Background The conventional thoracic endovascular aortic repair （TEVAR） involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous appro...Background The conventional thoracic endovascular aortic repair （TEVAR） involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable.In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.Methods The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 （group A） were compared with those using surgical femoral cutdown from January 2008 to November 2009 （group B）. Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit （CCU） stay, time from procedure to discharge,hospital stay, procedure expense, hospital cost.Results Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% （85/85） in group A vs. 97.4% （147/151） in group B （P 〈0.05）.There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% （8/85） vs. 22.5% （34/151） （P 〈0.01）. Local anesthesia with conscious sedation was used more often in group A, 68.2% （58/85） vs. 51.7% （78/151） in group B （P〈0.01）. The procedure duration was shorter, （96±33）minutes in group Avs. （127±41） minutes in group B （P〈0.01）. The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, （117.3±88.3） hours, （7.5±5.3） days and （15.3±6.8） days vs. （132.7±115.5） hours, （10.5±5.0） days and （19.5±7.8） days in group B （P〈0.01）. The procedure cost was RMB （109 000±30 000） Yuan in group A vs. RMB （108 000±25 000） Yuan in group B （P=NS）. The hospital cost was RMB （130 000±35 000） Yuan in group A vs. RMB （128 000±33 000） Yuan in group B （P=NS）.Conclusions Total percutaneous TEAVR with the Preclosing technique is safe and effective with meticulous technique and appropriate patient selection. The Preclosing technique decreases access-related complications, depends less on general anesthesia and the surgeon＇s cooperation, saves procedure time and shortens the CCU/hospital stay. With these advantages, the use of two percutaneous closure devices increases the hospital cost only slightly.展开更多
Background The perioperative aortic dissection （AD） rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone system...Background The perioperative aortic dissection （AD） rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons clAD rupture after the procedure. Methods The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software. Results Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients （74% vs. 100%, P=-0.213）. The aortic rupture patients are more likely to have ascending aortic diameters 〉4 cm （62.5% vs. 9.0%, P=0.032）, involvement the aortic arch concavity （62% vs. 27%, P=-0.041） and have had multiple stents placed （P=0.039）. Conclusions Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter 〉4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.展开更多
Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospin...Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid （CSF） pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.展开更多
文摘Background The conventional thoracic endovascular aortic repair （TEVAR） involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable.In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.Methods The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 （group A） were compared with those using surgical femoral cutdown from January 2008 to November 2009 （group B）. Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit （CCU） stay, time from procedure to discharge,hospital stay, procedure expense, hospital cost.Results Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% （85/85） in group A vs. 97.4% （147/151） in group B （P 〈0.05）.There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% （8/85） vs. 22.5% （34/151） （P 〈0.01）. Local anesthesia with conscious sedation was used more often in group A, 68.2% （58/85） vs. 51.7% （78/151） in group B （P〈0.01）. The procedure duration was shorter, （96±33）minutes in group Avs. （127±41） minutes in group B （P〈0.01）. The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, （117.3±88.3） hours, （7.5±5.3） days and （15.3±6.8） days vs. （132.7±115.5） hours, （10.5±5.0） days and （19.5±7.8） days in group B （P〈0.01）. The procedure cost was RMB （109 000±30 000） Yuan in group A vs. RMB （108 000±25 000） Yuan in group B （P=NS）. The hospital cost was RMB （130 000±35 000） Yuan in group A vs. RMB （128 000±33 000） Yuan in group B （P=NS）.Conclusions Total percutaneous TEAVR with the Preclosing technique is safe and effective with meticulous technique and appropriate patient selection. The Preclosing technique decreases access-related complications, depends less on general anesthesia and the surgeon＇s cooperation, saves procedure time and shortens the CCU/hospital stay. With these advantages, the use of two percutaneous closure devices increases the hospital cost only slightly.
文摘Background The perioperative aortic dissection （AD） rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons clAD rupture after the procedure. Methods The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software. Results Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients （74% vs. 100%, P=-0.213）. The aortic rupture patients are more likely to have ascending aortic diameters 〉4 cm （62.5% vs. 9.0%, P=0.032）, involvement the aortic arch concavity （62% vs. 27%, P=-0.041） and have had multiple stents placed （P=0.039）. Conclusions Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter 〉4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.
文摘Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid （CSF） pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.
