Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy

Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.

Surgical treatment of a rare brachial artery aneurysm postarteriovenous fistula closure after kidney transplant:A case report

BACKGROUND Brachial artery aneurysms are defined as dilations greater than 50%of the normal diameter,which are rare among all peripheral arterial aneurysms.While they are often present as pseudoaneurysms,true brachial artery aneurysms are also detected rarely.In this case report,the surgical repair method of true brachial artery aneurysms,which is a rare condition,is explained.CASE SUMMARY Herein,we present a 61-year-old male patient with complaints of swelling and pain in the right arm antecubital region that had been progressing over 6 mo.Upon the diagnosis of a true brachial artery aneurysm associated with arteriovenous fistula,the aneurysm was surgically repaired with an autologous saphenous vein graft.The patient was discharged without any neurovascular complications postoperatively.CONCLUSION True brachial artery aneurysms are rare and there are not any recommendations for their management in the current literature.Even though the treatment of true aneurysms in this artery is primarily based on a surgical treatment,endovascular repair also might be an option.

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

AIM To validate the feasibility of high resolution computed tomography(HRCT) of the lung prior to computed tomography angiography(CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair(EVAR) planning or follow-up.METHODS We conducted a retrospective study among 181 patients(143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or followup. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively. RESULTS There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm(range 4-56 mm). Eightynine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years(p-y, range 5-18 p-y). Eighty-two out of 102(76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20(50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4(20%) adenocarcinomas, 4(20%) squamous cell carcinomas, 1(5%) small cell lung cancer and 1(5%) breast cancer metastasis); 8 out of 20(40%) underwent bronchoscopy(8 pneumonia) and 2 out of 20(10%) underwent biopsy with the diagnosis of sarcoidosis.CONCLUSION HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.

Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdomi nal Aortic Aneurysm Repair:A Meta-Analysis

Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.

Follow-up of endovascular aortic aneurysm repair:Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

AIM: To validate the feasibility of digital tomosynthesis of the abdomen(DTA) combined with contrast enhanced ultrasound(CEUS) in assessing complications after endovascular aortic aneurysm repair(EVAR) by using computed tomography angiography(CTA) as the gold standard.METHODS: For this prospective study we enrolled 163 patients(123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d.RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33(96.96%) patients and for the absence of complications in 127/130(97.69%) patients; the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33(57.57%) patients and for the absence of complications in 129/130(99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively.CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases.

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

ObjectiveAcute 肾损害(AKI ) 经常发生在基于导管的 interventional 过程和增加死亡以后。然而，类型 B 尖锐大动脉的解剖(AAD ) 的 AKI 以前胸的 endovascular 动脉瘤修理(TEVAR ) 的含意仍然保持不清楚。这研究与类型 B AAD.MethodsBetween 2009 在病人在 TEVAR 前评估了 AKI 的发生，预言者，和在里面医院结果并且 2013， 76 个病人回顾地被评估从症状发作在 36 h 以内为类型 B AAD 收到了 TEVAR。病人被分类进 no-AKI 对 AKI 组，并且 AKI 的严厉进一步根据肾疾病被上演：在外科手术前的 AKI 的 TEVAR.ResultsThe 发生前改进全球结果标准是 36.8% 。在里面医院复杂并发症与 no-AKI 相比在有外科手术前的 AKI 的病人是显著地更高的(50.0% 对 4.2% 分别地；P &#x0003c；0.001 ) ，包括尖锐肾的失败(21.4% 对 0 分别地；P &#x0003c；0.001 ) ，并且他们与 AKI 的严厉增加了(P &#x0003c；0.001 ) 。身体温度和白血房间计数的最大的层次是以前显著地与最大的浆液 creatinine 有关铺平 TEVAR。Multivariate 分析在承认上显示出那收缩血压(或：1.023；95% CI：1.003-1.044；P = 0.0238 ) 并且双边的肾的动脉参与(或：19.076；95% CI：1.914-190.164；P = 0.0120 ) 外科手术前的 AKI.ConclusionsPreoperative AKI 的强壮的预言者经常与类型 B AAD 在病人被发生，并且与更高的在里面医院复杂并发症相关并且提高了煽动性的反应。承认和双边的肾的动脉参与上的收缩血压是为在 TEVAR 前的 AKI 的主要风险因素。

Supraceliac Aortic Clamping for Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Short Aortic Neck Length

Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.

Celiac Artery Aneurysm Due to Chronic Spontaneous Dissection: Two Cases of Surgical Repair

In this report, we describe two surgical cases of celiac artery aneurysm due to chronic and asymptomatic spontaneous dissection without atherosclerotic change or medial degeneration. Case 1 had replacement of the celiac and common hepatic arteries using a knitted Dacron prosthetic graft, and case 2 had simple aneurysmectomy. The incidence of celiac artery dissection is increasing lately, but subsequent aneurysm is relatively rare. Our two cases had no atherosclerotic risk factors, so it might be possible that celiac artery aneurysm due to spontaneous dissection may produce different findings from dissection of other arteries. We consider that the need for surgery should be determined carefully if the asymptomatic celiac artery aneurysm due to dissection is small and unless it shows any changes in its diameter in the follow-up period.

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of the-se findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

Extracranial Internal Carotid Artery (ICA) Aneurysm Repair and End to End Anastamosis of the Artery

We present a case of extracranial internal carotid artery (ICA) aneurysm, which presented as an inflammatory submandibular swelling in the upper part of the right side of the neck. The lack of frank pulsatility and signs of inflammation though was a bit confusing, the Doppler and CT angiogram clinched the diagnosis. We were able to surgically resect and reform the ICA using the native vessel itself, which is an unusual technique, which we thought was worth presenting.

Endovascular Repair for Abdominal Aortic Aneurysm with an Ectopic Pelvic Kidney: Case Report and Procedural Consideration of the Aberrant Renal Artery

A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and two aberrant renal arteries, one each from the left and right common iliac arteries was found on computed tomography. Because of the high risk of rupture, surgery was recommended and an endovascular aneurysm repair was performed. The antegrade flow of the aberrant renal artery from the left common iliac artery was preserved. The right aberrant renal artery was covered with stent graft. The patient’s serum creatinine level remained unchanged throughout the postoperative course, with an uneventful postoperative recovery.

Surgical repair of an emergent giant hepatic aneurysm with an abdominal aortic dissection:A case report

BACKGROUND Hepatic artery aneurysm(HAA)is the second most common visceral aneurysm.A significant number of hepatic aneurysms are found accidentally on examination.However,their natural history is characterized by their propensity to rupture,which is very serious and requires urgent treatment.An emergent giant hepatic aneurysm with an abdominal aortic dissection is less commonly reported.CASE SUMMARY We report the complicated case of a giant hepatic aneurysm with an abdominal aortic dissection.A 66-year-old female presented with the complaint of sudden upper abdominal pain accompanied by vomiting.Physical examination showed that her blood pressure was 214/113 mmHg.Her other vital signs were stable.Computed tomography found a giant hepatic proper aneurysm and dissection of the lower segment of the abdominal aorta.Furthermore,angiography showed a HAA with the maximum diameter of approximately 56 mm originating from the proper hepatic artery and located approximately 15 mm from the involved bifurcation of the left and right hepatic arteries with no collateral circulation.Therefore,we decided to use a stent to isolate the abdominal aortic dissection first,and then performed open repair.After the operation,the patient recovered well without complications,and her 3-month follow-up checkup did not reveal any late complications.CONCLUSION Open surgery is a proven method for treating giant hepatic aneurysms.If the patient's condition is complex,staged surgery is an option.

Successful use of emergent endovascular aneurysm repair for a ruptured hypotensive abdominal aortic aneurysm

Ruptured aortic aneurysm has a surgical mortality ranging from 50%-70%, one of the highest rates of all vascular emergencies [1-5]. Less invasive approaches to repair have been developed that could potentially improve these statistics [1,5-7]. Endovascular aneurysm repair (EVAR) is a minimally invasive approach that may be an alternative to open surgical repair for select cases of ruptured aortic aneurysms [1,5]. Unfortunately, the role of EVAR in patients with acute rupture of an abdominal aneurysm is not clear, especially for patients that are hemodynamically unstable [1,8-10]. The literature is limited regarding use of EVAR in this population of patients. We present a case of the successful use of EVAR for an emergent repair in a hypotensive hemodynamically unstable patient with an acutely ruptured abdominal aortic aneurysm (AAA).

Application Effects of Total Percutaneous Technique in Endovascular Repair of Abdominal Aortic Aneurysm

Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.

西藏地区腹主动脉瘤腔内隔绝修复术的中期随访结果分析

目的分析西藏地区腹主动脉瘤(AAA)患者腔内隔绝修复手术的转归情况。方法收集2015年5月至2023年4月西藏自治区人民医院收治的31例AAA患者的临床资料,所有患者均进行了AAA腔内隔绝修复术。收集所有患者的基本特征、合并疾病、AAA最大直径、术前检查结果等信息,观察所有患者的治疗情况、围手术期并发症发生情况及随访结果。结果31例AAA患者中,美国麻醉医师协会(ASA)3级患者18例,4级患者7例。27例患者经双侧股动脉入路,4例患者经双侧股动脉和左侧肱动脉入路,手术成功率为100%。围手术期间1例患者出现臀肌跛行症状。随访时间为1~93个月。随访期间,失访2例,死亡2例,Ⅰ型内漏1例,Ⅱ型内漏1例。经随访,所有患者未发生支架移位、内漏等并发症。结论在西藏地区采用腔内隔绝修复术治疗AAA是安全、有效的。

以3D影像融合技术引导腔内治疗主动脉疾病研究进展

3D影像融合技术是以锥形束CT为介导将介入治疗前和治疗中的影像数据融合并以之引导介入操作,可显著提高腔内介入治疗主动脉疾病成功率,减少辐射暴露和碘对比剂用量并缩短治疗时间等。本文就3D影像融合技术用于引导腔内治疗主动脉疾病研究进展进行综述。

Stanford A型主动脉夹层治疗的发展及现状

主动脉夹层(aortic dissection,AD)是一种极其凶险的心血管外科急危重症,发病急,进展迅速,病情复杂凶险,病死率极高。该疾病术后易出现并发症,手术死亡率高。AD有多种分型,Stanford分型是临床最常用的分型之一,以Stanford A型AD最常见且最凶险。随着医疗技术的快速发展,目前AD的诊治水平已经显著提升,本文就Stanford A型AD治疗的发展及现状作一综述。

胸腹主动脉瘤精准外科诊疗体系构建及应用

胸腹主动脉瘤(TAAA)累及主动脉及胸腹段多支内脏动脉和脊髓供血动脉,但因动脉病变受累范围广、异质性高,手术重建主动脉及多支内脏动脉难度较大,围手术期病死率及截瘫、脏器缺血等严重并发症发生率较高,因此,TAAA患者需要制定个体化的临床诊治策略。本述评归纳总结中国医学科学院北京协和医学院北京协和医院TAAA精准外科诊疗体系的构建与应用,通过改良传统术式建立TAAA全腔内治疗体系,应用血流仿真模型制定手术策略,优化特殊病因TAAA的诊疗策略,从而提升TAAA的诊治水平,改善患者的预后情况,以期为TAAA的诊治提供参考。

腹主动脉瘤腔内治疗术径路血管解剖学特征及并发症的研究进展

腹主动脉瘤(AAA)是腹主动脉节段的病理性扩张,腔内治疗(EVAR)是解剖结构合适的AAA患者的首选治疗方式。径路血管作为EVAR术中穿刺以及器械输送的途径,其解剖学特征对血管并发症的发生有着显著影响。本文对EVAR径路血管解剖学特征及其并发症的研究情况进行综述。

1例EVAR术后支架感染合并全身感染病人行自体深静脉原位重建术的护理

总结1例腹主动脉瘤腔内修复术后(EVAR)支架感染合并全身感染病人行自体深静脉原位重建术的护理:术前预防瘤体破裂、积极控制感染预防休克的发生;术后做好生命体征的监测及专科观察,严格消毒隔离预防再感染发生,做好血压的控制、疼痛的管理,给予营养支持、手术伤口的护理及引流的观察,并实施心理护理;严防移植物破裂、吻合口瘘及下肢静脉高压的发生。经过积极的治疗和护理,病人术后感染控制,伤口恢复良好,未出现严重的并发症,康复出院。认为EVAR术后支架感染合并全身感染的病人病情危急,基础情况差,感染面积广,死亡率高;自体深静脉原位重建术式复杂,该手术方式对治疗和护理要求高,通过全程的管理能有效提高病人术后生存率,减少感染及并发症的发生。