Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
Objective To investigate the further results of thoracoabdominal aortic aneurysm (TAAA) repair， and analyze the midterm results of 63 cases treated by total thoraco abdominal aortic replacement with a tetrafurcate graft. Methods From August 2003 to October 2007，total thoracoabdominal aortic replacement with a tetrafurcate graft was performed in 63 consecutive patients with Crawford Ⅱ TAAA in Fu Wai Hospital. There were 46 male and 17 female with a mean age of 39.98 years (17-71 years). All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach and underwent profound hypothermia with shorttime interval circulatory arrest. T6 to T12 intercostal arteries were reconstructed by arterial tube technique. The celiac artery， superior mesenteric artery and right renal artery were joined into a patch and anastomosed to the end of the main graft. Left renal artery was anastomosed to an 8 mm branch or joined to the visceral arterial patch. The other 10 mm branches were anastomosed to iliac arteries. KaplanMeier method was used to perform survival analysis. Results All the cases were followed，and the mean followup time was 36.57(8-57) months. No patient died during the operation. Early mortality rate was 7.94%（5/63）. Among them， 4 patients died of multiple organ failure. Two of them were caused by neurological complications, and the other 2 of them were caused by renal failure. One patient died of low cardiac output syndrome after surgery because of coronary artery disease. This patient underwent coronary artery bypass grafting (CABG) emergently, but couldn’t wean from cardiopulmonary bypass. The incidence of stroke and temporary neurological dysfunction was 9.52%（6/63）, 4 of them were temporary neurological dysfunction and were cured before discharged from hospital. Paraplegia and paraparesis occurred in 2 and 1, respectively. They were all [CM(158.3mm]cured before leaving hospital. Pulmonary complication was 25.40%(16/63)， and12 of them were cured. Pseudoaneurysmal change was observed in reconstructed intercostal arteries in 2 patients with Marfan syndrome, but neither of them underwent paraplegia or paraparesis. One patient died at 20th, 23rd, 30th month after discharge, respectively. The survival time of this group was 50.64±2.13 months（95%CI：46.47,54.84 months） with a survival rate of 92.06% after 1 year， 88.38% after 2 years， 86.11% after 3 years. Conclusion Using tetrafurcate graft is a reliable method in total thoracoabdominal aortic replacement and has a satisfactory midterm survival rate. The intercostal arteries reconstruction by arterial tube technique in total thoracoabdominal replacement is simple, and it is helpful in spinal cord protection.
Objective To investigate the early effectiveness of total percutaneous endovascular aneurysm repair (TPEVAR) in treating asymptomatic abdominal aortic aneurysm (AAAA) by comparing with surgical femoral cutdown endovascular aneurysm repair (SFCEVAR). Methods Between January 2010 and May 2011, 41 cases of AAAA were treated with TPEVAR in 26 cases (TPEVAR group) and with SFCEVAR in 15 cases (SFCEVAR group). The maximum tumor diameter ranged from 3.5 to 9.2 cm (mean, 5.7 cm) in TPEVAR group, and ranged from 3.5 to 10.0 cm (mean, 6.9 cm) in SFCEVAR group. There was no significant difference in gender or age between 2 groups (P gt; 0.05). Results All patients underwent EVAR successfully. The patients were followed up 6-23 months (mean, 13.5 months). No significant difference was found in the outer diameters of the delivery system for main body and iliac leg, operation time, contrast media dosage, hospitalization days, or postoperative hospitalization days between 2 groups (P gt; 0.05). The patients of SFCEVAR group had more bleeding volume and longer ICU stay than patients of TPEVAR group (P lt; 0.05). The incidence of minor complication was 7.7% (2/26) in TPEVAR group and 33.3% (5/15) in SFCEVAR group, showing no significant difference between 2 group (χ2=4.42, P=0.08); the incidence of major complication in SFCEVAR group (20.0%, 3/15) was significantly higher than that in TPEVAR group (0) (χ2=5.61, P=0.02). Conclusion TPEVAR shows safer and more effective than SFCEVAR in treating AAAA.
Objective To compare the effectiveness between conventional open repair (OR) and endovascular repair (EVRAR) for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases (OR group) or by EVRAR in 8 cases (EVRAR group). There was no significant difference in age, sex, the neck length (less than 2 cm), the neck angulation of aneurysm (more than60°), il iac severe tortuosity, preoperative systol ic pressure, and preoperative comorbidity between 2 groups (P gt; 0.05). The blood transfusion volume, operation time, intensive care unit (ICU) stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups (P gt; 0.05). EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay (P lt; 0.05), but OR group was significantly better than EVRAR group in reinterventions and graftrelated complications (P lt; 0.05). Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.
Objective To explore the diagnosis and treatment of ruptured abdominal aortic aneurysm (RAAA). Methods Between January 1996 and December 2009, 14 patients with RAAA were treated. There were 13 males and 1 female with an average age of 65 years (range, 50-82 years). The main cl inical manifestations were abdominal pain and/or back pain. Ten cases had low blood pressure or shock. All cases were accurately diagnosed with CT, Doppler ultrasonography,or operation. The aneurysm diameter was from 4.5 cm to 8.0 cm. Eleven cases were treated by conventional operation, 1 by endovascular aortic repair, 1 by conservative treatment, and 1 case died after admission treatment. Results Perioperative death occurred in 6 cases (mortal ity rate was 50%) in 12 surgical patients. One case died after conservative treatment. The overall mortal ity rate was 57.14% (8/14). The causes of death included circulatory failure in 2 cases and multiple organ failure in 4 cases. The other 6 cases were cured. The postoperative hospital ization days were 12 to 34 days (14 days on average). A total of 4 cases were followed up 11 to 40 months without related compl ication. Conclusion Surgical treatment is still a main method to treat RAAA. Early diagnosis, appropriate resuscitation, and urgent surgical repair are crucial to reduce the mortal ity rate of RAAA.
Objective To explore the method of surgical treatment and endoluminal repairs of infrarenal abdominal aortic aneurysm (AAA)so as to improve the safety of surgical treatment. Methods The information of surgical treatment was analysed restrospectively in 195 cases of infrarenal AAA treated from January 1981 to December 2004. Of the patients, 155 were males, 40 were females with a mean age of 56.5 years. The diametersof the aneurysm were larger than 5 cm in 183 patients (93.8%) and 4 to 5 cm in12 patients (6.2%). Of the 175 patients who underwent selective operation, graft replacements were performed in 139 and endovascular aneurysmal repairs in 36. Twenty patients (10.3%) suffering from aneurysm rupture were given emergency operation. Results There were 6 deaths in the patients underdingselective operation(6/175, 4.3%) and in those undergoing emergengcy surgery (6/20, 30%) respectively within 30 days. The other patients were followed up from 1 month to 21 years ( 8.7 years on average), and there were 16 deaths (8.9%) during the follow-up. Nodeath was found in the endoluminal repaired group. Endoleak occurred in 8 patients, including 5 cases of type Ⅰand 3cases of type Ⅱ. After 6 months, CT scan showed that endoleak disappeared in 6 and rernained in 2. Late type Ⅱ endoleak occurred in 1 and endoleak disappearedafter endoluminal embolization. Conclusion With improvement of vascular surgical technique and development of endogafting, the safety of AAA both on surgicaland interventional means would be improved.
Objective To evaluate the safety and efficacy of treating type Ⅱ endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms with coil embolization. Methods A retrospective review of patients with type Ⅱ endoleaks treated with coil embolization was performed. Data regarding the technical, clinical, and imaging outcomes during perioperation and followed-up were collected. Results The technical success rate and the initial clinical success rate of treating type Ⅱ endoleaks with coil embolization were 100% (14/14). The mean operating time was (124.3±11) min, a mean of (127±15) mL contrast agent and a mean of (7±2) coils were used. During perioperation, one patient suffered left limb paralysis, all the patients were discharged with no perioperative mortality. Twelve patients were followed-up. During the period of 3 to 57 months of followed-up (average: 17.3 months), Type Ⅱ endoleaks reoccurred in one patient with coil embolization of the feeding vessels alone and two patients with coil embolization of the aneurysm sac alone. Since the aneurysms did not enlarge during the followed-up, these 3 patients continued followed-up without reinterventions. Conclusion Treating type Ⅱ endoleaks with coil embolization appears to be safe, and it can prevent aneurysm sac enlargement effectively. Because of the high risk of reoccurrence, follow-up after embolization is important.
Abdominal aortic aneurysm (AAA) is a common lethal aortic disease in clinical practice. At present, the imaging diagnostic methods used for AAA mainly include Doppler ultrasound, computed tomography and magnetic resonance imaging (MRI), but these methods can only observe the morphological changes of the aorta. These techniques used for the risk assessment of aneurysms, such as aneurysm rupture have some certain limitations. With the continuous development of molecular imaging technology and the further understanding of the pathogenesis of AAA, positron emission tomography (PET), molecular MRI and single photon emission computed tomography (SPECT) techniques can be used to observe the pathological changes of the AAA and assess the risk of rupture from cell and molecular level. In this paper, the latest application of PET, molecular MRI, SPECT in the risk assessment was discussed.
Objective To discuss feasibility and effectivity of intraoperative ultrasound (US) during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods A radiographic contrast nephropathy patient of abdominal aortic aneurysm and left internal iliac artery aneurysm was treated by EVAR without iodine contrast media assisted by US. Then summarized the data of this patient. Results The precise placement of the stent-graft was performed for abdominal aortic aneurysm. The left internal iliac artery aneurysm was successfully treatment with the stent-graft and coils. Intraoperative Ⅱ type endoleak from inferior mesenteric artery and Ⅰ b type endoleak from right iliac stent were identified by using US. The operative duration was 120 min and the blood loss was only 20 mL. Ⅱ type endoleak was still detected and the Ⅰ b type of endoleak was loss on postoperative a week. Conclusion Intraoperative US-assisted EVAR in patients with infrarenal abdominal aortic aneurysm represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents.
The phenomenon of sex differences exists in patients who have abdominal aortic aneurysms (AAA). The occurrence rate of AAA is higher in male, while the rates of rupture and postoperative mortality are higher for female. This phenomenon of sex differences would affect the diagnosis, treatment and postoperative rehabilitation for AAA patients. This article reviewed the recent research status of sex differences on AAA, and explored the phenomenon of sex differences from the aspects of threshold determination, biomechanics and mechanobiology. This review points out that the sex differences on AAA could ascribe to the differences of biomechanical environment and biological properties induced by the vascular size, anatomy structure and structure components of abdominal aortic artery. The comprehensive investigations of the sex differences on AAA could help to optimize the diagnosis, treatment and device design, patient care and rehabilitation strategy of AAA based on sex differences phenomenon.