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.

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。

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.

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).

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.

Surgical Treatment of Aortic Aneurysm and Aortic Dissection:A Retrospective Analysis of 122 Cases

The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement （n=3）, aortic root replacement （n=43）, hemi-arch replacement/total arch replacement ＋ elephant trunk technique （n=32）, thoracic/thoracoabdominal aortic replacement （n=8） and endovascular repair （n=36）. In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage （n=1）, respiratory failure （n=1） and multiple organ dysfunction syndrome （MODS） （n=2）. Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.

Ischemic <i>Cauda equina</i>Syndrome Due to Spinal Embolization as a First Manifestation of an Infrarenal Abdominal Aortic Aneurysm

Spinal cord ischemia is an uncommon complication of an abdominal aortic aneurysm (AAA). We report the case of a 59-year-old man admitted for an acute ischemic Cauda equina syndrome secondary to a spinal cord embolization from an unknown partially thrombosed aortic aneurysm. The patient being at risk of further embolization, we achieved an emergency EVAR. The vascular post-operative course was uneventful. Neurologically, a post operative lumbar medullar MRI confirmed an ischemic Cauda equina syndrome and six months after the surgery, the patient still had a motor and sensory deficit in both lower limbs.

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。

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。

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。

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。

Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

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.

腹主动脉瘤腔内修复术后Ⅱ型内漏相关再干预的危险因素分析

目的探讨腹主动脉瘤(AAA)患者腔内修复术(EVAR)后Ⅱ型内漏(T2EL)相关再干预的危险因素及危险阈值。方法收集2015年1月至2021年12月于内蒙古医科大学附属医院进行EVAR的97例AAA患者的临床资料,根据是否进行了术后T2EL相关再干预将患者分为再干预组(n=14)和非再干预组(n=83)。比较两组患者的临床特征。分析两组患者AAA的形态学特征,确定T2EL的发生情况。分析AAA患者EVAR术后T2EL相关再干预的危险因素并确定其危险阈值,进而评估AAA患者EVAR术后T2EL相关再干预的风险。结果再干预组患者的吸烟比例、高血压比例均高于非再干预组患者(P﹤0.05)。再干预组患者的瘤体最大直径、肠系膜下动脉(IMA)直径、腰动脉(LA)数量均明显大于非再干预组患者(P﹤0.01)。多因素分析结果显示,瘤体最大直径、IMA直径、LA数量均是AAA患者EVAR术后T2EL相关再干预的独立危险因素(P﹤0.05)。受试者工作特征(ROC)曲线分析结果显示,瘤体最大直径≥56.85 mm、IMA直径≥2.95 mm的AAA患者在EVAR术后因T2EL而再次干预的风险较高。结论具有危险因素的AAA患者EVAR术后T2EL相关再干预的可能性较高,而高于IMA直径和瘤体最大直径风险阈值的AAA患者EVAR术后T2EL相关再干预的可能性更高。

复杂解剖结构腹主动脉瘤腔内修复术后主要并发症的影响因素分析

目的 探讨复杂解剖结构的腹主动脉瘤(AAA)腔内修复术(EVAR)后发生并发症的影响因素。方法 收集2007年8月至2022年6月于内蒙古医科大学附属医院行EVAR治疗的162例AAA患者的临床资料,根据EVAR术后是否发生并发症将其分为并发症组(n=42)和无并发症组(n=120)。记录患者的一般情况、实验室检查指标、腹主动脉瘤解剖形态信息、术中指标,统计术后1个月病死率及并发症发生情况,分析EVAR术后发生并发症的影响因素。结果 两组患者血清白蛋白水平、老年营养风险指数(GNRI)、髂动脉狭窄/闭塞、短瘤颈、大成角、瘤颈血栓比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,GNRI﹤82、瘤颈血栓、髂动脉狭窄/闭塞均是复杂解剖结构AAA患者EVAR术后发生并发症的独立危险因素(P﹤0.05)。结论 GNRI﹤82、髂动脉狭窄/闭塞及瘤颈血栓可提示行EVAR的复杂解剖结构的AAA患者术后并发症发生风险增高。

Mycotic Aneurysm of Infrarenal Aorta: A Case Report and Review of Literature

Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.

短瘤颈腹主动脉瘤腔内修复治疗术的研究进展

我国近十年来,腹主动脉瘤(abdominal aortic aneurysm,AAA)的腔内治疗需求不断增加,引起了临床医师和患者的广泛关注。然而,对于具有复杂解剖结构、不同长度、角度的瘤颈或移植物边界铆定区的“复杂”动脉瘤的有效修复方法还未得到充分研究。此外,血管内修复技术在情况复杂的动脉瘤紧急修复中发挥的具体作用还不清楚。因此许多先进的血管内技术和设备已经被开发出来,以规避以上问题,这些包括开窗内移植物以及个性化定制的开窗内移植物;浮潜程序,如烟囱、潜望镜和夹层技术;分支支架装置等。本文综述目前血管内修复技术针对复杂的短瘤颈AAA分别所适用的病例以及每种技术的优势和劣势。

超声造影在腹主动脉瘤腔内修复术后内漏诊断中的价值研究

目的:探讨超声造影(CEUS)在腹主动脉瘤腔内修复术(EVAR)后内漏诊断中的临床应用价值。方法:选取2020年1月至2022年10月在本院行EVAR的腹主动脉瘤(AAA)患者93例,所有患者均进行CEUS及CT血管成像(CTA)检查,分析对照两项检查对内漏及内漏分型的诊断结果,应用Kappa分析法评价两者的一致性。结果:93例患者中,CTA提示无内漏70例,发生内漏23例,其中Ⅰ型3例,Ⅱ型16例,Ⅲ型4例;CEUS提示无内漏72例,发生内漏21例,其中Ⅰ型5例,Ⅱ型14例,Ⅲ型2例。CEUS诊断术后内漏总体符合率95.69%,灵敏度为86.95%,特异度为98.57%,阳性预测值95.23%,阴性预测值95.83%,与CTA诊断结果的一致性Kappa值为0.881(P<0.001)。CEUS对23例内漏患者分型的总体符合率为73.91%,与CTA诊断结果的一致性Kappa值为0.516(P<0.001)。结论:CEUS在EVAR术后内漏诊断中具有较高的应用价值,可作为EVAR术后随访的有效检查手段。

瘤颈角度对腹主动脉瘤腔内修复术后支架位移的影响

目的研究瘤颈角度对腹主动脉瘤腔内修复术后支架位移的影响。方法选用28名患者CT影像分别建立术前腹主动脉瘤(abdominal aortic aneurysm,AAA)模型、术后两次随访(postoperative follow-up)AAA模型和覆膜支架模型,并根据术前瘤颈角度将模型分为非严重成角组(n=14)和严重成角组(n=14)。测量每个模型的几何形态,分析手术前后AAA几何参数、术后支架位移变化。通过血流动力学模拟计算术后第1次随访模型的位移力。结果两组患者在瘤长度、最大直径、位移力、瘤颈长度变化和瘤体积变化有明显差异(P<0.05)。支架重心位移和近端位移无显著差异(P>0.05)。在内漏发生情况上,未严重成角组中有2例,严重成角组中有4例(P>0.05)。结论严重的瘤颈成角可导致支架位移力显著增加以及近端锚固区减小,进而增加支架位移发生的可能性。建议在临床方面医生应加强对严重瘤颈成角患者的术后随访,警惕远期内漏的发生。