Analysis of risk factors for retrograde type A dissection associated with thoracic endovascular aortic repair / 中华放射学杂志

Objective:To investigate the risk factors for retrograde type A dissection (RTAD) associated with thoracic endovascular aortic repair (TEVAR) which provided the basis for clinical risk stratification and treatment decision.Methods:The clinical data of 1 688 patients with thoracic aortic disease who underwent TEVAR in our center from January 2004 to December 2019 were retrospectively analyzed. The pathological classification included aortic dissection (1 592 cases) and other thoracic aortic diseases (96 cases). Univariate analysis and categorical multiple logistic regression analysis were used to explore the risk factors for the development of RTAD during or after TEVAR.Results:A total of 18 cases of RTAD were found, with an overall incidence of 1.1% (18/1 688), all of which occurred in aortic dissection group. After adjusting for confounding factors, multivariate logistic regression analysis showed that the incidence of RTAD was significantly decreased(OR=0.27,95%CI 0.07-0.96, P=0.043) when the oversize of stentgraft was 11%-20%, the oversize of stentgraft was ≤10% as the control group, and the difference was statistically significant( P<0.05). The ascending aorta diameter was <40 mm as the control group, and there was no significant difference in the incidence of RTAD between the ≥40 mm group and the control group(OR=2.71,95%CI 0.94-7.84, P=0.065). Conclusions:Aortic dissection is more likely to develop RTAD than other thoracic aortic diseases. A proper stentgraft oversizing ratio could reduce the probability of RTAD. That is to say that a too low stentgraft oversizing ratio is not recommended.

Multi-channel embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair / 中华普通外科杂志

Objective:To evaluate multi-channel transcatheter embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair (EVAR).Methods:Data of 8 cases of type Ⅱ endoleak after EVAR from Oct 2017 to Nov 2020 at the Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital were retrospectively analyzed.Results:All patients who suffered from type Ⅱ endoleak that originated from lumbar arteries after EVAR were successfully treated with coils and mixture of Compant medical glue and iodipin through multi-channel. The technical success rate was 100%, the operative time was 80-150 min. Right lower limb dyskinesia occurred in 1 patient after operation, the symptom disappeared by anticoagulation and trophic neurotherapy for 2 months. Type Ⅱ endoleak didn't recur in all patients, and no mortality during the 4-38(14.1) months follow-up period.Conclusion:Multi-channel transcatheter embolotherapy has definite effects for the treatment of type Ⅱ endoleak from lumbar arteries after EVAR, with high technical feasibility, few perioperative complications, low mortality among other advantages. The results of short and medium term are satisfactory.

Effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism / 中华放射学杂志

Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.

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 / 中华胸心血管外科杂志

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.

Clinical impact of transjugular intrahepatic portosystemic shunt on refractory hepatic sinus obstruction syndrome caused by Gynura segetum / 中华肝胆外科杂志

Objective:To study the treatment outcomes of transjugular intrahepatic portal shunt (TIPS) on refractory hepatic sinus obstruction syndrome (HSOS) caused by Gynura segetum.Methods:The clinical data of 15 patients with refractory HSOS caused by Gynura segetum treated at the Department of Vascular Surgery, Henan Provincial People's Hospital from January 2017 to April 2021 were retrospectively analyzed. There were 7 males and 8 females, with ages ranging from 30 to 85 years, mean ± s. d. (61.2±14.1) years. Albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl transferase, and portal vein pressure were compared before and after TIPS. The liver function and renal function of these patients were followed up.Results:When compared with pre-operation, the albumin, alanine aminotransferase, aspartate aminotransferase and other indexes were significantly improved after TIPS (all P<0.05). The portal vein pressure of 15 patients significantly decreased from the preoperative volume of (41.7±3.5) cmH 2O (1 cmH 2O=0.098 kPa) to (28.3±4.4) cmH 2O ( t=10.41, P<0.001). The preoperative liver function was Child-Pugh grade A in 1 patient, grade B in 8 patients, grade C in 6 patients. The postoperative Child-Pugh grading was grade A in 14 patients and grade B in 1 patient. Ascites, gastrointestinal bleeding, abdominal pain, abdominal distention and spontaneous peritonitis all disappeared in these 15 patients. Postoperative hepatic encephalopathy developed in 2 patients and hepatic myelopathy in 1 patient. Conclusion:TIPS for treatment of HSOS caused by Gynura segetum resulted in a rapid recovery of liver function, rapid symptomatic relief, with a low incidence of hepatic encephalopathy/hepatic myelopathy.

Application of transmesenteric vein extrahepatic portosystemic shunt to treat extrahepatic portal vein obstructive disease / 中华放射学杂志

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.

Pararenal abdominal aortic pseudoaneurysm endovascular repair: a report of 5 cases / 中华普通外科杂志

Objective:To investigate the application of in vitro fenestration endovascular aortic repair(fEVAR) in the juxtarenal abdominal aortic pseudoaneurysm and its up to mid-term results.Methods:The clinical data of 5 cases of juxtarenal abdominal aortic pseudoaneurysm from Oct 2016 to Jul 2019 at the Department of Vascular Surgery, Henan Provincial People′s Hospital was retrospectively analyzed, including therapy options, accesses, techniques of fenestration, bundle of the stent-graft, near to medium-term effects.Results:All patients were treated with fEVAR, the technical success rate was 100%. Stent modify time ranged from 50 to120 minutes, fEVAR time ranged from 75 to 210 minutes. The follow-up period was 15~42 months. All of the stents are in good position, there is no stent-related complications, and no deaths. Primary diseases are well controlled.Conclusion:The treatment for juxtarenal abdominal aortic pseudoaneurysms with fEVAR , as a full-intraluminal method, is of minimal invasion, few perioperative complications, low mortality. Result of up to mid-term follow up is satisfactory.

Treatment strategies and outcomes of endovascular repair of Stanford type B aortic dissection accompanied with retrograde type A aortic dissection / 中华放射学杂志

Objective:To investigate the treatment strategies for the thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection (TBAD) accompanied with intra-or post-operational retrograde type A aortic dissection (RAAD).Methods:TBAD patients who underwent TEVAR in Henan Provincial People′s Hospital from February 2004 to January 2020 were retrospectively analyzed. Among 1 176 cases, 14 cases (1.2%) were accompanied with RAAD. Another 9 patients who received TEVAR at other hospitals with TBAD accompanied with RAAD were also collected. In total 23 patients [18 males and 5 females, age as (54±12) years old , ranging from 38 to 79] were included in this study. There were 15 cases of typical dissection, 7 cases of intramural haematoma, and 1 case of penetrating aortic ulcer. Sixteen patients received surgical operation, 1 received hybrid surgery, and the remaining 6 patients underwent conventional therapies. The clinical data and followed up data were collected and analyzed.Results:Among 23 cases, 2 RAAD cases were discovered during the TEVAR, 8 cases were discovered during the perioperative period, 5 cases were discovered within 3 months after discharge, and 8 cases were discovered at more than 1 year after TEVAR, with the longest time point of 120 months after TEVAR. The RAAD rupture was located on the greater curvature side of the aorta in 21 cases, and on the minor curvature side in 2 cases. In 13 cases, the rupture was close to the stent head, and in 10 cases, the rupture was located on the ascending aorta and more than 2 cm from the stent head. Followed up data were collected in 21 cases, with the mean follow-up time as (59±40) months, ranging from 1 to 134 months. Six patients died, with 3 cases of all-reason death and 3 cases of cardiac-reason death. Among the 16 patients receiving surgical operation, one patient died during the perioperative period, and 1 patient suffered from the cerebral infarction and mediastinal infection. Well recovery was found in 1 patient received the hybrid operation. Five of 6 patients who received the conventional treatment died.Conclusions:RAAD is a serious complication related to TEVAR, with low incidence and high mortality rate. RAAD can occur in the early or late stages of TEVAR. TEVAR-associated RAAD has poor therapeutic outcomes, and the surgical operation should be recommended as the preferred treatment for RAAD in clinical practice.

The efficacy analysis of AngioJet rheolytic thrombectomy for treatment of acute pulmonary embolism / 中华放射学杂志

Objective:To investigate the safety and efficacy of AngioJet rheolytic thrombectomy (ART) treatment in patients with acute pulmonary embolism (APE).Methods:The clinical data of 21 consecutive APE patients with failed fibrinolytic therapy or fibrinolytic therapy contraindications were reviewed retrospectively, from January 2017 to October 2018 in Henan Provincial people's Hospital. Patients were classified into massive pulmonary embolism (MPE, 10 cases) and sub-massive pulmonary embolism (sMPE, 11 cases) according to the clinical presentation and CT angiography (CTA) results. All the patients were treated with emergency ART. The technical success rate and procedural success rate were calculated based on the angiography results and the occurrence of serious adverse events. The pre- and postoperative parameters including shock index (SI), Miller index (MI), mean pulmonary artery pressure (MPAP) and partial pressure of arterial oxygen (PaO 2) were compared using independent sample t test or Wilcoxon signed ranks test. Results:The technical success rate was 100% (21/21), and the procedural success rate was 71.4%(15/21) with 4 patients presenting severe arrhythmia, 1 patient with intraoperative severe dyspnea and 1 patient with intracranial hemorrhage. Both MPE and sMPE patients showed improvement of clinical symptoms after operation. It showed that the postoperative SI, MI and MPAP values decreased and PaO 2 increased compared with the preoperative values, with significant differences found (all P<0.05). All patients were discharged from hospital, except 1 patients left hospital due to serious illness. The mean follow-up period was (5.3±1.2) months, and 2 MPE patients expired due to cancer and acute myocardial infarction. All survivors didn't show recurrent APE symptoms and follow-up CTA showed no signs of embolism in pulmonary artery. Conclusion:ART can be used safely and effectively in APE patients, and can be prosposed as a new strategy in treatment of APE.

Treatment of aberrant subclavian artery combined with aortic dissection and analysis of interim results / 中华放射学杂志

Objective This retrospective study is to investigate the clinical features, treatment methods, and follow?up results of aberrant subclavian artery (ASA) combined with aortic dissection (AD). Methods Totally 17 patients with ASA combined with AD (ASA+AD) admitted to our hospital from August 2013 to February 2018,were included. Among these patients,there were 14 acute cases and 3 chronic cases;13 males and 4 females; aged from 28 to 82 years,with the mean age of (54±14) years. All the ASAs in these 17 patients were located behind the esophagus. There were 15 cases of aberrant right subclavian artery (ARSA),including 13 cases of Stanford type B AD (TBAD) and 2 cases of Stanford type A AD (TAAD). The other 2 cases of aberrant left subclavian artery (ALSA) was combined with TBAD. In these 15 patients combined with TBAD, 8 cases received the hybridization treatment, 4 patients underwent the simple transluminal stent?graft placement,and 3 cases were subjected to the conservative treatment. All the other 2 patients combined with TAAD received the surgical treatment. Results Out of these 17 patients,16 cases were successfully followed up,while 1 patient was lost in the follow?up period (who received the conservative treatment). The follow?up period lasted from 5 to 58 months, with an average of (30 ± 15) months. In the patients receiving the hybridization treatment, 1 case reported perioperative death, and another 1 case suffered from severe endoleakage. In the patients receiving the simple transluminal stent?graft placement,1 case reported coldness in right upper extremity, combined with numbness. One case receiving the surgical treatment reported severe endoleakage within 3 months after operation. Moreover, 2 cases reporting severe inner leakage underwent the secondary embolization treatment, obtaining satisfactory embolization effects. For the one case reporting coldness in right upper extremity, combined with numbness, after endovascular repairing treatment,the symptoms were significantly relived after drug treatment,without surgical treatment. No sever complications had been reported for the other patients during the follow?up period. Conclusion Patients with ASA+AD should be clearly diagnosed before surgery, and specific surgical plans should be determined according to specific conditions. Surgical treatment should be preferred for the patients of ASA combined with TAAD. For the patients of ASA combined with TBAD,the TEVAR or hybridization treatment or fenestration treatment could be considered,according to the condition of the arch branch vessels.

Clinical analysis of renal artery branch lesions caused by fibromuscular dysplasia in children / 中华实用儿科临床杂志

Objective To explore the lesion types of renal branches and evaluate the clinical results of endovascular treatment for renal artery branch lesions associated with fibromuscular dysplasia (FMD).Methods Eight cases with renal artery branch lesions due to FMD from June 2014 to December 2015 in Department of Vascular and Endovascnlar Surgery,Henan Provincial People's Hospital were retrospectively reviewed.The computed tomography angiography was routinely performed to ascertain the property of renal artery lesion,and digital-subtraction angiography was further performed to confirm FMD diagnosis and analyze lesion characteristics.The renal artery branch lesion types,blood pressure (BP),renin activity,glomerular filtration rate (GFR) and restenosis after operation were observed,and the outcomes were recorded.Results In 8 patients,6 patients were found with the second grade renal branch lesions and 2 patients were found with tertiary branch lesions,involving 2 and more branch arteries for 4 cases and 1 branch for 4 cases.Five cases with branch-type cystic dilatation or aneurysms with coexisting stenosis including 1 case with dissecting aneurysm and renal local infarction,and 1 case with aneurysm located in the bifurcations of branches,and 3 cases with only branch stenosis were found.The angiography showed the small branch lesions of renal artery indicating FMD-mediated focal (5 cases) and multiple stenosis (3 cases).The branch stenosis was not operated in 1 case with dissecting aneurysm and renal local infarction,as BP could be controlled by antihypertensive treatment.Other 7 cases underwent endovascular angioplasties and the technical successful rate was 100％ without complications.After 1 week of operation,BP was improved,renal function remained normal,plasma renin activity was reduced and GFR was recovered for all patients.During the follow-up period (3 to 12 months),BP improvement was observed in 3 cases,and cure were found in 4 cases,and patient's GFR and plasma renin activity were improved in all patients.There were 2 cases with re-intervention during the follow-up period due to restenosis,and the involved branches were unobstructed without obvious stenosis after 1-year follow-up.Conclusions FMD can affect the renal branch artery with different lesions types and endovascular treatment is the first choice for the renal branch lesion of FMD.

Clinical experience in treatment of the isolated abdominal aortic dissection / 中华放射学杂志

Objective This retrospective study is to analyze and summarize the clinical features and therapeutic experience of the isolated abdominal aortic dissection(IAAD). Methods Totally 17 patients of IAAD, who were admitted to our hospital from January 2009 to January 2016, were included in this retrospective analysis. Five patients with obvious pain or abdominal aorta diameter of 30 mm accompanied with sub-renal anchorage area of 15 mm, underwent endovascular repair. In these 5 patients, 4 cases were subjected to bifurcated stent graft endovascular repair and 1 case received the aorta uni-iliac endovascular repair combined with femoral-femoral artery bypass treatment. Moreover, 2 patients with sub-renal anchorage area of less than 15 mm were subjected to surgical treatment. In these 2 patients, 1 case with obvious pain and abdominal aorta diameter of 30 mm underwent the abdominal aorta-right iliac artery bypass combined with femoral-femoral artery bypass, while the other case with abdominal aorta diameter of 30 mm but no pain received the abdominal aorta-bilateral iliac artery bypass. Furthermore, 8 patients with no obvious pain and abdominal aorta diameter of less than 30 mm received conservative medical treatment. In addition, there were 2 patients with obvious pain and abdominal aorta diameter of 30 mm suffering from sudden death during the surgical preparation. Important complications of these patients during hospitalization and follow-up period were recorded, analyzed, and compared. Results For the 5 patients undergoing endovascular repair, the averaged hospitalization duration was(15.4 ± 2.9)d, one of whom died during hospitalization. There were 3 cases with follow-up period of ≥ 12 months, and 1 case reported left iliac branch occlusion. For the 2 patients subjected to surgical treatment, the follow-up period was less than 12 months, and no serious complications occurred during hospitalization or follow-up period. For the 8 patients receiving conservative medical treatment, the averaged hospitalization duration was(11.1±5.2)d. There were 4 cases with follow-up period of ≥ 12 months, and no serious complications occurred during hospitalization or follow-up period. Conclusions Endo or open surgical treatment is recommended for patients with isolated abdominal aortic dissection with obvious pain or abdominal aortic diameter of 30 mm. For the patients with no pain and abdominal aortic diameter of less than 30 mm, conservative medical treatment is recommended.

Effect of atorvastatin on lower extremity function of patients with hypertension and peripheral arterial disease

This paper aims to discuss the short-term effect of Atorvastatin on lower-extremity function of patients with hypertension and peripheral arterial disease [PAD]. 40 patients with hypertension and ankle-brachial index [ABI] less than 0.9 were divided into the control group [20 cases] and Atorvastatin group [20 cases] and treated for 6 months. The variation between the 6-min walk and the gait speed of 4-m-walk before and after the treatment were respectively observed. With regard to the two groups, differences of the drop-out values before and after the treatment were adjusted in accordance with gender, ages, body mass index [BMI], difference values of systolic pressure, ABI, difference values of total cholesterol [TC], difference values of low density lipoprotein, triacylglycerol, smoking and drug-taking situation. After the treatment, the 6-min walk had no obvious change between the two groups [P>0.05], but the 4-m normal and rapid walking speed changed obviously [P<0.01]. Short-term therapy with atorvastatin can significantly delay the decline of the walking speed in short distance and improve the lower-extremity function of patients with hypertension and PAD

Study on the small intestine absorptive kinetics characters of tanshinol and protocatechualdehyde of Salvia miltiorrhiza extracts in rats in vivo

In order to provide scientific basis for clinical selection of drugs, to compare and analyze the effective constitutes and the intestinal absorption in vivo in rats of the compound salvia tablets and compound salvia dropping pills [taken as the representatives]. Determine the contents of tanshinol, protocatechuic aldehyde, salvianolic acid B and tanshinone II A, cryptotanshinone, ginseng saponin Rg1 and Rb1 in the compound salvia tablets and compound salvia dropping pills by High Performance Liquid Chromatography [HPLC]. The intestinal absorption condition of the tanshinol, protocatechuic aldehyde, salvianolic acid B of the compound salvia tablets and compound salvia dropping pills in rats were detected by intestinal perfusion experiment. Only the intake of protocatechuic aldehyde in the compound salvia tablets was higher than in the compound dropping pills, the intake of the other 6 effective constitutes were all lower than in the compound dropping pills. The intestinal absorption of protocatechuic aldehyde was rather complete, while the intestinal absorption of tanshinol and salvianolic acid B were not significant. The duodenum was the main absorption region of these three components. The absorption of protocatechuic aldehyde was different in different regions of the intestines. Each intake of the effective constitutes in the tablets and dropping pills were significantly different, and the rat intestinal absorption of part of the components were different

Comparision of the long-term outcome of open surgical repair with the thoracic endovascular repair for ;the complicated type B dissection / 实用医学杂志

Objective To compare the long-term efficacy of the traditional open surgery (OSP) with the thoracic endovascular aneurysm repair (TEVAR) in the treatment of patients with the complicated Stanford B aortic dissection. Methods The retrospective analysis of the clinical data was conducted in 118 patients (OSP 45 vs. TEVAR 73) with the complicated type B aortic dissection from January 2004 to January 2015. The long-term survival rate was compared between the two groups and the influencing factors of the postoperative survival was analyzed by using the Cox-regression analysis. Results Significant differences in age, sex and operation time were observed between the two groups (P 0.05). The refractory hypertension and preoperative aortic overall diameter > 55 mm were the risk factors for the long-term survival (P = 0.021, OR = 11.1, 95%CI:1.428 ~ 86.372; P = 0.001, OR = 4.5, 95%CI: 1.842 ~ 11.346). Conclusions Compared with OSP, no obvious advantage of TEVAR was shown in the ten-year overall cumulative survival. In view of the influence factors of refractory hypertension and the aortic diameter for the long-term survival , we should pay attention to the blood pressure control and the performance of endovascular repair technology whether pre- or post-operation.

Hybrid operation for the treatment of Stanford type B aortic dissection / 介入放射学杂志

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.

Wingspan stent system in the treatment of symptomatic intracranial atherosclerotic stenosis / 中华放射学杂志

Objective To assess the safety, feasibility, short-and mid-term efficacy of wingspan stent for treating patients with symptomatic intracranial artery stenosis. Methods A total of 113 patients with severe symptomatic intracranial stenosis were enrolled and Gateway-wingspan stenting were performed on all patients. The technical success, the pre- and post-stenting stenosis, perioperative complications, clinical outcome and restenosis rates were recorded, and chi-square test was used for analysis of complication rate by comparing our results with the results of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study and NIH multi-center Wingspan stenting trial. Results The technical success rate was 99. 1% ( 112/113). The mean pre and post-stent stenoses were (80.7 ± 9.3)% and (27.7 ± 9.7)% (χ2 =9.397,P < 0. 05 ). The total complication rate was 4.4% (5/113 ) during the follow-up ( mean 14. 5 months, range 1-28 months), and the frequency of restenosis was 12. 5% (5/40) at 6 months. The primary endpoint events, ischemic stroke, and lesion-related ischemic stroke were lower in our study (4.5%, 3.5%,3.5% ) compared with the results of WASID trial (21.1%, 20. 4%, 15.0% ,P<0. 05). For those with poor outcome in the three high-risk sub-groups which were with more than 70% stenosis, or last event from the treatment was less than 17 days, or NIHSS was above 1, a better outcome was observed in our group (4. 5% ,4. 7% and 2. 0% in our study, 19.0%, 17.0% and 19. 6% in previous study, P < 0. 05). The medium-term efficacy in this group (4. 5% ) significantly improved compared with NIH study ( 14. 0% ,P <0. 05 ). Conclusions Wingspan stenting for symptomatic intracranial arterial stenosis is with good safety,feasibility and low perioperative stroke rate and mortality. The incidence of primary endpoint events and the ischemic events are lower than those of medication group, and the efficacy of stenting is significantly better than medication even in high-risk population.

Treatment of symptomatic intracranial atheromatous stenosis with the Gateway balloon and Wingspan stent system: short and medium term results / 中华放射学杂志

he improvement of operation skill and stent system, a better outcome in the future could be achieved.