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 modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforat...We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.展开更多
Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular...Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.展开更多
Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of...Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.展开更多
Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA). The purpose of this study was to describe our primary experience and e...Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA). The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients. Methods Between March 2011 and May 2012, nine male patients (mean age, (79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography (CTA) was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter. Results Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was (8.9±1.4) days, mean blood loss was (360.5±46.8) ml, and mean iodinated contrast volume was (230.6±58.3) ml. The mean follow-up time was (7.6±4.2) months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up. Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.展开更多
The goals of future development of endovascular aortic stent grafting were towards. extension of the proximal seal, preservation of vital branches, deployment, and low profile delivery ease of systems. Fenestrated aor...The goals of future development of endovascular aortic stent grafting were towards. extension of the proximal seal, preservation of vital branches, deployment, and low profile delivery ease of systems. Fenestrated aortic stent graft is a viable option for treating aortic aneurysms with short necks, and more than 5000 grafts have been implanted worldwide. The first device available, the Zenith fenestrated graft (Cook Medical, USA), involved placing a proximal tube fenestrated component, then accessing each target vessels from the contralateral side with a sheath, and bridging the connection with a covered stent. A bifurcated distal component is then placed to complete the endovascular repair.展开更多
Background:The fenestrated stent technique has been developed for the treatment of aneurysms with branches.However,the hole size and type,which are the key factors for optimal treatment outcomes,are still controversia...Background:The fenestrated stent technique has been developed for the treatment of aneurysms with branches.However,the hole size and type,which are the key factors for optimal treatment outcomes,are still controversial in clinical application.Therefore,a hemodynamics investigation in terms of the size and type of the hole was performed with the objective of providing evidence for optimization of this technique.Method:Six cases were modeled for comparison:cases 1 and 2 corresponded to suprarenal aortic aneurysm(SRAA)models with no stent and a multilayer stent(MS),respectively;cases 3–6 represented the SRAA models treated with fenestrated stent grafts(FSGs)including a small-sized hole(SSH,3 mm),middle-sized hole(MSH,6 mm),large-sized hole(LSH,9 mm),and multiple holes(MH,which included the features of both the MS and stent graft,6 mm),respectively.The total stent area in cases 4 and 6 was equal to the cross-section of the branch.Results:As opposed to cases 1 and 2,the pressure on the aneurysmal wall reduced more significantly with FSG intervention(cases 3–6),and the area of low wall shear stress(WSS)on the aneurysmal wall was unexpectedly large in case 5 owing to jet flow deflection.The branch flux increased with the increase of the hole size,and normal blood flow in the branch was only observed in case 5.Interestingly,the weakest jet flow was found in case 5.Conclusion:Our findings indicate that the diameter of the hole should be slightly larger than that of the branch to achieve better aneurysm isolation and preserve branch patency.展开更多
Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying arou...Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying around the fenestration as a result of the balloon angioplasty of the seal zone.This novel stent cuff design will also facilitate more complete biointegration of the devices,eliminate the hemodynamic variation as well as significantly reduce the possibility of a Type III endoleak.The feasibility of this concept is demonstrated by observations made from in-situ tests performed in a Beta endograft design.Flared cuffs made of poly(ε-caprolactone)supported with a weft-knitted polyester structure can be manufactured with various configurations to optimize the transition from the main body of the endograft,thus preventing the currently marketed designs’hemodynamic perturbation while also promoting endograft biointegration.This concept represents an evolution in branch graft design,which may enhance the long-term durability of customized fenestrations and open new applications for in-vivo graft fenestration in the near future.Further ongoing investigation to optimize its structure,X-ray opacity,fixation to the flared stent,and material biocompatibility are still required to build upon this concept’s proof.展开更多
Blunt traumatic thoracic aortic injury(BTAI)is an extremely serious medical condition with a high rate of associated mortality.Recent advances in techniques such as thoracic endovascular repair offer new opportunities...Blunt traumatic thoracic aortic injury(BTAI)is an extremely serious medical condition with a high rate of associated mortality.Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner.A 65 year-old-male suffered from multiple injuries after a fall,including BTAI in the aortic arch,which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery,development of an intimal flap in the left common carotid artery,and dissection of the left subclavian artery.Based on the imaging information of this patient and our clinical experience,the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels,additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery.The intervention yielded satisfactory early outcomes.Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft.Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.展开更多
BACKGROUND Percutaneous drainage(PCD)and endoscopic approaches have largely replaced surgical drainage as the initial approach for(peri)pancreatic fluid collections(PFC)s,while complications associated with endoscopic...BACKGROUND Percutaneous drainage(PCD)and endoscopic approaches have largely replaced surgical drainage as the initial approach for(peri)pancreatic fluid collections(PFC)s,while complications associated with endoscopic stent implantation are common.AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration(ETGF),which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation,and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall.METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled.Indications for intervention were consistent with related guidelines.We analyzed patients baseline characteristics,technical and clinical success rate,recurrence and reintervention rate,procedure-related complications and adverse events.RESULTS Seventy-two eligible patients were retrospectively identified(ETGF=34,PCD=38)from October 2017 to May 2021.Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group(97.1 vs 76.3%,P=0.01).There were no statistically significant differences regarding recurrence,reintervention and incidence of complication between the two groups.While long-term catheter drainage was very common in the PCD group.CONCLUSION Compared with PCD,ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall.ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.展开更多
BACKGROUND Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound.Solitary liver cysts are divided into simple and solitary intrahepatic bilia...BACKGROUND Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound.Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts,depending on the biliary connection.While some solitary liver cysts are symptomatic in childhood,even in newborns,they are often found incidentally in adults.CASE SUMMARY A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting,respiratory problems,and abdominal bloating complaints.On examination,the abdomen was greatly distended and extremely tight.She had repeated vomiting for 3 d,no stool output,and decreased urine.The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm×10 cm×14 cm,extending from the liver or right kidney to the pelvis.In the magnetic resonance imaging examination of the patient,a solitary cystic structure of 10 cm×10 cm×14 cm in the right abdomen was observed,extending to the pelvis and possibly originating from the liver.The patient was operated via fenestration after her fluid and electrolytes improved.Oral nutrition was initiated on the 2nd postoperative day,and the drain was removed on the 5th postoperative day.The patient visited the outpatient clinic control 1 mo later with no clinical complaints.CONCLUSION Congenital liver cysts are usually followed without complications.They rarely reach gigantic dimensions and may cause respiratory distress,intestinal obstruction and recurrent vomiting.Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.展开更多
BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open d...BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.展开更多
BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results ...BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration. METHODS: A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated. RESULTS: There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively. CONCLUSION: Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.展开更多
Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent ad...Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.展开更多
Objective: To report a scala tympani drill-out technique for managing malformed facial nerve covering the entire oval window(OW).Methods: Data from three cases with OW atresia, malformed stapes and abnormal facial ner...Objective: To report a scala tympani drill-out technique for managing malformed facial nerve covering the entire oval window(OW).Methods: Data from three cases with OW atresia, malformed stapes and abnormal facial nerve courses were reported, in which a scala tympani drill-out technique was employed with a TORP between the tympanic membrane and scala tympani fenestration for hearing reconstruction.Results: Air conduction hearing improved in two of the three cases following surgery. In the third case, there was no improvement in air conduction hearing following a canal wall up mastoidectomy and tympanoplasty. There were no vertigo, tinnitus or sensorineural hearing loss in the three cases.Conclusion: The scala tympani drill-out technique, which is basically fenestration at the initial part of the basal turn, provides a choice in hearing reconstruction when the OW is completely covered by abarrently coursed facial nerve.展开更多
AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxfor...AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis.Quantitative synthesis was then performed.RESULTS Based on available level III literature,HRCT has a relatively low sensitivity of 58%(95%CI: 49.4-66.9),a high specificity,95%(95%CI: 89.9-98.0) and a positive predictive value of 92%(95%CI: 84.1-95.8).HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre,retrofenestral and dense sclerotic lesions,despite the advent of more advanced CT scanners with improved collimation.CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical,HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician,helping to delineate extent of disease and exclude other causes.展开更多
With the advance of invasive interventions,the treatment model for infected necrotizing pancreatitis(INP)has shifted from open surgery to the step-up minimally invasive treatment.Late intervention,originating from the...With the advance of invasive interventions,the treatment model for infected necrotizing pancreatitis(INP)has shifted from open surgery to the step-up minimally invasive treatment.Late intervention,originating from the open surgery era,has been questioned in the minimally invasive period.With the emergence of new high-quality evidence about the timing for intervention,it seems to be increasingly apparent that,even in the age of minimal invasiveness,“late intervention”waiting for the necrotic collections to be encapsulated is still necessary.This opinion review mainly discusses the intervention timing for INP.展开更多
In this study, we explored the operation options for middle cranial fossa arachnoid cysts (MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial ...In this study, we explored the operation options for middle cranial fossa arachnoid cysts (MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y (mean=5.4 y). All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration (F) resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting (S). We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ (Galassi classification), cysto-peritoneal shunting is better for cysts of type Ⅲ.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 modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.
文摘Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.
文摘Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.
文摘Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA). The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients. Methods Between March 2011 and May 2012, nine male patients (mean age, (79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography (CTA) was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter. Results Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was (8.9±1.4) days, mean blood loss was (360.5±46.8) ml, and mean iodinated contrast volume was (230.6±58.3) ml. The mean follow-up time was (7.6±4.2) months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up. Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.
文摘The goals of future development of endovascular aortic stent grafting were towards. extension of the proximal seal, preservation of vital branches, deployment, and low profile delivery ease of systems. Fenestrated aortic stent graft is a viable option for treating aortic aneurysms with short necks, and more than 5000 grafts have been implanted worldwide. The first device available, the Zenith fenestrated graft (Cook Medical, USA), involved placing a proximal tube fenestrated component, then accessing each target vessels from the contralateral side with a sheath, and bridging the connection with a covered stent. A bifurcated distal component is then placed to complete the endovascular repair.
基金supported by Grants-in-Aid from the National Natural Science Foundation of China(Nos.11772210 and 11272224)the Sichuan Province Science and Technology Support Program(No.2018HH0073).
文摘Background:The fenestrated stent technique has been developed for the treatment of aneurysms with branches.However,the hole size and type,which are the key factors for optimal treatment outcomes,are still controversial in clinical application.Therefore,a hemodynamics investigation in terms of the size and type of the hole was performed with the objective of providing evidence for optimization of this technique.Method:Six cases were modeled for comparison:cases 1 and 2 corresponded to suprarenal aortic aneurysm(SRAA)models with no stent and a multilayer stent(MS),respectively;cases 3–6 represented the SRAA models treated with fenestrated stent grafts(FSGs)including a small-sized hole(SSH,3 mm),middle-sized hole(MSH,6 mm),large-sized hole(LSH,9 mm),and multiple holes(MH,which included the features of both the MS and stent graft,6 mm),respectively.The total stent area in cases 4 and 6 was equal to the cross-section of the branch.Results:As opposed to cases 1 and 2,the pressure on the aneurysmal wall reduced more significantly with FSG intervention(cases 3–6),and the area of low wall shear stress(WSS)on the aneurysmal wall was unexpectedly large in case 5 owing to jet flow deflection.The branch flux increased with the increase of the hole size,and normal blood flow in the branch was only observed in case 5.Interestingly,the weakest jet flow was found in case 5.Conclusion:Our findings indicate that the diameter of the hole should be slightly larger than that of the branch to achieve better aneurysm isolation and preserve branch patency.
基金This work was supported by“the Fundamental Research Funds for the Central Universities”(2232019D3-16)(China)the 111 Project 2.0“Biomedical Textile Materials Science and Technology”(B07024)(China)+3 种基金the Shanghai Science and Technology Support Project(18441902600)(China)the Engineering Research Center of Technical Textiles Ministry of Education(China)the Department of Surgery at Laval University(Quebec,Canada)the Fonds de Recherche de chirurgie vasculaire of the CHU(Quebec,Canada).The generous gift of device,by Medtronic and Vascutek is greatly acknowledged.The authors extend their appreciation to Boyin Qin,Yvan Douville,Pascal Rheaume,and Raymond Labbe.
文摘Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying around the fenestration as a result of the balloon angioplasty of the seal zone.This novel stent cuff design will also facilitate more complete biointegration of the devices,eliminate the hemodynamic variation as well as significantly reduce the possibility of a Type III endoleak.The feasibility of this concept is demonstrated by observations made from in-situ tests performed in a Beta endograft design.Flared cuffs made of poly(ε-caprolactone)supported with a weft-knitted polyester structure can be manufactured with various configurations to optimize the transition from the main body of the endograft,thus preventing the currently marketed designs’hemodynamic perturbation while also promoting endograft biointegration.This concept represents an evolution in branch graft design,which may enhance the long-term durability of customized fenestrations and open new applications for in-vivo graft fenestration in the near future.Further ongoing investigation to optimize its structure,X-ray opacity,fixation to the flared stent,and material biocompatibility are still required to build upon this concept’s proof.
文摘Blunt traumatic thoracic aortic injury(BTAI)is an extremely serious medical condition with a high rate of associated mortality.Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner.A 65 year-old-male suffered from multiple injuries after a fall,including BTAI in the aortic arch,which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery,development of an intimal flap in the left common carotid artery,and dissection of the left subclavian artery.Based on the imaging information of this patient and our clinical experience,the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels,additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery.The intervention yielded satisfactory early outcomes.Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft.Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.
基金Zhongyuan Talent Program,No.ZYYCYU202012113The Key R and D Program of Henan Province,No.222102310038.
文摘BACKGROUND Percutaneous drainage(PCD)and endoscopic approaches have largely replaced surgical drainage as the initial approach for(peri)pancreatic fluid collections(PFC)s,while complications associated with endoscopic stent implantation are common.AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration(ETGF),which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation,and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall.METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled.Indications for intervention were consistent with related guidelines.We analyzed patients baseline characteristics,technical and clinical success rate,recurrence and reintervention rate,procedure-related complications and adverse events.RESULTS Seventy-two eligible patients were retrospectively identified(ETGF=34,PCD=38)from October 2017 to May 2021.Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group(97.1 vs 76.3%,P=0.01).There were no statistically significant differences regarding recurrence,reintervention and incidence of complication between the two groups.While long-term catheter drainage was very common in the PCD group.CONCLUSION Compared with PCD,ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall.ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.
文摘BACKGROUND Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound.Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts,depending on the biliary connection.While some solitary liver cysts are symptomatic in childhood,even in newborns,they are often found incidentally in adults.CASE SUMMARY A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting,respiratory problems,and abdominal bloating complaints.On examination,the abdomen was greatly distended and extremely tight.She had repeated vomiting for 3 d,no stool output,and decreased urine.The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm×10 cm×14 cm,extending from the liver or right kidney to the pelvis.In the magnetic resonance imaging examination of the patient,a solitary cystic structure of 10 cm×10 cm×14 cm in the right abdomen was observed,extending to the pelvis and possibly originating from the liver.The patient was operated via fenestration after her fluid and electrolytes improved.Oral nutrition was initiated on the 2nd postoperative day,and the drain was removed on the 5th postoperative day.The patient visited the outpatient clinic control 1 mo later with no clinical complaints.CONCLUSION Congenital liver cysts are usually followed without complications.They rarely reach gigantic dimensions and may cause respiratory distress,intestinal obstruction and recurrent vomiting.Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.
文摘BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.
文摘BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration. METHODS: A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated. RESULTS: There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively. CONCLUSION: Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.
文摘Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.
文摘Objective: To report a scala tympani drill-out technique for managing malformed facial nerve covering the entire oval window(OW).Methods: Data from three cases with OW atresia, malformed stapes and abnormal facial nerve courses were reported, in which a scala tympani drill-out technique was employed with a TORP between the tympanic membrane and scala tympani fenestration for hearing reconstruction.Results: Air conduction hearing improved in two of the three cases following surgery. In the third case, there was no improvement in air conduction hearing following a canal wall up mastoidectomy and tympanoplasty. There were no vertigo, tinnitus or sensorineural hearing loss in the three cases.Conclusion: The scala tympani drill-out technique, which is basically fenestration at the initial part of the basal turn, provides a choice in hearing reconstruction when the OW is completely covered by abarrently coursed facial nerve.
文摘AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis.Quantitative synthesis was then performed.RESULTS Based on available level III literature,HRCT has a relatively low sensitivity of 58%(95%CI: 49.4-66.9),a high specificity,95%(95%CI: 89.9-98.0) and a positive predictive value of 92%(95%CI: 84.1-95.8).HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre,retrofenestral and dense sclerotic lesions,despite the advent of more advanced CT scanners with improved collimation.CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical,HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician,helping to delineate extent of disease and exclude other causes.
文摘With the advance of invasive interventions,the treatment model for infected necrotizing pancreatitis(INP)has shifted from open surgery to the step-up minimally invasive treatment.Late intervention,originating from the open surgery era,has been questioned in the minimally invasive period.With the emergence of new high-quality evidence about the timing for intervention,it seems to be increasingly apparent that,even in the age of minimal invasiveness,“late intervention”waiting for the necrotic collections to be encapsulated is still necessary.This opinion review mainly discusses the intervention timing for INP.
文摘In this study, we explored the operation options for middle cranial fossa arachnoid cysts (MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y (mean=5.4 y). All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration (F) resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting (S). We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ (Galassi classification), cysto-peritoneal shunting is better for cysts of type Ⅲ.