ObjectiveTo evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing.MethodsThe clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment.ResultsAll the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.
ObjectiveTo explore the efficacy of using a single branch stent-graft to treat primary intramural hematoma located at the distal arch or descending aorta in Stanford A type aortic intramural hematoma. MethodsFrom July 2020 to November 2022, 10 patients with primary intramural hematoma of Stanford A type aortic intramural hematoma were treated with endovascular repair using a single branch stent-graft in the Department of Cardiovascular Surgery at The University of Hong Kong-Shenzhen Hospital. There were 9 males and 1 female, aged from 32 to 66 years, with a mean age of (47±10.4) years. All patients had intramural hematoma involving the ascending aorta and aortic arch, diagnosed as type A intramural hematoma, with the tear located in the descending aorta. Among them, 6 patients were complicated by ulceration of the descending aorta with intramural hematoma, and 4 patients had changes of the descending aortic dissection. All patients underwent endovascular stent repair, with 8 patients undergoing emergency surgery (≤14 days) and 2 patients undergoing subacute surgery (15 days to 3 months). Results There were no neurological complications, paraplegia, stent fracture or displacement, or limb or visceral ischemia during the perioperative period in all patients. One patient had continuous chest pain after surgery, and the stent had a new tear at the proximal end, requiring ascending aorta and partial arch replacement. As of the latest follow-up, all patients had obvious absorption or complete absorption of the intramural hematoma in the ascending aorta and aortic arch compared with before the operation. ConclusionSingle branch stent-graft treatment of retrograde ascending aortic intramural hematoma is safe and effective, with good short-term results.
Objective To investigate the short and medium term results of Castor single branched stent combined with parallel stent technique in the reconstruction of supra-aortic branches in total endovascular repair of aortic arch lesions. Methods The clinical data of patients with aortic arch disease who were treated with single-branch stents combined with parallel stents for Z1 anchoring and total endovascular repair from April 2022 to August 2022 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed, and the perioperative and follow-up conditions of the patients were analyzed. ResultsThere were 4 males and 1 female with an average age of 46.2±18.6 years. This study included 1 patient of thoracic aortic aneurysm and 4 patients of acute non-A non-B aortic dissection. The success rate of surgical technique was 100.0%. The operative time was 132.3±45.1 min, the immediate postoperative isolation of lesions was satisfactory, and there were no adverse events and death in perioperative period. The median follow-up time was 13 (11-15) months. During the follow-up period, all patients survived without stent displacement, type Ⅰa endoleak, parallel stent stenosis and occlusion, and no re-operation. Conclusion The short and medium term results of single branched stents combined with parallel stents in total endovascular repair of aortic arch diseases requiring Z1 anchoring is satisfactory.
ObjectiveTo explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. MethodsA retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. ResultsA total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. ConclusionFor proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.
ObjectiveTo evaluate the feasibility, safety and efficacy of endovascular treatment for chronic thoracoabdominal aortic dissection. MethodsThe patients with chronic thoracoabdominal aortic dissection who underwent total endovascular treatment at Shanghai City First People’s Hospital between December 2021 and March 2024 were retrospectively analyzed. The patients were divided into single-trunk group and double-trunk group according to the treatment methods. Clinical data including demographic characteristics, preoperative risk factors, surgical details, postoperative complications and long-term follow-up data were collected. Outcome measures mainly included surgical success rate, in-hospital mortality, endoleak rate and incidence of branch restenosis. ResultsThirty-four patients with thoracoabdominal aortic dissection were treat with total endovascular treatment. That success rate of operation was 100%. The in-hospital mortality was 2.94%. the incidence of paraplegia was 0.00%. the incidence of cerebral infarction was 2.94%. The incidence of type Ⅲ endoleak was 5.88%. The incidence of branch artery stenosis was 8.82%. The incidence of dissection progression was 8.82%. The reintervention rate was 14.71%. In the aspect of reconstruction of splanchnic artery branches, fenestration stent was the main method in the single-trunk group, and branch stent was the main method in the double-trunk group, the difference was statistically significant (P<0.05). There was no significant difference in perioperative and mid-term follow-up results between the two groups (P>0.05). ConclusionTotal endovascular treatment is a safe and effective treatment option for patients with thoracoabdominal aortic dissection.