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Objective:The perioperative and early follow-up data of the simultaneous hybrid CAS+ OPCABG and sequential CAS+ OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+ OPCABG.Methods:A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021, among which 12 patients received simultaneous CAS+ OPCABG and 14 patients received staged sequential CAS+ OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results:There were no significant differences in the operation time, drainage on the first day after surgery, ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group, but no secondary thoracotomy occurred in both groups. The number of days in hospital after operation was significantly less in the simultaneous group. There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group, but there was no statistical difference between the two groups. There was no new cerebral infarction in the two groups, carotid artery ultrasound stent was unobstructed, and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion:Simultaneous CAS+ OPCABG surgery is safe and feasible, it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.
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@#Nowadays, the development of the medical instrument industry makes rapid changes in clinical practice. Hybridization of latest technology is playing an increasingly important role in the diagnosis and treatment of disease. Especially, the trend of the integration of three-channel hybrid technology in diagnosis and treatment of early lung cancer has become increasingly obvious. This paper will focus on the technical advance of the three-channel multi- mirror robot and its application in the diagnosis and treatment of early lung cancer.
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A 75-year-old man was referred to our hospital with a chief complaint of sudden back pain and fever. Enhanced CT showed a Kommerell diverticulum (KD) with right aortic arch and aberrant left subclavian artery (ALSA). It also showed type B aortic dissection with a closed false lumen and the horizontal diameter of the KD was 73 mm. We decided on elective surgery because the size of the KD was so large ; he also had aortic dissection and difficulty in swallowing due to compression of the esophagus. We avoided thoracotomy because it was challenging to approach to the KD and reconstruct the ALSA in situ. There also was the risk of injury to organs around the KD especially the esophagus and trachea via thoracotomy. Therefore, we performed an elective one-stage operation comprising total arch replacement (TAR) and frozen elephant trunk (FET) through median sternotomy followed by thoracic endovascular aortic repair (TEVAR). We could perform the operation safely with a good field of view. This strategy did not need a thoracotomy or in situ reconstruction of the ALSA. The post-operative course was uneventful and he was discharged 18 days after the operation. A CT scan 6 months after the operation showed size reduction of the thrombosed KD with no residual leakage of the stent graft. This hybrid method is one effective option for a KD with right aortic arch and ALSA. We report a successful one-stage hybrid operation for KD with some literature review.
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@#Kommerell's diverticulum is a rare congenital abnormal aortic development. The diverticulum can occur in both left and right aortic arches, from which an aberrant subclavian artery rises to the contralateral side. Only a small number of patients with Kommerell's diverticulum present symptoms. Dysphagia, dyspnea, chest discomfort and upper extremity blood pressure difference are common in adult patients. The risk of aortic dissection or aortic aneurysm rupture is higher in such patients than that in patients with normal aorta. Early surgical intervention is recommended to improve the prognosis. Treatment options include open surgical repair, hybrid operation and total endovascular repair. The choice of surgical method depends on the specific anatomy of patients, the patients' state and the preference of surgeons. This paper reviewed and summarized the surgical methods and early results of the treatment of Kommerell's diverticulum reported in the literature from 2015 to 2020.
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Objective:To evaluate the effect of remote endarterectomy in the treatment of complex lower extremity ischemia.Methods:Twenty-one limb ischemic patients underwent remote endarterectomy in Beijing Hospital from Sep 2016 to Feb 2020. Clinical data including general condition, the lesion of lower artery before operation and follow up outcomes were collected. Then the patency rate and limb salvage rate were calculated.Results:The technique success rate was 71.4% (15/21). The 3, 6, 12 month patency rate were 93.3%, 85.6% and 74.1%, respectively. The 1-year limb salvage rate was 93.3% (14/15). In the 6 patients converted to artificial vessel bypass, the 3,6,12 months patency rates were 76.7%, 66.7% and 46.8%, respectively. The 1-year limb salvage rate was 66.7%.Conclusions:Remote endarterectomy of the lower extremity artery is an alternative option in the treatment of complex ischemic lesions of the lower extremity artery, other than artificial vessel bypass.
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Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.
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Multi-modalities integration is important in improving the outcome of patients with neurovascular diseases.Based on hybrid operation, this mode also integrates modern intraoperative image and monitoring techniques such as neuronavigation and intraoperative electrophysiological monitoring, providing safe, effective and cost-efficient therapies to certain diseases with the cooperation of neurosurgery and neurology department, which has been becoming the direction of modern individualized precise neurosurgery development.
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Aortoiliac occlusive disease (AIOD) can be difficult to treat. We performed aorto-uni-iliac (AUI) stent-grafting with external-iliac artery crossover bypass in 3 cases of extensive AIOD (mean age 69 years). Lesions were TASC II type D in 2 and D+A in 1. Mean ankle-brachial index of diseased side was 0.52. Bare stent placement for iliac stenosis was also done in 2 cases. All cases were a technical success with no complications. Mean operation time was 123 min and mean hospital stay was 11 days. We have been keeping good patency. We consider it an effective treatment option for AIOD.
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A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.
Subject(s)
Humans , Middle Aged , Aorta , Aorta, Thoracic , Cardiac Tamponade , Heart , Hemoperitoneum , Hemorrhage , Laparotomy , Resuscitation , Rupture , Shock , Stents , Sternotomy , Trauma Centers , UltrasonographyABSTRACT
The clinical application of hybrid surgical technique for treatment of cerebrovascular diseases has gone through a course of more than 10 years. From intraoperative angiography in the treatment of intracranial aneurysms and cerebral arteriovenous malformations at the begining to various applications for more complicated cases at present, hybrid operation has become a new world in the treatment of cerebrovascular diseases. At the same time we notice that the clinical application of hybrid surgery is lack of large-scale multicenter clinical control studies, and there are still different opinions on the indication, technical process,quality control,team building and so on. As a new technique and clinical hotspot,hybrid operation for cerebrovascular diseases has a good prospect,and need to be further standardized.
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Hybrid operating room can provide a wonderful platform for the integration ofopen surgery, endovascular treatmentand radiological examinations,making high-quality imaging guided neurosurgery possible. In recent years, there were many reports on hybrid operations thatcombining microsurgery and endovascular technique) for the treatment of cerebrovascular diseases, including complex intracranial aneurysms (giant, fusiform and wide-neck, etc), complcx arteriovenous malformations (AVM) especially those with high Spetzler-Martin grade(IV-V) .complex arteriovenous fistulas (AVF) that cannot be repaired by the traditional treatment, and tandem stenoses of innominate artery, common carotid artery and carotid bifurcation. In hybrid operation, the efficacy can be evaluated in real time,so that treatment process is simplified and medical cost is lowered, offering new opportunities and challenges for the treatment of complex cerebrovascular diseases,but there are still some problems to be solved by further research and development.
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The clinical characteristics of a patient who received hybrid racanalizaion for chronic occlusion of right internal carotid artery was retrospectively analyzed in this report The advantages of hybrid operation for such lesion was discussed and reviewed. This patient was a 59 years old man, who suffered from numbness and weakness at right extremities accompanied with clumsy response. DSA revealed ulcerative plaque in the left internal carotid artery and occlusion of the right internal carotid artery. The hybrid operation to racanalize the occluded right internal carotid artery was performed. Firsdy, right carotid endarlerectomy was perfomed. Intraoperative DSA confirmed right internal carotid artery was recanalized, but the ipsilatcral M2 segment became invisible. It was occluded by a detached embolus which was retrieved by a stent to recover the patency of the artery. This case suggested that hybrid recanalization of occluded internal carotid artery could make use of merits of both endarterectomy and interventional techniques, thus increasing the opportunity of recanalization. Besides, control radiological imaging can be performed at any time during operation to better assure patients' safety.
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Patient 1 was a 73-year-old female who was diagnosed as symptomatic severe stenosis of • left middle cerebral artery with left internal carotid artery tortuosity. Hersymptoms persisted despite the optimal medical therapy. Reconstruction of the left internal carotid artery was successfully performed by truncating the redundant segment and following end-to-end anastomosis, then intracranial steht was deployed via a new available approach. Patient's symptoms alleviated after operation and never reoccured in 12-month follow-up. Patient 2 was a 70-year-old male who had basilar artery severe stenosis with left vertebral artery. Tortuosity and contralateral one slendemess. He suffered from recurrent posterior circulation ischemia even with optimal medical therapy. During the hybrid operation, the left vertebral artery was exposed and cut open so that an available approach for endovascular procedure was created. No recurrence of symptoms in follow- up after operation with for 9 months. Relevant literature was reviewed. We concluded that for treatment of symptomatic severe intracranial artery stenosis with proximal vascular tortuosity, hybrid operation can be safe and effective.
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Objective To evaluate the safety and effectiveness of balloon-assisted clipping of paraclinoid aneurysms with hybrid operatioa Methods From July 2011 to July 2018,119 consecutive patients treated with the balloon-assisted clipping of paraclinoid aneurysms at the Hybrid Operation Room, Department of Neurosurgery, West China Hospital,Sichuan University were enrolled retrospectively. Patients' age, gender, Hunt-Hess grade, ocular symptoms at admission, and location and size of aneurysms were collected. Balloon-assisted craniotomy for clipping aneurysms was used ,95 of them were treated with detachable balloon at the proximal end of the aneurysms, and 24 were blocked by balloons in the aneurysm neck straddles. During the operation,the state of discharge after surgery,and the follow-up results at 6 months after discharge of the patients were observed. The operation effect and complications were evaluated.Results Of the 119 patients,94 were female and 25 were male;aged 27 -82 years (mean 57 ± 15 years). Twenty-nine patients (24. 4%) showed decreased vision,62 (52. 1%) had dizziness and headache symptoms. The remaining 28 had no obvious symptoms. Hunt-Hess grade III in 3 cases (2. 5%) ,grade I-II in 42 cases (35. 3%) ,the remaining 74 (62. 2%) were unruptured aneurysms. Twenty-one patients (17.6%) had clinoid segment aneurysms, 82 (68.9%) had ophthalmic segment aneurysms, and 16 (13. 4%) had posterior communication aneurysms. The maximum diameter of the aneurysms was 5 to 35 mm (mean 19 ±7 mm) ,and the aneurysm diameter of 112 patients (94.1%) were > 10 mm. The aneurysms were successfully clipped in 111 cases (93. 3%) during the operation. Five patients had aneurysm neck and internal carotid artery lacerations during the clipping,and one was obviously unable to be clipped due to the neck calcification. After Hyperglide balloon saddle block, 1 patient occurred balloon rupture during the puncture and aspiration of the aneurysmal cavity. When the balloon was blocked in 1 case, balloon displacement occurred during repeated filling adjustment of aneurysm clips and the distal end detached into an aneurysm cavity and was clipped by an aneurysm clip. Three patients died at discharge, they were all aneurysm neck and internal carotid artery lacerations, and they were patients with massive cerebral infarction after aneurysm tapping. Five patients were in a coma; another 6 had hemiplegia symptoms. The remaining 105 patients (88. 2%) had no obvious neurological deficits at discharge. Six months after discharge, 11 patients with neurological deficits were followed up by telephone. Among the 5 comatose patients,3 died within one week after discharge. The consciousness of 2 cases changed from coma to indifference, their left limb muscle strength was grade III,and blurred vision was the same as before operation. Of the 6 hemiplegic patients, 1 died 3 months after discharge, and the other 5 had clear consciousness and their blurred vision was the same as before operation, all had limb hemiplegia, and their muscle strength was grade I - U - Conclusion Hybrid surgery with balloon-assisted clipping technique may effectively treat complex paraclinoid aneurysms.
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Stylocarotid artery syndrome is a rare condition resulted from compression of the internal or external carotid artery by the styloid process of temporal bone. Patient was presented with left limbs weakness, then compression of the right carotid artery by elongated styloid process was found. He was treated by styloid process truncation with hybrid technique. After operation, compression of carotid artery was relieved. No arterial perforation or dissection happened. This case demonstrated that treatment of carotid artery stylocarotid syndrome with hybrid operation that combines endovascular techniques, radiological imaging and surgical resection can be minimally invasive, safe and effective.
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Objective@#To evaluate the clinical value and outcomes of technical improvement of hybrid operatical clipping for large paraclinoid internal carotid artery aneurysms.@*Methods@#A review was conducted on 18 cases of large paraclinoid internal carotid artery aneurysm which were clipped by balloon non-fluoroscopic occlusion of the parent artery via a micro-bone window frontolateral approach in hybrid operating room at Neurosurgery Department of Tianjin Medical University General Hospital from June 2014 to December 2017. There were 8 males and 10 females with age of (63±4) years. There were 6 cases of unruptured aneurysm and 12 cases of ruptured aneurysm of subarachnoid hemorrhage (6 cases of grade Ⅱ, 4 cases of grade Ⅲ and 2 cases of grade Ⅳ in Hunt-Hess classification). Frontolateral approach incision (average length of about 5 cm) and bone window about 3 cm×3 cm were performed. No incision of the neck was needed to expose the internal carotid artery for temporary occlusion. In the operation, the balloon was slowly pushed to the preset position of the internal carotid artery under non-fluoroscopy. The balloon was expanded to block the blood flow of internal carotid artery. Then aneurysm was clipped. The balloon was loosened and retraced to the guiding catheter after clipping. The clipping condition was examined by cerebral angiography. If there was residual aneurysm neck or stenosis of the parent artery, the balloon was pushed under non-fluoroscopy again to temporary occlusion and the clip was adjusted until the aneurysm neck was clamped satisfactorily.@*Results@#Eighteen aneurysms were successfully clipped in hybrid operating room. Fourteen aneurysms showed complete occlusion of the aneurysm neck and no stenosis of the parent artery. Four cases showed residual aneurysm neck after clipping by intraoperative angiography, then aneurysms were clipped satisfy by adjusting the aneurysm clip. The patients were followed up for 3 months to 1 year. Ten patients recovered well (modifed Rankin score (mRS): 0), and 3 patients had no obvious disability (mRS: 1). Two patients with Hunt-Hess grade Ⅲ were slightly disabled (mRS: 2). 1 patients with Hunt-Hess grade Ⅲ were moderately disabled (mRS: 3). 1 patients with Hunt-Hess grade Ⅳ were severely disabled (mRS: 4). One elderly patients with Hunt-Hess grade Ⅳ were seriously disabled (mRS: 5).@*Conclusions@#Application of balloon non-fluoroscopic occlusion clipping for large paraclinoid internal carotid artery aneurysm via a micro-bone window frontolateral approach is safe, effective and minimally invasive.
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Intracranial aneurysm is a focal lesion of the intracranial arterial wall induced by congenital abnormalities or trau-ma,and its rupture leads to an extremely high mortality. Microsurgical clipping and intravascular intervention are the two main treat-ment options for intracranial aneurysms,and each has its advantages and disadvantages. Hybrid surgery combines the advantages of the two strategies to solve some of the problems that defy a single surgical technique or interventional therapy. This article introduces the concept of hybrid surgery,the history of its development,and its advantages,disadvantages and prospects in the treatment of intracra-nial aneurysm.
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Objective Analysis of hybrid cardiac and non-cardiac operations.Methods 11 patients received hybrid operations during 2000 ～2016 in our hospital were summarized, meanwhile another 11 patients undergoing only cardiac sur-gery served as controls.The level of CK-MB, TNI and visual analogue pain scores were recorded.The hospitalization expenses and postoperative hospital time were compared between the two groups .Results There was no death during hospitalization . There were no serious complications such as wound infection, delayed wound healing, postoperative bleeding requiring re-thora-cotomy and hemostasis, malignant arrhythmia, cerebral infarction and so on.Longer operation time[(358 ±79)min vs.(224 ±56)min, P<0.01], more allogeneic red blood cells transfusion[(3.2 ±1.6)U/case vs.(1.1 ±0.8)U/case, P<0.05] and more plasma transfusion[(515 ±234)ml/case vs.(284 ±92)ml/case, P<0.01]in hybrid operation group than those in the control group.There was no significant difference about CK-MB and TNI between two groups perioperatively(P>0.05). The wound pain was mild after cardiac surgery , and the wound pain was moderate after hybrid operation , which had little effect on rehabilitation exercises such as cough.4 days longer of postoperative hospital stay and 23 thousand yuan of hospitalization cost in hybrid operation group than those in the control group.One patient diagnosed of unstable angina pectoris and sigmoid colon cancer with intestinal obstruction was failed to resection of the tumor after received pericardial stripping and coronary ar-tery bypass surgery.The patient died three weeks after surgery due to intestinal obstruction and cachexia .The remaining 10 pa-tients were underwent successful surgery, cured and left hospital.No serious cardiovascular events, tumor recurrence and me-tastasis were found as followed up for 6-20 months.Conclusion Our practices show that hybrid cardiac and non-cardiac op-erations can be done safely and effectively.
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This article summarized nursing experience of 7 cases of carotid body tumors treated by hybrid operation.Key points of nursing included:preoperative carotid compression training,postoperative blood pressure management,head and neck immobilization together with lower extremity immobilization,and prevention and nursing of complications.All patients were recovered and discharged.
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Objective To discuss the perioperative nursing based on a recent patient with acute Stanford type A aortic dissection undergoing hybrid operation including David, debranch and thoracic endovascular aortic repair procedures. Methods The specialised perioperative nursing tactis were recommended including routine practice, pain control, psychological guidance, vital signs management, respiratory care, anti-coagulation therapy and other related treatments. Results As the active treatment and nursing, this patient recovered successfully and discharged smoothly with no sign of any complications. Conclusions Even though the condition of Stanford type A aortic dissection patients is unstable, complicated and dangerous, the promotion of their life quality could be still accessible by well organized combine of both doctors′ and nurses′ endeavor: David, debranch and thoracic endovascular aortic repair procedures.