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Objective:To summarize the clinical experience and effect of applying 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm.Methods:From August 2019 to November 2020, 15 patients with thoracic/abdominal aneurysm involving visceral arteries were admitted to our center, including 11 males and 4 females, with mean age of 57-82(68.26 ±4.73) years old. According to diameters of visceral artery, thoracic aorta, abdominal aorta, and bilateral iliac arteries measured by CTA, we selected suitable stents and made a 3D printing model by professional software to guide the position of intraoperative external fenestration and the fenestration diameter to implement full cavity repair.Results:All operations were completed and one case was converted to laparotomy. The average time of operations was(200.67±41.00)min and hospital stay was(13.47±4.16)days without any death, organ failure, endoleak, paraplegia, graft infection and other complications.Conclusion:The application of 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm is feasible and effective, and the short-term results are satisfactory.
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Objective:To explore the feasibility, safety and effectivity of applying transmesenteric vein extrahepatic portosystemic shunt (TEPS) to treat extrahepatic portal vein obstructive disease (EHPVOD).Methods:From December 2020 to April 2021, 12 patients with EHPVOD in the Vascular Surgery Department of Zhengzhou University People′s Hospital were prospectively enrolled in the study. The infra-umbilical median longitudinal minilaparotomy was performed to expose the branch of superior mesenteric vein (SMV). RUPS-100 was introduced into the trunk of SMV. A balloon with a diameter of 20 mm was introduced through right internal jugular vein (RIJV) into inferior vena cava (IVC). Under fluoroscopy, RUPS-100 was used to puncture the balloon in IVC. A stiff guide wire was used to establish the pathway between RIJV and SMV. Finally the portosystemic shunt between IVC and SMV was established with a covered stent-graft. The total operative time, the time of establishing portosystemic shunt alone, the dosage of contrast agent, the preoperative and postoperative pressure of SMV were recorded. Paired t test was used to compare the preoperative and postoperative pressure of SMV. Results:All 12 patients were successfully performed TEPS. The total operative time was (113±32) min, the time of establishing portosystemic shunt alone was (31±5) min, the dosage of contrast agent was (129±48) ml. The postoperative pressure of SMV [(14.3±2.1) mmHg] decreased significantly ( t=20.125, P<0.01) compared to baseline [(27.8±2.7) mmHg]. All portal hypertension symptoms released after the operations.There was 1 case of delayed incision healing, 1 case of bacteremia and 1 case of slight hepatic encephalopathy, but all of them were cured. There was no death case. Postoperative CT showed all portosystemic shunts were patent. Conclusion:TEPS is a new, safe, effective and feasible treatment method for patients of acute and chronic EHPVOD.
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Objective To discuss the influencing factors of intracranial cerebral hemorrhage complicationin patients with acute ischemic stroke (AIS) after receiving Solitaire AB stent mechanical thrombectomy.Methods The clinical data of 32 AIS patients,who were treated with Solitaire AB stent thrombectomy during the period from June 2015 to October 2016 at authors' hospital,were retrospectively analyzed.The basic materials of patients,who developed intracranial hemorrhagic transformation (HT) after Solitaire AB stent thrombectomy,were analyzed and compared with the results of related studies published at home and abroad.Results Solitaire AB stent thrombectomy was successfully accomplished in all the 32 AIS patients.The postoperative fatality rate was 9.4％ (3/32).Three patients developed symptomatic intracranial HT after Solitaire AB stent thrombectomy,including artery occlusion in anterior circulation (n=1) and artery occlusion in posterior circulation (n=2),with the HT incidence being 9.4％ (3/32).Of the 3 patients,conservative treatment was adopted in 2 and ventricular external drainage with implantation of liquid storage bag through ventricular drilling-hole was carried out in one.Finally,2 patients died of HT and one patient recovered by conservative treatment.The percentage of HT death patients in all deaths was 66.7％ (2/3).Conclusion Intracranial HT is a fatal complication of embolectomy in AIS patients.In clinical practice,the indications of thrombectomy should be strictly observed,besides,intraoperative fine manipulation and sandardized perioperative management are also very important to reduce the incidence of bleeding complications.
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Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.