Clinical value of dual-source CT angiography in diagnosis and following-up observation after endovascular exclusion of Stanford type B aortic dissection / 实用放射学杂志

Objective To investigate clinical value of dual-source CT angiography (DSCTA)in diagnosis and following-up obser-vation after endovascular exclusion (EVE)of Stanford type B aortic dissection (AD).Methods 63 cases with type B aortic dissection were diagnosed by DSCTA,and 24 cases among these cases underwent EVE were following-up observed by DSCTA.Imaging recon-struction and analysis were finished at special workstation.All CT findings of dissection were carefully observed in every case,CT values of true and false lumens were measured at arterial-phase.The length and the width of proximal neck,and the maximum di-ameter of AD were measured in those cases that initial crevasse located at aortic arch or proximal descending thoracic aorta.The out-comes and complications of 24 cases underwent EVE were focused.Results The extension of dissection,the site of crevasse,mor-phological features of true and false lumens and tearing intimal flap,and involving main branches of aorta were accurately shown by DSCTA.Average CT value of true lumen was higher than false lumen at arterial-phase in all cases (P=0.000).In 60 cases that ini-tial crevasse located at aortic arch or proximal descending thoracic aorta,the length and the width of proximal neck of dissection changed from 0.3 cm to 9.6 cm(average 3.4 cm)and from 2.3 cm to 3.8 cm(average 2.9 cm)respectively,and the maximum di-ameter of AD was between 3.1 cm and 9.0 cm(average 5.3 cm).AD after EVE did not unceasingly enlarge in all 24 cases,false lu-men shrinked in 1 1 cases,thrombus in false lumen added in most cases,stent endoleaking were observed in 1 1 cases.Conclusion DSCTA with convenient,effective and non-invasive advantages,is one of important imaging methods in diagnosis and following-up observation after EVE of type B aortic dissection.

Therapeutic strategy for pseudoaneurysms: a report of 21 cases / 介入放射学杂志

Objective To study the locations, types and causes of different pseudoaneurysms in order to find out the optimal individualized treatment for different pseudoaneurysms. Methods Different methods were applied in treating 21 patients with pseudoaneurysm, which were located at limb (n = 11 ), spleen (n =3), kidney (n = 2) , common lilac artery (n = 1), internal iliac artery (n = 1), gallbladder (n = 1) and penis (n = 1 ). Different managements were employed in treating these pseudoaneurysms. Temporary obstruction of blood circulation with balloon together with arterial anastomosis or direct incision neoplasty was performed in 9 cases with pseudoaneurysms at limb arteries close to the larger joints. Endovascular stent graft was used to isolate the trunk type of pseudoaneurysm in 4 cases, in 2 of them branch arterial embolism and stent graft endovascular exclusion were applied as they had common iliae artery trunk type of pseudoaneurysm at the opening of internal iliac artery. Gelfoam together with metallic coils embolization was employed in 6 cases with terminal type of pseudoaneurysms. Results After different treatments, tumor cavities disappeared in the 21 cases with pseudoaneurysms. Distal arterial pulse returned to normal and no nerve damage occurred in 11 cases with limb pseudoaneurysms. No internal hemorrhage was observed and distal blood circulation returned to normal after graft endovascular exclusion in 2 eases with pseudoaneurysms at spleen artery trunk and in 2 cases with pseudoaneurysms at iliac artery trunk. In 6 cases with terminal type of pseudoaneurysms,the tumor cavity disappeared, hemorrhage stopped and no ischemic necrosis of organ occurred. But one of them with multiple traumatic pseudoaneurysms located at the second grade branch died one week after embolism due to a serious pelvic trauma accompanied with serious infection. Conclusion Based on the locations, types and causes of pseudoaneurysms, different individualized treatment should be adopted in order to obtain optimal results with least damages.

Exploration of peri-operative nursing care for endovascular exclusion of thoracic aortic dissection / 重庆医科大学学报

Objective:To explore the key points of care for Aortic Dissecting Aneurysm patient who is undergoing an operation of endovascular exclusion.Methods:Made conclusion and analyze on the 5 cases,and to look into the satisfactory rate of the patients post-operatively.Results:The 5 cases are performed successfully,and there isn't any nursing complication occurred and the satisfactory rate of care is 100%.Conclusion:Knowledge education related to the operation,good cooperate among the operation team,consistent observation and good communication skills are the key points of a successful operation.

Surgical treatment of thoracic aortic dissecting aneurysm: A report of 115 cases / 医学研究生学报

Objective: The present study aims to summarize the clinical experience in the surgical treatment of thoracic aortic dissecting aneurysm.Methods: We retrospectively analyzed the clinical data of 115 cases of thoracic aortic dissecting aneurysm treated by surgery from December 1995 to December 2006.Thirty-eight of them were DeBakey type I aortic dissection,18 type Ⅱ,and 59 type Ⅲ.Of the 38 DeBakey type I patients,30 underwent ascending aorta with total aortic arch replacement(2 cases of total thoracic aortic artificial vessel replacement,25 Wheat procedure and 3 aortic valvuloplasty) and the other 8 received ascending aorta with semi-aortic arch replacement.Of the 59 DeBakey type Ⅲ patients,36 underwent descending aortic aneurysm resection with artificial vessel replacement via left posterolateral thoracic incision by left heart bypass or aorta to artery bypass(using Cott tubes),while the other 23 received endovascular stent-graft exclusion in descending aorta via the femoral artery.Results: All the patients were successfully treated except 5 that died during the perioperative period.The survivors were followed up for 3-118 months,among whom 2 died long-term death after the operation and the others were living healthy.Conclusion: Surgical treatment improves the clinical outcome of thoracic aortic dissecting aneurysm.Bilateral perfusion via the carotid artery in aortic arch replacement has a definite cerebral protective effect.Surgical procedures can be simplified by using the modified elephant trunk technique.Endovascular stent-graft exclusion is safe and effective in the treatment of DeBakey type Ⅲ aortic dissection.

Imaging evaluation and clinical application of imageology in treatment of aortic aneurysm and dissection / 中国现代普通外科进展

Objective:To evaluate the imaging changes of patients with aortic aneurysm before and after the operation,and provide information for treatment and prognosis.Methods:Analyzed the imaging results with ultrasound,MRI,CT and DSA detection of 102 patients with aortic aneurysm or dissection who were treated by covered stent,and evaluated the clinical value of this operation.Results:The sensibility of ultrasound,MRI and CT were 82.6%,98.0%and 97.5%,and the specificity of these detections were 98.2%,100%and 100%.Conclusion:Exactly imaging evaluating is critical to diagnosis and a successful operation.Ultrasound,MRI,CT and DSA have their own advantages in diagnosing aortic aneurysm and dissection,choosing the best imaging method is critical to a fast diagnos is and successful operation.

Prevention of paraplegia after endovascular exclusion for Stanford B thoracic aortic dissection aneurgsm / 介入放射学杂志

Objective To assess the prophylactic measures of paraplegia and paralysis after endovascular graft exclusion(EVE) for Stanford B thoracic aortic dissections(TAD). Methods The records of 116 consecutive patients undergoing endovascular TAD repair from 1998 to 2001 were retrospectively reviewed. Steroids were administrated postoperatively in high risk patients likely to be candidates for paraplegia or paralysis. Results No paraplegia or paralysis occurred postoperatively in all cases, including the patient undengone selective spinal artery angiography (SSAA). Conclusions Transluminal repair can avoid spinal cord ischemia due to aortic cross-clamping, there is still a risk of spinal cord injury caused by occlusion of intercostal arteries under the cover of endograft. A combination of the prophylactic measures, including SSAA and steroids, have been able to reduce the risk of paraplegia and paralysis. A graft-stent of appropriate length is the key point fo this procedure.

Surgical approach of endovascular exclusion for thoracic aortic dissection / 介入放射学杂志

Objective To evaluate the surgical approach of endovascuar exclusion for thoracic dissection.Methods Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were earried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography(MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitonial approach and graft was delivered through this artery. Results Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications.Conclusions Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications.

Stent placement in the management of proximal endoleak after endovascular exclusion for abdominal aortic aneurysms / 介入放射学杂志

Objective To assess the value and safety of stent placement in treating proximal endoleak after endovascular exclusion for abdominal aortic aneurysms.Methods Three patients with primary endoleak and one patient with secondary endoleak underwent implantation of stent. Stents were deployed below renal artery in 1 case and cross bilateral renal arteries in 3 cases. Results In all 4 patients, the stents were successfully implanted and the endoleaks were completely occluded. No complications such as renal function damage, stent shift or endoleak reappearance were observed. Conclusion Stent placement appears to be a feasible, effective and safe treatment option for endoleak after endovascular exclusion for abdominal aortic aneurysms.

Recognition and treatment of outflow tract stenosis during and after endovascular exclusion for abdominal aortic aneurysm / 介入放射学杂志

Objective To study the cognition and treatment of outflow tract stenosis in and after endovascular exclusion for abdominal aortic aneurysm. Methods From Mar 1997 to Oct 2002, in 136 patients undergoing abdominal aortic aneurysm endovascular exclusion, 8 patients had outflow tract stenosis during the operation, and 3 patients had outflow tract stenosis after operation. The stenosis of 5 patients occurred at the crotch of the graft stent. PTA was done in 7 patients with stents placed in stenotic segment in 2 patients. 2 patients were treated with crossover operation. Results Following up 1 month to 2 years, all patients have no lower limbs ischemia. Conclusions The diagnosis of outflow tract stenosis during and after abdominal endovascular exclusion for aortic aneurysm must be in time. The treatment should be according to the different causes of stenosis.

Construction of a canine endoleak model in the course of endovascular exclusion for abdominal aortic aneurysm / 介入放射学杂志

Objective To design an experimental model of endoleak after endovascular exclusion(EVE). Methods Infrarenal aortic aneurysms were created with bovine jugular vein segements or patches. Then they were undergone endovascular stent graft exclusion of the aneurysm. Using modification of prosthetic vessel and changing the attachment site, endoleaks were formed druing the course of aneurysm exclusion. Results All the 6 aneurysms possessed satisfactory configuration just as clinical patterns. Intraoperative arteriography revealed endoleaks in 5 dogs after the exclusion, two of which were proximal and three were distal.Conclusions This experiment shows the hemodynamics and treatment of endoleak for EVE.