Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.
Objective To evaluate surgical treatment of infected pseudoaneurysm (PA) caused by injection of addictive drugs. Methods The clinical data of 17cases of infected PA caused by drug injection were reviewed retrospectively. Ofthem, 1 case was female, and the other 16 cases were male, aging 24-38 years. The locations were brachial artery in 1 case and femoral artery in 16 cases. Fourteen cases were treated by artificial blood vessel transplantation after resection of the aneurysm and radical debridement, 1 case by amputation for serious infection, and 2 cases by non-operation for different reasons. Results Among 14 cases treated by prosthetic grafts, 13 cases achieved satisfactory results, no blood drawback of lower extremity occurred after operation; 1 case had to be amputated for serious infection. After 3 months of operation, the color Doppler examination showed that the 9 artificial vessel grafts were patent and the pulse of arteria dorsal pedis was good. Conclusion Though artificial vessel grafting has high risk in the vicinity of infected PA, it is still an effective procedure for revascularization in condition that there is no suitable autogenous conduit available for auto transplantation. Sufficient drainage, anti-infection and anti-coagulation therapy should be the key factors after the operation.
rom Aug.1965 to Dec. 1992,29 patients suffered from the peudoaneurysms were treatedwlth 4 different methods. They were:1.ligating the vessels;2. repairing the defected area in thearterial watl: 3, anastomosing the vessels after the peudoaneurysms being removed; 4, repoiring thearteries with vessel grafts after the resection of the poudoaneurysm or by-passing operation. Of the 4different methed, the method 3 and 4 gave the best results. It was thought that the operation should bep...
Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
ObjectiveTo summarize the etiology and prevention measures of carotid artery pseudoaneurysms following carotid endarterectomy (CEA) and discuss the complications and prognosis of it performed surgery and endovascular treatment. MethodsThe process and experience of diagnosis and treatment of two patients with carotid pseudoaneurysm following CEA admitted in this hospital from January 2000 to March 2014 were analyzed retrospectively. The related English literatures concerning carotid artery pseudoaneurysm following CEA in PubMed, SpringerLink, ELSEVIER, and ScienceDirect database were searched and then made a conclusion. Results①The incidence of carotid artery pseudoaneurysms following CEA in this hospital was 0.31% (2/641). These two patients were treated with surgery and endovascular therapy respectively, and both recovered well after the treatment.②Thirty-nine related literatures totally were collected, including 187 patients with carotid artery pseudoaneurysm. One hundred and forty patients were treated with artificial patches during CEA, and 36 patients suffered secondary infection in the surgical sites. One hundred and fifty-two patients were treated with surgery, while 33 patients were treated with endovascular therapy, the residual two patients were accepted hybrid surgery. The overall incidence of cranial nerve injuries, the incidence of 30-day stroke, and the incidence of 30-day mortality were 6.4% (9/141), 7.4% (12/163), and 2.7% (5/182), respectively. ConclusionsSurgical site infection is one of the important reasons which lead to carotid artery pseudoaneurysm following CEA. Aneurysm resection and carotid artery reconstruction is still the main treatment of the carotid artery pseudoaneurysm; endovascular therapy could be used as a choice for a part of the patients. How to reduce the perioperative cranial nerve damage and the incidence of complications such as stroke still need further to be studied.
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.