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Objective:To assess the clinical value of Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods:The clinical data of 5 patients of distal false lumen enlargement after thoracic endovascular aortic repair for Stanford type B aortic dissection (TBAD) from 2019 to 2020 was retrospectively analyzed.Results:All five patients were male. Combining Gore C-TAG stent-graft segmented release mode with 'periscope’ technique was used. All five patients successfully underwent secondary endovascular repair, no intraoperative thoracotomy or major postoperative complications during hospitalization occurred . Compared to aortic CTA imaging in pre- and post-secondary endovascular repair, the curative efficacy of this method in the treatment of distal reentry tear of aortic dissection was evaluated. It showed that distal reentry tears were covered completely without reperfusion of aortic false lumen, as well as branch stents with well-perfusion based on aortic CTA imaging during the first year following-up.Conclusions:Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection is technically applicable and highly successful with satisfactory short-term results.
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Objective:To assess the value of AngioJet Ultra thrombectomy device in dealing with limb graft occlusion after endovascular repair for abdominal aortic aneurysm.Methods:The clinical data of 12 unilateral limb graft occlusion cases treated with percutaneous mechanical thrombectomy (PMT) after endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) from Dec 2014 to Nov 2019 was retrospectively analyzed.Results:All 12 patients were male, age ranging from (63±12) years old.Four cases had left iliac limb graft occlusion and eight cases had right iliac limb graft occlusion. All cases were treated with PMT and iliac branch angioplasty. Successful rate was 100%.Nine cases with bifurcated stent-graft were then implanted bare/covered stent. Postoperative intermittent claudication/ gluteus claudication disappeared. Hemoglobinuria occurred in 2 cases after operation, in which one suffered from mild renal impairment and recovered. Median following-up time was 18 months, there was no recurrence of lower limb ischemia.Conclusion:Application of AngioJet Ultra thrombectomy device in PMT treatment was safe, effective and less traumatic for iliac limb graft occlusion after endovascular anortic repair for abdominal aortic aneurysm.
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Objective To explore the influence of different initial intimal tear positions on abdominal branch perfusion in Stanford B aortic dissection.Methods CTA data of 130 patients with Stanford B aortic dissection were reviewed retrospectively.The involved aortic branches (celiac trunk,superior mesenteric artery,bilateral renal artery) were classified into different types according to the degree of ischemia and perfusion damage,and their relationship with different initial intimal tear positions were also analyzed.Results There were 542 branches in 130 patients,in which 465 branches (465/542,85.79％) were ischemic,including 337 branches (337/542,62.18％) of dynamic ischemia and 128 branches (128/542,23.62％) of static ischemia,77 branches (77/542,14.21％) without ischemia.In ischemic branches,the perfusion in 69 (69/542,12.73 ％) of them were impaired and those of the other 396 branches (396/542,73.06 ％) were unimpaired.In all of the 69 branches of impaired perfusion,37 branches (37/69,53.62％) were dynamic ischemia and 32 branches (32/69,46.38％) were static ischemia,and the difference was no statistically significant (x2 =3.077,P =0.215).Furthermore,no significant impact was found in initial intimal tear positions on ischemic patterns (dynamic and static) or perfusion patterns (unimpaired and impaired;x2 =1.352,0.776,P=0.509,0.678).Conclusion Initial intimal tear positions has no significant impact on ischemia pattern or perfusion pattern of abdominal aortic branches.The evaluation of abdominal aortic branches is helpful for guiding surgery.
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Objective To evaluate the safety and efficiency of transcatheter anastomotic leakage closure after surgical procedures for non-infected ascending aortic pathology with different occlusion devices. Methods From Dec. 2013 to Sep. 2015, six cases received interventional therapy for anastomotic leakage after surgical procedures for non-infected ascending aortic pathology using occluders. Four cases were with proximal graft-vessel anastomotic leakage, including two pseudoaneurysms at the site of aortic roots and two ascending aorta to right atrium shunts. The other two cases were with artificial grafts to intraoperative stent anastomotic leakage leading to endoleak type Ib. The anastomotic leakage was totally occluded by single ADOⅡrespectively in four cases. Two detachable coils were implanted in one case with artificial graft to intraoperative stent anastomotic leakage, but mild residual shunt to false lumen was detected by DSA and follow-up CTA. The second interventional procedure was carried out one month later, and one ADO Ⅱ was used to close the residual leakage totally. One PDA occluder was implanted along arteriovenous guide-wire track via aortic root to right atrium fistula in one case. Results All the anastomotic leakages of the six cases were totally excluded by different occlude devices percutaneously. The technical success rate was 100%. Follow-up time was from 1 month to 4 years. The patients' clinical condition improved obviously. Follow-up CTA showed no recurrence of anastomotic leakage. Complete thrombosis and marked shrinkage of the pseudoaneurysm were achieved in two cases, and the partial thrombosis and shrinkage of the false lumen were achieved in 2 cases. Conclusion Trans-catheter closure is an alternative treatment for ascending aortic surgical anastomotic leakage, which may achieve satisfactory short-and mid-term results.
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<p><b>OBJECTIVE</b>To analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis.</p><p><b>METHODS</b>Clinical data of 9 patients underwent endovascular therapy due to moderate renal artery stenosis (50%-69%) in Anzhen hospital from May to September 2013 were retrospectively analyzed. Fractional flow reserve (FFR) were measured in patients with moderate stenosis in renal artery and abnormal glomerular filtration rate (GFR) or different between renal artery angiography and ultrasound before the procedure. Endovascular therapy was not applied for patients with FFR > 0.90, and the patients were subsequently followed up clinically. Endovascular therapy was applied in patients with FFR less than 0.90 or the pressure difference between the two ends of stenosis was more than 20 mmHg (1 mmHg = 0.133 kPa). Blood pressure, ultrasound and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively.</p><p><b>RESULTS</b>There were 6 patients diagnosed as severe renal artery stenosis (≥ 70%) and the other 3 patients diagnosed as moderate renal artery stenosis by renal artery ultrasound before operation. Two patients with FFR > 0.90 were not undertaken the endovascular therapy. Seven patients with FFR < 0.90 underwent endovascular therapy. After renal artery stenting, renal stenosis was relieved immediately and the transstent blood flow was fluency in these 7 patients. There was significant difference in the FFR before and after operation (0.81 ± 0.09 vs.0.94 ± 0.03, P = 0.008). Among the patients underwent endovascular therapy, blood pressure was normal without medication in 2 patients and well controlled with 1 or 2 combined antihypertensive drugs in the rest 5 patients.</p><p><b>CONCLUSION</b>In patients with moderate renal artery stenosis, fractional flow reserve measurement could be used as a useful index to guide intervention procedure and to evaluate the efficacy of endovascular therapy.</p>
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Humans , Angiography , Constriction, Pathologic , Therapeutics , Fractional Flow Reserve, Myocardial , Hemodynamics , Renal Artery , Diagnostic Imaging , Renal Artery Obstruction , Therapeutics , Retrospective Studies , Stents , UltrasonographyABSTRACT
<p><b>OBJECTIVE</b>To observe the feasibility and clinical efficacy of thoracic endovascular aortic repair (TEVAR) for patients with Stanford B aortic dissection using personalized two stent-grafts implantation (TSI).</p><p><b>METHODS</b>This retrospective review included 56 patients who underwent TSI during TEVAR for Stanford B aortic dissection from Jan 2012 to May 2013 in Beijing Anzhen hospital. There were 8 patients in acute phase (within 2 weeks from onset of symptoms), 11 patients in chronic phase (greater than 2 months following initial dissection) and 37 patients in subacute phase (between 2 weeks and 2 months from onset of symptoms). Infrarenal aorta was involved in 34 patients (60.7%) and suprarenal aorta involved in 22 patients (39.3%), the mean aortic lesion length was (226 ± 13)mm. Thoracic and abdominal aortic angiography was performed during operation to measure aortic diameters of proximal and distal landing zone, and the distance between them. The proximal stent-grafts were implanted in distal aorta to the origin of left subclavian artery with oversize rate of 10%-15% according to proximal landing zone according to procedural guideline. Then the distal newly customized large tapered stent-grafts were sequentially deployed according to the diameters of both the distal end of proximal stent and distal landing zone (aortic true lumen), and overlapping length of the two stent-grafts was more than 30 mm. Patients were followed-up at 3 months, 6 months, and yearly thereafter post operation.</p><p><b>RESULTS</b>TSI procedure was successful in all patients and 122 stent-grafts were implanted. The mean length of implanted stent-grafts was (197.6 ± 20.3)mm. The mean diameter taper span was (7.5 ± 1.8)mm with proximal oversize rate of (12.8 ± 3.4)% and distal oversize rate of (11.2 ± 4.1)%. The mean angle between the distal end of stent and aorta was (2.3 ± 1.3)°. The diameter of proximal and distal landing zone, and angle between the distal end of stent and aorta remained unchanged during follow up (mean: (10.0 ± 4.0) months). The total thrombosis rate of the false lumen was 98.2% (55/56), thrombosis rate of stent segment was 82.1% (46/56) . Stent-related complications were observed in 2 patients (3.6%) , including acute spinal cord ischemia due to paraplegia (n = 1) and malposition of distal stent (n = 1).</p><p><b>CONCLUSIONS</b>Encouraging short-term outcomes are obtained from current personalized two stent-grafts implantation strategy for patients with Stanford B aortic dissection. Further prospective clinical studies are warranted to evaluate the long-term efficacy of this procedure.</p>
Subject(s)
Humans , Acute Disease , Aortic Dissection , Aorta , Aortic Aneurysm , Aortic Aneurysm, Thoracic , Therapeutics , Aortography , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Prospective Studies , Retrospective Studies , Stents , Subclavian Artery , Thrombosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objective To summraize the safety and efifcacy of modiifed transcatheter closure of atrial septal defect. Methods From Dec. 2012 to Dec. 2013, 100 cases performed modiifed transcatheter closure of atrial septal defect in our center (72 were famale and 28 were male) with average age (37±16) years. The diagnosis was conifrmed by transthoracic echocardiography. All the atrial septal defect closures were completed in the modiifed way by direct delivery of the closure devices without the need of guidence wire. Results One hundred and one defects were identiifed in 100 patients, with 1 patient had 2 defects. The mean diameter of the defect was (20.3±6.6) mm. 100 devices were implanted successfully. Complete closure was revealed in all the patients after the procedure. One patient developed atrial ifbrillation during the procedure. No other serious complication occurred till the last follow-up. Conclusions The modiifed transcatheter closure of atrial septal defect is an effective procedure with high successful rate and low rate of complications.