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Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique

Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.

Management of Endoleak after Endovascular Exclusion for Aortic Dissection

腔内隔绝术（endovascular exclusion, EVE）最早用于治疗腹主动脉瘤，1994年Dake报道将其用于B型主动脉夹层（aortic dissection, AD）的治疗，国内自1998年开展。在EVE治疗AD的10余年历史中，内漏的预防和处理始终是一个备受关注的问题，现结合笔者的经验讨论AD术后内漏相关的问题。......

创伤性主动脉夹层并发肾功能衰竭一例

VASCULAR BYPASS GRAFTING COMBINED WITH ENDOVASCULAR AORTIC REPAIR FOR TREATMENT OFAORTIC DILATATION DISEASE

Objective To summarize the cl inical experience of vascular bypass grafting combined with endovascularaortic repair (EVAR) for aortic dilatation disease. Methods Between January 2008 and August 2011, 12 patients with aorticdilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 wasfemale, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA),including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 casesof abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwentfemoral artery bypass grafting after EVAR. Results After operation, pulmonary infection occurred in 3 patients, renalinsufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groinwound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVARof the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation,and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak,no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and12 months after operation. Conclusion Vascular bypass grafting combined with EVAR can expand the indications forendovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifiesthe surgical procedure, and reduces the difficulty of endovascular treatment.

Improvement of Visceral Arterial Blood Supply after Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

ObjectiveTo investigate the improvement of visceral arterial blood supply after thoracic endovascular aortic repair (TEVAR) for patients with Stanford type B aortic dissection (AD). MethodsWe retrospectively analyzed clinical data of 35 patients with Stanford type B AD undergoing TEVAR in Mianyang Central Hospital from January 2013 to March 2014. There were 30 male and 5 female patients with their age of 45-82(62.5±10.0) years. Among the 140 main visceral arteries (celiac artery, superior mesenteric artery, left and right renal arteries) of the 35 patients, blood supply of 79 arteries were compromised, including 36 arteries with stenosis and blood supply via the true lumen, 18 arteries with blood supply via both true and false lumen, 18 arteries with blood supply via the false lumen, and 7 arteries without blood supply. Improvement of blood supply of main visceral arteries was analyzed. ResultsAll the operations were successfully performed without in-hospital death. Operation time was 97.8 (68-147) minutes, length of ICU stay was 12-34 h, and length of hospital stay was 10-21 days. None of the patients had cerebral infarction, acute renal failure, AD rupture or stent migration after TEVAR. Blood supply of the compromised visceral arteries showed improvement in various degrees. ConclusionFor the treatment of Stanford type B AD, TEVAR can not only successfully block the rupture of AD, but also improve blood supply of main visceral arteries, avoid or reduce the complications resulting from compromised visceral arterial blood supply and visceral ischemia.

分期杂交手术治疗胸腹主动脉夹层

目的总结腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层的经验。方法自 2018 年 1 月至 2019 年 6 月，南京鼓楼医院采用腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层 12 例，男 10 例、女 2 例，年龄 36～63（50±9）岁。结果随访 6～24 个月，全组无死亡，1 例术后左下肢单瘫，1 例出现肾功能不全。随访期间 1 例患者术后 1 个月出现主动脉支架近端逆撕，行全主动脉弓置换术后痊愈。2 例患者出现腹腔干动脉近端内漏，予以弹簧圈栓塞后痊愈，其余患者 CT 血管造影（CTA）检查未见吻合口造影剂渗漏及人工血管扭曲、闭塞。结论腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层可取得良好近期疗效，中远期疗效仍有待进一步观察随访。

腔内隔绝术、联合血管旁路移植术治疗主动脉夹层动脉瘤

摘要: 　目的　总结腔内隔绝术、联合血管旁路移植术治疗主动脉夹层动脉瘤的临床经验, 以提高其治疗效果。方法　自2002 年9 月至2006 年12 月, 共完成腔内隔绝术或联合血管旁路移植术8 例。对4 例近端支架固定区lt; 15mm的患者于腔内隔绝术前行椎动脉2左颈总动脉端侧吻合术1 例, 应用8mm 人工血管行左锁骨下动脉2左颈总动脉旁路移植术2 例, 左锁骨下动脉2左颈总动脉2右颈总动脉旁路移植术1 例, 手术后8～ 10d, 行腔内隔绝手术。4 例破口距左锁骨下动脉开口gt; 15mm 的患者直接行腔内隔绝手术。　结果　行血管旁路移植的4 例患者术后恢复良好, 术后8～ 10d行腔内隔绝手术, 8 例患者腔内隔绝手术操作顺利, 隔绝术后3～ 8d 出院, 无住院死亡。出院前增强CT 扫描无内漏发生。随访4 例, 随访时间2～ 48 个月, 其中1 例患者长期胸痛, 经对症处理胸痛缓解; 4 例患者夹层内血栓机化良好, 无内漏出现或夹层剥离的现象发生。　结论　腔内隔绝手术是一种创伤小、恢复快、疗效好的治疗方法, 腔内隔绝术联合血管旁路移植术治疗主动脉夹层动脉瘤, 扩大了腔内隔绝术的手术适应证。

急诊主动脉腔内隔绝术成功治疗食管癌术后吻合口主动脉瘘一例

腔内隔绝术治疗Stanford B型主动脉夹层--116例临床分析

目的 探讨腔内隔绝术(EVGE)治疗Stanford B型主动脉夹层动脉瘤的手术指征、术前评估方法、手术操作技巧、并发症防治原则及临床应用前景. 方法 对自1998年9月至2001年12月间施行的116例Stanford B型胸主动脉夹层动脉瘤EVGE进行了回顾性研究.术前CT血管造影(CTA)或磁共振血管造影(MRA)显示:夹层动脉瘤最大直径平均66.2±18.1mm,72例患者表现为单一夹层裂口,44例表现为多裂口.经股动脉或髂动脉将移植物导入胸主动脉封闭夹层裂口,手术在数字剪影血管造影(DSA)监视下完成. 结果 术中移植物成功释放115例,72例单一夹层裂口患者中62例使用单一移植物,8例使用2个移植物,2例使用3个移植物,6例手术结束时残存I型内漏;44例多夹层裂口者,18例使用2个移植物同时封闭不同部位夹层裂口,26例远端夹层裂口旷置,1例中转开胸手术.平均随访时间15.4±11.2个月,围手术期死亡6例,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症;术后11个月猝死1例,2例分别于术后14个月和24个月再发Stanford A型胸主动脉夹层而行Bentall手术,其余患者未出现与夹层及手术相关的并发症. 结论 EVGE治疗Stanford B型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法,短期的随访结果表明该技术安全、有效.内漏是该方法的主要并发症,并可能导致术后患者死亡,远期疗效有待继续随访.

主动脉弓部夹层动脉瘤手术治疗

目的 总结通过人工血管旁路术延长锚定距离后，腔内隔绝术（endovascular graft exclusion，EVGE）治疗主动脉弓部夹层动脉瘤的疗效。 方法 2005 年9 月－ 2007 年9 月，采用血管旁路术后二期行EVGE 治疗主动脉弓部夹层动脉瘤10 例。男9 例，女1 例；年龄33 ～ 55 岁，平均38 岁。合并高血压病8 例，尿毒症1 例。DSA 示近端破口位于左颈总动脉与左锁骨下动脉之间4 例；破口距左锁骨下动脉开口lt; 1.5 cm 且左椎动脉为优势动脉6 例，合并无名动脉瘤1 例，升主动脉及主动脉弓部壁内血肿1 例。 结果 除1 例患者由于真腔闭塞未能行EVGE 治疗外，9 例均顺利完成EVGE 治疗。术后即刻造影示Ⅰ型内漏、Ⅱ型内漏（左锁骨下动脉未结扎所致）各1 例，分别于治疗后1、3 个月经计算机X 线断层扫描血管造影术证实内漏消失。8 例破口封堵良好，1 例并发降主动脉周围血肿而失访。8 例获随访，随访时间12 ～ 36 个月，降主动脉假腔内血栓形成。 结论 人工血管旁路术延长锚定距离，不仅可扩大EVGE 的适应证，还能降低Ⅰ型内漏。