Objective To evaluate puncture technique in thoracic endovascular aortic repair with abdominal aortic aneurysm and assess the feasibility and safety of using a pre-close technique for puncture and closure of femoral access sites. Methods From May 2010 to August 2013, the pre-close technique which involved two 6 F per-close ProGlide devices deployed in the femoral artery before upsizing to a 18-25 F sheath and one or two deployed before upsizing to a 14-16 F sheath were applied to 42 patients with abdominal aortic aneurysm (group A). Forty-seven patients using surgical femoral cutdown from December 2006 to April 2010 were enrolled into group B. The rate of technical success, time from procedure to the aortic delivery, operation time, low limb braking time, local complication, time from procedure to discharge, local vascular diameter after 3 months was evaluated and compared between two groups. Results There was no significant difference in endograft external diameter between two groups ( P>0.05). The rate of technical success was 97.62%(41/42) in group A and 95.74%(45/47) in group B, and there had no significant difference (P>0.05). Time from procedure to the aortic delivery, operation time and time from procedure to discharge in group A were significantly shorter than those in group B: (21.79 ± 5.79) min vs. (41.37 ± 11.79) min, (127.66±37.83) min vs. (157.84±42.71) min, (6.59±1.89) d vs. (9.14±2.57) d, P<0.05. The incidence rate of local complications, low limb braking time, and local vascular diameter after 3 months had no significant difference between two groups:7.14%(3/42) vs. 8.51%(4/47), (8.51± 1.83) h vs. (8.38±1.79) h, (1.05 ±0.36) mm vs. (0.98 ±0.31) mm, P>0.05. Conclusion The puncture technique with per-close ProGlide is safe and effective in percutaneous endovascular aortic repair which can be adopted as an alternative technique of surgical femoral cutdown approach in patients with abdominal aortic aneurysm.

Objective To investigate the correlations between the time of thoracic endovascular aortic repair (TEVAR) and prognosis in patients with type B acute aortic dissection (AADB). Methods The clinical data of 156 AADB patients with TEVAR was retrospectively analyzed and divided into 3 groups according to the time from onset of symptom to TEVAR:less than seven days was deifned as group 1 (G1, n=87), seven days to fourteen days group 2 (G2, n=48);more than fourteen days was group 3 (G3, n=21). The status of aortic reconstruction at three months TEVAR, in-hospital mortalities, mean hospital expense and length of stay were compared among three groups. Results Before TEVAR, there was no signiifcant differences in the ratio of smallest true lumen diameter and largest false lumen diameter amony the three groups (0.47±0.33, 0.42±0.18, 0.47±0.27, respectively, P>0.05). At three months after TEVAR, the ratio of largest true lumen diameter and largest false lumen diameter among the three groups was signiifcantly greater in group 1 (1.76±0.51) than group 2(1.42±0.30) and group 3(1.34±0.34, P < 0.05), when there was no signiifcant difference between the later two groups. Complete aortic reconstruction (8 from group 1 and 4 from group 2) was achieved in 12 patients at 3 months after TAVAR. Eight patients died during hospitalization, 5 from visceral ischemic, 2 from proximal aortic dissection, one patient from sudden death. Compared with G3, the hospital expense of group 1 and group 2 was cut down about ￥20000. Length of stay was signiifcant greater in group 3 than in group 1 and group 2 (P<0.05). Conclusions Early TEVAR for AADB was safe and beneifcial for aortic reconstruct and reducing the hospital expense and length of stay.