ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
ObjectiveTo explore the value of the long time lower abdominal aorta balloon block technology in the pelvis or sacrum tumor surgery. MethodsFrom January 2005 to June 2013, the sacrum or pelvic tumor patients underwent the long time lower abdominal aorta balloon block technology in the Orthopedics Department of West China Hospital of Sichuan University were enrolled. According to the balloon blocking time, patients were divided into A (<90 mins), B (90 to 180 mins), and C (>180 mins) groups. The intraoperative blood loss, blood transfusion amount, average lengths of hospital stay, postoperative volume of drainage, and postoperative complications were compared among the three groups. ResultsA total of 78 patients were included, of which 21 were in group A, 38 were in group B and 19 were in group C. All patients received en bloc resection, and did not experience intraoperative balloon shift and abdominal aorta flow leakage. Comparing the three groups, there were significant differences in intraoperative blood loss (P=0.026) and average lengths of hospital stay (P=0.021). Further pairwise comparison showed the intraoperative blood loss and average lengths of hospital stay in group C were significantly higher than those in group A and group B. In addition, there were no statistical differences among the three groups in blood transfusion amount, postoperative volume of drainage and postoperative complications. ConclusionIn the pelvis and sacrum tumor surgery, extending the time of abdominal aorta balloon block can reduce bleeding, save blood, increase the safety of surgery without increasing in postoperative complications.
Objective To review the progress of artificial intelligence (AI) and radiomics in the study of abdominal aortic aneurysm (AAA). Method The literatures related to AI, radiomics and AAA research in recent years were collected and summarized in detail. Results AI and radiomics influenced AAA research and clinical decisions in terms of feature extraction, risk prediction, patient management, simulation of stent-graft deployment, and data mining. Conclusion The application of AI and radiomics provides new ideas for AAA research and clinical decisions, and is expected to suggest personalized treatment and follow-up protocols to guide clinical practice, aiming to achieve precision medicine of AAA.
ObjectiveTo summarize the current advancement of peroxisome proliferator activated receptors (PPARs) participating in formation of abdominal aortic aneurysm (AAA) and to find out the potential treatment strategy of AAA. MethodsRelevant literatures about PPARs and formation of AAA were reviewed. ResultsAAA involved inflammation of all the layers of aorta, and the formation of AAA needed many kinds of inflammatory cells and cytokines. Many researches in vitro or in vivo had shown that PPARs could reduce the expression of inflammatory cytokines, to reduce formation of AAA. However, PPARγ was also confirmed to participate in the formation of AAA and the mechanism might be the transformation of macrophage from type 1 macrophage (M1) to type 2 macrophage (M2). According to the existing studies, the assumption could be that PPARγ can suppress the inflammatory function of M1 to reduce formation of AAA at the initiating stage, and promote formation of AAA by inducing the transform of macrophage to M2 at the late stage. ConclusionPPARs may be a potential targeting point for the prevention of AAA. More studies are needed to show the feasibility and to decide the application timing.
This paper interprets clinical practice guideline for abdominal aortic aneurysm of American Society for Vascular Surgery in 2018.
目的 探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法。方法 回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习。结果 术后患者头痛明显好转，血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19。术后2周复查CTA示人工血管通畅，术后3个月复查彩超示人工血管通畅，血压在(140～150)/(80～95) mm Hg间波动，双眼视力1.0左右，已恢复正常生活。结论 大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血，病变复杂，手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果。
ObjectiveTo summarize the surgical treatment plan and experience of patients with Marfan syndrome complicated with Stanford type B aortic dissection, and to explore the treatment strategy selection.MethodsA retrospective analysis was conducted on 27 patients with Marfan syndrome complicated with thoracoabdominal aortic diseases who were treated in the department of cardiovascular surgery of our hospital from January 2013 to June 2019, including 13 males and 14 females, with an average age of 32.2±8.6 years. According to the patients' conditions, 19 of them received single pump-assisted blood transfusion combined with total thoracoabdominal aortic replacement (TAAAR), and 8 received thoracic endovascular aortic repair (TEVAR) in critically ill and pregnant patients. The patients were followed up in the outpatient clinic, and the thoracoabdominal aortic CT angiography was reexamined at 3 months, 6 months, 12 months and annually. The outcome of surgery, the incidence of intermediate cardiovascular adverse events, defined as the reoperation due to aortic or cardiac diseases, and intermediate survival rate were studied.ResultsAll 27 patients successfully completed the operation, the operation time was 60-852 (395.10±222.60) min, the spinal cord ischemia time was 14-26 (19.33±3.44) min, and the abdominal viscera ischemia time was 16-23 (19.83±1.94) min. Eight patients of TEVAR were all operated in acute phase and 19 patients of TAAAR in chronic phase. Two early postoperative deaths occurred in TEVAR patients. One died of puerperal infection and multiple organ dysfunction after cesarean section at the same time. After TEVAR, type A dissection re-ocurred in one patient. The family member gave up the treatment, and the patient died of the dissection ruptured after cesarean section. During the average follow-up of 47.6±36.7 months, 1 patient died of cerebrovascular accident and 9 patients were reoperated for adverse cardiovascular events, including 4 in TEVAR and 5 in TAAAR.ConclusionTAAAR is the first choice for the treatment of Marfan syndrome combined with thoracoabdominal aortic diseases. TEVAR is easy to operate, with a low incidence of early mortality and complications, but has the risk of internal leakage and avulsion, and a high reoperation rate in the middle stage, so it can be used for high-risk elderly patients not suitable for open surgery, or as a bridge therapy for emergency patients before open surgery.
ObjectiveTo discuss the risk factors of type Ⅱ endoleak after endovascular aneurysm repair(EVAR). MethodsThe clinical data of 197 cases of abdominal aortic aneurysm who underwent EVAR in our hospital from Jan. 2006 to Mar. 2011 were analyzed retrospectively, and risk factors of type Ⅱ endoleak were explored by logistic regression. ResultsOf the 197 cases, 18 cases suffered from type Ⅱ endoleak. Result of logistic regression showed that the risk of type Ⅱ endoleak increased per 1 of the increase of lumbar artery number(OR=1.822, P=0.010) and per 1 mm of the increase of lumbar artery diameter(OR=1.256, P=0.040). All of the cases were followed up for 1-36 months(median value of 16.8 months). Only 1 case was intervened by inferior mesenteric artery embolism for the growth rate larger than 5 mm during half a year, who was not found growth of diameter after the embolism. The type Ⅱ endoleaks of other 17 cases closed ultimately or keeping stable. ConclusionsType Ⅱ endoleak after EVAR is affected by the number and diameter of lumbar artery. Persistent type Ⅱ endoleak without enlargement of diameter of aneurysm sac needs to beclosely followed-up instead of re-intervention.
ObjectiveTo summarize the research progress of relationship between distal landing zone geometric and outcomes of endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm. MethodsThe domestic and foreign literature on the accumulation of the impact of proximal and distal landing zone geometric morphology on clinical outcomes, the evaluation methods for related complications of proximal and distal landing zones, preventive measures for adverse outcomes related to the geometric morphology of the distal landing zone, and the pathophysiological mechanisms of complications related to the distal landing zone were retrieved to make an review. ResultsThe irregular geometric morphology of the proximal landing zone was closely associated with adverse events following EVAR. The morphology of the distal landing zone was actually more complex than that of the proximal zone, and the measurement methods for its parameters were also more complicated. Common methods used in the literature for studying landing zones included the centerline distance method, the minimum distance method, and the landing area method. Primary preventive measures for adverse outcomes related to the geometry of the distal landing zone included increasing radial support force and contact area, using endostaples, and extending the landing zone. In addition to anatomical factors, the distal landing zone was also influenced by various pathophysiological factors. ConclusionsThe morphology and related pathological changes of the distal landing zone significantly impact the clinical outcomes following EVAR for abdominal aortic aneurysm. However, current research on the distal landing zone is limited. Future studies should focus on developing new technologies and methods to improve the evaluation and management of the distal landing zone, thereby reducing the complications after EVAR, enhancing the success rate of the surgery, and improving patient survival quality.