ABSTRACT
Objective To investigate the suitable therapeutic schedule for Stanford B aortic intramural hematoma associated with calcification. Methods During the period from March 2009 to March 2012, a total of 15 patients of Stanford B aortic intramural hematoma with calcified plaque were admitted to authors’ hospital. The diagnosis was proved in all patients by CT angiography of the entire aorta with a 64-row CT scanner. Of the 15 patients, death occurred in one, thoracic endovascular aortic repair (TEVAR) treatment was adopted in 7 and conservative therapy was carried out in 7. All the patients were followed up for one year. CT angiography was employed at 3, 6 and 12 months after the treatment to evaluate the therapeutic results. Results One patient died of acute myocardial infarction after admission to hospital when the long-tem use of antiplatelet drugs was stopped. Seven patients received TEVAR treatment and the remaining 7 patients were treated with strict conservative therapy, and all these patients were asymptomatic at the time of discharge. During the follow- up period, CT angiography performed at 3, 6 and 12 months after the treatment showed that the intramural hematoma lesions gradually shrank or were absorbed in 13 patients, and the patients were asymptomatic. The remaining one patient was lost in touch. Conclusion The key to treat Stanford B aortic intramural hematoma with calcification is to prevent deterioration of the lesion. While strict conservative treatment is kept on, TEVAR should be promptly carried out for patients who need to take antiplatelet drugs over a long period of time, for patients whose clinical symptoms are not improved, for patients in whom the relived symptoms recur, and for patients whose CT angiography shows that the penetrating aortic ulcer becomes worse.
ABSTRACT
Objective To explore the effect of conservative treatment for Stanford B aortic intramural hematoma without calcified plaque and the midterm follow-ups.Methods Clinical data of 20 patients with Stanford B aortic intramural hematoma without calcified plaque which were confirmed by CTA of the whole aorta were retrospectively analyzed.There were 12 males and 8 females,with the age of 35～ 52 years.All of them received pharmacotherapy and psychotherapy.Results All the 20 cases were asymptomatic after conservative medical treatment when they discharged,and were followed up whit imaging tests.They all lived without symptoms during the follow-up period.The pleural fluid on the left side was disappeared in 11 cases after 3 months and the aortic intramural hematoma was absorbed in 13 cases after 6 months.After 1 year there were total 18 cases without aortic intramural hematoma,while The thickness and scope of the hematoma were reduced significantly in the other 2 cases.Conclusion It' s ease to find whether the patient with Stanford B aortic intramural hematoma got calcified plaque or not; the conservative treatment for Stanford B aortic intramural hematoma without calcified plaque has satisfactory clinical effect in midterm follow-ups.
ABSTRACT
Objective To explore the surgical strategy and effects for treating complex malignant tumors of the inferior vena cava (IVC) or/and the tumors extending into right atrium/ventricle.Methods Between Dec 2004 and Jul 2008, eight patients underwent surgical resections, among those seven patients with tumors of IVC or the tumors extending into right atrium/ventricle were operated on under deep hypothermia with cardiopulmonary bypass( CPB), and one patient with recurrence of leiomyosarcoma of the IVC successfully underwent en bloc resection and caval reconstruction. The prosthetic graft was used for IVC reconstruction in two patients and vascular patch in the other two patients. Preoperative chest roentgenography, computed tomography, ultrasonography, or magnetic resonance imaging was used to exclude the presence of metastatic disease, to assess local resectability of the tumour and the extent of involvement and obstruction of the IVC. Results One patient died of liver failure postoperatively. The postoperative course was uneventful in other 7 patients. On follow-up two patients died 2 and 5 months later due to functional disorder of the liver. Three patients have been followed up for 14 - 24 months and were