BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft ...BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.展开更多
Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in...Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in their origin.Additionally,it is well recognised that the talar articular cartilage strongly differs from that in the knee.Despite this fact,many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee.Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans.However,depending on the size of the lesions,surgical approaches are necessary to treat many of these defects.Bone marrow stimulation techniques may achieve good results in small lesions.Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation.Autologous chondrocyte transplantation,as a restorative procedure,is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor.The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.展开更多
Endovascular aneurysm repair is a new and minimally invasive repair for patients with abdominal aortic aneurysm (AAA). However, endotension is one of the post-operative compliances of endo-vascular aneurysm repair in ...Endovascular aneurysm repair is a new and minimally invasive repair for patients with abdominal aortic aneurysm (AAA). However, endotension is one of the post-operative compliances of endo-vascular aneurysm repair in abdominal aortic aneurysm. Typically, endotension is mainly a result of pressure transmitted to the aneurysm sac through endovascular implanted graft (EVG) by intermediary of the stagnant blood filled aneurysm cavity. Focusing on a representative AAA with an EVG, a fluid-structure interaction (FSI) solver has been employed to provide physical insight for evaluating the blood flow dynamics, maximum AAA-stresses and deformations. Although implanting an EVG can reduce the sac pressure, mechanical stress and wall deformation in AAAs significantly, they remain non-zero. These magnitudes depend on multi-factors including blood flow conditions such as velocity and pressure, as well as EVG and aneurysm geometries. In this study, it was found that blood flow velocity deceleration occurs on the graft due to the curvature of its neck, so greater curvature of the graft neck can contribute to vortex formation in this area and exert load on the graft wall. In the iliac bifurcation region, divaricating of the flow leads to a large net flow momentum change. It results in additional stress on the implant graft and may lead to graft migration. One of the peak wall stress points is in the neck region where the stent-graft is in contact with the aneurysm wall. This necessitates considering adequate graft fixation to withstand the stresses of blood flow through the implanted graft. Also, maximum deformation of sac wall occurs in around the large diameter of the sac, and deformation during the systole phase is higher than that during the diastole phase.展开更多
基金Supported by National Natural Science Foundation of China,No.81600375
文摘BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
文摘Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in their origin.Additionally,it is well recognised that the talar articular cartilage strongly differs from that in the knee.Despite this fact,many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee.Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans.However,depending on the size of the lesions,surgical approaches are necessary to treat many of these defects.Bone marrow stimulation techniques may achieve good results in small lesions.Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation.Autologous chondrocyte transplantation,as a restorative procedure,is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor.The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.
文摘Endovascular aneurysm repair is a new and minimally invasive repair for patients with abdominal aortic aneurysm (AAA). However, endotension is one of the post-operative compliances of endo-vascular aneurysm repair in abdominal aortic aneurysm. Typically, endotension is mainly a result of pressure transmitted to the aneurysm sac through endovascular implanted graft (EVG) by intermediary of the stagnant blood filled aneurysm cavity. Focusing on a representative AAA with an EVG, a fluid-structure interaction (FSI) solver has been employed to provide physical insight for evaluating the blood flow dynamics, maximum AAA-stresses and deformations. Although implanting an EVG can reduce the sac pressure, mechanical stress and wall deformation in AAAs significantly, they remain non-zero. These magnitudes depend on multi-factors including blood flow conditions such as velocity and pressure, as well as EVG and aneurysm geometries. In this study, it was found that blood flow velocity deceleration occurs on the graft due to the curvature of its neck, so greater curvature of the graft neck can contribute to vortex formation in this area and exert load on the graft wall. In the iliac bifurcation region, divaricating of the flow leads to a large net flow momentum change. It results in additional stress on the implant graft and may lead to graft migration. One of the peak wall stress points is in the neck region where the stent-graft is in contact with the aneurysm wall. This necessitates considering adequate graft fixation to withstand the stresses of blood flow through the implanted graft. Also, maximum deformation of sac wall occurs in around the large diameter of the sac, and deformation during the systole phase is higher than that during the diastole phase.
