Endovascular stent treatment of the iliac vein stenosis caused by a pelvic lymphocele secondary to gynecologic malignancy

Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of symptomatic lymphoceles,compression symptoms persist,all patients were performed endovascular stent therapy,clinical symptoms of lower limb were completely relieved.Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy,endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.

Experimental Study and Design of Balloon- expandable Endovascular Stent Expansion

The application background and experimental research overview of medical endovascular stent are presented. Based on the analytical comparison of the current research achievements, the life cycle of medical endovascular stent is pointed out and the characteristics of stent expansion in the life cycle are emphasized on. The experimental scheme of in vitro stent expansion based on the machine vision technology in LabVIEW is presented. The selection and usage of the chosen component devices and design of measurement program for experiment are expatiated. A special drug-loading stent was expanded on the assembled platform of selected equipments and experimental results were analyzed. The experimental scheme presented in the paper provides powerful experimental support for the optimization of stent design and computer simulation of stent expansion by the finite element analysis.

Vascular morphological change due to endovascular stent placement for intracranial aneurysm

Objective The purpose of this study was to quantify the vascular angle change due to intracranial stent placement and its effect on hemodynamics. Methods Fifteen patients with a wide-necked anterior communicating artery aneurysm were treated with stent-assisted coiling. Centerlines of the parent vessels were calculated and determined the exact change in

Endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome

To evaluate the effect of endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome.Methods Forty-two cases of Cockett syndrome with femoral veins reflux were treated with iliac vein stent implantation or venoplasy,and superficial femoral veins were constricted with ePTFE graft patch at the level of the first valves.Results All the iliac veins were patent after stent implantation.A follow-up of 8 to 45 months revealed that limb swelling disappeared in 38 cases with no varicose.Slight limb swelling was left over in 3 cases.Stent thrombosis,developed in one case two months later,subsided by a successful thrombolysis.Conclusion The procedure is mini-invasive,safe and effective for the treatment of Cockett syndrome.6 refs,1 fig.

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes

Objective To evaluate the early and mid-term results of endovascular repair for acute and chronic type B aortic dissection, and to compare the clinical outcomes between the 2 groups. Methods From May 2002 to December 2006, 50 patients with type B aortic dissection were treated by endovascular stent-graft. There were 23 patients in the acute aortic dissection (AAD) group and 27 patients in the chronic aortic dissection (CAD) group. All patients were followed up from 1 to 54 months (average, 17±16 months).The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 50 patients. Compared to the CAD group, the AAD group had a higher percentage of pleural effusion (17.4% vs. 0%, P=0.04) and visceral /leg ischemia (26.1% vs 3.7%, P=0.04). Procedure related complications, including endoleak and post-implantation syndrome, occurred more frequently in the AAD group than in the CAD group (21.7% vs 3.7% and 30.4% vs 11.1%, respectively; P=0.08 and P=0.04). Kaplan–Meier analysis showed no difference in the survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P=0.42 by log-rank test). However, the event-free survival rate was higher in patients with chronic dissection than in patients with acute aortic dissection(96.2% vs 73.9%; P=0.02 by log-rank test). Conclu- sions Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B aortic dissection. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.

Custom Made Fenestrated Stent Graft Collapse after Thoracic Endovascular Aortic Repair: A Case Report

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.

Endovascular stent-grafts for acute and chronic type B aortic dissection： comparison of clinical outcomes

Background Endovascular stent-graff treatment has emerged as an alternative for patients with type B aortic dissection （AD）, either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type BAD. Methods From May 2002 to July 2007, 67 patients with type BAD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase （AAD group） and 35 patients in the chronic phase （CAD group）. The patients were followed up from 1 to 65 months （average, 17_＋16 months）. The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion （15.6% vs 0, P=-0.02） and visceral/leg ischemia （21.9% vs 2.9%, P=0.02）. Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group （21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P=0.02 and P=0.02）. Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups （86.4% vs 92.3%, P=0.42 by Log-rank test）. But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection （96.2% vs 73.9%; P=0.02 by Log-rank test）. Conclusions Endovascular repair with stent-graff was safe and effective for the treatment of both acute and chronic type BAD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.

Endovascular treatment of blood blister-like aneurysms in the internal carotid artery using a Willis covered stent

Background Despite the current availability of flow diverter devices(FDD), problems remains regarding optimal endovascular treatment(EVT) for blood blister-like aneurysms(BBAs) of the internal carotid artery(ICA). Objective To evaluate the safety and efficacy of EVT of BBAs in the ICA with a Willis covered stent. Methods 20 consecutive patients(5 men and 15 women) with ruptured BBAs underwent EVT using a Willis covered stent in two institutions from March 2013 to March 2018. Clinical observations, angiographic characteristics, and procedural and follow-up outcomes were retrospectively evaluated. Results 20 consecutive patients(5 men and 15 women) with ruptured BBAs underwent EVT using a Willis covered stent in two institutions from March 2013 to March 2018. Clinical observations, angiographic characteristics, and procedural and follow-up outcomes were retrospectively evaluated. Conclusion Our initial results demonstrate that reconstructive EVT using a Willis covered stent provides a viable approach to treat ICA BBAs. However, an expanded clinical evaluation and larger cohort are needed to confirm the results.

The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation

Intracranial aneurysm occurs when a cerebral artery develops an abnormal sac-like dilatation, and will cause massive bleeding in the subarachnoid space upon rupture. Endovascular stenting is a minimally invasive procedure in which a flow-diverting stent is deployed to cover the aneurysm neck, thereby restricting blood from entering the aneurysm and reducing the risk of rupture. The stent porosity, a crucial factor determining the intra-aneurysmal hemodynamics following treatment, is investigated by computational fluid dynamics techniques. Based on the computational results, a low porosity stent will dramatically reduce the flow velocity and the flow rate inside the side branch vessel. Conversely, a high porosity stent may not provide adequate flow reduction inside the aneurysm, possibly causing treatment failure. An advisable range of optimal stent porosity would be 60% to 75%, which can drastically reduce the flow rate into the aneurysm while preserving enough blood flow for the side branch vessel. Clinically, deployment of two or more flow-diverting stents may not increase treatment efficacy but can potentially lead to adverse effects due to side-branch hypoperfusion. The present quantitative analysis can also provide practical insight for future stent design.

Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bellbottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.

Research Progress on the Effect of Number of Stent Retriever Passes on the Outcome of Endovascular Treatment of Acute Ischemic Stroke

Introduction: Endovascular treatment is an effective treatment for large vessel occlusive ischemic stroke. The number of Stent Retriever passes is an important link in the strategy of endovascular treatment, and is closely related to the clinical outcome and prognosis of patients with acute ischemic stroke, but there is still a lack of unified understanding. In order to provide reference for clinical practice and related research, this paper reviewed the recent important literatures. Methods: We searched PubMed, Embase, and Cochrane databases, using the terms “stents”, “stroke” and “thrombectomy”. Priority was given to human studies. Only English language papers were accepted. Analyze the articles by title and abstract. Results: The number of Stent Retriever passes is closely related to the rate of recanalization, hemorrhagic transformation, recanalization time, surgical procedures and clinical prognosis. Along with the increase of the number of Stent Retriever passes, the vascular recanculation rate decreased successively, in turn, reduced the rate of blood vessels, 3 times may be the target vascular occlusion which should try the best of times, ≥4 times may not improve the opportunity of recanalization and not conducive to the prognosis, at the same time, increase the risk of HT and related complications occurred. Conclusion: It is necessary to avoid unplanned, additional attempts at EVT. The number of Stent Retriever passes has significant effects on the outcome of EVT of AIS in many aspects. How to better personalized EVT strategy is the focus of future research.

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report

BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.

Carotid-subclavian bypass and endovascular aortic repair of Kommerell’s diverticulum with aberrant left subclavian artery:A case report

BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.

Case Report of a Pseudoaneurysm of Ascending Aorta Treated by Stent

Pseudoaneurysms of the ascending aorta are a rare complication of aortic and cardiac surgery. In this article, we present a clinical case of a 56-year-old patient with a fortuitous diagnosis of a pseudoaneurysm of ascending aorta that was treated by an endovascular stent-graft. We discuss in this article the diagnostic and therapeutic aspect of the case and the place of endovascular treatment for the ascending aorta.

支架,放还是不放?这是个生物力学问题

血管支架用于扩张血管狭窄病变部位,以达到血流通畅的目的。但什么样的狭窄血管需要放支架?这是个生物力学问题。本文从血管狭窄的功能学评价指标来分析血管狭窄、心肌缺血和支架治疗之间的逻辑关系,用农田灌溉这样形象的比喻来阐明冠脉支架介入术的生物力学机理,启发读者思考临床医学背后的基础工程科学原理。

52例症状性颅内动脉粥样硬化性狭窄患者个体化血管内治疗的回顾性分析

目的评估症状性颅内动脉粥样硬化性狭窄(sICAS)患者个体化血管内治疗的安全性和有效性。方法回顾性收集2019年1月至2022年12月在我院接受个体化血管内治疗的sICAS患者的临床资料,分析血管重建成功率、围手术期并发症发生率和死亡情况,以及随访期间复发性缺血性脑卒中(IS)、短暂性脑缺血发作、死亡和血管再狭窄的发生率。结果52例sICAS患者共有55处病变,均接受血管内治疗。患者平均年龄为(62.94±9.04)岁。术前病变血管狭窄程度为90%(80%,99%),狭窄长度为8(5,11)mm。采用的手术方式分别为球囊扩张式支架植入术(25例,27个病变)、自膨式支架植入术(19例,20个病变)、单纯球囊扩张血管成形术(8例,8个病变)。术后残余狭窄程度为10%(0,20%),较术前降低且差异有统计学意义(P<0.001)。血管重建成功率为94.23%(49/52),围手术期并发症发生率为3.85%(2/52)。临床随访12(12,18)个月,影像学随访10(6,12)个月,血管再狭窄发生率为7.69%(4/52),复发性IS发生率为1.92%(1/52),无患者死亡。结论个体化血管内治疗对sICAS安全、有效,其可提高血管重建成功率,降低围手术期并发症、远期IS复发和再狭窄风险。

血管内治疗小脑后下动脉瘤24例临床经验

目的 探讨血管内治疗小脑后下动脉(PICA)瘤的治疗策略、安全性及临床疗效。方法 回顾性分析安徽医科大学第一附属医院2017年7月至2022年1月行血管内治疗的24例PICA动脉瘤病人的临床资料(其中,PICA近端13例、过渡段1例、远端10例;以蛛网膜下腔出血首诊的21例、未破裂动脉瘤3例),单纯栓塞12例、动脉瘤及载瘤动脉闭塞7例(闭塞材料使用弹簧圈3例、Onyx胶4例)、支架辅助弹簧圈栓塞5例。术后随访3~24个月。结果 24例PICA动脉瘤病人术中动脉瘤均栓塞顺利。23例病人无近期并发症,1例出血病人合并严重脑血管痉挛自动出院(临床预估死亡)。随访结果:19病人远期随访无复发;4例复发,其中2例二期行支架辅助栓塞,后期随访良好、未再复发;1例首次支架辅助栓塞病人再次行穿支架网孔弹簧圈单纯栓塞,后期随访良好、未再复发;1例首次单纯栓塞病人再次行弹簧圈栓塞,后期随访良好、未再复发。结论 血管内治疗PICA动脉瘤安全、可行,疗效可靠。根据动脉瘤血管解剖位置,对于破裂出血的PICA动脉瘤首次治疗倾向单纯栓塞或载瘤动脉闭塞术。首次单栓病例术后复发,可二期行支架辅助栓塞能取得满意效果。对于复发动脉瘤经再次血管内治疗可获得满意效果。

锁骨下动脉完全闭塞的腔内治疗:单中心回顾性研究

目的探讨腔内治疗锁骨下动脉完全闭塞的有效性和远期通畅率。方法回顾性收集2018年6月至2023年6月北京大学第一医院38例行腔内治疗的锁骨下动脉完全闭塞患者临床资料,分析患者的手术成功率、并发症、症状缓解率和随访通畅率。结果技术成功率为92.1%(35/38),其中顺行及逆行再通的成功率分别为78.9%(30/38)和62.5%(5/8)。病变近端残端形态分型平钝型开通成功率比鸟嘴型更低(66.6%比94.1%,P=0.039)。症状缓解率为93.5%(29/31),无围手术期并发症发生。患者术后随访6~68个月,中位随访时间38个月,6例患者出现再狭窄,Kaplan-Meier分析显示术后5年通畅率为77.4%,未发现锁骨下动脉闭塞患者远期通畅率的独立预后因素。结论腔内治疗锁骨下动脉完全闭塞安全有效,远期通畅率较高。

腔内治疗自发性颈动脉夹层合并缺血性脑卒中的分析

目的探讨腔内技术在治疗自发性颈动脉夹层合并缺血性脑卒中患者的应用和疗效。方法回顾性分析2018年6月至2023年6月郑州大学第一附属医院利用腔内技术治疗的35例自发性颈动脉夹层合并缺血性脑卒中患者临床资料,统计患者住院及随访期间脑缺血和脑出血事件发生率、支架通畅率和死亡率等。结果手术成功率100%。围手术期发生远端栓塞1例,发生蛛网膜下腔出血1例,均经保守治疗后复良好;发生无症状性支架内闭塞2例;死亡1例,因脑出血继发脑水肿、脑疝死亡,死亡率为2.86%。患者随访6~60个月,平均(27.62±14.80)个月,发生无症状性支架内狭窄1例,1例患者因远端残余夹层动脉瘤形成行二次手术。患者均无脑缺血及死亡事件发生。结论腔内技术用于治疗自发性颈动脉夹层合并缺血性脑卒中患者成功率高,安全性较好,围手术期并发症发生率低。

覆膜支架与裸支架在主髂动脉闭塞症中的疗效分析

主髂动脉闭塞症(AIOD)是以盆腔缺血和/或下肢缺血为主要表现的疾病,其发病率、就诊率呈逐年上升趋势,已成为血管外科的常见疾病。随着介入材料不断发展和手术医师介入技术的不断提高,腔内治疗凭借其创伤小、操作方便、效果明确、周期短、病死率低、术后并发症少等优点,逐步成为临床医师治疗AIOD的首选治疗方式。目前关于裸支架和覆膜支架在AIOD患者中的疗效研究较少,本综述旨在探讨覆膜支架与裸支架在AIOD中的疗效,以期为AIOD患者的腔内治疗提供参考。