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 summarize the critical point of diagnosis and endovascular repairment (EVR) to thoracic aortic aneurysm (TAA), thoracic pseudoaneurysm (TPA) and aortic dissection (AD), by comparison the computerized tomography angiography (CTA) images before and after EVR to observe effects, so as to explore a unique index of imageology to assess the pathological development and evaluate therapeutically effect in dynamic and systemic reviews in pre, intra, postEVR and followup period. Methods Fortyeight patients involving aneurysm or dissection of thoracic aorta were treated with EVR based on the preoperative CTA imaging. Before and after the introducing of stentgraft, digital substation angiography (DSA) was taken place and sequential enhanced CTA was followed to evaluate the effects of the treatment. All imagings of CTA and DSA were collected and induced into e-FilmTM database to select key sections for analyses and measurement. Results Fortynine EVR were preformed and 54 stent grafts were implanted in 48 cases, with endothelial tears sealed in 42 cases of dissection, aneurismal cavities excluded in 2 cases of aortic aneurysm, and rupture site closed in 4 cases of pseudoaneurysm. Endoleakage happened in 9 cases, which were treated successfully by appropriate measures. One case suffered hemorrhage from introducing artery (iliac) which was controled by surgery, but he died of disseminated intravascular coagulation and then multiple organs failure. Fortyseven cases were followed up in 6-51 months with a satisfied clinical effect. Conclusion EVR is favorable in the effect of repairment to true, false and dissection of thoracic descending aorta. Chest pain and CTA scan is the key of early diagnosis of aortic dissection. Certain sections and leftanterior oblique viewing are the crucial profile for assessment and evaluation before and after operation.
Objective To evaluate the importance of "one-stop" hybrid operating room in the individualized treatment of aortic pathology. Method We retrospectively analyzed the clinical data of 247 patients of aortic pathology who were operated in the hybrid operating room in our hospital from January 2013 through December 2014. There were 193 males and 54 females at age of 24-83(54±12) years. Results Thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) was applied in 132 patients, including 122 simple patients and 10 complexes. Fenestrated TEVAR was applied in 61 patients. Hybrid operation was done in 54 patients. Perioperative death occurred in 9 patients (3.6%). Perioperative complication rate was 11.7% (29/247) . The patients were followed up for one year. During follow-up, five patients were dead. The one-year survival rate was 98.0% (242/247) . Conclusions "One-stop" individualized treatment of aortic pathology shows its advantage, yet long-term result still needs to be followed up.
ObjectiveTo provide reference for the formulation of public health policies through exploring the disease burden of aortic aneurysm (AA) in young adults. MethodsFollowing the general analytical strategies used in the Global Burden of Disease (GBD) study 2019, we analyzed sex-specific mortality rates and years of life lost (YLLs) among young adults AA in China from 1990 to 2019, compared with global and sociodemographic index（SDI) stratified of young adults AA. Joinpoint was used to analyze the time trend of AA burden among young adults men and women in China. To analyze the attributable risk factors of AA burden in young adults and explore its characteristics. ResultsAmong young adults (15-39 years old) in China, the total of AA deaths in 2019 was 657 (95%UI 549-791), an increase of 16.9% compared with 1990. The mortality rate in 2019 was 0.13 per 100 000 person-years (95%UI 0.11-0.16), an increase of 30%. In 2019, a total of 36921 (95%UI 30 865-44 445) YLLs were produced by young adults in China, an increase of 13.21% compared with 1990. The YLLs rate was 7.42 per 100 000 person-years (95%UI 6.2-8.93), an increase of 24.92%. The male YLLs rate was 11.49 per 100 000 population years (95%UI 9.22-14.28), increasing by 35.18%; The female YLLs rate was 3.11 per 100 000 person-years (95%UI 2.36-3.98), a decrease of 3.12%. Both the AA mortality rate and YLLS in male young adults were higher than those in female, and the growth rate from 1990 to 2019 was significantly higher than that in female. ConclusionThe disease burden of AA among young adults in China increased significantly from 1990 to 2019, mainly among males. The time trend of male and female AA YLLs in Chinese young adults was obviously inconsistent. The AA YLLs of Chinese male young adults were positively correlated with economic development and the progress of medical technology, and were in the process of gradual increase. The AA YLLs of Chinese female young adults were much lower than the average level, which was closely related to the low smoking rate.