Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particu...Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of t he false lumen shown by enhanced computed tomographic scanning. Methods: The sub jects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 200 2. The mean follow-up period was 55 months (range, 30-83 months). Computed tom ographic scanning was performed at 1, 3, 12, and 36 months postoperatively to de tect thrombosis and obliteration of the false lumen after its exclusion by the s tent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric art ery. Results: Two patients died in the initial operation, but no patients requir ed additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric arter y level in 15 patients. Obliteration of the false lumen was recognized at the di stal edge of the graft in all patients, at the diaphragmatic level in 20 patient s, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes. Conclusions: In patients with acute t ype A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self- expanding stent, and this method might reduce the necessity of further operation s not only for the distal descending aorta but also for the thoracoabdominal aor ta.展开更多
主动脉夹层病变累及升主动脉者称为Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)。TAAD治疗方法主要有传统的开放手术,包括单纯人工血管置换术、Wheat术及Bentall术等,这些手术必须在深低温麻醉和体外循环等辅助下...主动脉夹层病变累及升主动脉者称为Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)。TAAD治疗方法主要有传统的开放手术,包括单纯人工血管置换术、Wheat术及Bentall术等,这些手术必须在深低温麻醉和体外循环等辅助下进行,而且操作复杂,创伤较大,同时术后并发症发生率和死亡率均较高[1]。为此,临床上逐渐发展一种新的治疗技术,即血管腔内治疗技术,主要包括杂交手术及完全血管腔内修复术[2]。展开更多
Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of pa...Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent- graft placement for the treatment of patients with PAUs. Methods: Between July 1999 and December 2004, endovascular stent- graft repair of PAU was performed in 22 patients(69.1± 7.8 years, 16 men), 3(14% ) of whom had contained aortic rupture. Stent- graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access. Results: Procedural success was achieved in all but 1 patient(technical success rate 96% ). Postoperatively, 1(5% ) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow- up of 27(range 1- 62) months, 1 patient underwent adjunctive stent- graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow- up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years. Conclusions: Endovascular stent- graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.展开更多
文摘Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of t he false lumen shown by enhanced computed tomographic scanning. Methods: The sub jects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 200 2. The mean follow-up period was 55 months (range, 30-83 months). Computed tom ographic scanning was performed at 1, 3, 12, and 36 months postoperatively to de tect thrombosis and obliteration of the false lumen after its exclusion by the s tent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric art ery. Results: Two patients died in the initial operation, but no patients requir ed additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric arter y level in 15 patients. Obliteration of the false lumen was recognized at the di stal edge of the graft in all patients, at the diaphragmatic level in 20 patient s, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes. Conclusions: In patients with acute t ype A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self- expanding stent, and this method might reduce the necessity of further operation s not only for the distal descending aorta but also for the thoracoabdominal aor ta.
文摘主动脉夹层病变累及升主动脉者称为Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)。TAAD治疗方法主要有传统的开放手术,包括单纯人工血管置换术、Wheat术及Bentall术等,这些手术必须在深低温麻醉和体外循环等辅助下进行,而且操作复杂,创伤较大,同时术后并发症发生率和死亡率均较高[1]。为此,临床上逐渐发展一种新的治疗技术,即血管腔内治疗技术,主要包括杂交手术及完全血管腔内修复术[2]。
文摘Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent- graft placement for the treatment of patients with PAUs. Methods: Between July 1999 and December 2004, endovascular stent- graft repair of PAU was performed in 22 patients(69.1± 7.8 years, 16 men), 3(14% ) of whom had contained aortic rupture. Stent- graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access. Results: Procedural success was achieved in all but 1 patient(technical success rate 96% ). Postoperatively, 1(5% ) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow- up of 27(range 1- 62) months, 1 patient underwent adjunctive stent- graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow- up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years. Conclusions: Endovascular stent- graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.
