The treatment of Stanford type B aortic dissection with unhealthy or short anchoring zone using physician-modified fenestration TEVAR / 中华普通外科杂志

Objective:To evaluate the efficacy and safety of physician-modified fenestration TEVAR for treating type B aortic dissection with unhealthy or short anchoring zone.Methods:Clinical data of patients with type B aortic dissection who received TEVAR for left subclavian artery fenesration from May 2016 to Dec 2018 were analyzed prospectively.Results:The technical success rate was 93.2%. One case was converted into chimney stenting. One case suffered type Ⅰendoleak. One case had type Ⅲ endoleak. There were no deaths or neurological complications during the perioperative period, and the mean hospital stay was 9.2 (5-26) days. The median follow-up time was 30 (12-42) months. One case developed type Ⅰ endoleak during follow-up. No retrograde dissection occurred and all LSA stents remained patent.Conclusion:Physician-modified fenestration TEVAR is safe and effective for the treatment of type B aortic dissection with unhealthy or short anchoring zone.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.Methods The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.Results There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent.The success rate of device release was 100％,the success rate of operation was 100％,and there were no intraoperative deaths.Postoperative complications occurred in 2 cases:one proximal stent tear dissection required open surgery,one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months.CTA examination in 16 patients 30 days after surgery,found 1 patient with type Ⅲ endoleak.CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necessitating distal stent implantation.Conclusion The branch TEVAR technique is effective method to reconstruct the arch branched artery.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective@#To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.@*Methods@#The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.@*Results@#There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent. The success rate of device release was 100%, the success rate of operation was 100%, and there were no intraoperative deaths. Postoperative complications occurred in 2 cases: one proximal stent tear dissection required open surgery, one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months. CTA examination in 16 patients 30 days after surgery, found 1 patient with type Ⅲ endoleak. CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necess itating distal stent implantation.@*Conclusion@#The branch TEVAR technique is effective method to reconstruct the arch branched artery.

On table fenestrated stent graft in zone 0 and zone 1 for aortic arch diseases / 中华普通外科杂志

Objective To evaluate fenestrated thoracic endovascular aortic repair (f-TEVAR) using fenestrated stent graft on table in zone 0 and zone 1 for aortic arch diseases.Methods 13 patients undergoing f-TEVAR by using physician modified fenestrated stent grafts (PMSGs) on table in zone 0 and zone 1 for aortic arch diseases between Nov 2015 and Mar 2018 were retrospectively reviewed.Results The median age was 59 years(range,33-81 years).PMSGs were deployed from Z0 in 5 patients and Z1 in remaining 8 patients.All but 3 patients underwent elective procedure.The technical success rate was 92.3％.Overall mortality was 7.7％ (1/13).There were no perioperative neurologic complications and paraplegia.One patient suffering from acute left leg ischemia and renal failure recovered after openembolectomy and dialysis.Median length of stay was 9.0 days (range,4-35 days).12 patients were survival at a median follow-up of 11.5 months (range,1.0-19.0 months).Retrograde dissection occurred in one patient and resolved after open repair.During follow up,all target vessels remained patent,with no fenestration-related type Ⅰ or Ⅲ endoleaks.Conclusions f-TEVAR using modified fenestrated stent grafts on table in Z0 and Z1 is feasible for the treatment of aortic arch diseases.

Fenestrated EVAR using physician-modified stent-grafts for thoraco-abdominal aortic lesions / 中华普通外科杂志

Objective To evaluate fenestrated endovascular aortic repair (FEVAR) using physician-modified stent-grafts (PMSGs) for thoraco-abdominal aortic lesions.Methods Seven cases of thoraco-abdominal aortic lesions (1 type Ⅲ thoraco-abdominal aortic aneurysm,1 type Ⅳ thoraco-abdominal aortic aneurysm,4 chronic thoraco-abdominal aortic dissection and 1 type Ⅰ endoleak after EVAR due to abdominal aortic aneurysm) were treated with FEVAR from Nov 2016 to Nov 2017.Results FEVAR was performed successfully in all cases.Type Ⅱ and Ⅲ endoleak occurred in 4 cases.One died of acute myocardial infarction 2 days postoperatively.Renal dysfunction deterioration occurred in one case of chronic dissection and improved after the medical treatment.Renal subcapsular hematoma was found in 2 cases postoperatively,and resolved after conservative therapy.Mean follow-up period was 7.2 months,target vessel patency was identified in 5 of the 6 cases.Conclusions FEVAR using PMSGs is a viable alternative to treat thoraco-abdominal aortic lesions.

HGPAEs vector-based RNAi inhibits the expression of gene encoding MyD88 in rat liver tissues / 中华微生物学和免疫学杂志

Objective To investigate the inhibitory effects of histidine grafted poly (β-amino es-ter) ( HGPAEs) vector-based RNA interference ( RNAi) on the expression of gene encoding myeloid differ-entiation factor 88 (MyD88) in rat liver tissues.Methods The sequence of small hairpin RNA (shRNA) was designed based on the genetic information of MyD 88.HGPAEs vector was constructed and coupled with shRNA plasmid targeting MyD88 to construct pMyD88-HGPAEs vector.Rats were divided into five groups including control group , HGPAEs treatment group , pHK-HGPAEs treatment group , shRNA treatment group and pMyD88-HGPAEs treatment group .The rats in each group were transfected with the corresponding inter-ventions through portal vein injection .Real-time PCR and Western blot assay were performed to detect the expression of MyD88 in liver tissues 3 days after transfection .Results The pMyD88-HGPAEs vector was successfully constructed .The expression of gene encoding MyD 88 was inhibited in rats from shRNA treat-ment group and pMyD88-HGPAEs treatment group (P<0.05).Significantly decreased expression of gene encoding MyD88 at mRNA and protein levels were observed in rats from pMyD 88-HGPAEs treatment group as compared with those from other groups (P<0.01).Conclusion HGPAEs vector might be used as a po-tential gene carrier .The expression of gene encoding MyD 88 in rat liver tissues could be significantly inhibi-ted through portal vein injection of pMyD 88-HGPAEs vector .This study provided evidences for further re-search on pMyD88-HGPAEs vector in a high responder model of rat orthotopic liver transplantation .