摘要:目的:探讨创伤性感染性假性股动脉瘤的诊断和外科治疗的临床经验。方法:回顾性分析２１例创伤性感染性假性股动脉瘤的临床资料,均行瘤体摘除及彻底的清创后,分别采用了血管结扎术和血管修复重建术两种不同的手术治疗方法。结果:血管修复重建术组中３例术后出现血管破裂大出血,要再次手术,１５例行股动脉结扎术,全部保肢成功。结论:瘤体切除加血管移植术是一种理想的方法,但在无条件行血管移植时,股动脉结扎术可做为一种有效的方案,对伴有皮肤缺损者行对侧胸脐皮瓣转移术。Abstract: Objective: 〖WT5”BZ〗To explore the traumatic infected femoral pseudoaneurysm diagnosis and surgical treatment of clinical experience. Methods: Retrospective analysis of 21 cases of traumatic infected femoral pseudoaneurysm of the clinical data were performed and the tumor removed after thorough debridement, respectively vascular ligation and blood vessel repair and reconstruction surgery of two different surgical treatment. Results: The blood vessel repair and reconstruction surgery group, three cases of postoperative bleeding blood vessel ruptures occurred, we must resurgery, 15 routine femoral artery ligation, all of the success of limb salvage. Conclusion: The tumor resection plus vascular graft is an ideal way, but in an unconditional line of vascular grafts, the femoral artery ligation can be used as an effective program for skin defects associated with the contralateral breast underwent umbilical flap transfer of patients.
Objective To introduce alternative approach of right auxiliary artery cannulation through a 8 mm hemoshield graft for cardiopulmonary bypass and selective antegrade cerebral perfusion. Methods Twentythree cases of acute type A dissection and 7 cases of ascending aortic aneurysm, in which aortic arch was involved, were evaluated. An 4-5 cm long incision beneath right clavicle was made to expose auxiliary artery with auxiliary vein and brachial plexus intact. An 8 mm hemoshield graft was anastomosed to auxiliary artery and connected to the arterial end of cardiopulmonary bypass circuit. The auxiliary artery cannula was used for arterial perfusion and also used for selective antegrade cerebral perfusion. Fifteen total arch and 15 semi-total arch replacement were performed. The graft connecting auxiliary artery was simply ligated when cardiopulmonary bypass was concluded. Results Arterial perfusion flow and pressure through auxiliary artery were not significantly different from that of cannulation via ascending aorta. No significant postoperative cerebral deficits and complications of right upper limb associated with cannulation of auxiliary artery occurred. Conclusion Arterial perfusion through right auxiliary artery provides an excellent approach for surgery of acute type A dissection and ascending aortic aneurysm with optimized body perfusion and allows for antegrade cerebral perfusion during circulatory arrest.
Objective To investigate the feasibility of a "pericardial lining" modified Bentall procedure for the treatment of patients with aortic root aneurysm. MethodsThis was a retrospective study that consecutively enrolled patients treated at the Affiliated Suzhou Hospital of Nanjing Medical University, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, and the First People's Hospital of Guangyuan from January 2023 to February 2024. Preoperative clinical data, imaging findings (including echocardiography and CT scans of the aortic root and the entire aorta), details of coronary artery management, surgical outcomes, and postoperative follow-up results were collected. All patients underwent the "pericardial lining" modified Bentall procedure: the aortic valve was replaced, and an autologous pericardial patch was divided into three equal leaflets based on the circumference of the aortic annulus measured by a valve sizer. These leaflets were then sutured to the aortic annulus. Fenestrations were created in two of the pericardial leaflets for anastomosis with the left and right coronary ostia. The pericardial leaflets were sutured to the wall of the aortic sinuses to form an integrated structure, thereby narrowing the sinus portion. A prosthetic vascular graft was anastomosed to the proximal and distal aorta, and no aortic root-to-right atrium shunt was created. Results A total of 5 patients, aged 37 to 68 years, were included. The preoperative Society of Thoracic Surgeons (STS) risk scores ranged from 2.8% to 3.9%. The diameter of the ascending aorta was 40-73 mm, the left ventricular end-diastolic diameter (LVEDD) was 45-71 mm, and the left ventricular ejection fraction (LVEF) was 47%-64%. Intraoperatively, the aortic cross-clamp time ranged from 85 to 180 min, and the cardiopulmonary bypass time ranged from 110 to 302 min. Postoperative follow-up echocardiography revealed that the ascending aortic diameter was 27-35 mm, LVEDD was 39-57 mm, and LVEF was 43%-61%. All surgeries were completed successfully with satisfactory immediate outcomes and no intraoperative complications. During the follow-up period, there was no mortality or reoperation. Conclusion For patients with aortic root aneurysm, the "pericardial lining" modified Bentall procedure yields satisfactory preliminary results, and the technique is demonstrated to be feasible.
This study aims to investigate whether displacement force on stents can accurately represents the displacement of the stent after endovascular aneurysm repair (EVAR) by comparing the measured stent displacement with the displacement forces calculated by computational fluid dynamics (CFD). And the effect of cross-limb and parallel-limb EVAR on stent displacements is further studied. Based on our objective, in this study, ten cross-limb EVAR patients and ten parallel-limb EVAR patients in West China Hospital of Sichuan University were enrolled. Patient-specific models were first reconstructed based on the computed tomography angiography images, then the stent displacements were measured, and the displacement forces acting on the stents were calculated by CFD. Finally, the \begin{document}$ \mathrm{cos}\;\alpha $\end{document} value of the angle between the displacement force and the displacement vector was used to analyze the matching degree between the displacement and the displacement force. The results showed that the displacement forces on cross-limb stents and parallel-limb stents were (2.67 ± 2.14) N and (1.36 ± 0.48) N, respectively. Displacements of stent gravity center, stent displacements relative to vessel, and vessel displacements of cross-limb and parallel-limb stents were (4.43 ± 2.81) mm and (6.39 ± 2.62) mm, (0.88 ± 0.67) mm and (1.11 ± 0.71) mm, (3.55 ± 2.88) mm and (5.28 ± 2.52) mm, respectively. The mean \begin{document}$ \mathrm{cos}\;\alpha $\end{document} for cross-limb and parallel-limb stents were 0.02 ± 0.66 and − 0.10 ± 0.73, respectively. This study indicates that the displacement force on the stent can’t accurately represent the displacement of the stent after EVAR. In addition, the cross-limb EVAR is probably safer and more stable than the parallel-limb EVAR.
rom Aug.1965 to Dec. 1992,29 patients suffered from the peudoaneurysms were treatedwlth 4 different methods. They were:1.ligating the vessels;2. repairing the defected area in thearterial watl: 3, anastomosing the vessels after the peudoaneurysms being removed; 4, repoiring thearteries with vessel grafts after the resection of the poudoaneurysm or by-passing operation. Of the 4different methed, the method 3 and 4 gave the best results. It was thought that the operation should bep...
ObjectiveTo understand risk factors of abdominal aortic aneurysm (AAA) rupture and the latest progress.MethodThe domestic and foreign related literatures on risk factors affecting AAA rupture were retrieved and reviewed.ResultsBesides some definite risk factors of AAA rupture, including age, gender, hypertension, smoking, family history, complications (such as diabetes mellitus, hypertension, dyslipidemia, etc.), the biomechanical factor was the crucial factor of AAA rupture, including the aortic compliance, aortic wall peak value of pressure, aortic wall calcification, and hemodynamics. The latest imaging methods such as the high resolution ultrasound, function and molecular imaging, and phase contrast magnetic resonance imaging could provide technical supports for the prediction of AAA rupture.ConclusionsThere are many risk factors affecting AAA rupture. Clinicians might prevent and make individualize treatment for AAA rupture according to its risk factors, and risks of AAA rupture could be more accurately assessed with help of new medical imaging examination.
Objective To discuss the clinical application value of CT angiography (CTA) in traumatic pelvic artery pseudoaneurysm and dissecting aneurysm. Methods A total of 8 patients including 7 with traumatic pelvic artery pseudoaneurysm and 1 with dissecting aneurysm diagnosed by CTA in Suining Central Hospital from August 2012 to January 2016 were enrolled in this study, in whom 6 patients with traumatic pseudoaneurysm treated with embolotherapy were confirmed by digital subtraction angiography. Image post-processing techniques of CTA including curve planar reformation, multiplanar reconstruction and volume rendering were used. Results In the seven patients diagnosed as solitary traumatic pelvic artery pseudoaneurysm by CTA, 3 had superior gluteal artery pseudoaneurysm, 2 had inferior gluteal artery pseudoaneurysm, and 2 had external iliac artery pseudoaneurysm. The 7 pseudoaneurysms were pouch-shaped with the short diameters ranged from 9 to 64 mm and the long diameters ranged from 11 to 78 mm. Six locations of artery laceration were displayed clearly, thereinto 1 case was combined with arteriovenous fistula. In addition, a vessel occlusion caused by the limitation of right external iliac artery dissecting aneurysm and the thrombosis in left side of the external iliac artery was found in 1 case. Conclusions As a non-invasive diagnostic technique, CTA can accurately diagnose traumatic pelvic artery pseudoaneurysm and dissecting aneurysm, clearly display the location relationship of pseudoaneurysm and its parent artery, and find whether arteriovenous fistula exists. Beyond that, the true and false lumen of dissecting aneurysm can be precisely identified by this technique. CTA can provide important image information for formulating individual treatment plan.
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.