ObjectiveTo assess the causes and risk factors of multiple-intervention in endovascular aortic repair (EVAR) for type B aortic dissection (TBAD). MethodsWe retrospectively analyzed the clinical data of 347 TBAD patients initially treated with EVAR in our hospital between January 1999 and December 2013. The patients were stratified into a multiple-intervention group (34 patients) and a single-intervention group (313 patients). We analyzed the differences of clinical data of the two groups. ResultsThere were 9 patients with endoleak, 10 patients with new dissection, 8 patients with incomplete thrombosis of the false lumen, 4 patients with new aneurysm, 2 patients with retrograde dissection, and 1 patient with iliac artery occlusion in the multiple-intervention group. Higher proportions of chronic dissection and smoking occurred in the multiple-intervention group (79.4% versus 50.8%, 61.8% versus 40.3%, P=0.002, 0.018, respectively). Both of the degree and proportion of hyperglycemia were higher in the multiple-intervention group (6.9±2.3 mmol/L versus 5.7±1.8 mmol/L, P=0.027; 44.1% versus 22.7%, P=0.011). There were statistical differences in oversizing rate of grafts (14.6%±3.2% versus 11.3%±2.5%, P<0.001), operation time (172 min versus 82 min, P<0.001), and blood loss (280 ml versus 100 ml, P=0.006) between the two groups. ConclusionEndoleak, new dissection, and incomplete thrombosis of the false lumen are the main causes of multiple-intervention. While in chronic phase, smoking, hyperglycemia, too big oversizing, and complicated lesion or operation are the potential risk factors.
ObjectiveTo evaluate the feasibility and security of endovascular repair of abdominal aorta using branched stent graft in a novel in vitro vascular model. MethodsThe branched stent graft for the abdominal aorta was designed. The novel in vitro vascular model was established to test this stent graft. Attempts were made to optimize the procedure of stent graft and to evaluate the feasibility of this device. The branched stent graft for abdominal aorta was tested by a novel in vitro vascular model. The number of stent graft released and expanded was recorded respectively. The pressure and situation of branch vessels were assessed before and after stent graft released. The endoleak during releasing process was observed by digital subtraction angiography (DSA). ResultsThe stent graft was successfully deployed in the novel in vitro vascular model. The releasing process was all properly achieved (100%, 30/30). The pressure changes of branch vessels were no statistical significances (P > 0.05) between before and after stent graft released. The stent grafts were well landed, and were fully expanded and properly positioned by DSA. No endoleak occurred. ConclusionThe branched stent graft for abdominal aorta in a novel in vitro vascular model is safe and feasible.
ObjectiveTo discuss the feasibility about the using of transcatheter aortic valve implantation (TAVI) in severe aortic valve stenosis chinese patients, then to make more exploration and accumulate enough experience. MethodsWe selected 10 out-patients with severe aortic valve stenosis and calcified with 9 males and 1 females at age of 76.4 (65-81) years in our hospital from January 2011 to March 2014. All the patients can't tolerate traditional open surgery through preoperative evaluation. So we chose the Sepian TX system, balloon dilated transcatheter aortic valve, to treat them via transfemoral approach. ResultsTen patients accomplished TAVI successfully. One patient was assisted by the left-ventricular puncture. No complication occurred. The function of aortic valve after TAVI improved significantly. The hospital stay time was 3-5 days. The patients were followed up for 3-34 months. One patient died of pulmonary cancer during the following-up. ConclusionTranscatheter balloon dilated aortic valve replacement can be used in chinese severe aortic valve stenosis patient, but more accurate preoperative preparation, evaluation, and operation are needed.