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find Keyword "主动脉腔内修复术" 22 results
  • EFFECTIVENESS COMPARISON BETWEEN DOUBLE Perclose ProGlide CROSSING SUTURE AND TRADITIONAL SUTURE FOR CLOSURE OF PUNCTURE SITES IN ENDOVASCULAR AORTIC REPAIR

    Objective To compare the advantages and disadvantages between double Perclose ProGlide crossing suture and traditional suture for the closure of 20F or 22F access points so as to provide a basis for selecting appropriate approach to repair the puncture points in endovascular aortic repair. Methods Between June 2007 and May 2011, 103 patients (115 common femoral arteries) underwent endovascular aortic repair using sheaths of 20F or 22F (outer diameter); double Perclose ProGlide crossing suture was performed for closure of puncture sites in 57 cases (64 common femoral arteries) (double Perclose group) and traditional suture in 46 cases (51 common femoral arteries) (traditional group). There was no significant difference in age, gender, or disease duration between 2 groups (P gt; 0.05). Results The operation time, blood loss, and hospitalization days of double Perclose group were significantly better than those of traditional group (P lt; 0.05). Ecchymoma in inguinal region and lymphatic leakage occurred in 5 cases (5 common femoral arteries) and 2 cases (2 common femoral arteries) of double Perclose group respectively, in 2 cases (2 common femoral arteries) and 6 cases (8 common femoral arteries) of traditional group respectively; no significant difference was found in the rate of the early complication between double Perclose group and traditional group (7.8% vs. 15.7%, χ2=1.76, P=0.19). The technique success rate of double Perclose group was 96.9% (62/64), and was 100% (51/51) in traditional group, showing no significant difference (χ2=0.31, P=0.50). All patients were followed up, 2-19 months (mean, 15 months) in double Perclose group and 2-18 months (mean, 14 months) in traditional group. Pseudoaneurysm occurred in the puncture region at 3 months in 1 case (1 common femoral artery) of double Perclose group, and incision and suture therapy was performed; no arteriostenosis or pseudoaneurysm occurred in other cases; and the rate of mid-term complication was 1.6% (1/64) in double Perclose group and was 0 in traditional group, showing no significant difference (P=1.000). Conclusion Double Perclose ProGlide crossing suture has the same effectiveness to traditional surture in repairing the puncture point with 20F or 22F, but it is superior to traditional suture in reducing operation time, blood loss, and hospitalization days.

    Release date:2016-08-31 04:24 Export PDF Favorites Scan
  • Advancement of Endovascular Aortic Repair for Treatment of Aortic Diseases

    Release date:2016-09-08 10:24 Export PDF Favorites Scan
  • EFFECTIVENESS EVALUATION OF THORACIC ENDOVASCULAR AORTIC REPAIR FOR BLUNT THORACIC AORTIC INJURY WITH HOSTILE STENT-GRAFT PROXIMAL LANDING ZONE

    ObjectiveTo explore the effectiveness of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) with hostile stent-graft proximal landing zone. MethodsA retrospective analysis was made on the clinical data of 13 patients with BTAI with hostile stent-graft proximal landing zone treated by TEVAR between December 2007 and December 2014. There were 10 males and 3 females with the mean age of 44 years (range, 24-64 years). The imaging examination indicated Stanford type B aortic dissection in 7 cases, pseudoaneurysm in 3 cases, aneurysm in 1 case, and penetrating ulcer in 2 cases. According to the partition method of thoracic aortic lesion by Mitchell, 8 cases underwent stent-graft with left subclavian artery (LSA) coverage, 3 underwent chimney stents for LSA, and 2 for left common carotid artery (LCCA). In 2 cases receiving chimney TEVAR involving LCCA, one underwent steel coils at the proximal segment of LSA to avoid type II endoleak and the other underwent in situ fenestration for endovascular reconstruction of LSA. ResultsAll TEVAR procedures were successfully performed. The mean operation time was 1.8 hours (range, 1-3 hours); the mean intraoperative blood loss was 120 mL (range, 30-200 mL); and the mean hospitalization time was 15 days (range, 7-37 days). No perioperative death and paraplegia occurred. The patients were followed up 3-30 months (mean, 18 months). Type I endoleak occurred in 1 case during operation and spontaneously healed within 6 months. Hematoma at brachial puncture site with median nerve compression symptoms occurred in 1 case at 3 weeks after operation; ultrasound examination showed brachial artery pseudoaneurysm and thrombosis, and satisfactory recovery was obtained after pseudoaneurysmectomy. No obvious chest pain, shortness of breath, left upper limbs weakness, numbness, and dizziness symptoms were observed. Imaging examination revealed that stentgraft and branched stent remained in stable condition. Meanwhile the blood flow was unobstructed. No lesions expanded and ruptured. No new death, bacterial infection, or other serious complications occurred. ConclusionAccording to Mitchell method, individualized plan may be the key to a promising result. More patients and further follow-up need to be included, studied, and observed.

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  • 对腔内修复Stanford B型主动脉夹层手术范围的质疑——应将“远端旷置”改为“全程修复”

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  • Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

    ObjectiveTo evaluate clinical outcomes of thoracic endovascular aortic repair (TEVAR)for the treatment of Stanford type B aortic dissection (AD)and descending aortic aneurysm. MethodsClinical data of 20 patients with Stanford type B AD or descending aortic aneurysm who underwent TEVAR in West China Hospital from March to June 2013 were retrospectively analyzed. There were 19 male and 1 female patients with their age of 41-76 (58.3±10.2)years. Clinical outcomes were analyzed. ResultsAmong the 20 patients, 18 patients were successfully discharged, 1 patient refused further postoperative treatment and was discharged, and 1 patient died postoperatively. Sixteen patients (88.9%)were followed up for over 3 months. In all the patients during follow-up, true lumen diameter recovered within the scope of intravascular stents, and there was thrombosis in false lumen or aneurysm lumen. ConclusionTEVAR provides a new choice with significant advantages for the treatment of Stanford type B AD, especially for the elderly and patients with concomitant serious diseases, so it is worthy of clinical application.

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  • 降主动脉“逆行”去分支与主动脉腔内修复术杂交治疗 Stanford A 型主动脉夹层

    Release date:2017-09-26 03:48 Export PDF Favorites Scan
  • Repair of type Ⅰa endoleak after thoracic endovascular aortic repair

    Objective To retrospectively review our experience of correction of type Ⅰa endoleak after thoracic endovascular aortic repair(TEVAR). Methods From August 2009 to May 2016, 29 patients with type Ⅰa endoleak after TEVAR (25 males, 4 females at mean age of 56±10 years (range, 41–86 years) underwent treatment: open surgery in 15 patients (an open surgery group), hybrid aortic arch repair in 6 patients (a hybrid group) and cuff extension in 8 patients(a cuff group). A history of hypertension was noted in 25 patients, diabetes mellitus in 3 patients, coronary artery disease in 3 patients, lung infection in one patient, aortic root aneurysm in one patient and aberrant right subclavian artery in one patient. Results In the open surgery group, no death was observed. Continuous renal replacement therapy and re-intubation was done in one patient and drainage of pericardial effusion in one patient. No death was noted in the hybrid group and persistent type Ⅰa endoleak in one patient. In the cuff group, thrombosis of the left common artery was noted in one patient and bypass of the left axillary artery to the left axillary artery and the left common carotid artery was done. Unfortunately, he died of cerebral infarction and total in-hospital death rate was 3.4% (1/29). Bypass of the left axillary artery to the left axillary artery was done in one patient with left upper limb ischemia. There were 4 (14.2%) deaths during follow-up: 3 deaths in the open surgical group and one death in the cuff group. Endoleak was observed in one patient in the hybrid group and one in the cuff group. Conclusion The corresponding procedure, including open surgery, hybrid aortic arch repair or cuff extension, is scheduled to be done according to the characteristics of type Ⅰa endoleak. Satisfactory outcomes are achieved in patients with typeⅠa endoleak.

    Release date:2018-09-25 04:15 Export PDF Favorites Scan
  • Stanford B 型主动脉夹层腔内修复术后并发 A 型夹层的外科治疗

    目的总结 Stanford B 型主动脉夹层胸主动脉腔内修复术(TEVAR)后并发 A 型夹层的临床特点及外科治疗经验。方法自 2013 年 11 月至 2018 年 3 月,南京鼓楼医院外科治疗 Stanford B 型主动脉夹层 TEVAR 术后并发的 A 型夹层患者 14 例,其中男 13 例 、女 1 例,年龄 24~66(52±3)岁,合并高血压 13 例,糖尿病 2 例,马方综合征 1 例。所有患者在深低温停循环选择性脑灌注下施行手术,近心端 13 例行升主动脉置换术,1 例行 Bentall 术。共实施全弓置换加象鼻手术 13 例,弓部开窗支架植入术 1 例。结果全组无死亡,1 例术后右上肢单瘫,1 例术后血行感染,1 例出现右侧偏瘫及肾功能不全行肾脏替代治疗。随访 6~45 个月,随访期间 1 例患者术后 1 个月因原介入支架远端胸降主动脉发生新的夹层再次行 TEVAR,其余患者 CT 血管造影检查未见吻合口造影剂渗漏及人工血管扭曲。结论B 型主动脉夹层 TEVAR 术后并发 A 型夹层及时给予外科手术治疗可取得良好疗效。

    Release date:2019-07-17 04:28 Export PDF Favorites Scan
  • CUFF 预开窗技术治疗胸主动脉腔内修复术后近端内漏

    目的探讨胸主动脉腔内修复手术中即时造影提示覆膜支架近端出现Ⅰ型内漏,通过追加植入体外预开窗的支架延长段(CUFF)以延长锚定区,并消除Ⅰ型内漏的手术方式的安全性、有效性及其技术要点。方法2016~2017 年阜外医院血管外科中心实施胸主动脉腔内修复手术 623 例,其中 6 例患者在第 1 枚覆膜支架植入后,采取了追加植入 1 枚体外预开窗 CUFF 的方法处理了近端Ⅰ型内漏并保留了弓部分支动脉。6 例患者平均年龄 63.3(54~76)岁,男 4 例、女 2 例,其中 Stanford B 型主动脉夹层 2 例,胸主动脉假性动脉瘤 1 例,主动脉穿通性溃疡 3 例,全部接受经股动脉途径的胸主动脉腔内修复术治疗。结果本组手术成功率 100.0%,预开窗技术分支动脉保留成功率 100.0%,预开窗平均时间 10.3(6~17)min。5 例保留了左锁骨下动脉,1 例同时保留了左颈总动脉和左锁骨下动脉,后者经开窗向左颈总动脉植入覆膜支架 1 枚。本组锁骨下动脉均未植入支架。Ⅰ型内漏消除率 83.3%(5/6),1 例患者术后仍有微少量内漏,未予进一步处理。所有患者均获得门诊或电话随访,随访时间 10.3(3~25)个月,即时造影残留微少量内漏患者于术后 3 个月随访时内漏完全消失,所有患者生活质量改善,无死亡患者。结论对于腔内修复治疗术中出现近端Ⅰ型内漏的主动脉弓降部疾病患者,采取追加植入体外预开窗 CUFF 的方法,可在延长近端锚定区的同时成功保留弓上分支动脉。

    Release date:2020-01-17 05:18 Export PDF Favorites Scan
  • "J. D" technique: A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair

    ObjectiveTo report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR).MethodsTwenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D"technique (a group B). The clinical efficacy of the two groups was compared.ResultsIn the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups.ConclusionThe "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.

    Release date:2020-04-26 03:44 Export PDF Favorites Scan
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