ABSTRACT
Tracheo-Innominate artery fistula is a rare but devastating complication after tracheostomy. We report a 17-year old man who underwent the transection of the innominate artery and tracheal patch closure (under partial sternotomy) after the endovascular covered stent placement for the recurrent tracheo-innominate artery fistula. Fortunately, his postoperative course was uneventful without any new neurological, bleeding, or infective complication 34 months after the surgery.
ABSTRACT
BACKGROUND@#Bronchopleural fistula (BPF) is one of the most serious and rare postoperative complications, especially the bronchial stump fistula after lobectomy/pneumonectomy. Common treatment options include conservative medical treatment combined with surgery. However, due to the delayed healing of the fistula, the chest cavity continues to communicate with the outside world, and the patient is prone to complicated with severe thoracic infection and respiratory failure, so that the physical condition can hardly tolerate the second surgical procedure. Endoscopic treatment provides a new option for the treatment of this complication.@*METHODS@#A case of right pulmonary squamous cell carcinoma was admitted to the Department of Thoracic Surgery II, Peking University Cancer Hospital in June 2016. The diagnosis and treatment was retrospectively analyzed, and the literature was reviewed.@*RESULTS@#A 65 year old male patient was admitted to hospital because of "cough with blood in sputum for 3 months". Chest computed tomography (CT) showed soft tissue density mass shadow in the right lower lobe. A tumor could be seen in the opening of the right middle lobe and basal segment of lower lobe. Biopsy confirmed squamous cell carcinoma. Diagnosis consideration: squamous cell carcinoma of the middle and lower lobe of the right lung (cT2aN2, IIIa). Patients received gemcitabine plus cisplatin neoadjuvant chemotherapy for 2 cycles, and the effect of chemotherapy showed stable disease (SD). Four weeks after chemotherapy, the patient underwent video-assisted thoracic surgery (VATS) assisted right middle and lower lobectomy and mediastinal lymph node dissection. On the 5th day after operation, the patient developed acute respiratory distress syndrome (ARDS) and was transferred to intensive care unit (ICU) again after endotracheal intubation. On the 7th day after operation, the patient developed a right intermediate trunk bronchial stump fistula, but due to ARDS, the patient's physical condition could not tolerate the second operation. Under the support of extracorporeal membrane oxygenation (ECMO), a membrane covered, expandable, hinged stent was inserted into the intermediate trunk bronchial stump through rigid bronchoscope, and was successfully blocked. Due to no improvement in ARDS and irreversible pulmonary interstitial fibrosis, the patient received double lung transplantation successfully after systemic anti-infection treatment.@*CONCLUSIONS@#Endoscopic implantation of covered stent is a simple, safe and effective method for closure of bronchial stump fistula. When the patient's clinical situation is not suitable for immediate surgery, endoscopic stent implantation can be used as a preferred treatment method to create opportunities for follow-up treatment.
ABSTRACT
Objective:To explore the feasibility and effectiveness of 3D printing aortic model for preoperative evaluation and surgical simulation, and to assist interventional treatment of coarctation of the aorta(CoA).Methods:From December 2017 to January 2019, 8 patients with congenital coarctation of the aorta who underwent percutaneous balloon dilatation and covered stent placement in Xijing Hospital of Air Force Military Medical University were analyzed retrospectively. Among them, 7 cases were male and 1 case was female. The age was(32.00±14.93) years old. Before operation, CT data of patients' heart and aorta were collected, reconstructed with Mimics software, and 3D printing technology was used to make the model of patients' aortic lesions. Before operation, the operation simulation was carried out to determine the best operation scheme and estimate the possible situation, and the relevant clinical data of patients during hospitalization and follow-up were collected.Results:One stent graft was successfully implanted into CoA through femoral artery in all 8 patients. The mean diameter of CoA increased from(3.70±2.94) mm before operation to(18.01±1.51) mm immediately after operation( P<0.05), and the mean systolic pressure difference decreased from(83.75±25.44) mmHg before operation to(14.63±8.09) mmHg after operation( P<0.05). The mean systolic blood pressure of the right upper extremity decreased from(204.13±22.31) mmHg before operation to(145.63±32.08) mmHg after operation( P<0.05), and there was no significant difference between the two groups. During the period of hospitalization and follow-up, no corresponding cardiovascular complications were found. Conclusion:The short-term effect of percutaneous balloon dilatation covered stent implantation on CoA in adolescents and adults is obvious. 3D printing model can reproduce the anatomical model of CoA site of patients individually, which is feasible and effective for the preoperative evaluation of CoA and the preparation of operation plan.
ABSTRACT
@#Objective To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis. Methods Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer, including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP, CNKI and CBM, from inception to January 2020. Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria. Quality of the enrolled literatures was evaluated, and data were extracted from the included studies. Afterwards, single-arm meta-analysis was carried out by the R3.6.3 software. Results A total of 12 English and 5 Chinese studies were included, which were all case series, and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale (NOS). After analyzing the clinical prognosis of 260 patients, the 30-day mortality was 6% (95%CI 0.04 to 0.11, P=0.97), the late mortality was 8% (95%CI 0.05 to 0.14, P=0.78), the incidence of endoleak was 21% (95%CI 0.16 to 0.29, P=0.06), the incidence of stroke was 5% (95%CI 0.03 to 0.09, P=0.99), the incidence of new aortic dissection was 7% (95%CI 0.04 to 0.11, P=0.96), the incidence of dissection progression was 10% (95%CI 0.07 to 0.16, P=0.24), and the absorption rate of intramural hematoma was 84% (95%CI 0.37 to 1.00, P<0.01). Conclusion Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients, and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery. Endoleak, stroke and new aortic dissection are the early serious complications of this method.
ABSTRACT
Objective To evaluate the safety,efficacy of interventional treatment for late postpancreaticoduodenectomy hemorrhage (LPPH).Methods From Jan 2008 to Dec 2017,678 patients underwent pancreaticoduodenectomy (PD).33 patients (4.9％) suffered from LPPH.30 of these 33 patients underwent diagnostic angiography and endovascular treatment,either transcatheter arterial embolization (TAE,n =21) or covered stent placement (CSP,n =9),and the other 3 underwent laparotomy.Results The incidence of LPPH is 4.9％ with a 12％ motality.The most common presentation is bleeding from abdominal drainage (24.2％) and melena (24.2％).The incidence of sentinel bleeding (SB) is 45.5％ and postoperative pancreatic fistula (POPF) is 69.7％.Intra-abdominal infection were identified in 24 patients (72.7％) and the most common pathogenic bacteria is pseudomonas aeruginosa (11/24,45.8％).The mean time between PD operation and LPPH was 17.4 days.In 21 patients receiving TAE,4 got liver damage and 2 with liver abscesses,1 died.The most common site of LPPH is GDA stump and re-bleeding occurred in 5 patients.9 patients by CSP got bleeding under control.In all 7 re-bleeding patients,2 were saved by CSP,1 was saved by TAE,while the other 4 died.Conclusion Early intervention plays an important role for LPPH.CSP is better than TAE.
ABSTRACT
Objective To evaluate the efficacy of covered stent (CS) in the treatment of central venous occlusive disease (CVOD) of different branches in hemodialysis patients. Methods Twenty-five cases of CVOD in the First Affiliated Hospital of Sun Yat-sen University from Oct 2015 to June 2018 were enrolled. All patients underwent percutaneous transluminal angioplasty (PTA)+stent graft (PTS) successfully. The stent grafts of different diameters were implanted according to intraoperative angiography to measure the diameter of normal blood vessels around the diseased vessels. The operation was successful and the follow-up data was complete. According to the different branches of central venous lesions, the patients were divided into three groups: subclavian vein group, brachiocephalic vein group and superior vena cava group. The stent diameter, primary patency andassisted primary patency time were analyzed and compared in the three groups. Results The diameters of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group were (10.29 ± 0.42) mm, (12.29 ± 0.32) mm and 13.00 mm, respectively. There were significant differences in the diameters of the subclavian vein group, the superior vena cava group and the brachiocephalic vein group (both P<0.05). As of the end of follow-up, the primary patency time of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group was (10.57 ± 2.00) months, (19.40±3.28) months, and (32.75±3.28) months respectively. The primary patency time of the superior vena cava group was significantly longer than the other two groups (P<0.05). There was no significant difference in the primary patency time between the subclavian vein group and the brachiocephalic vein group (P=0.072). The assisted primary patency time of the subclavian vein group, the brachiocephalic vein group and the superior vena cava group was (15.57 ± 3.20) months, (25.14 ± 2.39) months, (39.00 ± 3.03) months. There was a statistically significant difference in the assisted primary patency time between the three groups (P<0.05). Conclusions There are differences in vascular patency between postoperative vascular grafts of different diameters in different sites. The larger the diameter of the lumen stent, the longer the stent patency time is. It is important to protect the blood vessels with smaller diameters.
ABSTRACT
Objective@#To investigate the medium-term curative effect of transjugular intrahepatic portosystemic shunt (TIPS) through jugular vein with covered Viatorr stent.@*Methods@#Data of 105 consecutive patients with covered Viatorr stent of our hospital was retrospectively analyzed. Follow-up was performed after surgery, and color Doppler was reviewed to evaluate the efficacy of TIPS.@*Results@#Transjugular intrahepatic shunt was successfully established in all patients. The pressure gradients of portal vein before and after operation were 22.33 ± 6.4 mmHg and 9.78 ± 4.9 mmHg, respectively,P< 0.01, and the difference was statistically significant. The follow-up period ranged from 12.7 to 15.6 months, with an average of 13.09 ± 1.4 month. Total bilirubin and coagulation time increased after operation, but there was no significant difference in total bilirubin and coagulation time at 1, 3, 6 and 12 months after operation. The patency rate of shunt was 100%, 99.05%, 99.05% and 99.05% at 1, 3, 6 and 12 months after operation. The incidence of hepatic encephalopathy was 34.2%, 29.5%, 19.1% and 14.3% respectively. The recurrence rate of symptoms was 0%.@*Conclusion@#Patients with cirrhotic portal hypertension who underwent TIPS with covered Viatorr stent had a lower rate of restenosis, improved liver function, and a lower incidence of severe hepatic encephalopathy. However, the long-term efficacy needs further observation.
ABSTRACT
Objective@#To evaluate the efficacy of covered stent (CS) in the treatment of central venous occlusive disease (CVOD) of different branches in hemodialysis patients.@*Methods@#Twenty-five cases of CVOD in the First Affiliated Hospital of Sun Yat-sen University from Oct 2015 to June 2018 were enrolled. All patients underwent percutaneous transluminal angioplasty (PTA)+stent graft (PTS) successfully. The stent grafts of different diameters were implanted according to intraoperative angiography to measure the diameter of normal blood vessels around the diseased vessels. The operation was successful and the follow-up data was complete. According to the different branches of central venous lesions, the patients were divided into three groups: subclavian vein group, brachiocephalic vein group and superior vena cava group. The stent diameter, primary patency and assisted primary patency time were analyzed and compared in the three groups.@*Results@#The diameters of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group were (10.29±0.42) mm, (12.29±0.32) mm and 13.00 mm, respectively. There were significant differences in the diameters of the subclavian vein group, the superior vena cava group and the brachiocephalic vein group (both P<0.05). As of the end of follow-up, the primary patency time of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group was (10.57±2.00) months, (19.40±3.28) months, and (32.75±3.28) months respectively. The primary patency time of the superior vena cava group was significantly longer than the other two groups (P<0.05). There was no significant difference in the primary patency time between the subclavian vein group and the brachiocephalic vein group (P=0.072). The assisted primary patency time of the subclavian vein group, the brachiocephalic vein group and the superior vena cava group was (15.57±3.20) months, (25.14±2.39) months, (39.00±3.03) months. There was a statistically significant difference in the assisted primary patency time between the three groups (P<0.05).@*Conclusions@#There are differences in vascular patency between postoperative vascular grafts of different diameters in different sites. The larger the diameter of the lumen stent, the longer the stent patency time is. It is important to protect the blood vessels with smaller diameters.
ABSTRACT
Objective To investigate the effect of covered stent on the treatment of Stanford type B aortic dissection and its effect on cardiopulmonary function. Methods From June 2014 to December 2015, sixty-four AD patients treated in our hospital were selected and were divided into the control group(30 cases) and the observation group ( 32 cases) . The control group was treated with conservative treatment while the observation group was treated with covered stent. After treatment,two groups of patients were followed up for at least 24 months to understand the recovery status after treatment and evaluate the effect. . Results The time of hospitalization of the observation group ((26. 10±8. 14) d) was shorter than that of the control group ((33. 89 ±8. 32) d) (t＝4. 963,P＜0. 05),and there was no statistically significant difference in the mortality and complication rate in 30d after operation between the two groups (χ2＝1. 084,0. 015,P＞0. 05); at 24 months after discharge,the survival rate (93. 75%(30/32)),standard rate of blood pressure 93. 75 (30/32) and treatment compliance rate(90. 63 (29/32)) of the observation group were higher than those of the control group (53.33%(16/30); 60.00(18/32);73.33(22/30)) (χ2 ＝ 13.210、10.088、4.771,P＜0.05) . After treatment,the cardiac output((4. 99±0. 53) L/min) and left ventricular ejection fraction((51. 88±3. 64)%) of the observation group were higher than those of the control group((4. 13±0. 13) L/min,(46. 30 ±9. 63)%). The end systolic diameter of left ventricle (( 55. 75 ± 2. 11) mm) and left ventricular end diastolic diameter ((57. 80± 3. 53) mm) of the observation group were less than those of the control group (( 65. 77 ± 2. 21), (64. 54±2. 67) mm). The differences between the two groups were statistically significant(t＝8. 643、3. 054、8. 436、18. 263,P＜0. 05). Conclusion Covered stent is safe and effective in the treatment of Stanford type B aortic dissection.
ABSTRACT
Objective To evaluate the clinical effect of endovascular therapy with covered stent in treating aortoiliac occlusive disease. Methods The clinical data of 20 patients with aortoiliac occlusive disease, who received endovascular therapy with covered stent during the period from January 2014 to December 2016, were collected. According to Rutherford standard of clinical symptom classification, gradeⅢ, grade Ⅳ and grade V were seen in 9, 7 and 4 patients respectively. Based on the Trans-Atlantic Society Coalition (TASC) treatment guidelines Ⅱ classification, B type, C type and D type were observed in 4, 7 and 9 patients respectively. The postoperative primary patency and secondary patency of the stent as well as the clinical efficacy were analyzed. Results Endovascular treatment was successfully accomplished in all 20 patients. After the treatment, the clinical symptoms were significantly relieved. Two patients developed complications (10％). One patient developed thrombus at the distal end of stent, which was improved after thrombolytic therapy. Another patient developed hematoma at puncture site, which was absorbed after conservative therapy. No perioperative death occurred. The patients were followed up for 5-37 months, with a mean of (17±10) months. The primary patency rate was 95％ and the secondary patency rate was 100％. Conclusion For the treatment of aortoiliac occlusive disease, endovascular therapy with covered stent has excellent clinical efficacy.
ABSTRACT
Objective To evaluate the efficacy and safety of endovascular repair with covered stent in treating ruptured carotid artery pseudoaneurysms.Methods The clinical data of 15 patients with ruptured carotid artery pseudoaneurysm,who were admitted to Sun Yat-Sen Memorial Hospital of Zhongshan University during the period from July 2009 to July 2015 to receive emergency rescue with endovascular covered stent implantation,were retrospectively analyzed.Of the 15 patients,the rupture of common carotid artery pseudoaneurysm caused by direct trauma was seen in one and caused by cervical operation was observed in one,the rupture of internal carotid artery pseudoaneurysm caused by cervical operation was found in 3,and the rupture of internal carotid artery pseudoaneurysm due to radiotherapy for nasopharyngeal carcinoma was seen in 10.Results Successful rescue with endovascular repair using covered stent implantation was obtained in all 15 patients.No immediate procedure-related complications or death occurred.The mean follow-up time was 11 months.During the follow-up period,no re-bleeding or cerebral ischemic complications occurred.Conclusion For the treatment of ruptured carotid artery pseudoaneurysms,endovascular repair with covered stent is minimally invasive,safe and effective with less complications;and along with the occlusion of carotid artery rupture,the blood supply of the head and neck returns to normal.However,further clinical researches with larger samples are needed before its long-term efficacy can be completely clarified.
ABSTRACT
Objective To discuss the efficacy and safety of covered Cheatham-Platinum stent (CCPS) implantation in treating coarctation of the aorta (CoA).Methods The clinical data of 11 patients with CoA who had received CCPS implantation were retrospectively analyzed.Results Successful implantation of single CCPS was accomplished in all 11 patients.After the implantation,the diameter of coarctation site was immediately dilated from preoperative (4.76+0.89) mm to postoperative (12.86+0.90) mm (t=24.86,P＜0.001),and the average systolic blood pressure difference across the coarctation was immediately reduced from preoperative (38.55+10.02) mmHg to postoperative (9.82+6.60) mmHg,the difference was statistically significant (t=10.8,P＜0.001).The patients were followed up for 3-79 months,with a mean of (31.91±27.58) months.The clinical symptoms were relieved in all patients and the activity tolerance was obviously improved.No complications such as endoleak,acute injury of aortic wall,re-coarctation or re-stenosis,vascular injury of puncture site,or death occurred in all patients.Conclusion For the treatment of CoA,implantation of CCPS has excellent short-term and mid-term effect,meanwhile,this technique can effectively avoid complications such as aortic wall iniurv.(J Intervent Radiol.2017.26:211-214)
ABSTRACT
Objective To compare the curative effect of thoracic endovascular repair (TEVAR) plus medication with that of pure medication in treating uncomplicated type B aortic dissection,and to discuss the treatment strategy for uncomplicated type B aortic dissection.Methods The clinical data of 118 patients with definitely confirmed uncomplicated type B aortic dissection,who were admitted to authors' hospital during the period from 2004 to 2015,were retrospectively analyzed.Among the 118 patients,57 patients received TEVAR plus medication (TEVAR group) and 61 patients were treated with pure medication (drug group).The complications and mortality within one month and during follow-up period in both groups were calculated respectively,and Kaplan-Meier survival curves were used to compare the survival rate between the two groups.Results The incidences of complications and morbidity during hospitalization and within one month after treatment in TEVAR group were 5.2％ and 0％ respectively,which in the drug group were 0％ and 0％ respectively.The patients were followed up for 1-110 months,with a mean of (43.3±36.7) months.The incidence of main complications and the mortality in TEVAR group were 7.0％ and 5.3％ respectively,which in the drug group were 6.6％ and 8.1％ respectively.The one-,2-,4-and 7-year cumulative survival rates in TEVAR group were 100％,97.1％,93.5％ and 78.0％ respectively,which in the drug group were 98.4％,96.4％,90.8％ and 72.7％ respectively,the differences between the two groups were not statistically significant (~=0.019,P=0.890).Conclusion For the treatment of uncomplicated type B aortic dissection,TEVAR plus medication is superior to pure drug therapy in reducing expansion rate of false cavity,but TEVAR carries some procedure-related complications,besides,TEVAR can not improve the survival rate.(J Intervent Radiol,2017,26:266-269)
ABSTRACT
Objective To evaluate the safety and efficacy of Viabahn covered stent in treatment of hepatic artery pseudoaneurysm (HAPA) caused by surgery.Methods Clinical data of 7 patients with postoperative massive intra-abdominal hemorrhage and diagnosed as HAPA with emergency angiography were collected from November 2015 to May 2016.All the patients underwent Viabahn covered stent implantation.Perioperative and postoperative clinical data of the patients were recorded,and with 1-month follow-up.Results All the 7 cases were diagnosed as extrahepatic HAPA and successfully completed Viabahn covered stent procedure,and curative rate was up to 100％.One case experienced transient vasospasm in the hepatic artery proximal to the stent.All the patients repeated hepatic artery CT angiography scans one week after surgery,with no evidence of bleeding.With 1-month follow-up,all the patients were in stable conditions.Conclusion Viabahn covered stent is minimally invasive,simple and effective interventional approach for HAPA.
ABSTRACT
Objective To discuss the feasibility,safety and validity of ViabahnTM self-expanding covered stent in endovascular repair of femoral pseudoaneurysm caused by intravenous drug injection.Methods The clinical data of 9 patients with femoral pseudoaneurysm caused by intravenous drug injection,who were admitted to authors' hospital during the period from April 2014 to April 2015,were retrospectively analyzed.The pseudoaneurysms were located at the common femoral artery in 6 patients and at the superficial femoral artery in 3 patients.Endovascular repair with ViabahnTM self-expanding covered stent was performed in all the 9 patients.The intraoperative angiographic findings,the sizes of the implanted stents,and the manifestations of the angiography performed immediately after stent implantation were recorded,after operation,the patients were kept under close observation to evaluate the improvement of clinical symptoms,the effect of pseudoaneurysm repair,and the occurrence of endoleak,stent infection,in-stent stenosisand fracture of stent.Anti-infection treatment was employed both before and after the stent implantation;after the stent implantation debridement and/or drainage for soft tissue infection area of inguinal region was adopted.Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 9 patients,with a technical success rate of 100％.Angiography performed immediately after stent implantation showed that complete repair of pseudoaneurysm cavity was obtained in all 9 patients,the distal segment of the parent artery was patent,and no endoleak occurred.The patients were followed up for 6-12 months,and limb salvage was successful in all patients,no intermittent claudication or muscular atrophy occurred.CT angiographyreexamination showed that no endoleak,stent infection,stent fracture or in-stent stenosis occurred.Conclusion Under the conditions of adequate anti-infection,local debridement and drainage,the use of ViabahnTM self-expanding covered stent can promptly close the break of femoral pseudoaneurysm to save the patient's life.Because of the excellent qualities,such as flexibility,adhesion and patency,of ViabahnTM self-expanding covered stent,the postoperative occurrence of intermittent claudication,stent fracture and in-stent stenosis can be effectively reduced.It is expected that ViabahnTM self-expanding covered stent may become one of the vascular reconstruction methods for femoral pseudoaneurysm caused by intravenous drug injection,although its long-term curative effect needs to be further observed and verified.
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 discuss the feasibility of the establishment of a Y-shaped channel with windowing technique in treating the stent shunt obstruction occurring after transjugular intrahepatic portosystemic shunt (TIPS).Methods From February 2012 to December 2016,puncture windowing technique was employed in 7 patients to establish a Y-shaped channel in order to treat the stent shunt obstruction complicated by gastric varices bleeding or ascites due to recurrent portal hypertension.The preoperative Child-Pugh scores of liver function ranged from 5 to 10 points,with a mean of (6.85±1.56) points.The blood flow in both the portal vein and the shunt was determined before operation as well as at 5 days and 1,3,6months after operation;the post operative results were compared with preoperative ones.Results Y-shaped channel was successfully reconstructed in all 7 patients.The patients were followed up for a mean of 11months.Neither death nor hepatic encephalopathy occurred.Conclusion For the treatment of post-TIPS stent shunt obstruction,Y-shaped channel reconstruction within the occluded stent by using windowing technique is safe and effective,the operation is simple and easy.Therefore,this technique has certain clinical value.
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.
ABSTRACT
<p>Endovascular treatment is a first-line treatment for renal arteriovenous malformations (AVMs). Endovascular treatment might be effective in patients with aneurysmal-type renal AVMs, which involve one feeding artery and one drainage vein, because control of the feeding artery, rather than the aneurysm itself, could have a therapeutic effect. Herein, we describe two cases of patients with renal AVM with multiple renal artery aneurysms, who were treated by controlling the arterial inflow alone. In Case 1, the patient was a 76-year-old woman with renal AVM discovered during examination for another medical condition. A computed tomography scan revealed four renal aneurysms (φ38/44/24/35 mm) ranging from an intimal defect in the right renal artery to the drainage vein running into the inferior vena cava (IVC). Although we had planned to use a covered stent in the right renal artery to cover the intimal defect without embolization of the aneurysms, a minor artery proximal to the aneurysm was found near the orifice of the right renal artery. Therefore, we used a covered stent in the right renal artery after embolization of the most proximal aneurysm was performed. In Case 2, a 78-year-old man was referred to our facility because a renal AVM was found during examination for lower back pain. The distal posterior branch of the right renal artery attached to the multiple aneurysms and directly drained into the IVC, which was diagnosed as an aneurysmal-type renal AVM. Because there were no arteries arising from the aneurysms in the right renal artery, which fed the renal parenchyma, embolization of only the inflow artery was performed. For both patients, renal blood flow was maintained without any decrease of the renal function. In these patients, although renin-angiotensin system activity was within the normal range, and blood pressure became better controlled postoperatively. In addition, there was significant improvement in the brain natriuretic peptide (BNP) levels postoperatively. Thus, we believe that unstable hypertension and/or high-output heart failure as well as the aneurysmal size should be assessed in the management of renal AVMs.</p>
ABSTRACT
Objective To investigate the efficacy and safety of covered stent in treatment of esophageal perforation. Methods Observe and analyzed the effect and complications of covered metallic stent in esophageal perforation. In all of 40 cases, the most common causes were iatrogenic, esophageal cancer, and foreign body. Results All patients with esophageal perforation got successful esophageal stent placement. All of them recovered smoothly in eating. The stents were removed 4 days to 1 month later. Gastroscopy and angiography confirmed esophageal perforation has healed. 3 cases of esophageal cancer patients with dysphagia obviously relieved after stent placement. The main complications in stent and stent migration for chest pain after operation. 6 cases (15 %) of patients with stent displacement, while 2 cases (5 %) of esophageal cancer patients with food obstruction and stent displacement. Conclusion Treatment of esophageal perforation with covered metal stents endoscopically is effective and safe.