 5 patients needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80.0%. And the short-term obliteration rate was 89.5% in the conventional surgery group.</p><p><b>CONCLUSIONS</b>foam sclerotherapy combined with sapheno-femoral ligation involves a shorter treatment time, less postoperative discomfort and results in more rapid recovery compared to conventional GSV stripping.</p>

Surgical treatment of peripheral arterial aneurysms: a report of 35 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment strategies of peripheral arterial aneurysms.</p><p><b>METHODS</b>Thirty-five cases were reviewed from July 1998 to December 2007, and 28 cases were male, 7 cases were female. Eleven cases were popliteal artery aneurysms, 15 cases were femoral artery aneurysms, 4 cases were extracranial carotid aneurysms and 5 cases were subclavian artery aneurysms. All cases had either open procedures or endovascular procedures.</p><p><b>RESULTS</b>Surgical open procedures were performed on 24 cases, and endovascular procedures were performed on 11 cases. The perioperative complication rate were 16.7% (4/24) and 0% for open and endovascular groups respectively. The average follow-up time was 41 months (7 months to 8 years). The accumulative five year patency were 61% and 48% for surgical grafts and stent grafts respectively. Two cases died of diseases and one had stroke during follow-up.</p><p><b>CONCLUSIONS</b>Surgical open repair is still standard procedure for most peripheral arterial aneurysms and endovascular repair may have its own advantage for high risk patients.</p>

Endovascular repair: alternative treatment of ruptured abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As an alternative to open aneurysm repair, endovascular aortic repair (EVAR) has been applied to ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.</p><p><b>METHODS</b>From July 1997 to September 2007, 20 men and six women with rAAA (median age, 68 years) were treated with EVAR. Most patients with suspected rAAA underwent emergency computed tomographic angiography (CTA). The procedure was performed under general or local anesthesia. Endovascular clamping was attempted in hemodynamically unstable patients. Bifurcated endografts and aorto-uni-iliac (AUI) endografts with crossover bypass were used. Patients had CT scan prior to discharge, 3, 6, 12 months after discharge, and annually thereafter.</p><p><b>RESULTS</b>Time between diagnosis and EVAR ranged from 1 hour to 5 days. EVAR was performed under general anesthesia in 21 patients, and under local anesthesia in five patients. Endovascular aortic clamping was performed in four patients. There was no conversion to open surgery during EVAR. Stent-graft insertion was successful in all patients. One patient died during EVAR from acute myocardial infarction. Ten patients had systolic blood pressure < 80 mm Hg. Eleven patients received a blood transfusion. Mean aneurysm size was (47 +/- 12) mm. Mean ICU stay was (8 +/- 3) days, mean hospital stay (18+/- 6) days, and mean procedure time (120 +/- 32) minutes. The 30-day mortality was 23% (6/26 patients), and major morbidity 35% (9/26 patients). Early endoleak occurred in 8/26 patients (31%). The mean follow-up was (18 +/- 7) months. No patient demonstrated migration of the stent-graft.</p><p><b>CONCLUSIONS</b>EVAR is a safe and effective option for treatment of acute rAAA, independent of the patient's general condition. Immediate and mid-term outcomes are favorable, but long-term outcome is unknown. Multi-center studies are necessary to establish the role of EVAR for rAAA.</p>

Catheter-directed foam sclerotherapy of incompetent saphenous reflux: early results / 中华外科杂志

<p><b>OBJECTIVE</b>To describe observation of availability of catheter-directed foam sclerotherapy for the great saphenous vein varicosis.</p><p><b>METHODS</b>A selective series of 30 patients of vein varicosis were treated with foam sclerotherapy using a standard technique for foam delivery from April 2008 to August 2008. Patients were treated with 1% polidocanol foam through a catheter, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV). All successfully treated patients were examined by colour duplex two weeks after the procedure.</p><p><b>RESULTS</b>Thirty patients with an insufficiency reflux of the GSV were treated with the catheter-directed foam sclerotherapy. Primary technical success was achieved in all the patients. The concentrations (1.0%) and doses (6 to 8 ml) of polidocanol was mainly we used. Five patients experienced transient scotomas and developed segmental phlebitis of a collateral vein. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), a closure of the GSV was found at control visits 2 weeks, 3 months after treatment.</p><p><b>CONCLUSION</b>The use of an endovascular catheter inserted percutaneously over a guidewire is feasible in most patients and has resulted in high primary occlusion rates.</p>

Hybrid treatment for thoracoabdominal aortic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of hybrid conventional open and endovascular treatment of thoracoabdominal aortic aneurysm (TAAA), and evaluate the immediate and long term outcomes.</p><p><b>METHODS</b>From September 1998 to October 2008, 15 TAAA patients were treated by hybrid-procedures. The mean patient age was 58.7 years (ranged from 44 to 72 years). The aneurysms were Crawford type I in 2, type II in 8, type III in 2, type IV in 3. The median aneurysms diameter was (67.5 +/- 7.5) mm (ranged from 55 to 82 mm). Patients were followed up before dismissal, 3, 6, 12 months later, and annually thereafter.</p><p><b>RESULTS</b>Two patients were antegrade revascularization, the others were retrograde revascularization. Mean operation time was (8.1 +/- 1.4) h (ranged from 6.8 to 12.7 h), mean blood loss was (956.7 +/- 80.1) ml (ranged from 750 to 3,000 ml). Two patients died during perioperative time, no paraplegia. During follow up revealed shrinkage of aneurysm, no graft migration and paraplegia, but 1 died for acute myocardial infarct.</p><p><b>CONCLUSIONS</b>Hybrid treatment is a safe and effective option for treatment of TAAA. Immediate and mid-term outcomes are favorable, but long-term surveillance is indefinite.</p>

Treatment of left subclavian artery in endovascular repair of thoracic aortic aneurysm and thoracic aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD).</p><p><b>METHODS</b>In 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover.</p><p><b>RESULTS</b>DSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg.</p><p><b>CONCLUSIONS</b>EVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.</p>

The feasibility study of endovascular reconstruction of aortic arch with modular branched stent-graft system in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair.</p><p><b>METHODS</b>After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed.</p><p><b>RESULTS</b>Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and artery rupture of left subclavian respectively during operation. In the eight successful cases, two proximal type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed.</p><p><b>CONCLUSION</b>It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.</p>

Mid-long term complications of endovascular repair in aortic diseases and its secondary interventional strategies / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and effects of secondary intervention for mid-long term complications of endovascular repair (EVR) in aortic diseases.</p><p><b>METHODS</b>From May 1999 to Jun 2007, 21 patients with mid-long term complications after EVR were treated in our center. Of these cases, 15 cases received first EVR for abdominal aortic aneurysm (AAA), 3 cases for thoracic aortic aneurysm (TAA) and 3 cases for aortic dissection (TAD). The mid-long term complications included 11 cases of type I endoleak, 4 cases of type II endoleak, 2 cases of type III endoleak and 4 cases of migration of stent grafts. Proximal or distal extensions were used for type I and III endoleak in 9 cases. Fenestrated, scallop and bifurcated stent grafts were used to reconstruct the aortic arch in 3 cases. Emboli technique was used in treating type II endoleak. Thrombectomy and bypass technique were used in 4 cases with stent graft limb occlusion. One ruptured AAA accepted open surgery.</p><p><b>RESULTS</b>Secondary endovascular technique were undergone in 20 (95.2%) cases. One case died in 30 days after the secondary intervention and endoleak remained after the secondary operation in 5 cases. Three cases died of the secondary intervention.</p><p><b>CONCLUSIONS</b>Endoleak and limb occlusion were the chief mid-long complications after EVR. Secondary endovascular technique can be used in most cases and carries great challenges in aortic arch lesions.</p>