Objective To investigate the therapeutic effects of endovascular covered stent on vertebral dissecting aneurysm and carotid-cavernous fistula (CCF). Methods From March 2006 to May 2007, Jostent coronary stent grafts were used to treat 4 patients with vertebral dissecting aneurysm and 3 patients with CCF. The patients of vertebral dissecting aneurysmwere male and 37-57 years old, the lesion was located on the left vertebral artery in 3 patients and on the right vertebral artery in 1 patient, with the primary symptoms of sudden headache and vomiting; CT scan demonstrated subarachnoid hemorrhage; and the medical history varied from 2 days to 10 years. The patients of CCF were male and 35-51 years old, the lesion was located on the left carotid artery in 2 patients and on the right carotid artery in 1 patient, with the primary symptoms of headache, lateral exophthalmos, eyeball distending pain, conjunctive hyperemia and impaired eyesight; all 3 patients got head injury 2 days to 1 month before the appearance of symptoms and 1 of them had a history of severe nosebleed; and the medical history ranged from 1 week to 2 months. Results For the patients with vertebral dissecting aneurysm, complete obl iteration of aneurysms was achieved, the circulations of the vertebral artery, the adjacent posterior inferior cerebellar artery and the adjacent anterior inferior cerebellar artery were smooth, no compl ications relative to operation occurred, and no recurrence of symptoms and intracranial rehaemorrhagia were observed during the follow-up period of 8 months-2 years. For the patients with CCF, the fistula were completely obl iterated, the circulation of carotid artery was smooth, the exophthalmus and conjunctiva hyperemia were improved obviously 3 days after operation, the eyesight of patient was improved at different levels over the follow-up period of 1-3 months. Conclusion Endovascular covered stent is a new and useful tool for the treatment of vertebral dissecting aneurysm and CCF .
Objective To compare preventive effect between continuous dissecting suture and traditional interrupted suture, silver ion dressing and traditional dressing, on the incisional surgical site infection (SSI) after ostomy for colorectal surgery, and to explore the influencing factors of SSI. Methods ① Sixty patients underwent the firstly elective open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Mar. 2015 to Jan. 2016, were collected to equivalently divided into continuous dissecting suture group and traditional interrupted suture group randomly. ② Twenty-seven patients with emergency open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to Jun. 2015, as well as 33 patients with elective open ostomy for colorectal surgery, who were treated in the same 2 Departments from Jul. 2015 to May. 2016, were collected to equivalently divided into silver ion dressing group and traditional dressing group. ③ Clinical data of 184 patients with elective open ostomy for colorectal surgery who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to May. 2016 were collected to analyze the influencing factors of SSI after elective open ostomy for colorectal surgery. Results ① There was no significant difference in the incidence of SSI between continuous dissecting suture group (3.3%, 1/30) and traditional interrupted suture group (16.7%, 5/30), P=0.085. ② The incidence of SSI in silver ion dressing group (6.7%, 2/30) was significantly lower than that of traditional dressing group (30.0%, 9/30), P=0.020. ③ There were 28 patients (15.2%) of the 184 elective patients and 11 patients (40.7%) of the 27 emergency patients suffered from SSI after open ostomy for colorectal surgery, and the incidence of SSI in elective surgery group was lower than that of emergency surgery group (P=0.001). ④ Results of logistic regression model showed that, patients with body mass index (BMI) <25 kg/m2 had lower risk of SSI than patients with BMI≥25 kg/m2(OR=0.383, P=0.023), patients received permanent colostomy had higher risk of SSI than patients received protective ileostomy (OR=4.370, P=0.004), patients underwent Mile’s surgery had higher risk of SSI than patients received distal anastomosis (OR=4.406, P=0.005). Conclusions The ostomy is a high risk factor for incisional SSI after elective open ostomy for colorectal surgery, especially for the obesity patients and patients who receive colostomy. The using of silver ion dressing play an important role in preventing the incisional SSI.
Surgical intervention for chronic thoracoabdominal aortic dissecting aneurysms (cTAADA) is regarded as one of the most challenging procedures in the field of vascular surgery. For nearly six decades, open repair predominantly utilizing prosthetic grafts has been the treatment of choice for cTAADA. With advances in minimally invasive endovascular technologies, two novel surgical approaches have emerged: total endovascular stent-graft repair and hybrid procedures combining retrograde debranching of visceral arteries with endovascular stent-graft repair (abbreviated as hybrid procedure). Although total endovascular stent-graft repair offers reduced trauma and quicker recovery, limitations persist in clinical application due to hostile anatomical requirements of the aorta, high costs, and the lack of universally available stent-graft products. Hybrid repair, integrating the minimally invasive ethos of endovascular repair with visceral artery debranching techniques, has increasingly become a significant surgical modality for managing thoracoabdominal aneurysms, especially in cases unsuitable for open surgery or total endovascular treatment due to anatomical constraints such as aortic tortuosity or narrow true lumens in dissections. Recent enhancements in hybrid surgical approaches include ongoing optimization of visceral artery reconstruction strategies based on hemodynamic analyses, and exploration of the comparative benefits of staged versus concurrent surgical interventions.
ObjectiveTo explore the current research status of endovascular treatment for isolated superior mesenteric artery dissection (ISMAD) so as to provide a reference for vascular surgeons and patients in selecting surgical methods. MethodThe recent domestic and international literature on the endovascular treatment for ISMAD was collected and summarized. ResultsThe current endovascular treatment methods for ISMAD mainly included catheter-directed thrombolysis and stent placement. For the ISMAD patients with true intraluminal thrombus formation, true luminal occlusion, and partial embolization of branch vessels, catheter-directed thrombolysis were performed by continuously pumping urokinase locally to dissolve thrombus and improve distal blood supply. The stent placement mainly included two main types: bare stent placement and covered stent placement, both aiming to promote true lumen recanalization, false lumen thrombosis, and vascular remodeling through mechanical support and blood flow redirection. The bare stents had unique advantages such as being well-developed, offering a wide range of options, and having stable performance. However, covered stents were superior to bare stents in terms of mid-term patency rate and in-stent restenosis. ConclusionsWith the development of technology, endovascular treatment has become an indispensable method for ISMAD patients. Extensive multicenter case reports from both domestic and international studies have supported the safety and efficacy of endovascular treatment. Catheter-directed thrombolysis, bare stent placement, and covered stent placement offer targeted solutions for various types of ISMAD patients, providing more minimally invasive and effective treatment.