Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Postoperative Complications ; Stents

OBJECTIVESTo analyze risk factors associated to acute renal failure (ARF) post deep hypothermia circulatory arrest (DHCA) surgery of type A aorta dissection patients, researching correlations to hospital mortality rate.

METHODSThere were 273 samples of type A aorta dissection patients collected between September 2011 and May 2013 , all of which had surgery done under DHCA. Categorize the samples into two groups based on whether postoperative ARF happened: non-ARF group(n = 163) and ARF group(n = 110). Conducted regression analysis correlations between postoperative ARF and mortality and one or more risk factors of gender, age, history of illness, type of aorta dissection, heart functional class, pre- and post-operative serum creatinine (sCr), DHCA time, blood loss and blood transfusion volume, postoperative complications, etc.

RESULTSAmong the 110 samples of ARF group (40.3%), 21 (7.7%) conducted continuous renal replacement therapy (CRRT). Among 16 (5.9%) died in hospital, 3 (1.8%) died with functional renal, 13 (11.8%) died with ARF. Single factor analysis: male (χ(2) = 6.075, P = 0.014), preoperative sCr (t = 2.955, P = 0.004), dissection extended to renal artery(χ(2) = 5.103, P = 0.024), cardiopulmonary by-pass (CBP) time (t = 2.435, P = 0.017), DHCA time (t = 2.215, P = 0.031), average lower limb artery blood pressure during CBP (t = -2.832, P = 0.007), during surgery and 24 h postoperative blood loss (t = 2.157, P = 0.034) and blood transfusion (t = 2.426, P = 0.018), postoperative acute respiratory dysfunction (χ(2) = 36.307, P = 0.000), postoperative endotracheal reintubation (χ(2) = 9.167, P = 0.002), postoperative low blood pressure (χ(2) = 10.202, P = 0.001), postoperative temporary neurological deficits (χ(2) = 7.512, P = 0.006), postoperative infection (χ(2) = 11.088, P = 0.001) were the risk factors for ARF. The logistic regression analysis revealed that preoperative sCr (P = 0.023) and acute respiratory dysfunction (P = 0.011) were independent determinants of ARF; preoperative ARF (P = 0.022), CRRT (P = 0.003) and permanent neurological deficits were independent determinants for hospital mortality.

CONCLUSIONSARF is a common complication of post Type A aorta dissection surgery under DHCA, and is the risk factor of hospital mortality. It is important to enhance peri-operative protection of the renal function.

Acute Kidney Injury ; etiology ; Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology

OBJECTIVETo investigate the feasibility of one-stage replacement of total aorta for patient with renal failure.

METHODSThe patient was male, 43 years old. The type I aortic dissection was secondary to type III aortic dissection 4 months after endovascular treatment of descending aorta using stented graft 1 year ago. All important branches from aorta were irrigated by false lumen of dissection except left renal artery. The patient has been dialyzed because of renal failure before 5 months with low platelets. Single-stage replacement of total aorta from ascending aorta to iliac artery was successful under deep hypothermia and cardiopulmonary bypass. The operation lasted 12 h. Blood loss during operation was 9000 ml and infusion of blood and blood plasma 7300 ml (including 1500 ml of blood retrieval) and blood platelet 800 ml.

RESULTSAutonomic activity of four limbs was recovered 2 d after operation, and mind recovered 4 d after surgery. The intubation of trachea was extracted 1 week after operation. Re-check through CT showed all vascular prostheses and reconstructed visceral arteries and intercostal arteries were patent though no recovery of renal function.

CONCLUSIONOne-stage replacement of total aorta for patient with renal failure is feasible.

Adult ; Aneurysm, Dissecting ; complications ; surgery ; Aorta ; surgery ; Aortic Aneurysm ; complications ; surgery ; Blood Vessel Prosthesis Implantation ; Feasibility Studies ; Humans ; Male ; Renal Insufficiency ; complications

INTRODUCTIONAtherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction.

CLINICAL PICTUREA 30-year-old lady presented with acute peripartum massive anterior ST segment myocardial infarction and cardiogenic shock. This was due to acute Stanford type A aortic dissection with the intimal flap occluding the left coronary ostium. The initial diagnosis was not apparent. Echocardiography confirmed the diagnosis.

TREATMENT AND OUTCOMEShe underwent emergency surgical repair (Bentall procedure). Pathology confirmed underlying idiopathic cystic medial degeneration.

CONCLUSIONA high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.

Acute Disease ; Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; surgery ; Aortic Aneurysm ; complications ; diagnosis ; surgery ; Echocardiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; etiology ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Shock, Cardiogenic ; etiology

Aneurysm, Dissecting ; complications ; surgery ; Aortic Aneurysm ; complications ; surgery ; Endovascular Procedures ; adverse effects ; Humans ; Spinal Cord Ischemia ; prevention & control ; Stroke ; prevention & control

Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm, Thoracic ; complications ; Coronary Artery Bypass ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged

Objective To evaluate the early and midterm results of surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with Marfan syndrome(MFS). Methods The clinical data of patients with MFS undergoing TAAA repair in Fuwai Hospital between January 2009 and December 2017 were retrospectively analyzed.These patients were divided into two groups:MFS group(=58)and non-MFS group(=98).The baseline data,early postoperative results,and midterm follow-up outcomes were compared between these two groups. Results MFS patients were significantly younger(32 years old 45 years old,=9.603,=0.000)and more frequently had a history of aortic aneurysm or dissection(19% 0,=19.996,=0.000)than non-MFS patients.However,the proportions of males and smokers were significantly lower when compared with non-MFS patients(55.2% 80.6%,=11.489,=0.001;13.8% 46.9%,=17.686,=0.001).There was no significant difference in proportion of emergency operation,prophylactic cerebrospinal fluid drainage,operation time,intra-operative circulation management,and intra-operative blood transfusion(all >0.05).The 30-day mortality rate was significantly lower in MFS group than in non-MFS group(0 9.2%, [Formula: see text]=5.034,=0.025). Conclusions For patients with MFS,TAAA repair provides lower 30-day mortality and comparative middle-term survival.However,the re-intervention rate is higher among MFS patients,highlighting the importance of close follow-up.
Adult ; Aneurysm, Dissecting ; Aortic Aneurysm, Thoracic ; complications ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Humans ; Male ; Marfan Syndrome ; complications ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the post-operative complications of aortic endovascular grafting exclusion (EVGE) and its reasons and treatments.

METHODSClinical data of 82 cases received aortic endovascular grafting exclusion from January 2002 to October 2008 were retrospectively analyzed. Seventy-one cases were male and 11 cases were female with the age of 33 to 78 years and the average age of 49.2 years. There were 66 cases of thoracic aortic dissecting aneurysms and 16 cases of abdominal aortic aneurysm. The effect, post-operational complications and its treatment were investigated.

RESULTSThere were 90.1% patients had been followed up with the time of 3 to 78 months with technical success of 90.3%, clinical success of 94.1%, peri-operational mortality of 2.4%, total mortality of 6.1% and mortality associated with EVGE of 2.4%. Twenty-one cases underwent complications including type I endoleak (13 cases), abdominal aortoduodenal fistula (1 case), narrow true lumen (2 cases), reverse Stanford A dissection (2 cases), post EVGE syndrome (12 cases), delayed healing of inguinal incision (5 cases), constipation (3 cases), cerebral infarction (1 case). No paraplegia, left subclavian artery ischemia, contrast media associated nephrosis, ischemic colitis, ischemic neurologic injury, and artery embolism occurred. Post operation 4 cases had the second intervention including 2 type I endoleak and 2 narrow true lumen.

CONCLUSIONSThe technique-related complications still hinder the long-term effect of EVGE. It needs to be further investigated on technique improvement and treatment standardization.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies

OBJECTIVETo discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR).

METHODSRetrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure.

RESULTSFollow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage.

CONCLUSIONSThe complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.

Adult ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies

OBJECTIVETo analyze the reasons of complications after hybrid procedure in the treatment of aortic arch diseases.

METHODSData from 34 consecutive patients (28 male and 6 female) of aortic arch diseases treated with hybrid procedure between January 2001 and December 2008 was analyzed retrospectively. The mean age of the patients was 56.7 years (ranged from 34 to 75 years). Of the 34 patients, 27 were aortic dissections (21 cases of Stanford type A dissections and 6 cases of Stanford type B dissections) and 7 were aortic arch aneurysms. Hybrid procedure included ascending aorta (AA)-innominate artery-left common carotid artery (LCCA) bypass (n = 3), AA-LCCA-left subclavian artery (LSA) bypass (n = 2), AA-LCCA bypass and coronary artery bypass (n = 1), LCCA-right common carotid artery (RCCA) bypass (n = 13), RCCA-LCCA and LCCA-LSA bypass (n = 3), LSA-LCCA-RCCA bypass (n = 2) and LCCA-LSA bypass (n = 9). All the patients received single stage (n = 26) or staged (n = 8) endovascular repairs.

RESULTSThe complications occurred in 32.4% (11/34), with 11.8% (4/34) of all patients having lethal complications. The complications included 1 case of rupture of aortic dissection (2.9%), 2 cases of stroke (5.9%), 2 cases of stomal leak and pseudoaneurysm (5.9%), 1 case of myocardial infarct (2.9%), 1 case of pulmonary embolism (2.9%), 1 case of neck hematoma (2.9%) and 3 cases of endoleak (8.8%). In the period of follow-up (6 to 50 months), all patients were alive except for 4 perioperative deaths.

CONCLUSIONSComplication rate of hybrid procedure in the treatment of aortic arch diseases is higher than that of simple endovascular repair of descending aortic diseases. Reducing the lethal complications is the key to disseminate this technique.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies