In recent years, the diagnosis and management technology of type B aortic dissection (TBAD) has developed rapidly worldwide along with evidence-based medicine practice and clinical research data. But the standard clinical criteria are still limited. Based on this, the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) established an expert group dominated by aortic surgeons to collate and analyze the comprehensive literature data of acute and chronic, complicated and uncomplicated TBAD. And then, the group formulated and officially released the clinical practice guidelines for TBAD in 2022. In this paper, we interpreted and analyzed the main contents of the guideline in combination with domestic research, in order to provide reference and help for the clinical diagnosis and treatment of TBAD at the present stage in China.
In recent years, the worldwide incidence rate of peripheral artery and aortic diseases has increased year by year, significantly increasing the cardiovascular mortality and incidence rate of the whole population. In the past, peripheral artery and aortic diseases were often more prone to missed diagnosis and delayed treatment compared to coronary artery disease. The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases for the first time combines peripheral arterial and aortic diseases, integrating and updating the 2017 guidelines for peripheral arterial disease and the 2014 guidelines for aortic disease. The aim is to provide standardized recommendations for the management of systemic arterial diseases, ensuring that patients can receive coherent and comprehensive diagnosis and treatment, thereby improving prognosis. This article interprets the main content of the guideline in order to provide reference and assistance for the clinical diagnosis and treatment of peripheral artery and aortic diseases in China at the current stage.
Objective To investigate the security and efficiency of endovascular repair for Stanford type B aortic dissection (AD) with severe complications. Methods Between January 2003 and December 2009, 60 patients having Stanford type B AD with severe compl ications were treated, including 39 males and 21 females with an average age of 43.7 years (range, 34-71 years). Severe compl ications included 27 cases of huge hemothorax, 1 case of paraplegia, 7 cases of acute renal failure,10 cases of cel iac trunk ischemia, 10 cases of superior mesenteric artery ischemia, and 5 cases of severe limb schemia. Emergency stent-graft deployment were appl ied in all patients, and 64 stent-grafts were successfully implanted. Results All patients survived and were followed up 3-86 months. Hemothorax disappeared after 28 days to 3 months of operation in all hemothorax patients; renal function returned normal after 1 to 9 days; l imb and visceral ischemia disappeared gradually after 1 to 14 days; and muscular strength of lower limb in the paraplegia patient began to recover after 4 hours of operation. The postoperative CT angiography showed enlarged true lumen and thrombosis in the false lumen. Conclusion Emergency endovascular repair is a safe and effective method to treat Stanford type B AD with severe complications.
Transcatheter aortic valve replacement and endovascular abdominal aortic repair have now become the first-line treatment options for aortic stenosis and aortic disease, respectively. For patients with both diseases, combined procedures have been reported in a few domestic and foreign publications. However, all the procedures were performed under general anesthesia. Here, we reported a case of simultaneous minimalist transfemoral transcatheter aortic valve replacement and endovascular repair of the abdominal aorta for a 78-years-old male patient with aortic stenosis and abdominal aortic ulcer, and the surgical results were satisfactory.
ObjectiveTo investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention.MethodsA retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.ResultsAll patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened.ConclusionSCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.
Aortic arch disease is one of the research hotspots and treatment difficulties in the field of aorta, including aortic arch aneurysms, pseudoaneurysm, ulcer, dissection and intramural hematoma. By summarizing the clinical data of the vascular surgery center of Fuwai Hospital of Chinese Academy of Medical Sciences in the past five years and combining with the latest theories of the cutting-edge development of aortic surgery, the authors proposed the "HENDO" concept, including using hybrid technique (H), endovascular repair (Endo) and open surgery (O), properly to treat aortic arch pathologies individually. The authors advocated the establishment of HENDO team and cooperation mechanism in large aortic centers, to eliminate technical shortcomings of a single surgeon by fully mastering the three main technology clusters by teamwork. Accordingly, the best treatment for each patient can be administrated and the survival rate and quality of life can be improved eventually.
ObjectiveTo investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery.MethodsA retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years.ResultsThe operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention.ConclusionModified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.
ObjectiveTo explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery.MethodsFrom June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed.ResultsFinally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P＜0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P＜0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes.ConclusionCarotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.