Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exp...Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive展开更多
BACKGROUND A 63-year-old female was diagnosed with acute Stanford type A aortic dissection.The patient had pain in the chest and back for 1 wk.The computed tomography angiography(CTA)showed Stanford type A aortic diss...BACKGROUND A 63-year-old female was diagnosed with acute Stanford type A aortic dissection.The patient had pain in the chest and back for 1 wk.The computed tomography angiography(CTA)showed Stanford type A aortic dissection(Myla type III aortic arch).The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta.CASE SUMMARY Preoperatively,a three-dimensional(3D)-printed model of the aortic arch was made according to CTA data.Then,under the guidance of the 3D-printed aortic model,a pre-fenestrated stent-graft was customized,and the diameter of the stent-graft was reduced intraoperatively by surgeons.3D printing,triple prefenestration,and reduced diameter techniques were used during the surgery.The CTA examinations were performed at the 3rd mo and 1st year after the surgery;the results showed that the aortic dissection was repaired without endoleak,and all three branches of the aortic arch remained unobstructed.CONCLUSION Applying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case.The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.展开更多
目的探讨力量之塔技术在合并Ⅲ型主动脉弓颅内动脉瘤栓塞术中的应用效果。方法回顾性研究我院神经外科2016年8月~2018年8月介入栓塞治疗的合并Ⅲ型主动脉弓颅内动脉瘤22例。使用力量之塔技术建立导管路径栓塞颅内动脉瘤11例(实验组),使...目的探讨力量之塔技术在合并Ⅲ型主动脉弓颅内动脉瘤栓塞术中的应用效果。方法回顾性研究我院神经外科2016年8月~2018年8月介入栓塞治疗的合并Ⅲ型主动脉弓颅内动脉瘤22例。使用力量之塔技术建立导管路径栓塞颅内动脉瘤11例(实验组),使用常规导管系统栓塞颅内动脉瘤11例(对照组),通过比较两组动脉瘤在栓塞术中导管稳定性、栓塞时间、动脉瘤致密栓塞率、术后复发率及脑梗死发生率来评估治疗效果。结果 22例动脉瘤均成功栓塞,与对照组相比,实验组栓塞术中导管稳定性高(81.82% vs 27.27%),栓塞平均用时短(61.82±11.34 vs 82.72±14.79)min,致密栓塞率高(90.91% vs 36.36%),术后脑梗死发生率低(9.09% vs 63.64%),术后复发率低(18.18% vs 44.44%),差异均有统计学意义(P<0.05)。结论力量之塔技术辅助下栓塞合并Ⅲ型主动脉弓颅内动脉瘤栓塞术中导管稳定性高,手术时间短,致密栓塞率高,是一种安全可行的技术方法。展开更多
Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was descri...Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was described in an autopsy specimen in 1969.[1] In 1973, the persistence of a left fifth aortic arch was first reported.[2] Since then, several case reports have described PFAA in different forms. PFAA stenosis associated with type A interruption of the aortic arch (type-A IAA) is most common in clinical practice and requires surgical intervention. From 2013 to 2018, six cases [Table 1 and Table 2] were diagnosed using echocardiography and computed tomography angiography (CTA). Five cases were successfully treated with surgery and followed-up. The purpose of this study was to summarize the clinical characteristics and diagnostic features of PFAA stenosis associated with type-A IAA to improve its diagnostic accuracy and allow for complete pre-operative preparation and proper treatment.展开更多
Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complic...Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient's condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group(≤ 2 w), and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group(> 2 w), and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%(37/231) in the acute group, while 6.1 %(6/99) in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass(CPB) time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group(P < 0.05). The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group(P < 0.05). Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.展开更多
文摘Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive
基金Jiangsu Provincial Medical Youth Talent Foundation,No.QXRC201621Outstanding Youth Project supported by Nanjing Medical Science and Technology Development Foundation,No.JQX17003and Social Development Program of Jiangsu Province,No.BE2019604.
文摘BACKGROUND A 63-year-old female was diagnosed with acute Stanford type A aortic dissection.The patient had pain in the chest and back for 1 wk.The computed tomography angiography(CTA)showed Stanford type A aortic dissection(Myla type III aortic arch).The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta.CASE SUMMARY Preoperatively,a three-dimensional(3D)-printed model of the aortic arch was made according to CTA data.Then,under the guidance of the 3D-printed aortic model,a pre-fenestrated stent-graft was customized,and the diameter of the stent-graft was reduced intraoperatively by surgeons.3D printing,triple prefenestration,and reduced diameter techniques were used during the surgery.The CTA examinations were performed at the 3rd mo and 1st year after the surgery;the results showed that the aortic dissection was repaired without endoleak,and all three branches of the aortic arch remained unobstructed.CONCLUSION Applying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case.The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.
文摘目的探讨力量之塔技术在合并Ⅲ型主动脉弓颅内动脉瘤栓塞术中的应用效果。方法回顾性研究我院神经外科2016年8月~2018年8月介入栓塞治疗的合并Ⅲ型主动脉弓颅内动脉瘤22例。使用力量之塔技术建立导管路径栓塞颅内动脉瘤11例(实验组),使用常规导管系统栓塞颅内动脉瘤11例(对照组),通过比较两组动脉瘤在栓塞术中导管稳定性、栓塞时间、动脉瘤致密栓塞率、术后复发率及脑梗死发生率来评估治疗效果。结果 22例动脉瘤均成功栓塞,与对照组相比,实验组栓塞术中导管稳定性高(81.82% vs 27.27%),栓塞平均用时短(61.82±11.34 vs 82.72±14.79)min,致密栓塞率高(90.91% vs 36.36%),术后脑梗死发生率低(9.09% vs 63.64%),术后复发率低(18.18% vs 44.44%),差异均有统计学意义(P<0.05)。结论力量之塔技术辅助下栓塞合并Ⅲ型主动脉弓颅内动脉瘤栓塞术中导管稳定性高,手术时间短,致密栓塞率高,是一种安全可行的技术方法。
文摘Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was described in an autopsy specimen in 1969.[1] In 1973, the persistence of a left fifth aortic arch was first reported.[2] Since then, several case reports have described PFAA in different forms. PFAA stenosis associated with type A interruption of the aortic arch (type-A IAA) is most common in clinical practice and requires surgical intervention. From 2013 to 2018, six cases [Table 1 and Table 2] were diagnosed using echocardiography and computed tomography angiography (CTA). Five cases were successfully treated with surgery and followed-up. The purpose of this study was to summarize the clinical characteristics and diagnostic features of PFAA stenosis associated with type-A IAA to improve its diagnostic accuracy and allow for complete pre-operative preparation and proper treatment.
基金supported by The Medical Scientific Research Foundation of Guangdong Province(No.A2016028/No.A2015458)
文摘Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient's condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group(≤ 2 w), and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group(> 2 w), and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%(37/231) in the acute group, while 6.1 %(6/99) in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass(CPB) time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group(P < 0.05). The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group(P < 0.05). Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.
