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Objective To explore the differences of aortic diameter measured by catheter calibration method and centimeter sizing catheter calibration method in endovascular graft exclusion for Stanford type B aortic dissection.Methods A total of 30 patients with Stanford B type aortic dissections treated with endovascular graft exclusion were measured with the two calibration methods to measure aortic diameters at left subclavicular artery position.The measurement parameters were compared with CTA measurement results.Results Statistical differences of measurement parameters were found among catheter calibration,centimeter sizing catheter calibration and CTA (F=3.15,P＜0.05),and paired comparison showed statistical differences between catheter calibration method and CTA result (P＜0.05),and between the results of catheter calibration method and centimeter sizing catheter calibration method (P＜0.05),while no statistical difference was found between centimeter sizing catheter calibration method and CTA result (P＞0.05).Taking CTA as golden standard method,Bland-Altman analysis indicated that the centimeter sizing catheter calibration method exerted better consistency with CTA.Conclusion The measurement value of centimeter sizing catheter calibration method is identical to the CTA measurement result,and superior to catheter calibration method for precise stent selection in Stanford type B aortic dissection.
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Objective To evaluate the short-term and mid-to-long-term clinical effectiveness of endovascular isolation technique with covered-stent in treating Stanford type B aortic dissection. Methods A total of 183 patients with Stanford type B aortic dissection, who were admitted to authors’ hospital during the period from January 2005 to December 2013 to receive endovascular isolation treatment with covered-stent under general anaethesia, were enrolled in this study. The clinical data, including post-operative symptoms, complications, retention time in ICU, hospitalization days, 30-day mortality, etc. were retrospectively analyzed. After discharged from hospital, the patients were followed up to check the situation, position and shape of the stent, the diameter of dissection false lumen, the internal leakage, etc. The survival rate and the quality of life were determined. Results Endovascular isolation procedure with covered-stent was successfully accomplished in all the 183 cases. The retention time in ICU was (3.08 ± 1.93) days, the mean hospitalization time was (3.08 ± 1.93) days, and the 30-day mortality was 1.09%. After discharged from hospital, the patients were followed up regularly, and no collapse or displacement of stent was observed, and the stent remained in its normal shape. No recurrence of dissection, rupture or reversal tear was observed. No long existing internal leakage could be detected. During the follow-up period 4 patients died, among them three died from cerebral infarction and one died of natural death. The 5-year survival rate was 97.82% and the patient’s quality of life did not become apparently worse. Conclusion For the treatment of Stanford type B aortic dissection, endovascular isolation therapy with covered-stent has excellent short-term effect and stable mid-to-long-term result.
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Objective To evaluate the characteristics and the value of dual-source CT single-energy high pitch scanning technology in postoperative follow-up of endovascular graft exclusion to DeBakey Ⅲ aortic dissection.Methods All of 58 patients with endovas-cular graft exclusion to Debakey Ⅲ aortic dissection underwent dual-source CT checkup.30 patients (group A)were scanned with single-energy high pitch technology,voltage 120 kV,pitch 3.2;28 patients (group B)were scanned with dual-energy standard pitch technology,voltage 100 kV and 140 kV,pitch 1.0;both groups were used CareDose4D technology to automatically track the cur-rent.Image post-processing was completed at the workstation.The stent condition,endoleak and residual dissection were observed and analyzed.The differences of image quality and radiation dose between two scanning modes were compared.Results All of 58 cases,postoperative conditions to 9 cases were perfect,the proportion was 1 5.52%;43 cases were with distal residual dissection,the proportion is 74.14%;and 12 cases were accompanied with endoleaks,the proportion was 20.69%.The endoleaks manifestation in-cluded punctuate,band-like,and patchy high density around the stent in enhanced images.The difference of scan length between group A and group B was not statistically significant,the image quality of both groups met excellent standard .The acquisition time and effective radiation dose to group A were 1/4 and 56% of group B respectively.the differences of both groups were statistically significant.Conclusion Dual-source CT with single-energy high pitch scanning technology can ensure image quality and significantly reduce the effective radiation dose,it is a more advantageous scanning mode.
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Objective To analyse the preoperative diagnose and treatment experience of applying endovascular graft exclusion (EVGE)curing thoracic aortic dissection(AD) ,thus provide experience of diagnose and treatment for cure AD in clinical .Methods Review the clinical data ,therapeutic measures and follow‐up results of 226 AD patients .All patients were treated by EVGE ,coun‐terchecked by DSA post‐operation and reviewed .Results CTA and MRA in the diagnosis of crevasse position coincidence rate was 96 .8% and 95 .2% respectively .One case failed ,the remaining 225 cases were successfully placed graft ,success rate was 99 .6% .It showed that 93 .8% (211/225) complete disappearance of the false lumen or remarkable decrease of the endoleak was noted on the angiograms after stent implantation .No severe procedure‐related complications and death was observed .Conclusion CTA and MRA are important for us to choose appropriate routes ,can be the first choice of pre‐operation examination .EVGE is small trauma , short recovery time and effective in curing AD .
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Objective To analysis the efficacy and safety of endovascular graft exclusion for patients with Stanford type B aortic dissection.Methods The clinical data of 46 patients with Stanford type B aortic dissection who received endovascular graft exclusion were analyzed retrospectively.The stents were inserted from the femoral artery to exclude the tear of dissection,and all operation were peformed under digital subtraction angiography (DSA).The operative technique,outcome and complications were observed.Results The stents were successfully performed in all patients.The length of stay in hospital time after operation was 5-20 (12.9 ± 3.4) d.Endo-leak occurred in 2 patients and relieved after re-expanding.Followed up for 2 d to 5.1 years,average 36 months,1 patient got lacunar infarction and 1 patient died after leaving hospital 2 d.The others were free from the serious complications such as aortic dissection and paraplegia.Conclusion Endovascular graft exclusion is safe and effective for the treatment of Stanford type B aortic dissection in hospital and mid-term,and can significantly improve the survival rate and quality of life.
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Objective To evaluate the effectiveness of combination technique in treating descending thoracic aortic dissection with coronary heart disease by endovascular graft exclusion (EVGE) and percutaneous coronary intervention(PCI). Methods From April, 2002 to October, 2013, a total of 40 in-hospital patients with descending thoracic aortic dissection and coronary heart disease who underwent EVGE and PCI were analyzed for outcomes. All patients were performed EVGE before they underwent PCI in 3~7days of time. Long-term treatment were observed. Results For dissection tears, 40 trunk tectorial membrane stents were used. The rate of success of EVGE implantation was 100%. No paraplegia, death and other complications. 59 stents were placed to 54 target vessels of 40 patients. The success rate of PCI procedure was 100%and no severe complication occurred. All patients were followed up for average 56±31 months. The rate of followed up was 92.5%(37/40). During follow-up, 3 patients died including two patients died of cerebral hemorrhage and one case of malignant tumor. The major adverse cardiac events (MACE) rate was 6.9% in the 29 cases of patients who underwent EVGE and PCI during the clinical follow-up. Conclusions It is safe and feasible that treating descending thoracic aortic dissection with coronary heart disease by combination technique of EVGE and PCI.
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Objective To investigate the efficacy and the indication and the management of perioperative complications in treatment of infra- kidney abdominal aortic aneurysm (AAA) by using endovascular graft exclusion (EVGE). Methods From April 2006 to September 2008, 24 patients with infra- kidney abdominal aortic aneurysms were diagnosed by contrast-enhanced CT or MRI scan. Vascular access was obtained through the bilateral femoral artery after arteriotomy and stent-graft was deployed into AAA of below the renal artery to occlude the left over cavity of AAA. The stent- graft was extended and anchored to the both side wall of AAA, the blood flow enter into the arteria iliaca communis through the sten't.Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 20 patients and the type Ⅰ minor leakage in 4 patients. No stent movement or organ and both lower extremities ischemia was found at the early post operative stage in all the patients. Six months after the operation, in all the 24 patients, contrast-enhanced CT scan showed the disappearance of the aneurysm and thrombosis at the level of the stent. Conclusions EVGE is simple,minimally invasive,less complication and quick recovery after operation. Thus it becomes first choice for the treatment of AAA for the elder patients.
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Acute aortic dissection is the most lethal one among the diseases involving the aorta.This article reviewed the operative indications,methods,curative effects and clinical prospect of Endovascular Graft Exclusion (EVGE) for aortic dissection .The indications for EVGE are DeBakeyⅢB type aortic dissections with the intimal tear. EVGE is a minus invasive method with a firmly curative effects, and its clinical prospect will be very bright.
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This paper is to summarize our experiences in the operation indication and management of perioperative complications in treatment of Stanford B aortic dissection by using endovascular graft exclusion (EVGE). 32 patients underwent the procedure of EVGE . Various sizes of tubular grafts were introduced over the entry tear of aorta via the femoral artery. The procedure was technically successful in all patients. No Severe complication occurred during the perioperative period except one death due to heart infarction. These preliminary results suggest that EVGE is safe and efficient for Stanford B aortic dissection. EVGE is a method of first choice for the patients with this disease.
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Thirty two patients with Stanford B thoracic aortic dissections accepted endovascular graft exclusions. Four endoleaks occurred after the stent grafts were deployed. Three were cured with additional endovascular stent graft placement, while one sealed spontaneously. It is concluded that many factors are related to the occurrence of endoleaks. The detecting methods of intraoperative DSA and postoperative spiral CT of the thoracic aorta are effective on revealing endoleaks. It is advocated that additional endovascular procedures should be done immediately after the endoleaks are detected. Low volume of the leakage may seal spontaneously. But the topic of the mamagement and prognosis of delayed endoleaks is to be studied.
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To investigate the diagnosis and treatment of Stanford B thoracic aortic dissection eomplicated with renal ischemia, 29 cases of Stanford B thoracic aortic dissection admitted from January 1996 to April 2000 were retrospectively studied. Three of them had renal ischemia secondary to aortic dissection (2 acute,1 chronic). One patient in acute stage died 3 days after onset, the other patient in acute stage complicated with bilateral lower extremity ischemia was treated with fenestration of intimal flap, and the symptom was relieved. The patient in chronic stage was treated with endovascular graft exclusion for aortic dissection and the renal ischemia was relieved because of the restored true lumen blood. The results showed that palliative bypass helps relieve symptoms and improve survival rate. For the chronic aortic dissection complicated with renal ischemia, endovascular graft exclusion can restore the true lumen blood and relieve renal ischemia.
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In order to have better understanding of the etiology and treatment of the endoleak after endovascular graft exclusion for abdominal aortic aneurysms, experiences with the treatment of endoleak in 38 cases received EVGE for AAAs were reviewed.Among them, 4 cases were complicated with endoleak. Type Ⅰ endoleak occurred in two cases, type Ⅱ in one case, and type Ⅲ in one case. One case was converted to open surgery, the other three cases were kept under observation. The results showed that DSA is a useful in the diagnosis of endoleak.The endoleak can be sealed by stretching the graft and inserting an extension or another stent graft and embolizing collateral vessel.
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Colonic ischemia is a well documented complication of abdominal aortic reconstruction. In this retrospective study of abdominal aortic aneurysm patients undergone endovascular graft exclusion, the incidence and management of this complication were investigated. From Mar 1997 to Apr 2000,among the 40 patients who received elective endovascular graft exclusion for,infrarenal abdominal aortic aneurysm the bilateral hypogastric artery was retained in 30 patients, the unilateral hyogastric artery was retained in 10 patients. One patient had lower abdominal pain on the 28th day after operation, CTA showed the bilateral hypogastric artery occlusion, the symptoms were relieved after drug treatment. Retaining unilateral hypogastric artery can prevent the colonic ischemia after endovascular graft exclusion for abdominal aortic aneurysm, the chronic colonic ischemia secondary to bilateral hypogastric artery occlusion can be relieved by effective drug treatment.
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To explore the pathogenesis and treatment of fever, leukocytosis and thrombocytopenia after endovascular graft exclusion for aortic aneurysm or aortic dissection, 67 patients with infrarenal aortic aneurysm (38) and thoracic aortic dissection (29),were studied,and then received successful endovascular graft exclusion with Dacron covered stent grafts. Sepsis syndrome evaluation (physical examination, analysis of peripheral blood WBC, platelet and urine, chest radiograph, urine and blood cultures) was performed for all patients with postoperative temperature(T) higher than 38 5℃. Fever, leukocytosis and thrombocytopenia in peripheral blood were found in most patients, whose T, WBC and platelet returned to normal between 1 and 2 weeks. Sepsis evaluations failed to identify any source of infection in all patients. These results showed that fever and leukocytosis after endovascular stent graft repair for aortic aneurysm are resulted from systemic inflammatory response syndrome.
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Objective To investigate the surgical indication,complication management and therapeutic effect in treating Stanford B aortic dissection by using endovascular graft exclusion (EVGE).Methods Eight patients with Stanford B aortic dissection who underwent the procedure of mini-traumatic EVGE from April 2002 to April 2003 were analyzed.Tubular graft stents were introduced over the entry tear of aorta via the femoral or iliac artery.The lengths of the graft stents were 97-99mm and the diameters 34-42mm.Results The procedure was technically successful in all patients and no severe complications occurred during the perioperative period. All patients were alive with no delayed endoleak found during the follow-up of an average of (9.5?4.6) months.Conclusion EVGE is safe and efficient for Stanford B aortic dissection and it can be the first choice for treating these patients.
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Objective:To study the changes of platelet and blood coagulating function during endovascular graft exclusion(EVGE), providing reference for reasonable use of heparin and platelet. Methods:Using sonoclot analysis (SCT), 20 patients accepted EVGE were measured for ACT, clot rate, platelet function and hematocrit (HCT) and platelet count (PLT) after anesthesia induction(T 1), heparination(0.3 0.5 mg/kg)(T 2) and EVGE(T 3), respectively. The reasons for variability were analyzed. Results:ACT, clot rate and blood platelet function were normal at T 1. At T 2 ACT was prolonged [(289? 61.1) s,] clot rate and platelet function were decreased ( P
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Objective To evaluate the effect of endovascular graft exclusion (EVGE) for aorta aneurysm(AA). Methods From October,2000 to August 2002,5 cases of AA were treated by EVGE, 4 of which were thoracic and abdominal aortic dissecting aneurysm and the another one was abdominal AA. Results All the operations were successfully performed. The pseudo cavity in the 4 cases of aortic dissection disappeared after the operation,and the another aortic aneurysm was successfully isolated. Conclusions EVGE is an effective ,less trauma and safe, when the indications are carefully selected.
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Objective To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm(AAA). Methods Infrarenal aortic aneurysms were created with bovine jugular vein segements or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased siginificantly, and the pressure curve showed approximately linear. Conclusion The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existance.
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Objective To assess and compare the affects upon renal function after endovascular exclusion (EVE) or conventional surgery (CS) for infrarenal abdominal aortic aneurysms(IAAA). Methods The records of 157 consecutive patients with IAAA from 1997 to 2002 were retrospectively reviewed. There were a group of 115 patients undergoing EVE and a group of 42 patients undergoing CS. The postoperative changes of plasma Cr and BUN with EVE and CS were analyzed respectively and compared. Results The plasma Cr and BUN were significantly increased in the group of CS postoperatively, but no significant difference were shown before and after endovascular repair was discovered in the group of EVE. Moreover, there was a case with acute renal failure in CS group. Conclusion The affects upon renal function with EVE are much less than CS for IAAA patients.