Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. ...Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.展开更多
A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects w...A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient’s life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.展开更多
A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible...A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.展开更多
So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the-involved segment. Despite significant improvements, morbidity and mortality ...So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the-involved segment. Despite significant improvements, morbidity and mortality of open surgery remain high. As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,展开更多
BACKGROUND Aortic dissection(AoD)is a life-threatening disease.Its diversified clinical manifestations,especially the atypical ones,make it difficult to diagnose.The epileptic seizure is a neurological problem caused ...BACKGROUND Aortic dissection(AoD)is a life-threatening disease.Its diversified clinical manifestations,especially the atypical ones,make it difficult to diagnose.The epileptic seizure is a neurological problem caused by various kinds of diseases,but AoD with epileptic seizure as the first symptom is rare.CASE SUMMARY A 53-year-old male patient suffered from loss of consciousness for 1 h and tonicclonic convulsion for 2 min.The patient performed persistent hypomania and chest discomfort for 30 min after admission.He had a history of hypertension without regular antihypertensive drugs,and the results of his bilateral blood pressure varied greatly.Then the electroencephalogram showed the existence of epileptic waves.The thoracic aorta computed tomography angiography showed the appearance of AoD,and it originated at the lower part of the ascending aorta.Finally,the diagnosis was AoD(DeBakey,type I),acute aortic syndrome,hypertension(Grade 3),and secondary epileptic seizure.He was given symptomatic treatment to relieve symptoms and prevent complications.Thereafter,the medical therapy was effective but he refused our surgical advice.CONCLUSION The AoD symptoms are varied.When diagnosing the epileptic seizure etiologically,AoD is important to consider by clinical and imaging examinations.展开更多
目的探讨主动脉夹层和夹层动脉瘤患者采用血管腔内治疗的技术方法及疗效。方法随机选取2022年3月—2023年2月福建省立医院收治的90例主动脉夹层和夹层动脉瘤患者为研究对象,以随机数表法分成对照组(n=45)和研究组(n=45),对照组给予传统...目的探讨主动脉夹层和夹层动脉瘤患者采用血管腔内治疗的技术方法及疗效。方法随机选取2022年3月—2023年2月福建省立医院收治的90例主动脉夹层和夹层动脉瘤患者为研究对象,以随机数表法分成对照组(n=45)和研究组(n=45),对照组给予传统药物治疗,研究组给予血管腔内治疗,比较两组临床效果、生理状况[急性生理与慢性健康系统(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)评分]、生活质量[生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOL-74)]及并发症。结果研究组治疗总有效率为97.78%高于对照组的82.22%,差异有统计学意义(χ^(2)=4.444,P<0.05)。治疗后,两组APACHEⅡ评均降低,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组GQOL-74评分均升高,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率较对照组更低,差异有统计学意义(P<0.05)。结论血管腔内治疗主动脉夹层和夹层动脉瘤患者,能够提高临床疗效,加速病情恢复,提高生活质量,减少并发症发生。展开更多
文摘Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.
文摘A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient’s life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.
文摘A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.
文摘So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the-involved segment. Despite significant improvements, morbidity and mortality of open surgery remain high. As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,
基金Supported by the Sichuan Provincial Science and Technology Department,No.2019ZYZF0063,and No.2020YJ0497the Sichuan Medical Association,No.Q21049the Key Technology Plan of Yaan City,No.21KJH0006.
文摘BACKGROUND Aortic dissection(AoD)is a life-threatening disease.Its diversified clinical manifestations,especially the atypical ones,make it difficult to diagnose.The epileptic seizure is a neurological problem caused by various kinds of diseases,but AoD with epileptic seizure as the first symptom is rare.CASE SUMMARY A 53-year-old male patient suffered from loss of consciousness for 1 h and tonicclonic convulsion for 2 min.The patient performed persistent hypomania and chest discomfort for 30 min after admission.He had a history of hypertension without regular antihypertensive drugs,and the results of his bilateral blood pressure varied greatly.Then the electroencephalogram showed the existence of epileptic waves.The thoracic aorta computed tomography angiography showed the appearance of AoD,and it originated at the lower part of the ascending aorta.Finally,the diagnosis was AoD(DeBakey,type I),acute aortic syndrome,hypertension(Grade 3),and secondary epileptic seizure.He was given symptomatic treatment to relieve symptoms and prevent complications.Thereafter,the medical therapy was effective but he refused our surgical advice.CONCLUSION The AoD symptoms are varied.When diagnosing the epileptic seizure etiologically,AoD is important to consider by clinical and imaging examinations.
文摘目的探讨主动脉夹层和夹层动脉瘤患者采用血管腔内治疗的技术方法及疗效。方法随机选取2022年3月—2023年2月福建省立医院收治的90例主动脉夹层和夹层动脉瘤患者为研究对象,以随机数表法分成对照组(n=45)和研究组(n=45),对照组给予传统药物治疗,研究组给予血管腔内治疗,比较两组临床效果、生理状况[急性生理与慢性健康系统(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)评分]、生活质量[生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOL-74)]及并发症。结果研究组治疗总有效率为97.78%高于对照组的82.22%,差异有统计学意义(χ^(2)=4.444,P<0.05)。治疗后,两组APACHEⅡ评均降低,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组GQOL-74评分均升高,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率较对照组更低,差异有统计学意义(P<0.05)。结论血管腔内治疗主动脉夹层和夹层动脉瘤患者,能够提高临床疗效,加速病情恢复,提高生活质量,减少并发症发生。
