Objective To discuss the clinical application value of CT angiography (CTA) in traumatic pelvic artery pseudoaneurysm and dissecting aneurysm. Methods A total of 8 patients including 7 with traumatic pelvic artery pseudoaneurysm and 1 with dissecting aneurysm diagnosed by CTA in Suining Central Hospital from August 2012 to January 2016 were enrolled in this study, in whom 6 patients with traumatic pseudoaneurysm treated with embolotherapy were confirmed by digital subtraction angiography. Image post-processing techniques of CTA including curve planar reformation, multiplanar reconstruction and volume rendering were used. Results In the seven patients diagnosed as solitary traumatic pelvic artery pseudoaneurysm by CTA, 3 had superior gluteal artery pseudoaneurysm, 2 had inferior gluteal artery pseudoaneurysm, and 2 had external iliac artery pseudoaneurysm. The 7 pseudoaneurysms were pouch-shaped with the short diameters ranged from 9 to 64 mm and the long diameters ranged from 11 to 78 mm. Six locations of artery laceration were displayed clearly, thereinto 1 case was combined with arteriovenous fistula. In addition, a vessel occlusion caused by the limitation of right external iliac artery dissecting aneurysm and the thrombosis in left side of the external iliac artery was found in 1 case. Conclusions As a non-invasive diagnostic technique, CTA can accurately diagnose traumatic pelvic artery pseudoaneurysm and dissecting aneurysm, clearly display the location relationship of pseudoaneurysm and its parent artery, and find whether arteriovenous fistula exists. Beyond that, the true and false lumen of dissecting aneurysm can be precisely identified by this technique. CTA can provide important image information for formulating individual treatment plan.
The treatment of chronic thoracoabdominal aortic dissection aneurysm remains a major challenge in aortic surgery. Open surgery is the mainstream treatment at present. New devices for endovascular treatment of chronic thoracoabdominal aortic dissection are gradually applied in clinical practice. The hybrid procedure is a combination of open and endovascular procedures. The appropriate treatment should be selected according to the patient's age, anatomy, genetic aortic disease, and comorbidities.
Objective To identify the predictors of prolonged stay in the intensive care unit (ICU) in patients undergoing surgery for acute aortic dissection type A. Methods We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013. The mean age of the patients was 48.9±12.5 years, including 54 males (67.5%) and 26 females (32.5%). The patients were divided into two groups based on their stay time in the ICU. Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively. There were 67 patients with length of ICU stay shorter than 5 days, 13 patients with length of ICU stay 5 days or longer time. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors. Results The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately. Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups. In univariate analyses, there were statistically significant differences with respect to the age, the European system for cardiac operative risk evaluation (EuroSCORE), the preoperative D-dimmer level, total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), inotropes and occurrence of postoperative stroke, acute renal failure and acute respiratory failure, ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days. Multivariate logistic analysis showed that CPB time, occurrence of postoperative stroke, acute renal failure, or acute respiratory failure were independent predictors for prolonged ICU stay. Conclusion The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A. It can be predicted by CPB time, occurrence of postoperative stroke, acute renal failure, and acute respiratory failure were independent predictors for prolonged ICU stay. For patients with these risk factors, more perioperative care strategies are needed in order to shorten the ICU stay time.