Innominate Artery Cannulation for Proximal Aortic Surgery

ABSTRACT Introduction: The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. Methods: A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). Results: The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. Conclusion: Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.

Tratamiento endovascular con técnica de chimenea para patologías del arco aórtico / Endovascular management with chimney technique for pathologies ofthe aortic arch

Introducción. La patología del arco aórtico se ha tratado principalmente con cirugía por vía abierta, pero con una alta morbimortalidad. Las técnicas endovasculares híbridas y las reconstrucciones en "chimenea" son una técnica válida y segura para disminuir el riesgo y la mortalidad. Métodos. Se presentan dos pacientes con patología del arco aórtico y contraindicación de manejo quirúrgico abierto, atendidos en el Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia. Resultados. Se realizaron dos procedimientos endovasculares del arco aórtico para tratar un aneurisma torácico roto y una úlcera aórtica sintomática, con cubrimiento de los troncos supra aórticos con una endoprótesis y canalización de los vasos supra aórticos con prótesis cubiertas y uso de la "técnica de chimenea", de manera exitosa. Discusión. La patología del arco aórtico es de alta complejidad y se asocia con una morbimortalidad elevada por lo que, en los últimos 20 años se han desarrollado diferentes técnicas utilizando procedimientos percutáneos. Conclusión. La "técnica de chimenea" se puede realizar de una manera mínimamente invasiva en pacientes con patología del arco aórtico, no candidatos para cirugía abierta, con resultados exitosos.

Introduction. Aortic arch pathology has been treated mainly by open surgery, but with high morbidity and mortality. Hybrid endovascular techniques and "chimney" reconstructions are a valid and safe techniques to reduce risk and mortality. Method. Two patients with pathology of the aortic arch and contraindication for open surgical management, treated at the Vascular Surgery Service, Hospital Universitario Clínica de San Rafael, Bogotá, Colombia, are presented. Results. Two endovascular aortic procedures were performed successfully to treat a ruptured thoracic aneurysm and a symptomatic aortic ulcer, with coverage of the supra-aortic trunks with an endoprosthesis and cannulation of the supra-aortic vessels with covered prostheses and use of the "chimney technique". Discussion. The pathology of the aortic arch is highly complex and is associated with high morbidity and mortality, being the reason that during the last 20 years, different techniques have been developed using percutaneous procedures. Conclusions. The "chimney technique" can be performed with successful results in a minimally invasive manner in patients with pathology of the aortic arch, who are not candidates for open surgery

Aortic Root and Distal Arch Management During Type A Aortic Dissection Repair: Expanding Horizons

ABSTRACT The management of Type A aortic dissection has evolved over a period of a decade or so, and contemporary reports are suggesting a paradigm shift from a conservative approach to complete excision of the diseased aorta including root and distal arch. Improved cardiopulmonary bypass perfusion techniques, better understanding of the cerebral perfusion, and wide-ranging obtainability of prosthetic conduits gave surgical teams numerous choices. With improving outcomes and maturing surgical techniques, surgeons are performing extensive resections of the diseased aorta, but there is no standard protocol as far as the extent of the proximal and distal diseased aortic tissue resection is concerned. Aortic root replacement is associated with good early- and long-term outcomes and proffered solution in young and stable patients, for that reason many busy centres are endorsing total arch replacement in complex distal aortic dissections. This systemic review is discussing contemporary literature and associated pros and cons during surgical decision-making for these high-risk cases.

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching

ABSTRACT Introduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients' mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.

Cefalea en la disección aórtica, a propósito de un caso clínico / Headache as a symptom in aortic dissection: about a clinical case / Cefaleia em dissecção de aorta, tema de caso clínico

Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.

We describe the case of a 70-year-old patient, who seeks medical advice due to sudden, thunder headache, without alteration of the state of consciousness, accompanied by chest pain of 1 hour of evolution and of low intensity. Upon his admission, the patient was treated as a thunderclap headache, which is considered a red flag. His troponin was negative, and his head tomography was interpreted as normal. From admission he had normal vital signs, but when he was going to be discharged, he became hypotensive (completely asymptomatic) and due to his cardinal symptom (headache) that was asso-ciated with mild non-anginal chest pain, a thoracoabdominal angioCT was requested, with which dissecting aneurysm of the aorta was evidenced. With the presentation of this case, we seek to highlight the importance of the association of thunder-type headache with possible vascular conditions such as aortic dissection in the emergency department.

Descrevemos o caso de uma paciente de 70 anos que consultou por quadro de cefaleia súbita, tipo trovão, sem alteração do estado de consciência, acompanhada de dor torácica de uma hora de evolução e de baixa intensidade. Na admissão, foi tratado como cefaleia em trovoada, que é classificada, em termos de atenção, como bandeira vermelha. A me-dição da troponina foi negativa e uma tomografia de crânio foi lida como normal. Desde a admissão apresentava sinais vitais normais, quando ia receber alta ficou hipotenso (totalmente assintomático) e devido ao seu sintoma cardinal (cefaleia), que se associou a dores torácicas ligeiras e não anginosas, foi solicitada angiografia toracoabdominal, com cujo aneurisma dissecante da aorta foi demonstrado. Com a apresentação deste caso, o objetivo é destacar a importância no pronto-socorro da associação da cefaleia do tipo trovão com afecções vasculares como a dissecção da aorta.

Disección de la aorta abdominal a propósito de un caso / Abdominal aortic dissection apropos of a case

RESUMEN La disección de la aorta abdominal tiene una baja incidencia, se produce a partir de una laceración, desgarro o rotura intimal, con la consecuente separación longitudinal de las capas de la pared y la aparición de una falsa luz con flujo en su interior. Se presenta el caso de un hombre de 67 años de edad con antecedentes de hipertensión arterial, sin tratamiento regular, que acudió al cuerpo de guardia del Hospital Salvador Allende (La Habana, Cuba) por presentar dolor abdominal con irradiación a fosa ilíaca izquierda y espalda, de una semana de duración, que no aliviaba con los analgésicos habituales. Se le realizó ultrasonido abdominal y se encontró una dilatación aneurismática de la aorta abdominal, con signos de disección hacia la ilíaca derecha; por lo que se realizó angiotomografía que confirmó el diagnóstico. Se realizó baipás aorto-ilíaco con fenestración en aorta abdominal y anastomosis término-terminal en ambas arterias ilíacas.

ABSTRACT Abdominal aortic dissection has a low incidence. It may happen when a small tear or rupture occurs in the tunica intima, dividing the wall layers and forming a false channel, or lumen with blood flow inside. We present the case of a 67-year-old man with a history of high blood pressure, with no regular treatment, who sought care at the Hospital Salvador Allende (Havana, Cuba) as he presented with a week-long abdominal pain radiating to the left iliac fossa and back, which was not relieved by the usual analgesics. An abdominal ultrasound was performed which found an aneurysmal dilatation of the abdominal aorta, with signs of dissection towards the right iliac artery; therefore, computed tomography angiography (CTA) was performed and the diagnosis was confirmed. He underwent aorto-iliac bypass with abdominal-aortic-fenestration and end-to-end anastomosis in both iliac arteries.

Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report / Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Abstract Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks' duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Resumo Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Endovascular Treatment of Ruptured Vertebral Artery Dissecting Aneurysm in Fibromuscular Dysplasia

Background Fibromuscular dysplasia (FMD) affects predominantly the cervical and renal arteries and may cause the classical angiographic pattern of string-of-beads. The diagnosis is increasing with the advances of imaging techniques. Case Report A 37-year-old man presenting with subarachnoid hemorrhage due to a dissecting aneurysm of the vertebral artery was treated by angioplasty with stent, with good outcome. All of the cervical and renal arteries were diseased and showed dysplasia and/or ectasias. Conclusions There are no guidelines or protocols to treat patients with FMD.

Innominate vs. axillary artery cannulation in aortic surgery: a systematic review and meta-analysis

Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.

Application of valve-sparing aortic root reimplantation for aortic root disorders in patients with Marfan syndrome / 第二军医大学学报

ObjectiveTo evaluate the appropriate indications, key points of surgical techniques, and early to midterm outcomes of valve-sparing aortic root reimplantation in patients with Marfan syndrome. MethodsThe clinical data of 52 patients with Marfan syndrome who underwent valve-sparing aortic root reimplantation in our department from June 2006 to July 2017 were retrospectively analyzed. Preoperative patient characteristics, surgical techniques, and follow-up outcomes were summarized. ResultsThe patients had a mean age of (36.6±14.5) years, with 35 males and 17 females. Severe aortic valve insufficiency (AI) was found in 37 cases (71.2%) preoperatively. Echocardiography indicated that the average diameter of aortic annulus, aortic sinus, and sinotubular junction of this cohort were 22-30 mm, 40-56 mm, and 34-51 mm, respectively. Pure valve-sparing aortic root reimplantation was performed in 40 patients presenting aortic root aneurysm, with a cross-clamp time of 61-108 min and a mean of (81.3±11.6) min, and with a cardiopulmonary bypass time of 88-129 min and a mean of (97.3±10.8) min. The other 12 patients with Stanford type A aortic dissection underwent concomitant total arch replacement and elephant trunk implantation in the descending aorta, with a cross-clamp time of 93- 126 min and a mean of (107.4±11.2) min, and with a cardiopulmonary bypass time of 127-180 min and a mean of (143.5±17.1) min. Vascular prostheses with a diameter of ≤30 mm were adopted in all patients. Aortic root bleeding was drained to the right atriums in 9 patients. Transesophageal echocardiography was performed in 42 cases before extracorporeal circulation removal, with 16 cases presenting no AI, 18 presenting trace AI, and 8 presenting mild AI. There was one in-hospital death (1.9%) and no secondary thoracotomy for bleeding or other major complications. The mean follow-up was (3.2±2.1) years, with 43 cases completed the follow-up and no death during follow-up. Echocardiography in the latest follow-up indicated that 6 cases presented no AI, 24 presented trace AI, 12 presented mild AI, and only one case presented moderate AI, with 97.7% (42/43) patients free from moderate AI. No case underwent aortic valve replacement for severe AI. There were 39 (90.7%) patients in New York Heart Association classIand 4 (9.3%) patients in classII . ConclusionApplication of valve-sparing aortic root reimplantation using vascular prostheses with appropriate diameter is safe and effective for suitable patients with Marfan syndrome, and can obtain satisfactory outcomes.

Cardiac Tamponade during Endovascular Repair of Thoracic Aortic Dissection

Endovascular aortic repair is often performed for the treatment of aortic disease because of less invasiveness and fewer complications. Cardiac tamponade is a fatal disease that can lead to death if not treated properly. Cardiac puncture by rigid guide wire used in endovascular aortic repair may cause cardiac tamponade. Rapid diagnosis and treatment are needed when cardiac tamponade occurs. Confirmation of the cardiac tamponade can be accomplished with echocardiography. Continuous echocardiography should be monitor for detection of cardiac complications during endovascular aortic repair.

Spontaneous Basilar Artery Dissection: A Case Report and Literature Review

Spontaneous basilar artery dissection is a rare condition and a diagnostic challenge with a high potential for morbidity and mortality if untreated. It has an estimated incidence of 1 to 1.5 cases per 100,000 people. Few cases have been described in the literature up to the present day. The clinical outcomes, prognosis and treatment remain uncertain. The authors report the rare case of a 55-year-old female patient who presented to the Interventional Neuroradiology service at Hospital São Marcos, Teresina, in the state of Piauí, Brazil, with a history of severe headache located in the occipital region and in the nape with no improvement using common analgesics. A magnetic resonance imaging of the brain showed a saccular dilatation in the basilar artery, and a digital cerebral angiography showed a basilar artery dissection associated with a dissecting aneurysm.

Endovascular Treatment of a Giant Dissecting Aneurysm in an Infant

Introduction The incidence of intracranial aneurysms in the pediatric population is low, and endovascular treatment is becoming a safe and minimally invasive treatment option. In the present study, the occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Case Report A 3-month-old female infant presented with progressive proptosis and divergent strabismus at the right eye, in addition to inconsolable crying. Cerebral resonance, angiotomography and angiography exams demonstrated angiodysplasia in the right internal carotid artery with two large paraclinoid dissecting aneurysms with wide neck. The right internal carotid artery was occluded with coils by endovascular approach, without detriment to the perfusion of the ipsilateral hemisphere and without neurological deficits. The patient achieved good recovery, and a late control angiotomography confirmed the exclusion of the aneurysms. Conclusion Parent artery sacrifice via endovascular approach is an effective therapeutic option, but a long-termfollow-up is necessary to avoid recurrence and bleeding.

Stent-assisted technique for the management of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm / 医学研究生学报

Objective The stent-assisted technique is widely applied in the treatment of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm(VADA). This study investigated the perioperative complications and long-term clinical effect of stent-assisted coiling in the management of VADA-induced subarachnoid hemorrhage. Methods The clinical data on 19 cases of VADA-induced subarachnoid hemorrhage were analyzed retrospec-tively. All the patients underwent digital subtraction angiography (DSA)and stent-assisted coiling within 24 hours after admission.Two of the patients were diagnosed with bilateral VADA and treated with double stents,4 with a single stent,2 with the low-profile visualized intraluminal support device(LVIS),and 11 with double Enter-prise stents. Results Operations were successfully performed in all the cases. Three of the patients died within 2 weeks after surger-y,2 from post-operative rebleeding and the other 1 from some unknown cause;1 patient developed severe postoperative cognitive dys-function,while the other 15 were well recovered. The survived patients were followed up for 6 to 36 months,during which no obvious new neurological deficits were observed. Follow-up DSA revealed 2 cases of recurrence,1 case of stenosis in the stent,and 2 cases of vertebral artery occlusion. Conclusion Stent-assisted coiling is a safe and effective method for the management of VADA-induced subarachnoid hemorrhage,and double-stent implantation may achieve an even better effect.

The diagnostic value of ultrasound for dissecting aneurysm of isolated superior mesenteric artery / 中国医学装备

Objective: To investigate the diagnostic value of ultrasound for dissecting aneurysm of isolated superior mesenteric artery. Methods: 4 patients with dissecting aneurysm of isolated superior mesenteric artery who were diagnosed by angiography, the diagnostic gold standard, were examined by ultrasound, and the results were compared and analyzed. And then the accuracy and sensitivity of ultrasonic diagnosis of dissecting aneurysm of isolated superior mesenteric artery were further researched by using retrospective analysis. Results:In the 4 patients, 3 cases were correctly diagnosed as dissecting aneurysm of isolated superior mesenteric artery by ultrasound. And in the 3 cases, the area of dissection, range, true and false cavity, peeled intima echo and relevantly hemodynamic status were clearly showed in the results of ultrasound. The sensitivity, positive predictive value, false negative rate and accurate rate of ultrasonic diagnosis were 80 %, 100 %, 20 % and 80 %, respectively. Conclusion:The ultrasound detection has better sensitivity and accuracy in diagnosis of dissecting aneurysm of isolated superior mesenteric artery when angiography is no convenient and unconditional. And it provides effective and rapid detection for diagnosis of dissecting aneurysm of isolated superior mesenteric artery.

Roles of high-resolution magnetic resonance imaging in the diagnosis and treatment of vertebrobasilar dissecting aneurysms / 中国脑血管病杂志

Objective To investigate the roles of high-resolution magnetic resonance imaging (HR-MRI) in the diagnosis and treatment of vertebrobasilar dissecting aneurysms (VBDA).Methods From January 2016 to December 2016,62 patients with VBDA admitted to Xuanwu Hospital,Capital Medical University using 3.0 T HR-MRI (3D-TOF-MRA,3D-T1WI,and 3D-T1WI+C sequence) and diagnosed by DSA were analyzed retrospectively.They were divided into either an asymptomatic group (n=18) or a symptomatic group (n=44) according to their medical histories.Their clinical features,imaging features,and the relationship with prognosis were analyzed.Results HR-MRI revealed that the double lumen sign/intimal flap accounted for 27.8% (n=5) and 54.5% (n=24) respectively in the asymptomatic group and symptomatic group.The intramural hematoma accounted for 22.2% (n=4) and 43.2% (n=19) respectively in both groups.The enhancement of aneurysmal wall accounted for 33.3% (n=6) and 77.3% (n=34) in the asymptomatic group and symptomatic group.There were significant differences in the above features between the two groups (all P<0.05).In the symptomatic group,18.2% (n=8) of patients had aneurysm recurrence,which was significantly higher than the asymptomatic group (5.6%,n=1).The difference between the two groups was statistically significant (P<0.05).Conclusions HR-MRI can better reveal the lesion characteristics of VBDA.The rates of aneurysmal wall enhancement and recurrence in symptomatic VBDAs are higher,which indicates that HR-MRI can assess the stability of the aneurysmal wall and identify the prognosis to a certain extent.

Simultaneous Onset of Ischemic and Hemorrhagic Stroke Due To Intracranial Artery Dissection

Intracranial dissections commonly present as ischemic stroke and as hemorrhagic stroke. In general, while either ischemic stroke or hemorrhagic stroke may develop, the simultaneous onset of both may also occasionally occur. In this report, we present a case of simultaneous development of ischemic stroke and hemorrhagic stroke due to an intracranial artery dissection.

Endovascular Treatments for Ruptured Intracranial Vertebral Artery Dissecting Aneurysms: Experience in 16 Patients

OBJECTIVE: Intracranial vertebral artery dissecting aneurysms are rare lesions that are considered an important cause of spontaneous subarachnoid hemorrhage. We report our decade-long experience in treating ruptured intracranial vertebral artery dissecting aneurysms. MATERIALS AND METHODS: This retrospective single-center study included 21 consecutive patients between February 2005 and March 2015. Their clinical features included radiologic finding at the initial examination, treatment modality, functional outcome at the last follow-up, mortality, and radiologic outcome at more than 6 months after the initial treatment. RESULTS: All 16 aneurysms were treated endovascularly; aneurysm trapping was performed in 9 patients and vascular reconstruction was performed in 7 patients. For 6 aneurysms involving the posterior inferior cerebellar artery (PICA), the modalities of treatment were aneurysm trapping in 3 patients and vascular reconstruction in 3 patients. The mean duration of follow-up was 29 months (range, 6–70 months). Five patients expired, indicating a mortality rate of 31%. In surviving patients, the unfavorable outcome rate (modified Rankin Scale [mRS] > 2) was 36%. The overall mean mRS for survivors was 1.8. Angiographic follow-up in 11 survivors at 13 months, (range, 6–46 months) revealed recanalization of the aneurysm in one patient. CONCLUSIONS: Ruptured intracranial vertebral artery dissecting aneurysm is associated with poor functional outcome and high mortality. More immediate treatments are needed due to the high rebleeding rate in this disease condition. Endovascular treatment may be a useful option for ruptured intracranial vertebral artery dissecting aneurysms.

Risk factors for preoperative hypoxemia in acute type A aortic dissection / 第二军医大学学报

Objective To determine the risk factors associated with preoperative hypoxemia in acute type A aortic dissection. Methods The clinical data of 70 patients undergoing surgery for acute type A aortic dissection were collected from January 2013 to May 2014. Preoperative hypoxemia was defined by an arterial partial oxygen/inspired oxygen fraction (PaO2/FiO2) ratio ≤200 under static oxygen inhalation, and the patients were divided into hypoxemia group (n=21) and non-hypoxemia group (n=49) accordingly. The following data were collected, including age, gender, body mass index, smoking, drinking, history of hypertension, diabetes mellitus, coronary disease, CRP, D-dimer, PT, creatinine, BNP, ESR, IL-6, LVEF, pericardial effusion, the dissection involving renal artery, and mesenteric artery. The relationship between preoperative hypoxemia and the above data were analyzed by differences test and logistic regression analysis. Results We found that the body mass index, CRP, D-dimer, IL-6 and the dissection degree and involvement(renal artery and mesenteric artery) were significantly different between the hypoxemia group and non-hypoxemia group (P<0.05). According to logistic regression analysis, the independent predict factors for preoperative hypoxemia included CRP and D-dimer. Conclusion Body mass index, systemic inflammatory response, blood D-dimer, and dissection degree and scope are associated with preoperative hypoxemia. And CRP and D-dimer are the independent risk factors for preoperative hypoxemia in patients with acute type A aortic dissection.

Hybrid-Procedure for the Treatment of Thoraco-abdominal Dissecting Aneurysm of the Aorta in a Patient with Marfan Syndrome / 日本心臓血管外科学会雑誌

<p>Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.</p>