We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the dista...We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.展开更多
We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old ...We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old woman with the distal aortic arch aneurysm and the descending aortic aneurysm, and debranching TEVAR were performed. After 12 months follow up, urgent hospitalization was required for chest pain, and cardiac catheter examination with a coronary artery angioscope was performed. The endoluminal SG was observed. The observation in angioscope which is a video image is better than CT that is a still image, and observation in blood vessel or SG is possible. It may be possible to observe the endoluminal SG, allowing potential investigation of an endoleak, or the covering status of the SG with the native aortic vessel wall, or the state of intimal membrane formation in the endoluminal graft.展开更多
Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular ane...Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bellbottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.展开更多
Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and t...Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and three-dimensional structural analyses were performed on three patients(Patient Ⅰ,Patient Ⅱ and Patient Ⅲ)with aortic arch aneurysm,both before and after EMBSG implantation.Patient-specific alterations from preoperative to postoperative were analyzed via morphological and functional metrics.Patient Ⅰ and Patient Ⅱ showed notable curvature changes and area reduction after intervention procedure.Three patients showed an increase in flow velocity after EMBSG implantation,while the pressure drop from ascending aorta to the aortic arch was remarkable in Patient I and Patient Ⅱ with the value of 7.09mmHg,and 10.95mmHg,respectively.Patient I and Patient Ⅱ also showed elevated time-averaged wall shear stress(TAWSS)in the stenting region,while Patient Ⅲ showed a trivial change in TAWSS after intervention procedure.Three patients showed low relative residence time after EMBSG insertion.The short-term results of EMBSG in treating aortic arch aneurysm were promising.Hemodynamic parameters have the potential to assist in the outcome evaluation and might be used to guide the stent graft design and wise selection,thereby improving the long-term therapeutic effect in managing complex vascular disease.展开更多
A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d.Computed tomographic angiography(CTA)showed an irregular aortic arch aneurysm involving the left...A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d.Computed tomographic angiography(CTA)showed an irregular aortic arch aneurysm involving the left subclavian artery(LSA),with penetrating aortic ulcer and intramural hematoma.A modified fenestrated thoracic endovascular aortic repair(TEVAR)technique was performed successfully.Follow-up CTA showed that stent grafts were well-apposed,without endoleaks,migration,or branch artery occlusion,and the hematoma was almost completely absorbed.In this case,precise fenestrations were created by measurements based on three-dimensional CT reconstruction and angiography.Furthermore,the physician chose an LSA approach to catch the guide wire and deployed branched stent grafts,considering the oblique direction of this branch and the small size of the fenestration.This case shows that pre-fenestrated and inner bare stent enhancing TEVAR is a safe and feasible technique for repair of complicated aortic arch aneurysm.展开更多
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
Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have imp...Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have important protective functions against atherogenesis.The present study investigated four different LSA stent graft implantation schemes for their resulted blood flow patterns in the thoracic aortic with hemodynamic computational simulation methods:the flush branch(FB),the protruding branch(PB),the straight cuff branch(SCB)and the cured cuff branch(CCB).The results showed that the PB scheme could slightly enhance helicity of the swirling flow in the aorta,but the other three schemes had less effect on blood flow helicity.The PB scheme produced lowTAWSS,high-OSI and high-RRT around the LSA root,and the FB scheme had similar TAWSS,OSI and RRT in both value and distribution to those in the aorta without LSA stent graft implantation.The SCB and CCB schemes led to less area of high-OSI and high-RRT values along the walls of the LSA branch arteries.The results also showed that the PB scheme would significantly reduce blood supply to the LSA,on the contrary,the CCB scheme enhanced LSA blood supply and less effect on the total blood supply to the three branches of the thoracic aorta.In summary,all of the four schemes have no significant effect on the aortic swirling flow,however,in the terms of TAWSS,OSI,RRT and blood supply to the LSA,the CCB model might be the best option with less area of low-WSS,high-OSI,high-RRT and well blood supply in the LSA.展开更多
Objective To evaluate the early and mid-term results of endovascular repair for acute and chronic type B aortic dissection, and to compare the clinical outcomes between the 2 groups. Methods From May 2002 to December ...Objective To evaluate the early and mid-term results of endovascular repair for acute and chronic type B aortic dissection, and to compare the clinical outcomes between the 2 groups. Methods From May 2002 to December 2006, 50 patients with type B aortic dissection were treated by endovascular stent-graft. There were 23 patients in the acute aortic dissection (AAD) group and 27 patients in the chronic aortic dissection (CAD) group. All patients were followed up from 1 to 54 months (average, 17±16 months).The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 50 patients. Compared to the CAD group, the AAD group had a higher percentage of pleural effusion (17.4% vs. 0%, P=0.04) and visceral /leg ischemia (26.1% vs 3.7%, P=0.04). Procedure related complications, including endoleak and post-implantation syndrome, occurred more frequently in the AAD group than in the CAD group (21.7% vs 3.7% and 30.4% vs 11.1%, respectively; P=0.08 and P=0.04). Kaplan–Meier analysis showed no difference in the survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P=0.42 by log-rank test). However, the event-free survival rate was higher in patients with chronic dissection than in patients with acute aortic dissection(96.2% vs 73.9%; P=0.02 by log-rank test). Conclu- sions Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B aortic dissection. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.展开更多
The development of thoracic endovascular aortic repair(TEVAR)technology avoids the risk of patients opening the chest and is widely used in Stanford B-type dissection.[1–3]However,because TEVAR technology has clear r...The development of thoracic endovascular aortic repair(TEVAR)technology avoids the risk of patients opening the chest and is widely used in Stanford B-type dissection.[1–3]However,because TEVAR technology has clear requirements for vascular anatomy of the lesion,it limits its application to some patients.In the shortcomings of the proximal anchor zone,coverage of the left subclavian artery(LSA)origin without revascularization during TEVAR appears to have increased risk of stroke,upper extremity ischemia and paraplegia.[4]展开更多
Aortic dissection is a dangerous pathological condition where blood intrudes into the layers of the arterial walls, creating an artificial channel (false lumen). In the absence of thrombosis or surgical intervention, ...Aortic dissection is a dangerous pathological condition where blood intrudes into the layers of the arterial walls, creating an artificial channel (false lumen). In the absence of thrombosis or surgical intervention, blood will enter the false lumen through the proximal tear, and join the true lumen again through a distal tear. Rupture of the weakened outer wall will result in extremely high mortality rates. Type B thoracic aortic dissection (TAD), occurring along the descending aorta, can be repaired surgically by the deployment of an endovascular stent graft, concealing the proximal entry tear. Blood might still flow into the false lumen (FL) through the distal tear. The domain of such flow should be minimized, as complete thrombosis of the FL is generally believed to be more beneficial for the patient. The dependence on the area ratios of the lumens and size of these tears is studied by computational fluid dynamics.展开更多
文摘We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.
文摘We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old woman with the distal aortic arch aneurysm and the descending aortic aneurysm, and debranching TEVAR were performed. After 12 months follow up, urgent hospitalization was required for chest pain, and cardiac catheter examination with a coronary artery angioscope was performed. The endoluminal SG was observed. The observation in angioscope which is a video image is better than CT that is a still image, and observation in blood vessel or SG is possible. It may be possible to observe the endoluminal SG, allowing potential investigation of an endoleak, or the covering status of the SG with the native aortic vessel wall, or the state of intimal membrane formation in the endoluminal graft.
文摘Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bellbottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.
基金Beijing Natural Science Foundation(Z210012,7212094)National Natural Science Foundation of China(81970404,82170498)Beijing Science and Technology Planning Project(Z211100002921048).
文摘Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and three-dimensional structural analyses were performed on three patients(Patient Ⅰ,Patient Ⅱ and Patient Ⅲ)with aortic arch aneurysm,both before and after EMBSG implantation.Patient-specific alterations from preoperative to postoperative were analyzed via morphological and functional metrics.Patient Ⅰ and Patient Ⅱ showed notable curvature changes and area reduction after intervention procedure.Three patients showed an increase in flow velocity after EMBSG implantation,while the pressure drop from ascending aorta to the aortic arch was remarkable in Patient I and Patient Ⅱ with the value of 7.09mmHg,and 10.95mmHg,respectively.Patient I and Patient Ⅱ also showed elevated time-averaged wall shear stress(TAWSS)in the stenting region,while Patient Ⅲ showed a trivial change in TAWSS after intervention procedure.Three patients showed low relative residence time after EMBSG insertion.The short-term results of EMBSG in treating aortic arch aneurysm were promising.Hemodynamic parameters have the potential to assist in the outcome evaluation and might be used to guide the stent graft design and wise selection,thereby improving the long-term therapeutic effect in managing complex vascular disease.
文摘A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d.Computed tomographic angiography(CTA)showed an irregular aortic arch aneurysm involving the left subclavian artery(LSA),with penetrating aortic ulcer and intramural hematoma.A modified fenestrated thoracic endovascular aortic repair(TEVAR)technique was performed successfully.Follow-up CTA showed that stent grafts were well-apposed,without endoleaks,migration,or branch artery occlusion,and the hematoma was almost completely absorbed.In this case,precise fenestrations were created by measurements based on three-dimensional CT reconstruction and angiography.Furthermore,the physician chose an LSA approach to catch the guide wire and deployed branched stent grafts,considering the oblique direction of this branch and the small size of the fenestration.This case shows that pre-fenestrated and inner bare stent enhancing TEVAR is a safe and feasible technique for repair of complicated aortic arch aneurysm.
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.
基金This work was supported by the National Natural Science Foundation of China(Grant no.32160229)Youth Nature Science Foundation Program of Jiangxi Province(20202BABL214018)Technology Research Project of Jiangxi Education Department(GJJ190352).
文摘Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have important protective functions against atherogenesis.The present study investigated four different LSA stent graft implantation schemes for their resulted blood flow patterns in the thoracic aortic with hemodynamic computational simulation methods:the flush branch(FB),the protruding branch(PB),the straight cuff branch(SCB)and the cured cuff branch(CCB).The results showed that the PB scheme could slightly enhance helicity of the swirling flow in the aorta,but the other three schemes had less effect on blood flow helicity.The PB scheme produced lowTAWSS,high-OSI and high-RRT around the LSA root,and the FB scheme had similar TAWSS,OSI and RRT in both value and distribution to those in the aorta without LSA stent graft implantation.The SCB and CCB schemes led to less area of high-OSI and high-RRT values along the walls of the LSA branch arteries.The results also showed that the PB scheme would significantly reduce blood supply to the LSA,on the contrary,the CCB scheme enhanced LSA blood supply and less effect on the total blood supply to the three branches of the thoracic aorta.In summary,all of the four schemes have no significant effect on the aortic swirling flow,however,in the terms of TAWSS,OSI,RRT and blood supply to the LSA,the CCB model might be the best option with less area of low-WSS,high-OSI,high-RRT and well blood supply in the LSA.
文摘Objective To evaluate the early and mid-term results of endovascular repair for acute and chronic type B aortic dissection, and to compare the clinical outcomes between the 2 groups. Methods From May 2002 to December 2006, 50 patients with type B aortic dissection were treated by endovascular stent-graft. There were 23 patients in the acute aortic dissection (AAD) group and 27 patients in the chronic aortic dissection (CAD) group. All patients were followed up from 1 to 54 months (average, 17±16 months).The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 50 patients. Compared to the CAD group, the AAD group had a higher percentage of pleural effusion (17.4% vs. 0%, P=0.04) and visceral /leg ischemia (26.1% vs 3.7%, P=0.04). Procedure related complications, including endoleak and post-implantation syndrome, occurred more frequently in the AAD group than in the CAD group (21.7% vs 3.7% and 30.4% vs 11.1%, respectively; P=0.08 and P=0.04). Kaplan–Meier analysis showed no difference in the survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P=0.42 by log-rank test). However, the event-free survival rate was higher in patients with chronic dissection than in patients with acute aortic dissection(96.2% vs 73.9%; P=0.02 by log-rank test). Conclu- sions Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B aortic dissection. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.
文摘The development of thoracic endovascular aortic repair(TEVAR)technology avoids the risk of patients opening the chest and is widely used in Stanford B-type dissection.[1–3]However,because TEVAR technology has clear requirements for vascular anatomy of the lesion,it limits its application to some patients.In the shortcomings of the proximal anchor zone,coverage of the left subclavian artery(LSA)origin without revascularization during TEVAR appears to have increased risk of stroke,upper extremity ischemia and paraplegia.[4]
文摘Aortic dissection is a dangerous pathological condition where blood intrudes into the layers of the arterial walls, creating an artificial channel (false lumen). In the absence of thrombosis or surgical intervention, blood will enter the false lumen through the proximal tear, and join the true lumen again through a distal tear. Rupture of the weakened outer wall will result in extremely high mortality rates. Type B thoracic aortic dissection (TAD), occurring along the descending aorta, can be repaired surgically by the deployment of an endovascular stent graft, concealing the proximal entry tear. Blood might still flow into the false lumen (FL) through the distal tear. The domain of such flow should be minimized, as complete thrombosis of the FL is generally believed to be more beneficial for the patient. The dependence on the area ratios of the lumens and size of these tears is studied by computational fluid dynamics.
