Objective To summarize the critical point of diagnosis and endovascular repairment (EVR) to thoracic aortic aneurysm (TAA), thoracic pseudoaneurysm (TPA) and aortic dissection (AD), by comparison the computerized tomography angiography (CTA) images before and after EVR to observe effects, so as to explore a unique index of imageology to assess the pathological development and evaluate therapeutically effect in dynamic and systemic reviews in pre, intra, postEVR and followup period. Methods Fortyeight patients involving aneurysm or dissection of thoracic aorta were treated with EVR based on the preoperative CTA imaging. Before and after the introducing of stentgraft, digital substation angiography (DSA) was taken place and sequential enhanced CTA was followed to evaluate the effects of the treatment. All imagings of CTA and DSA were collected and induced into e-FilmTM database to select key sections for analyses and measurement. Results Fortynine EVR were preformed and 54 stent grafts were implanted in 48 cases, with endothelial tears sealed in 42 cases of dissection, aneurismal cavities excluded in 2 cases of aortic aneurysm, and rupture site closed in 4 cases of pseudoaneurysm. Endoleakage happened in 9 cases, which were treated successfully by appropriate measures. One case suffered hemorrhage from introducing artery (iliac) which was controled by surgery, but he died of disseminated intravascular coagulation and then multiple organs failure. Fortyseven cases were followed up in 6-51 months with a satisfied clinical effect. Conclusion EVR is favorable in the effect of repairment to true, false and dissection of thoracic descending aorta. Chest pain and CTA scan is the key of early diagnosis of aortic dissection. Certain sections and leftanterior oblique viewing are the crucial profile for assessment and evaluation before and after operation.
Objective To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak. Methods Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary. Results Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement. Conclusion The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.
Objective To study the diagnostic procedures and management of aortic stent graft infection. Methods Clinical data of 4 patients with aortic stent graft infection from 1998 to 2008 were analyzed retrospectively. Results Primary disease was thoracic endovascular aortic repair in 2 cases and endovascular aneurysm repair in another 2 cases. Constitutional symptoms and abscess information on imaging studies were presented in all patients. Salmonella choleraesuis was revealed in 2 cases. Surgical debridement, drainage and systematic antimicrobial therapies were given to 2 patients. The remaining 2 patients were managed with antimicrobial therapy only. During follow-up, there was no recurrence of infection. Conclusions Infection of aortic stent graft infection is a rare but potentially devastating complication. Radiologic studies can serve as important adjuncts in the diagnosis of endovascular graft infections. Several treatment options are available, some cases may be managed with conservative treatment.