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find Keyword "Stanford B 型" 4 results
  • Effects of Distal Tears on Aortic Remodeling after TEVAR for Stanford Type B Aortic Dissection in Subacute Period

    ObjectiveTo investigate the effect of distal tears on postoperative aortic remodeling after Thoracic Endovascular Aortic Repair (TEVAR) for the patients with subacute stage of Stanford type B aortic dissection.MethodsForty three cases with Stanford type B aortic dissection, admitted in Anhui Provincial Hospital from July 2011 to April 2015, who underwent TEVAR to repair the proximal aortic entrance tear, after which the blood reflex from distal tears were still observed were analyzed retrospectively. According to the number of heart volume required to fill the two groups, group A (≤2 heart rate) group B (>2 heart rate), We then assessed the changes of the true and false lumen area and analyzed the effects of direction of blood flow and the number of heart rate to fill the false lumen on formation of false lumen thrombosis in the period of 3–24 months.ResultsAll the stents were successful implanted. There was a statistically significant difference in lumen area between the two groups before and after surgery, and univariate analysis showed that the direction of distal rupture of blood flow into the false lumen had no effect on postoperative aortic remodeling (P<0.05), but postoperative hypertension (≥140/90 mmHg) slows down the formation of false lumen thrombosis.ConclusionPatients had entrance tear in the distal of aortic, still broken and faster flow after TEVAR stent-graft implantation in the proximal closed entrance tear. Blood pressure should be strictly controlled and close follow-up also needed, meanwhile, the distal entrances can be closed the same period if there is a faster flow from them.

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  • Stanford B 型主动脉夹层腔内修复术后并发 A 型夹层的外科治疗

    目的总结 Stanford B 型主动脉夹层胸主动脉腔内修复术(TEVAR)后并发 A 型夹层的临床特点及外科治疗经验。方法自 2013 年 11 月至 2018 年 3 月,南京鼓楼医院外科治疗 Stanford B 型主动脉夹层 TEVAR 术后并发的 A 型夹层患者 14 例,其中男 13 例 、女 1 例,年龄 24~66(52±3)岁,合并高血压 13 例,糖尿病 2 例,马方综合征 1 例。所有患者在深低温停循环选择性脑灌注下施行手术,近心端 13 例行升主动脉置换术,1 例行 Bentall 术。共实施全弓置换加象鼻手术 13 例,弓部开窗支架植入术 1 例。结果全组无死亡,1 例术后右上肢单瘫,1 例术后血行感染,1 例出现右侧偏瘫及肾功能不全行肾脏替代治疗。随访 6~45 个月,随访期间 1 例患者术后 1 个月因原介入支架远端胸降主动脉发生新的夹层再次行 TEVAR,其余患者 CT 血管造影检查未见吻合口造影剂渗漏及人工血管扭曲。结论B 型主动脉夹层 TEVAR 术后并发 A 型夹层及时给予外科手术治疗可取得良好疗效。

    Release date:2019-07-17 04:28 Export PDF Favorites Scan
  • Treatment strategy selection of Marfan syndrome combined with thoracoabdominal aortic diseases

    ObjectiveTo summarize the surgical treatment plan and experience of patients with Marfan syndrome complicated with Stanford type B aortic dissection, and to explore the treatment strategy selection.MethodsA retrospective analysis was conducted on 27 patients with Marfan syndrome complicated with thoracoabdominal aortic diseases who were treated in the department of cardiovascular surgery of our hospital from January 2013 to June 2019, including 13 males and 14 females, with an average age of 32.2±8.6 years. According to the patients' conditions, 19 of them received single pump-assisted blood transfusion combined with total thoracoabdominal aortic replacement (TAAAR), and 8 received thoracic endovascular aortic repair (TEVAR) in critically ill and pregnant patients. The patients were followed up in the outpatient clinic, and the thoracoabdominal aortic CT angiography was reexamined at 3 months, 6 months, 12 months and annually. The outcome of surgery, the incidence of intermediate cardiovascular adverse events, defined as the reoperation due to aortic or cardiac diseases, and intermediate survival rate were studied.ResultsAll 27 patients successfully completed the operation, the operation time was 60-852 (395.10±222.60) min, the spinal cord ischemia time was 14-26 (19.33±3.44) min, and the abdominal viscera ischemia time was 16-23 (19.83±1.94) min. Eight patients of TEVAR were all operated in acute phase and 19 patients of TAAAR in chronic phase. Two early postoperative deaths occurred in TEVAR patients. One died of puerperal infection and multiple organ dysfunction after cesarean section at the same time. After TEVAR, type A dissection re-ocurred in one patient. The family member gave up the treatment, and the patient died of the dissection ruptured after cesarean section. During the average follow-up of 47.6±36.7 months, 1 patient died of cerebrovascular accident and 9 patients were reoperated for adverse cardiovascular events, including 4 in TEVAR and 5 in TAAAR.ConclusionTAAAR is the first choice for the treatment of Marfan syndrome combined with thoracoabdominal aortic diseases. TEVAR is easy to operate, with a low incidence of early mortality and complications, but has the risk of internal leakage and avulsion, and a high reoperation rate in the middle stage, so it can be used for high-risk elderly patients not suitable for open surgery, or as a bridge therapy for emergency patients before open surgery.

    Release date:2020-07-30 02:16 Export PDF Favorites Scan
  • Analysis of 5-year follow-up results of hybrid surgery for complex type B aortic dissection

    Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P>0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.

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