ObjectiveTo investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection.MethodsA total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups.ResultsThe operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05).Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.
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.
ObjectiveTo report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR).MethodsTwenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D"technique (a group B). The clinical efficacy of the two groups was compared.ResultsIn the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups.ConclusionThe "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.
ObjectiveTo investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.MethodsFrom January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.ResultsThe operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).ConclusionIn situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
ObjectiveTo investigate the effect of fenestration on total cavopulmonary connection (TCPC) in the treatment of complex congenital heart disease. MethodsWe retrospectively analyzed the clinical data of 142 patients undergoing TCPC in Fu Wai Hospital between January 2010 and December 2013. The patients were divided into 2 groups depending on with fenestration or not. There were 71 patients including 44 males and 27 females at age of 65.7+24.5 months in the fenestration group. There were also 71 patients with 42 males and 29 females at age of 60.7+20.8 months in the no fenestration group. Perioperative variables were compared between the two groups. ResultsFour patients (2.82%) died postoperatively. The fenestration significantly increased in the patients with atrioventricular valve regurgitation (AVVI). There were no statistical differences in duration of mechanical ventilation, ICU hospitalized time, early mortality and complications between the two groups (P>0.05). But there were statistical differences in the postoperative pleural effusion duration and 24 h capacity requirement (9.1 d versus 13.1 d, 4.19 ml/(kg · h) versus 5.48 ml/(kg · h)) between the two groups. In the patients whose preoperative mPAP was more than 12 mm Hg, postoperative CVP was lower (P=0.046), maintaining the same blood pressure (SBP=80-90 mm Hg) of vasoactive drugs (P=0.019) and 24 h capacity requirement (P=0.041) were lower, pleural effusion duration was shorter (9.8 d versus 17.8 d, P=0.000) in the fenestration children. 113 patients were followed up for 1.1+1.2 years. SpO2 was 92.1%+3.5% in the fenestration children. Spontaneous closure occured in 8.5% of the patients. No severe cyanosis (SpO2<85%), limb embolism, or stroke. ConclusionFenestration should not be a routine in children of TCPC. Patients with fenestration or not can obtained satisfactory early clinical efficacy. Atrial septal fenestration should be considered in high-risk children with mPAP higher than 12 mm Hg or serious AVVI and be corrected at the same time. Fenestration contributes to stable circulation after TCPC surgery. It can shorten the duration of pleural effusion.
ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.
ObjectiveTo systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).MethodsThe databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).ConclusionsBoth F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.
To assess long-term outcomes of reoperation for recurrent lumbar disc herniation, and to compare results of different methods. Methods There were 95 patients who had reoperation for recurrent lumbar discherniation between February 1998 to February 2003, among whom a total of 89 (93.7%) were followed up and their primary data were reviewed. There were 76 patients, with the mean age of 42 years (range from 23 to 61), who met the inclusion criteria and were included. Among them, there were 55 males and 21 females. All patients had the history of more than one sciatic nervepain. The mean recurrent time was 69 months(range from 8 to 130 months). There were 48 patients in L4,5 and 28 patients in L5, S1, of whom we chose 30 to undergo larger vertebral plate discectomy (or two-side fenestration) and nucleus pulpose discectomy (group A), 24 to undergo the whole vertebral discectomy (group B) and 22 to undergo the whole vertebral discectomy and 360degrees intervertebral fusion(group C). The patients’ cl inical results in the three groups were compared, and the cl inical curative effects were evaluated by using cl inical functional assessment standard. Results Cl inical outcomes were excellent or good in 80.3% of the patients, including 80.0% of group A, 79.2% of group B and 81.8% of group C. There was no significant difference in each group (P gt; 0.05). These three groups were not different in age, pain-free interval and follow-up duration (P gt; 0.05). The mean intraoperative blood losses in the three groups were (110.7 ± 98.8), (278.7 ± 256.3), (350.7 ± 206.1) mL, respectively. The mean surgery time were (65.9 ± 22.8), (111.6 ± 24.3), (127.3 ± 26.7) minutes, respectively, and the mean hospital ization time were (6.7 ± 1.4), (10.2 ± 1.8), (12.2 ± 2.3) days, respectively. Group A was significantly less than group B or C (P lt; 0.05) and there was no significant difference between group B and C. All the patients were followed up for 36 to 96 months with an average of 86 months, and with (87.6 ± 27.0), (84.5 ± 19.8), (83.6 ± 13.5) months of group A, B and C, respectively. At the endof the follow-up, there were more cases of spinal instabil ity at the same level in group B (19 patients) than in group A (1 patient) or group C (no patient) in X-ray, and the difference was significant (P lt; 0.05). Conclusion Reoperation for recurrent lumbar disc herniation is effective. Larger vertebral plate discectomy or tow-side fenestration is recommended for managing recurrent lumbar disc herniation.
目的比较外剥内扎（注射）加开窗治疗环状混合痔和传统外剥内扎法治疗环状混合痔的临床疗效。方法80例环状混合痔患者分别接受外剥内扎（注射）加开窗治疗和传统外剥内扎法治疗，对两种术式的疗效进行比较。结果2组患者术后均未发生肛门失禁症状，肛门功能的差异无统计学意义（Pgt;0.05），而治疗组患者肛门狭窄、肛门水肿和疼痛明显轻于对照组（Plt;0.05），尿潴留、切口愈合时间以及复发也明显少于对照组（Plt;0.05）。结论外剥内扎（注射）加开窗术是环状混合痔的较好治疗方案。