Objective To investigate the further results of thoracoabdominal aortic aneurysm (TAAA) repair， and analyze the midterm results of 63 cases treated by total thoraco abdominal aortic replacement with a tetrafurcate graft. Methods From August 2003 to October 2007，total thoracoabdominal aortic replacement with a tetrafurcate graft was performed in 63 consecutive patients with Crawford Ⅱ TAAA in Fu Wai Hospital. There were 46 male and 17 female with a mean age of 39.98 years (17-71 years). All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach and underwent profound hypothermia with shorttime interval circulatory arrest. T6 to T12 intercostal arteries were reconstructed by arterial tube technique. The celiac artery， superior mesenteric artery and right renal artery were joined into a patch and anastomosed to the end of the main graft. Left renal artery was anastomosed to an 8 mm branch or joined to the visceral arterial patch. The other 10 mm branches were anastomosed to iliac arteries. KaplanMeier method was used to perform survival analysis. Results All the cases were followed，and the mean followup time was 36.57(8-57) months. No patient died during the operation. Early mortality rate was 7.94%（5/63）. Among them， 4 patients died of multiple organ failure. Two of them were caused by neurological complications, and the other 2 of them were caused by renal failure. One patient died of low cardiac output syndrome after surgery because of coronary artery disease. This patient underwent coronary artery bypass grafting (CABG) emergently, but couldn’t wean from cardiopulmonary bypass. The incidence of stroke and temporary neurological dysfunction was 9.52%（6/63）, 4 of them were temporary neurological dysfunction and were cured before discharged from hospital. Paraplegia and paraparesis occurred in 2 and 1, respectively. They were all [CM(158.3mm]cured before leaving hospital. Pulmonary complication was 25.40%(16/63)， and12 of them were cured. Pseudoaneurysmal change was observed in reconstructed intercostal arteries in 2 patients with Marfan syndrome, but neither of them underwent paraplegia or paraparesis. One patient died at 20th, 23rd, 30th month after discharge, respectively. The survival time of this group was 50.64±2.13 months（95%CI：46.47,54.84 months） with a survival rate of 92.06% after 1 year， 88.38% after 2 years， 86.11% after 3 years. Conclusion Using tetrafurcate graft is a reliable method in total thoracoabdominal aortic replacement and has a satisfactory midterm survival rate. The intercostal arteries reconstruction by arterial tube technique in total thoracoabdominal replacement is simple, and it is helpful in spinal cord protection.
Objective To understand the value of pre-coating in artificial vessel endothelialization. Methods Literature concerning precoating in artificial vessel endothelialization was extensively reviewed. Results Pre-coating included chemical coatings(collagen, fibronectin, laminin, poly-l-lysin, gelatin andextracellular matrix), pre-clotting(plasma, blood, serum and fibrin glue), chemical bonding (heparin, RGD and lectins) and surface modification. Most of them could enhance the adhesion of the endothelial cells. Conclusion Pre-coating couldimprove endothelialization, but further research is needed to search for the appropriate concentration and incubation time.
OBJECTIVE To investigate the clinical application of artificial blood vessel graft for arteriovenous fistulization. METHODS From October 1995 to August 1998, 23 cases with renal failure received PTEF artificial vessels grafting for arteriovenous fistulization in the forearm. The PTFE artificial vessel was 6 mm in diameter, and 40 cm in length. Artificial vessel "U"-shaped loop was formed from elbow incision to wrist incision, and perfused by 20 ml heparin saline. The two ends of artificial vessel were end-to-side anastomosed with superficial cubital vein and cubital artery respectively. RESULTS All of arteriovenous fistulas were successfully formed, and could be performed hemodialysis periodically. The artificial vessels could be punctured repeatedly, and had sufficient volume of blood flow. It had no rejection, no formation of false aneurysm, and no ischemia in arm or exacerbated reflux to heart. CONCLUSION The artificial vessel grafting for arteriovenous fistulization is a safe and convenient technique in clinical practice, especially when there is no autogenous vessels for arteriovenous fistula.