Surgical Strategy for Protecting Major Branch Arteries during Thoracic Endovascular Aortic Repair for Shaggy Descending Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

Endovascular repair or medication for the management of uncomplicated type B aortic dissection / 介入放射学杂志

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)

Endovascular aortic repair for Stanford type B aortic dissection: learning curve analysis / 介入放射学杂志

Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 70 patients with Stanford type B aortic dissection,who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years,were retrospectively analyzed.According to the sequence of operation date,the patients were equally divided into group A,B,C,D and E with 14 patients in each group.The operation time,procedure-related complications,postoperative hospitalization days were compared among the 5 groups,and the curative effects at different stages were evaluated.Results No statistically significant differences in the age,sex,classification,concurrent hypertension,concurrent diabetes,active smoking,maximum diameter of false lumen,viscera artery supplied by the false lumen,etc.existed between each other among the 5 groups (P＞0.05).The operation time of group A and group B was (3.29±0.61) hours and (2.87±0.37) respectively (P＜0.05),while the operation time of group C,group D and group E was (1.80±0.62) hours (1.74±0.34) hours and (1.52±0.39) hours respectively (P＞0.05).The operation time of group A and group B was significantly longer than that of group C,D,and E (P＜0.001).The difference in the occurrence of complications was not statistically significant between each other among the 5 groups (P＞0.05).The hospitalization time was gradually shortened from group A to group E,although the difference was not statistically significant (P＞0.05).The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively,with an operation frequency being 3.3 patients per year and 7 patients per year respectively;while the surgeries of 42 patients in group C,group D and group E were completed within 2.2 years,1.2 years and 0.5 years respectively,with an operation frequency being 6.4 patients per year,11.7 patients per year and 17.5 patients per year respectively.Conclusion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases;after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist,the operation time becomes significantly shortened,and the surgical skills of theinterventional physician team can been significantly improved.

Clinical experience in 36 cases of T4 esophageal carcinoma radical surgery combined with descending thoracic aortic segment replacement / 中国综合临床

Objective To summary the experience of T4 esophageal carcinoma surgery and to explore the methods and operating skills on descending thoracic aortic resection with prosthetic vascular graft replacement in patients with T4 locally advanced esophageal carcinoma invading descending thoracic aorta.Methods From Jan.2001 to Dec.2010,36 patients with esophageal carcinoma underwent esophagectomy and descending aortic replacement simultaneously in our hospital.The clinical data were retrospectively reviewed.All patients had a left posterior lateral incision via the 6th intercostal space.The vascular adventitia of the descending thoracic aorta in the left side was incised,and the aorta was clamped in the proximal and distal side of the invaded segment.Then the invaded segment was resected and replaced with artificial vessels.Esophageal carcinoma was radically resceted,and left cervical esophageal-gastro anastomosis was performed in all patients.Results Radical resection of esophageal carcinoma was achieved in all patients.There was no perioperative death,or severe complications such as paraplegina,acute renal failure and intestinal dysfunction occurred.Two patients had chylous hydrothorax,and one had late stage anastomotic stoma fistula.The post-operative hospital stay was 10-42 d,mean (15.5 ± 7.2 )d.The pathological examination revealed that all the patients had squamous cell carcinoma.The aortic tunica adventitia was invaded in all the patients,9(25％ ) had tunica media invasion,and there was no tunica intima invasion observed.The 1-,3-,and 5-year survival rate was 80.6％,46.2％ and 20.0％ respectively.Conclusion Combined esophagectomy and descending aortic replacement for locally advanced T4 esophageal carcinoma invading aorta can be considered as radical operation for selected patients,and it can improve the survival rate and life quality of the patients.

Amplatzer septal occluder found in the thoracic descending aorta by transesophageal echocardiography: A case report / 대한마취과학회지

Percutaneous device closure of atrial septal defect (ASD) has proven to be safe and effective, and become a widely accepted option to the surgical repair. However, the embolization of Amplatzer septal occluder (ASO) occurs in about 0.55% to 3.5% of cases, regardless of ASD size, device size, or the physician's expertise. We report a case of embolization of an ASO into the thoracic descending aorta, successfully removed through a surgical approach.