Application of endovascular balloon occlusion in complex aortic surgery / 中华胸心血管外科杂志

Objective:To summarize the experience of 15 cases of balloon endovascular occlusion assisted aortic replacement.Methods:15 patients who needed reoperation after aortic surgery underwent endovascular balloon occlusion assisted aortic replacement by DSA guidance in the hybrid OR. Main inclusion criteria: The target vessel to be blocked cannot be directly blocked. Based on the last CTA before the operation, the diameter of the target vessel was measured, and the appropriate diameter balloon and the appropriate diameter balloon and the amount of contrast agent were selected. The vascular approach was selected according to the CTA.During the operation, the balloon was filled and fixed well, the distal invasive blood pressure waveform showed advection, and the pressure close to hydrostatic pressure as the complete blocking standard.Results:All 15 cases of balloon endovascular occlusion assisted aortic surgery were successful. After the operation, 14 target vessels normally without damage, and there was no vascular complication. One case after surgical three-branch stent surgery underwent the second thoracoabdominal aortic replacement operation. After the stent was blocked by the balloon, the new tissue in the stent fell off, and the celiac trunk and superior mesenteric artery were embolized for reoperation.Conclusion:Balloon endovascular occlusion technology expands the indications of aortic surgery and simplifies the operation, that is a safe and effective occlusion method. Whether the target vessel is suitable for balloon occlusion should be judged before the operation to avoid related complications.

Efficacy of personalized endovascular repair using two stent-grafts for patients with Stanford B aortic dissection / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the feasibility and clinical efficacy of thoracic endovascular aortic repair (TEVAR) for patients with Stanford B aortic dissection using personalized two stent-grafts implantation (TSI).</p><p><b>METHODS</b>This retrospective review included 56 patients who underwent TSI during TEVAR for Stanford B aortic dissection from Jan 2012 to May 2013 in Beijing Anzhen hospital. There were 8 patients in acute phase (within 2 weeks from onset of symptoms), 11 patients in chronic phase (greater than 2 months following initial dissection) and 37 patients in subacute phase (between 2 weeks and 2 months from onset of symptoms). Infrarenal aorta was involved in 34 patients (60.7%) and suprarenal aorta involved in 22 patients (39.3%), the mean aortic lesion length was (226 ± 13)mm. Thoracic and abdominal aortic angiography was performed during operation to measure aortic diameters of proximal and distal landing zone, and the distance between them. The proximal stent-grafts were implanted in distal aorta to the origin of left subclavian artery with oversize rate of 10%-15% according to proximal landing zone according to procedural guideline. Then the distal newly customized large tapered stent-grafts were sequentially deployed according to the diameters of both the distal end of proximal stent and distal landing zone (aortic true lumen), and overlapping length of the two stent-grafts was more than 30 mm. Patients were followed-up at 3 months, 6 months, and yearly thereafter post operation.</p><p><b>RESULTS</b>TSI procedure was successful in all patients and 122 stent-grafts were implanted. The mean length of implanted stent-grafts was (197.6 ± 20.3)mm. The mean diameter taper span was (7.5 ± 1.8)mm with proximal oversize rate of (12.8 ± 3.4)% and distal oversize rate of (11.2 ± 4.1)%. The mean angle between the distal end of stent and aorta was (2.3 ± 1.3)°. The diameter of proximal and distal landing zone, and angle between the distal end of stent and aorta remained unchanged during follow up (mean: (10.0 ± 4.0) months). The total thrombosis rate of the false lumen was 98.2% (55/56), thrombosis rate of stent segment was 82.1% (46/56) . Stent-related complications were observed in 2 patients (3.6%) , including acute spinal cord ischemia due to paraplegia (n = 1) and malposition of distal stent (n = 1).</p><p><b>CONCLUSIONS</b>Encouraging short-term outcomes are obtained from current personalized two stent-grafts implantation strategy for patients with Stanford B aortic dissection. Further prospective clinical studies are warranted to evaluate the long-term efficacy of this procedure.</p>

Clinical analysis of modiifed transcatheter closure of atrial septal defect in 100 cases PU / 中国介入心脏病学杂志

Objective To summraize the safety and efifcacy of modiifed transcatheter closure of atrial septal defect. Methods From Dec. 2012 to Dec. 2013, 100 cases performed modiifed transcatheter closure of atrial septal defect in our center (72 were famale and 28 were male) with average age (37±16) years. The diagnosis was conifrmed by transthoracic echocardiography. All the atrial septal defect closures were completed in the modiifed way by direct delivery of the closure devices without the need of guidence wire. Results One hundred and one defects were identiifed in 100 patients, with 1 patient had 2 defects. The mean diameter of the defect was (20.3±6.6) mm. 100 devices were implanted successfully. Complete closure was revealed in all the patients after the procedure. One patient developed atrial ifbrillation during the procedure. No other serious complication occurred till the last follow-up. Conclusions The modiifed transcatheter closure of atrial septal defect is an effective procedure with high successful rate and low rate of complications.