Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B ...Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods From June 2001 to September 2007, 84 patients with chronic type B aortic展开更多
Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a mult...Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.展开更多
Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneou...Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure-related complications in this high-risk group of patients.展开更多
BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the...BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.展开更多
Within the recent months, endovascular repair of aortic aneurysms has become a rather interesting alternative to patients considering open surgery. In the past, the procedure was typically and more solely reserved... Within the recent months, endovascular repair of aortic aneurysms has become a rather interesting alternative to patients considering open surgery. In the past, the procedure was typically and more solely reserved to a selected group of elderly patients with several co-morbidities.……展开更多
Thoracic endovascular aortic repair(TEVAR)has been considered as a first-choice treatment for type B aortic dissection(TBAD).However,some patients that is lack of optimal landing zones(<15 mm in dissected Z2,Z3 or ...Thoracic endovascular aortic repair(TEVAR)has been considered as a first-choice treatment for type B aortic dissection(TBAD).However,some patients that is lack of optimal landing zones(<15 mm in dissected Z2,Z3 or the presence of a lusorian artery)still pose significant challenges for TEVAR.We utilized a surgical stent-graft implantation in the descending aorta combined with supra-aortic vessels transposition through median sternotomy for these special TBAD patients.The short-and mid-term results showed that our procedure is a good and alternative therapy for such kind patients.展开更多
Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the mor...Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. Methods: A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Results: A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354);TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable. Conclusions: In patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.展开更多
BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B...BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B aortic dissection(cTBAD)patients is rare,with few clinical or experimental studies to date having explored the causes of such collapse.CASE SUMMARY In the present report,we describe a rare case of true-lumen collapse in an 83-yearold patient diagnosed with cTBAD,and we discuss potential therapeutic interventions for such cases.Following thoracic endovascular aortic repair(TEVAR),computed tomography angiography revealed satisfactory stent-graft positioning,no endoleakage,true lumen enlargement,thrombus formation in the false lumen,and slight enlargement of the true lumen distal to the stent-graft.Computational hemodynamic analyses indicated that the wall shear stress and pressure within the false lumen were significantly reduced following TEVAR.CONCLUSION TEVAR treatment of cTBAD patients suffering from proximal true lumen collapse can facilitate some degree of effective remodeling.展开更多
Objective:To determine the clinical value of rhBNP in the treatment of patients with Stanford type B aortic dissection.Methods:From June 2018 to October 2021,162 patients with Stanford type B aortic dissection were se...Objective:To determine the clinical value of rhBNP in the treatment of patients with Stanford type B aortic dissection.Methods:From June 2018 to October 2021,162 patients with Stanford type B aortic dissection were selected from the Cardiology Department of Henan Provincial Chest Hospital and randomly divided into two groups:control group(81 patients)and observation group(81 patients).The patients in the control group were treated with conventional therapy.On the basis of the control group,the patients in the observation group were treated with rhBNP.The cardiac function,renal function,pulmonary function,and inflammatory indices before and after treatment for 72 hours,as well as the incidence of adverse reactions between the two groups were compared.Results:After treatment,the cardiac function(LVEF and NT-pro BNP),renal function(urine output for 24 hours,SCr,and Cys-C),pulmonary function(PaO_(2),SPO_(2),and PaO_(2)/FiO_(2)),and inflammatory(IL-6,hsCRP,and MCP-1)indices of the observation group improved significantly compared to those of the control group(p<0.05).Conclusion:rhBNP can improve cardiac function,renal function,and pulmonary function,as well as alleviate inflammation in patients with Stanford type B aortic dissection.Hence,in the treatment of patients with Stanford type B aortic dissection,rhBNP provides multi-organ protection.展开更多
Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm...Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.展开更多
Objective Acute Stanford type A aortic dissection is typically presented as antegrade dissection from a primary intimal tear in the proximal ascending aorta extending to the arch and the downstream distal aorta.Howeve...Objective Acute Stanford type A aortic dissection is typically presented as antegrade dissection from a primary intimal tear in the proximal ascending aorta extending to the arch and the downstream distal aorta.However,it may also develop in a retrograde fashion with an intimal tear located in descending aorta causing retrograde extension of aortic dissection into ascending aorta,namely,retrograde type A aortic dissection(RTAAD).Though open surgery remains the golden standard to treat type A dissection,as to RTAAD,the distal location of its primary entry tear in descending aorta warrants more extensive aortic repair with higher surgical risks of mortality or morbidity through a median sternotomy.Conversely,confining the surgical extent to the proximal aorta leaves the risks of complications related to the residual tear in the distal aorta untreated.More recently,thoracic endovascular aortic repair(TEVAR)is attempted for the treatment of RTAAD with favorable shortterm and long-term prognosis.To the best of our knowledge,this was the largest serial study to apply TEVAR in the treatment of RTAAD.展开更多
文摘Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods From June 2001 to September 2007, 84 patients with chronic type B aortic
基金supported by the National Nature Science Foundation of China[grant number 81800403].
文摘Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
文摘Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure-related complications in this high-risk group of patients.
基金We are very grateful to the patients and doctors who participated in the study and for the help and co-operation of the clinic staff. This work was supported by a grant from the National Natural Science Foundation of China to Dr. FAN XH （No. 81570430）.
文摘BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.
文摘 Within the recent months, endovascular repair of aortic aneurysms has become a rather interesting alternative to patients considering open surgery. In the past, the procedure was typically and more solely reserved to a selected group of elderly patients with several co-morbidities.……
基金supported by grants from the Young Program of National Natural Science Foundation of China(No.81600225)the Young Program of the Natural Science Foundation of Jiangsu Province(No.BK20160132)Jiangsu Province Special Program of Medical Science(BE2017610)
文摘Thoracic endovascular aortic repair(TEVAR)has been considered as a first-choice treatment for type B aortic dissection(TBAD).However,some patients that is lack of optimal landing zones(<15 mm in dissected Z2,Z3 or the presence of a lusorian artery)still pose significant challenges for TEVAR.We utilized a surgical stent-graft implantation in the descending aorta combined with supra-aortic vessels transposition through median sternotomy for these special TBAD patients.The short-and mid-term results showed that our procedure is a good and alternative therapy for such kind patients.
文摘Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. Methods: A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Results: A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354);TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable. Conclusions: In patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.
文摘BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B aortic dissection(cTBAD)patients is rare,with few clinical or experimental studies to date having explored the causes of such collapse.CASE SUMMARY In the present report,we describe a rare case of true-lumen collapse in an 83-yearold patient diagnosed with cTBAD,and we discuss potential therapeutic interventions for such cases.Following thoracic endovascular aortic repair(TEVAR),computed tomography angiography revealed satisfactory stent-graft positioning,no endoleakage,true lumen enlargement,thrombus formation in the false lumen,and slight enlargement of the true lumen distal to the stent-graft.Computational hemodynamic analyses indicated that the wall shear stress and pressure within the false lumen were significantly reduced following TEVAR.CONCLUSION TEVAR treatment of cTBAD patients suffering from proximal true lumen collapse can facilitate some degree of effective remodeling.
基金2018 Joint Construction Project of Henan Medical Science and Technology Research Plan(Project Number:2018010035)。
文摘Objective:To determine the clinical value of rhBNP in the treatment of patients with Stanford type B aortic dissection.Methods:From June 2018 to October 2021,162 patients with Stanford type B aortic dissection were selected from the Cardiology Department of Henan Provincial Chest Hospital and randomly divided into two groups:control group(81 patients)and observation group(81 patients).The patients in the control group were treated with conventional therapy.On the basis of the control group,the patients in the observation group were treated with rhBNP.The cardiac function,renal function,pulmonary function,and inflammatory indices before and after treatment for 72 hours,as well as the incidence of adverse reactions between the two groups were compared.Results:After treatment,the cardiac function(LVEF and NT-pro BNP),renal function(urine output for 24 hours,SCr,and Cys-C),pulmonary function(PaO_(2),SPO_(2),and PaO_(2)/FiO_(2)),and inflammatory(IL-6,hsCRP,and MCP-1)indices of the observation group improved significantly compared to those of the control group(p<0.05).Conclusion:rhBNP can improve cardiac function,renal function,and pulmonary function,as well as alleviate inflammation in patients with Stanford type B aortic dissection.Hence,in the treatment of patients with Stanford type B aortic dissection,rhBNP provides multi-organ protection.
文摘Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.
文摘Objective Acute Stanford type A aortic dissection is typically presented as antegrade dissection from a primary intimal tear in the proximal ascending aorta extending to the arch and the downstream distal aorta.However,it may also develop in a retrograde fashion with an intimal tear located in descending aorta causing retrograde extension of aortic dissection into ascending aorta,namely,retrograde type A aortic dissection(RTAAD).Though open surgery remains the golden standard to treat type A dissection,as to RTAAD,the distal location of its primary entry tear in descending aorta warrants more extensive aortic repair with higher surgical risks of mortality or morbidity through a median sternotomy.Conversely,confining the surgical extent to the proximal aorta leaves the risks of complications related to the residual tear in the distal aorta untreated.More recently,thoracic endovascular aortic repair(TEVAR)is attempted for the treatment of RTAAD with favorable shortterm and long-term prognosis.To the best of our knowledge,this was the largest serial study to apply TEVAR in the treatment of RTAAD.
