Experience with thoracic endovascular aortic repair applied in treating Stanford type B aortic dissection: An analysis of 98 cases.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has been frequently applied in Stanford type B aortic dissection since thoracic aortic diseases were first treated with artificial vessels. OBJECTIVES: The aim of this study was to analyze the clinical value of TEVAR applied in treating Stanford type B aortic dissection. MATERIAL AND METHODS: Between January 2007 and April 2014, 167 consecutive Stanford type B aortic dissection patients were treated with TEVAR and retrospectively analyzed. RESULTS: All patients had a successful operation. A total of 98 patients were followed-up and the duration of the follow-up ranged from 3 to 63 months with a mean of 25.6 ±8.4 months. Proximal type I endoleak occurred in 18 patients with an incidence rate of 18.37% and a cuff was deployed in 7 patients, in whom the endoleak disappeared after 3 months. Two patients died in the perioperative period: one died from aortic dissection rupture, while the other died from infectious shock. One patient died from acute myocardial infarction during the follow-up period. Tears occurred in the end piece of stent grafts in 12 patients, and additional TEVAR was performed. One patient had a proximal retrograde type A dissection; the patient was in an acceptable state of health apart from persistent chest and back pain, and is still in follow-up. Spinal cord ischemia, stent displacement and collapse did not occur. CONCLUSIONS: TEVAR is reliable and safe, and it can be widely applied in treating Stanford type B aortic dissection.

[Outcome comparison of open versus endovascular techniques in the treatment of abdominal aortic aneurysms].

OBJECTIVE: To compare the efficacy, cost and safety of endovascular aortic repair (EVAR) versus open surgery in the treatment of infrarenal abdominal aortic aneurysms. METHODS: Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital. Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm. In EVAR group, there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm. RESULTS: Among 86 open cases, there were inverted "Y" type artificial graft (n = 83) and straight artificial graft (n = 3). The surgical success rate was 98.8%, perioperative period mortality rate was 2.3%, a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml. The mean operative duration was 230 min, a mean hospitalization time (30 ± 3) days and a mean hospitalization cost RMB yuan 58 000. In EVAR group, the surgical success rate was 100% and perioperative period mortality rate 0.8%. Separating stent graft (n = 121, 91.7%), straight stent graft (n = 4, 3%) and one-stent-graft (n = 7, 5.3%). The mean operative duration was 150 min, a mean volume of blood loss 140 ml, a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800. The operative duration, volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group (P < 0.05). But the cost of group EVAR was significantly higher than that of group open surgery (P < 0.05). In group open surgery, 80 cases (94.1%) received a mean follow-up period of 46 months. And 79 artificial grafts maintained patency (98.8%) and 8 cases died (10%). There were 125 cases in group EVAR (94.7%) with a mean time of 32.5 months; stent graft patency in 120 cases (96%), 10 death; 8 complication cases (5.6%) involved stent migration (n = 2) and iliac artery branch occlusion (n = 6). Long-term effects had no significant difference between two groups (P > 0.05). In terms of the incidence of complications, group EVAR was significantly more than group open surgery (P < 0.05). CONCLUSION: In terms of operative duration, volume of blood loss and length of hospital stay, EVAR and open surgery treatment for infrarenal abdominal aortic aneurysms group EVAR is significantly better than group open surgery. As far hospitalization cost, group EVAR is significantly higher than group open surgery. But, in terms of incidence of long-term complications, group EVAR is significantly higher than group open surgery while the latter often requires further interventions.

[Treatment of severe acute deep venous thrombosis in lower extremity].

OBJECTIVE: To explore the method and effectiveness of treatment for severe acute deep venous thrombosis (DVT) in lower extremity. METHODS: Eighteen patients with severe acute DVT treated in our hospital from January 1, 2002 to December 31, 2008 were retrospectively analysed. All the patients had limb edema and pain, sixteen had limb cyanochroia(one had calf skin ulcer and foot gangrene), two had limb pallor, ten had weakened dorsalis pedis artery pulsation, eight had silent dorsalis pedis artery pulsation. Colour Doppler ultrasonography revealed DVT and superficial venous thrombosis in all diseased limbs. One patient underwent above knee amputation for limb gangrene. Seventeen underwent surgical thrombectomy, of which three were simple thrombectomy, five were supplemented with suprapubic saphenous vein bypass, six with suprapubic PTFE graft bypass, three with iliac vein lysis angioplasty. RESULTS: One patient died (5.6%) on the third day after surgery. Limb edema relieved in seven patients (41.2%), reduced in ten patients (58.8%). All diseased limbs regained normal artery pulsation and skin appearance except for one limb amputated. Sixteen patients (94.1%) were followed up by a mean of 34 months. Limb edema disappeared in five patients (31.3%), reduced in eight patients (50%), recurrent in three patients (18.7%). Among three recurrent patients, one died of malignant tumor 9 months after operation, two had their graft occluded resulting from intimal hyperplasia. CONCLUSIONS: Surgical thrombectomy is an effective method for treating severe acute DVT in lower extremity.