Aneurysm shrinkage after endovascular repair of aortic diseases.

BACKGROUND: There are two graft materials for endovascular repair of aortic diseases, i.e., polyester and expanded polytetrafluoroethylene (ePTFE). The latest reports have suggested that there is graft-specific difference in outcomes. The purpose of this article was to evaluate the difference in terms of aneurysm shrinkage. PATIENTS AND METHODS: Eighty-six patients who underwent endovascular repair of aortic diseases were included. Forty patients had true aortic aneurysms, 8 had aortic pseudoaneurysms, and 38 had aortic dissections. Eighteen patients with true aortic aneurysms were treated with stent grafts fabricated with polyester, while the other 68 patients, including 22 patients with true aneurysms, 8 patients with pseudoaneurysms, and 38 patients with aortic dissections, were treated with stent grafts fabricated with ePTFE. All patients were followed-up by computed tomography (CT) for more than 1 year. The mean follow-up term was 28 months. Computed tomography confirmed that there were sufficiently long necks, and the aneurysm or the entry tear was completely excluded without any endoleak in all patients. The diameter of the preoperative lesion was compared with that measured on follow-up CT at 1 year and at the end of the follow-up term. Increase or decrease in the diameter by more than 5 mm was defined as a significant diameter change. RESULTS: Aneurysm shrinkage was observed in 40% of patients with true aneurysms, 88% of patients with pseudoaneurysms, and 55% of patients with aortic dissections at 1 year. There was no significant increase in patients with aneurysm shrinkage at the end of follow-up in any groups. In the case of true aortic aneurysms, shrinkage of aneurysms was observed more frequently with polyester-fabricated stent grafts (67%, 13/18) than with ePTFE-fabricated ones (18%, 4/22) at 1 year (P<.01). In contrast, expansion of aneurysms was observed only in patients treated with ePTFE (14%, 3/22). Shrinkage of the descending aorta was observed in 55% of patients with acute aortic dissections and 36% of patients with chronic aortic dissections. There was no case with aortic enlargement in either group. There was no significant difference between acute and chronic dissection in terms of shrinkage of the descending aorta. CONCLUSION: Expanded polytetrafluoroethylene appears to be effective for the treatment of pseudoaneurysms and aortic dissections. However, polyester seems to be more effective than ePTFE when true aneurysms are to be treated.

Endovascular stent-graft treatment for thoracic aortic aneurysms: short- to midterm results.

PURPOSE: To evaluate short- and midterm results of the endovascular repair of thoracic aortic aneurysm (TAA) with the use of custom-made stent-grafts. MATERIALS AND METHODS: Between May 1997 and May 2003, 40 patients with TAA (26 degenerative/atherosclerotic, seven dissection-related, three traumatic, two mycotic, one anastomotic, and one penetrating ulcer) underwent endovascular stent-graft placement. The mean age of the patients (29 male and 11 female) was 67.2 years. Twenty-four of the 40 patients (60%) were judged not to be good candidates for conventional open repair. Stent-graft placement was performed in the angiography suite with general anesthesia and transient cardiac arrest or induced hypotension. Custom-made stent-grafts were used in all patients. Four of the 40 patients (10%) underwent preliminary extra-anatomic bypass surgery to provide a sufficiently long landing zone. The mean follow-up period was 16.7 months (range, 1-65 months). RESULTS: The technical success rate was 97.5% and the early mortality rate was 2.5% (one out of 40 patients). There were four late deaths (two procedure-related). Survival rates were 84.2%+/-6.6% at 1 year and 84.2%+/-6.6% at 2 years. Survival rates were not significantly different between surgical candidates and non-surgical candidates (P =.423). Intraprocedural complications included access artery complications in nine patients and bleeding in three patients. Postoperative complications included early aneurysmal expansion in one patient, pneumonia in one patient, wound infection in one patient, stroke in three patients, paraplegia in one patient, respiratory insufficiency in two patients, aortoesophageal fistula in one patient, and late aneurysmal expansion in three patients. The rates of freedom from first additional intervention were 91.0%+/-6.7% at 1 year and 74.5%+/-11.9% at 2 years. The rates of freedom from second additional intervention was 100% at 2 years. The rates of freedom from treatment failure were 84.7%+/-7.6% at 1 year and 69.3%+/-11.6% at 2 years. CONCLUSION: Endovascular repair of TAA with a custom-made stent-graft is a safe and effective alternative to open repair and continues to play an important role. However, careful follow-up is mandatory to manage complications.

[Expression of SCL gene in bone marrow stromal cells from patients with leukemia].

In order to investigate expression of SCL (stem cell leukemia) gene in bone marrow stromal cells (BMSC) and bone marrow cells from patients with leukemia and normal individuals, bone marrow mononuclear cells from AML (18 cases), CML (17 cases), ALL (7 cases) and normal individuals (33 cases) were cultured long-term in vitro. Nonadherent cells (hematopoietic cells) and amplified adherent cells (BMSC) were collected respectively. RT-PCR-ELISA assay was then performed to detect expression of SCL gene. The expression ratio of SCL gene were analyzed and its expression level was normalized by beta(2)M gene acting as an internal reference for the purpose of semi-quantitative analysis. The results indicated that the expression ratio of SCL gene was lower in BMSC from AML (27.8%) and CML (11.8%) than that in normal controls (69.7%, P < 0.05), while was higher in the nonadherent cells from CML (64.3%) than that in its corresponding BMSC (P < 0.05). Semi-quantitative analysis showed that SCL gene expression level in nonadherent cells from AML was higher than that in its corresponding BMSC (P < 0.05). In conclusion, the low-level expression state of SCL gene in BMSC from patients with AML and CML may be involved in the abnormal regulation of hematopoiesis in myelocytic leukemia.

Acute and contained rupture of the descending thoracic aorta: treatment with endovascular stent grafts.

PURPOSE: The purpose of this study was to evaluate feasibility and safety of endovascular stent grafting for the treatment of patients with rupture of the descending thoracic aorta. METHODS: Thirteen patients with rupture of the descending thoracic aorta were treated with endovascular stent grafting. Six patients were treated on the day of diagnosis because their vital signs were unstable, and the other seven patients were treated electively. Five patients had infection or potential infection, and the other eight patients did not. Expanded polytetrafluoroethylene-covered or polyester-covered Z stents were used in all patients. RESULTS: Stent grafts were successfully placed in all patients. No endoleaks were observed at the end of the procedure. However, rebleeding was observed within 2 weeks of the procedure in two patients with infection. Six patients (46%) died within 5 months of the procedure (mean survival period, 61 +/- 60 days). All five patients with infection (100%) died, and only one of eight patients without infection (13%) died (P <.01). The remaining seven patients are alive during the mean follow-up period of 21 months (overall survival rate, 54%), although additional surgical interventions, including surgical conversion in one case and upper extremity extraanatomic bypass in the other, were necessary in two of these patients. CONCLUSION: Endovascular stent grafting may be a safe and feasible method for the treatment of rupture of the descending thoracic aorta in selected patients without infection. However, its usefulness in terms of long-term prognosis appears to be extremely limited, especially in patients with infection.