The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.

Correlation between thoracic aorta 18F-natrium fluoride uptake and cardiovascular risk

AIM: To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride (18F-NaF) uptake, as a marker of ongoing calcification and cardiovascular risk factors.METHODS: Seventy-eight patients (44 females, mean age 63, range 44-83) underwent whole body 18F-NaF positron emission tomography/computed tomography. Cardiovascular risk (CVR) was used to divide these patients in three categories: Low (LR), medium (MR) and high risk (HR). 18F-NaF uptake was measured by manually drawing volumes of interest on the ascending aorta, on the aortic arch, on the descending aorta and on the myocardium; average standardized uptake value was normalized for blood-pool, to obtain target-to-background ratio (TBR). Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.RESULTS: A significant difference in whole thoracic aorta TBR was detected between HR and LR (1.84 ± 0.76 vs 1.07 ± 0.3, P < 0.001), but also between MR and HR-LR (1.4 ± 0.4, P < 0.02 and P < 0.01, respectively). Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta (P < 0.01). Myocardial uptake provided an effective CVR classes stratification (P < 0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered (R = 0.67), but it peaked when correlating the descending thoracic segment (R = 0.75), in comparison with the aortic arch and the ascending segment (R = 0.55 and 0.53, respectively).CONCLUSION: Fluoride uptake within the thoracic aorta wall effectively depicts patients’ risk class and correlates with cardiovascular risk. Descending aorta is the most effective in CVR determination.

Acute Type A Aortic Dissection—Replacement of Ascending Aorta, Aortic Arch and Antegrade Stenting of the Descending Thoracic Aorta Using the Thoraflex™Hybrid Plexus Device (Terumo Aortic)—“Frozen Elephant Trunk”: The Plymouth Way!

Objectives: To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. Materials: Thoraflex™ Hybrid Plexus Device (Terumo Aortic). Design: Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. Method/ Results: Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. Conclusions: We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.

The Effect of the LysoPC-induced Endothelial Cell Conditioned Medium on Proliferating Cell Nuclear Antigen Expression of the Calf Thoracic Aorta Smooth Muscle Cells

In order to study the effect of and mechanism of lysophosphatidylcholine (LysoPC) on proliferation of the calf thoracic aorta smooth muscle cells (ASMCs), the ASMCs were used to observe the effects of LysoPC induced endothelial cell conditioned medium on the DNA content and proliferating cell nuclear antigen (PCNA) expression in the calf thoracic ASMCs by flow cytometry and Western Blot technique. It was found that LysoPC induced endothelial cell conditioned medium could significantly promote PCNA expression of the calf ASMCs, induce the converting of ASMCs from G 0 /G 1 phase to S phase of DNA synthesis, and increase the tyrosine phosphorylation protein expression. Tyrosine protein kinase inhibitor (TPKi) RG50864 could obviously inhibit proliferation of LysoPC induced ASMCs in a dose dependence manner. The results indicated that the effect of LysoPC promoting the proliferation of ASMCs is partly evoked by endothelial cell derived growth factors such as PDGF and so on.

Expression of p-PPARγ in the aging thoracic aorta of spontaneously hypertensive rat and inhibitory effect of rosiglitazone

Objective:To investigate the expression of phosphorylated peroxisome proliferators-activated receptor y(p-PPARY) in the aging thoracic aorta of spontaneously hypertensive rat(SHR) and the inhibitory effect of rosiglitazone on the phosphorylation of PPART.Methods:16,32 and 64 week-old Wistar-Kyoto rats(WKY) and SHR were randomly and respectively divided into WKY,SHR and SHR+rosiglitazone group(9 in each group).The rats in SHR+rosiglitazone group were treated with rosiglitazone(5 mg/kg,intragastrically) for 56 d,whereas normal saline was applied in WKY and SHR groups.Systolic blood pressure(SBP)of rats was measured by tail cuff method.Histopathological damage of thoracic aorta was analyzed using Hematoxylin-Eosin(HE) staining.Immunohistochemical staining and western blot were performed to test the level of p-PPARY protein in the thoracic aorta arising from each group.Results:The SBP in 16,32 and 64 week-old SHR were significantly higher as compared with those in matched WKY rats(P【0.05,respectively).HE staining showed increased content of smooth muscle cell,wrinkled lining endothelium and increased thickness of internal elastic lamina in the thoracic aorta of SHR.Immunohistochemical staining and western blot indicated that the levels of p-PPARY in the thoracic aorta arising from SHR were obviously higher than those in the thoracic aorta arising from WKY rats(P【0.05,respectively).Importantly,the high SBP,histopathological abnormalities of the thoracic aorta and elevated p-PPARY expression were prominently abrogated by rosiglitazone treatment in SHR(P【0.05,respectively).Furthermore,the SBP,histopathological abnormalities of the thoracic aorta and p-PPARY expression were positively correlated with age in SHR(P【0.05,respectively).Conclusions:The PPARY phosphorylation was observed in the thoracic aorta of SHR and its expression was increased by the increase of age.Furthermore,rosiglitazone inhibited the PPARY phosphorylation and suppressed vascular aging in SHR.

Effect of swirling flow on LDL and ox-LDL uptake in rabbit thoracic aorta

Object To elucidate the physiological significance of the spiral flow in the arterial system from the viewpoint of atherogenic lipid transport,an ex vivo experimental comparative

Effect of bFGF on expression of MMPs mRNA on the rat thoracic aorta after ballon injury and cultured VSMCS

Background:Extracellular matrix (ECM) plays a very important role in the development ofrestenosis after PTCA The MMPs,enymes specialized in degradation of ECM,probably partciptesin extracelular matrix remodeling after balloon injury,but the factors that regulates MMPs activity arenot completely understood Basic fibroblast growth factor (bFGF),as a mitogen for a variety of cellstypes,influences metabolism of ECM.However,if effects on MMPs are not known.Methodsand Results:24 male Wistar rats were divided randomly into control group,balloon-injuried group andbFGF-treated group.The rats of control group were not treated.The rats in balloon-injuried group weredamaged by balloon and the thoracic aortas were harvested after two weeks.In the bFGF-treated grorp,balloon injury and the injuried vessels were collected after two weeks.The northern blot was used toinvestigate the MMP1,MMP2 and MMP9 mRNA expression of vesss.At the same time,the effectsof differet dose bFGF (0ng/ml,40ng/ml,80ng/ml and 120ng/ml) on the MMPs expression of culturedVSMCs were examined The results showed the bFGF can selectively increase the expression ofMMP1 and MMP9 mRNA without effect on the MMP2 on the injuried rat thoracic aorta,and dosedependently increase the MMP1 mRNA expression of cultured VSMCs without MMP2 and MMP9expression Conclusion:bFGF selectively increased MMPs mRNA expression on both injuried ratthoracic aorta and cultured VSMCs.This effect may be related to the degradation of ECM,remodelingof vessel after injuty.

Vasorelaxation Effect of Gastrodin on Isolated Thoracic Aorta Rings of Rats

Objective： To study the effect of gastrodin on isolated thoracic aorta rings of rats and to investigate the potential mechanism. Methods： A perfusion model of isolated thoracic aorta rings of rats was applied. The effect of cumulative gastrodin （5, 50, 100,150, 200, and 250 μ mol/L） on endothelium-intact aorta rings was investigated. The same procedure was applied to observe the effect of gastrodin on endotheliumintact/denuded aorta rings pre-contracted with 10.8 mol/L phenylephrine hydrochloride （PE）. The aorta rings incubated by 200 mmol/L gastrodin in the Ca2＋-free （K-H） solution was contracted by using PE. The effect of 200 mmol/L gastrodin on endothelium-denuded aorta rings pre-contracted with 60 mmol/L KCI was also observed. Results： Compared with the denuded gastrodin group, the intact gastrodin group could significantly relax the PE-contracted aorta rings （P〈0.01）. In Ca2＋-free （K-H） solution KHS, the PE-induced contraction rate of aorta rings pre-incubated by gastrodin was 6.5%± 0.7%, which was significantly less than the control group （11.8% ± 0.9%, P〈0.01）. However, after 3 mmol/L CaCl2 was added, the Ca2＋-induced contraction in the gastrodin group （51.7% ±2.4%） was similar to that in the control group （49.8% ± 2.8%）. The contractile rate of rings in the KCI-contracted gastrodin group （96.3%± 0.6%） was not significantly different from that in the control group （96.8± 1.2%）. Conclusions： Gastrodin has the effect of vasorelaxation on isolated thoracic aorta rings of rats. The mechanism of the vasorelaxation of gastrodin may mainly work through the inhibition of inositol 1,4, 5-trisphosphosphate receptor on the sarcoplasmic reticulum of the arterial smooth muscle, which leads to the reduction of the Ca2. released from the sarcoplasmic reticulum.

Comparative study on the effect of interventional and conservative therapy on the prognosis of patients with ruptured descending thoracic aorta

Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.[S Chin J Cardiol 2019;20(3):140-145]

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta

Tuberculous aortic aneurysm （TBAA） is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial,endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication.The outcome was favorable.

More to the picture of the psychological impact of endocarditis and thoracic aortic pathology

Over the years there has been substantial advanced in the diagnosis and surgical management of complex thoracic aortic disease and complex endocarditis.As these therapies are being offered to a growing segment of patients-and more and more patients are felt to potentially benefit from such therapies,the longterm consequences of these interventions is sometimes poorly understood.While traditional medical complications,such as stroke,renal failure,respiratory failure,and even death are often the focus of outcomes studies,little is known on the impact of these diseases and therapies on mental health.This commentary emphasizes the importance of better understanding the psychologic impact of endocarditis and thoracic aortic pathology as reviewed by Dr.Bagnasco.

A SD rat model of thoracic aortic aneurysms

Backgroud Thoracic aortic aneurysm (TAA) disease is a serious condition with both high mortality and morbidity rates associated with surgical therapy. Further understanding of the formation and progression of TAAs may provide novel, less invasive therapeutic strategies in patients with this devastating disease. Aneurysm formation is a complicated, dynamic process involving both cellular and extracellular processes. The mechanisms of TAA formation are poorly understood, mainly due to the lack of a useful and reproducible model. In 2003, Ikonomidis in South Carolina developed a murine model of TAA.The mouse model was less satisfactory because the small size of the murine aorta. The rat model has the advantage of larger aorta and the ability to do more research. Proper animal models are useful to understand the aetiology and evolution and they can be used to evaluate the efficacy of new treatments.Objective The goal of this study was to test the hypothesis that abluminal calcium chloride application could creat TAAs in the SD rats.MethOds Eight-week-old male Sprague-Dawley(SD) rats(n=60) were divided into two groups equally. All rats were anesthetized. An angiocath was then advanced through the mouth into the trachea under direct vision and connected to a rodent ventilator set at a respiratory rate of 180 breaths per minute. And their thoracic aortas were exposed via left thoracotomy. In the experiment group,a sponge soaked in 0.5 mol/L CaCl2 was placed on the distal half of the exposed descending thoracic aorta under direct vision. As control group, 0.5 mol/L CaCl2 was instead of 0.9% NaCl. After 15 min, the sponge was removed. Then the chest was closed. At 4,8,12 weeks, all animals undergoing fixation and aortic harvest were reanesthetized and the thorax was then opened beneath the xiphoid process. Potassium chloride was injected into the left ventricle under direct vision to arrest the heart. Then it was perfusion program and the entire animal was immersed in formalin. Seven days after fixation, the animal was removed from formalin, and the aorta was carefully harvested from its root to the renal arteries. The aorta was then immersed in an individually labeled jar containing a mixture of 80% methanol and 20% dimethyl sulfoxide (Dent’s solution).Diameter measurements were made using Axioplan 2 imaging system. Hematoxylin and eosin staining and Van Gieson and Verhoeff staining showed the elastic architecture and collagen structure. Immunohistochemical staining was performed to evaluate the presence of lymphocytes and macrophages. Results 12 weeks of CaCl2 treatment resulted in visually obvious dilation of the exposed distal descending thoracic aortic segment.The distal descending thoracic aortic diameter at 4,8,12 weeks was (0.82±0.13), (1.12±0.43), (1.65±0.58)μm respectively. The control group at 4,8,12 weeks was (0.81±0.04) , (0.94±0.12), (1.09±0.03)μm respectively. The diameter of the ascending aorta (used as an internal control) were not significantly different between groups. Hematoxylin and eosin stained slides showed disruption of the normal elastic lamellar architecture of the CaCl2-exposed aortic wall compared to the contralateral wall or untreated control. Van Gieson-stained sections showed decreased collagen content in the exposed region of aortic wall. Immunohistochemical study indicated significantly more CD3+cells and CD68+ cells in the aortas of CaCl2 treated groups than in control aortas. CD3+ cells were located in the media and surrounding the vasa vasorum in the adventitia. Conclusion We conclude that abluminal application of CaCl2 to the thoracic aorta reliably produces dilation, wall-thinning, and disruption of mural architecture, the hallmark signs of aneurysm formation. These results suggest that the rat is a useful and technically feasible model for the study of TAAs. To our knowledge, these findings describe for the first time the generation of a reproducible model of isolated TAA formation in SD rat.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.

Comparative study of the mechanical behavior of the superior thoracic artery and abdominal arteries using the finite elements method

The human body has been the subject of thorough researches—not only from medical perspective but from a technical one as well—are very rich, amongst them we find blood circulation system comprising: the heart, the arteries and the veins. The overriding role of these researches is to explain some cardiovascular pathology and provide an aid tool for the endoprothesis positioning in blood vessels while treating them. In this study we have developed a digital pattern using the common (engineering technique of the) finite element method (FEM) to simulate the mechanical behavior of the thoracic aorta and the abdominal aorta below the kidney under blood pressure effect. This pattern calculates the displacements, the stresses (constraints) and the deformations of the two arteries’ walls enabling us to know their experimentally determined mechanical and geometric properties. This pattern could be applied to detect the aneurysm and dissection phenomena.

Secondary aortoesophageal fistula initially presented with empyema after thoracic aortic stent grafting:A case report

BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality rate.The clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is absent.Early identification,early diagnosis,and early treatment are very important for improving prognosis.CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers.Blood tests revealed elevated inflammatory indicators and anemia.Chest computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural effusion.Pleural effusion tests showed empyema.After 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion.Esophageal endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle esophagus.However,on day 11,hematemesis and melena developed suddenly.Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis.Thoracic and abdominal aortic CT angiography confirmed AEF.Later that day,he suffered massive hemorrhage and hemorrhagic shock.Eventually,his family elected to discontinue treatment.CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.

天麻素可能通过抑制自噬信号改善大鼠肾性高血压

目的 探讨天麻素改善大鼠肾性高血压作用机制。方法 75只SD雄性大鼠随机分为5组(n=15):假手术组、肾性高血压模型组、模型+雷米普利(1 mg·kg^(-1))组和模型+天麻素(100和200 mg·kg^(-1))组。通过结扎肾动脉构建肾性高血压大鼠模型,以尾动脉收缩压>18.12 kPa为造模成功。造模成功后,给药组大鼠分别ig给予相应剂量的雷米普利或天麻素,连续4周。采用比色法检测大鼠血清超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量,采用ELISA检测血清血管紧张素2(Ang-2)和醛固酮(ALD)含量及血清和胸主动脉组织白细胞介素1β(IL-1β)、IL-6和肿瘤坏死因子α(TNF-α)含量,HE染色观察大鼠主动脉病理结构的改变。Western印迹法检测大鼠主动脉组织自噬蛋白微管相关蛋白轻链3Ⅱ(LC3-Ⅱ)与LC3-Ⅰ的比值(LC3-Ⅱ/LC3-Ⅰ)。结果 与假手术组比较,模型组大鼠血清Ang-2含量显著升高(P<0.01),ALD显著降低(P<0.01);血清和主动脉组织SOD活性显著降低(P<0.01),MDA含量显著升高(P<0.01),IL-1β,IL-6和TNF-α含量均显著升高(P<0.01);胸主动脉壁增厚且炎症细胞浸润,自噬蛋白LC3-Ⅱ/LC3-Ⅰ比值显著升高(P<0.01)。与模型组比较,模型+天麻素(100和200 mg·kg^(-1))组大鼠尾动脉收缩压显著降低(P<0.01);血清Ang-2含量显著降低(P<0.01),ALD含量升高(P<0.01),血清SOD活性增加(P<0.01);血清和主动脉组织MDA,IL-1β,IL-6和TNF-α含量降低(P<0.01);大鼠主动脉组织病理改变改善,同时LC3-Ⅱ/LC3-Ⅰ降低(P<0.01)。结论 天麻素可改善肾性高血压模型大鼠血压,其机制可能与降低LC3-Ⅱ/LC3-Ⅰ比值有关。

CT胸椎骨定量与冠脉及胸主动脉钙化相关研究

目的探讨常规CT中胸椎椎体骨质定量与冠脉及胸主动脉钙化相关性。方法收集217例患者一般资料、生化指标及冠脉CTA。测量冠脉、胸主动脉钙化积分,分为钙化组与非钙化组。测量T6~11椎体松质骨及皮质骨密度,椎体骨赘积分。进行组间比较、相关分析及回归分析。结果冠脉与胸主动脉钙化组年龄、收缩压、血糖及骨赘积分均高于非钙化组,松质骨密度低于非钙化组(P<0.05)。冠脉钙化积分与年龄、收缩压、血糖、皮质骨密度及骨赘积分正相关,与松质骨密度负相关(P<0.05)。胸主动脉钙化积分与年龄、收缩压及骨赘积分正相关,与松质骨密度负相关(P<0.05)。回归分析示年龄、收缩压、血糖及骨赘积分是冠脉钙化的独立风险因素,年龄、收缩压及骨赘积分是胸主动脉钙化的独立风险因素(P<0.05)。ROC曲线示联合应用各独立风险因素能提高对冠脉及胸主动脉钙化风险的预测价值。结论椎体骨赘积分增高和松质骨密度减低与冠脉及胸主动脉钙化显著相关。

Direct visualization of postoperative aortobronchial fistula on computed tomography

BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic surgery.Direct visualization of the fistula via imaging is rare.AIM To investigate the relationship between computed tomography(CT)findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.METHODS Six patients(mean age 71 years,including 4 men and 2 women)with suspected ABF on CT(air around the graft)at our hospital were included in this retrospective study between January 2004 and September 2022.Chest CT findings included direct confirmation of ABF,peri-graft fluid,ring enhancement,dirty fat sign,atelectasis,pulmonary hemorrhage,and bronchodilation,and the clinical course were retrospectively reviewed.The proportion of each type of CT finding was calculated.RESULTS ABF detection after surgery was found to have a mean and median of 14 and 13 years,respectively.Initial signs and symptoms were asymptomatic in 4 patients,bloody sputum was found in 1 patient,and fever was present in 1 patient.The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients.Of the 6 patients,3 survived,2 died,and 1 was lost to follow-up.The locations of the ABFs were as follows:1 in the ascending aorta;1 in the aortic arch;2 in the aortic arch leading to the descending aorta;and 2 in the descending aorta.ABFs were directly confirmed by CT in 4/6(67%)patients.Peri-graft dirty fat(4/6,67%)and peri-graft ring enhancement(3/6,50%)were associated with graft infection,endoleaks and pseudoaneurysms were associated with hemoptysis(2/6,33%).CONCLUSION Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT.CT is useful for the diagnosis of ABF and its complications.

消痰化瘀利窍方对慢性间歇性低氧小鼠胸主动脉内皮细胞损伤的保护作用

目的:探讨消痰化瘀利窍方(Xiaotan Huayu Liqiao Formula,XHLF)改善慢性间歇性低氧(Chronic Intermittent Hypoxia,CIH)小鼠胸主动脉内皮细胞的损伤作用机制。方法:将24只健康的8周龄雄性C57BL/6N小鼠随机分成常氧组(Con组)、慢性间歇性低氧暴露组(CIH组)、慢性间歇性低氧+消痰化瘀利窍方组(CIH+XHLF组)、常氧+消痰化瘀利窍方组(Con+XHLF组)。CIH组与CIH+XHLF组暴露于间歇性低氧的环境中,CIH+XHLF组和Con+XHLF组每日给予消痰化瘀利窍方灌胃(26.8 g/kg/d),而CIH组与Con组给予同等体积生理盐水,共计处理28 d。采用尾套法监测小鼠血压;HE和Masson染色观察胸主动脉病理改变;检测血清中一氧化氮(NO)、血管内皮生长因子(VEGF)含量;透射电镜观察线粒体形态;Tunel染色观察胸主动脉细胞凋亡情况;免疫组织化学染色检测Cleaved Caspase-3、Bcl-2相关X蛋白(Bax)、B淋巴细胞瘤-2基因(Bcl-2)蛋白表达。结果:与Con组相比,CIH组小鼠血压出现升高(P<0.05);血管内膜不平整,细胞核排列紊乱,弹性纤维减少;血清中VEGF水平升高,NO水平下降(P<0.05);线粒体皱缩、嵴断裂;凋亡水平增加,Cleaved Caspase-3、Bax蛋白表达增强,Bcl-2蛋白表达减弱(P<0.05)。与CIH组相比,CIH+XHLF组小鼠血压下降(P<0.05),血管内皮功能和损伤改善(P<0.05),血管内皮线粒体损伤改善,凋亡水平下降(P<0.05)。结论:XHLF可能通过抑制凋亡改善CIH暴露引起的胸主动脉血管损伤和功能障碍。