Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood for postoperative complications of elective endovascular repair for abdominal aortic aneurysm (AAA). Methods From August 2016 to November 2021, the clinical data of patients with AAA who received endovascular isolation repair for the first time in the Department of Vascular Surgery of Beijing Hospital were retrospectively analyzed, including the basic information of the patients, comorbid diseases, and the largest diameter of AAA, preoperative blood labotry test, postoperative complications, long-term survival rate and other indicators. The optimal NLR in peripheral blood was determined, and the differences in postoperative complications and long-term survival rates between the high NLR group and the low NLR group were analysed. Results A total of 120 patients with AAA underwent endovascular isolation for the first time were included in this study, including 105 males and 15 females. The age ranged from 52 to 94 years, with an average of (73.3 ± 8.26) years. The largest diameter of abdominal aortic aneurysm was 35 to 100 mm, with an average of (58.5 ± 12.48) mm. The best cut-off value of NLR for predicting postoperative complications of AAA was 2.45 by using Yoden index screening. Those with NLR ≥2.45 were in the high NLR group (n=66), and those with NLR <2.45 were in the low NLR group (n=54). There was no statistically significant difference between the two groups in the incidence of overall complications and the incidence of sub-complications (P>0.05). The results of logistic regression analysis suggested that NLR was an independent risk factor for complications after endovascular repair of AAA (P<0.05). The median survival time of patients in the high NLR group and the low NLR group was 31.47 months and 35.28 months, respectively, and there was no statistically significant difference between the two groups (P>0.05). Conclusion NLR can be used as a reference predictor of complications after elective endovascular repair of AAA, but more research results are still needed to confirm.
Objective To review the progress of artificial intelligence (AI) and radiomics in the study of abdominal aortic aneurysm (AAA). Method The literatures related to AI, radiomics and AAA research in recent years were collected and summarized in detail. Results AI and radiomics influenced AAA research and clinical decisions in terms of feature extraction, risk prediction, patient management, simulation of stent-graft deployment, and data mining. Conclusion The application of AI and radiomics provides new ideas for AAA research and clinical decisions, and is expected to suggest personalized treatment and follow-up protocols to guide clinical practice, aiming to achieve precision medicine of AAA.
Objective To investigate pathogenesis and therapeutic prospect of abdominal aortic aneurysm (AAA). Methods Relevant literatures about pathogenesis and ways of treatment for AAA in recent years were reviewed. Results The formation of AAA are associated with heredity, anatomy, environment and biochemistry and other factors. All factors influence and interact with each other. The metabolic disequilibrium of aortic intermediate extracellular matrix plays an important role in the pathogenesis of AAA. The main reasons for the formation of AAA may be the increase of activity of matrix metalloproteinases and the disequilibrium of genetic expressions of elastin and collagen. The therapy of AAA includes surgical and medical treatment. The methods of medical treatment are still in the process of exploration and research. Conclusion The formation of AAA is a synergistical result of multiple factors, and medical treatment is an important supplement of surgical treatment.
ObjectiveTo determine the influence of proximal aneurysm neck anatomy on typeⅠA endoleak follo-wing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm. MethodsFrom September 2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR. The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of typeⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. ResultsThe recurrence of typeⅠA endo-leak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren't related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. ConclusionsThe complicated proximal aneurysm neck anatomy is a major cause for the typeⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The applica-tion of EVAR depends largely on the shape of the proximal aneurysm neck.
ObjectiveTo understand risk factors of abdominal aortic aneurysm (AAA) rupture and the latest progress.MethodThe domestic and foreign related literatures on risk factors affecting AAA rupture were retrieved and reviewed.ResultsBesides some definite risk factors of AAA rupture, including age, gender, hypertension, smoking, family history, complications (such as diabetes mellitus, hypertension, dyslipidemia, etc.), the biomechanical factor was the crucial factor of AAA rupture, including the aortic compliance, aortic wall peak value of pressure, aortic wall calcification, and hemodynamics. The latest imaging methods such as the high resolution ultrasound, function and molecular imaging, and phase contrast magnetic resonance imaging could provide technical supports for the prediction of AAA rupture.ConclusionsThere are many risk factors affecting AAA rupture. Clinicians might prevent and make individualize treatment for AAA rupture according to its risk factors, and risks of AAA rupture could be more accurately assessed with help of new medical imaging examination.
ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
ObjectiveTo summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.MethodsA case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.ResultsThe clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.ConclusionsFor patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
Objective To evaluate the importance of "one-stop" hybrid operating room in the individualized treatment of aortic pathology. Method We retrospectively analyzed the clinical data of 247 patients of aortic pathology who were operated in the hybrid operating room in our hospital from January 2013 through December 2014. There were 193 males and 54 females at age of 24-83(54±12) years. Results Thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) was applied in 132 patients, including 122 simple patients and 10 complexes. Fenestrated TEVAR was applied in 61 patients. Hybrid operation was done in 54 patients. Perioperative death occurred in 9 patients (3.6%). Perioperative complication rate was 11.7% (29/247) . The patients were followed up for one year. During follow-up, five patients were dead. The one-year survival rate was 98.0% (242/247) . Conclusions "One-stop" individualized treatment of aortic pathology shows its advantage, yet long-term result still needs to be followed up.