Dissections after percutaneous transluminal coronary angioplasty (PTCA) are risk factors for acute or subacute vessel closures. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute closure from thrombus formation. Thirty three coil (Gianturco-Roubin) stents were implanted into the coronary arteries of 32 patients with dissections after PTCA during the period of March 1993 to December 1993. The indications for stent implantation were acute closure in 6 (18.8%), threatened closure in 6 (18.8%) and suboptimal result in 20 (62.4%) patients. Stent insertion were successful in 30 (94%) patients. The diameter stenosis in an immediate angiographic findings after stenting was decreased from 87% to 18% by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 (3%) patient. A non-Q wave myocardial infarction occurred in 1 (3%) patient. Complications included hematoma of the arterial access site requiring blood transfusion in 4 (12.5%) patients and hemopericardium in 1 (3%) patient. Our initial clinical experience of flexible coil coronary stent imply that stenting is efficacious treatment for acute dissections that are causing acute or threatened closure following angioplasty. The long term follow-up result in all groups of patient who received coronary stents is needed for better evaluation of new devices and prognosis.
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/etiology/*therapy ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Coronary Aneurysm/etiology/*therapy ; *Coronary Vessels ; Female ; Human ; Male ; Middle Age ; *Stents

Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting ; etiology ; Female ; Humans ; Male ; Middle Aged ; Stents ; Subclavian Steal Syndrome ; complications ; diagnosis ; therapy

Acupuncture Therapy ; Aged ; Aneurysm, Dissecting ; complications ; Brain ; diagnostic imaging ; pathology ; Cerebral Infarction ; etiology ; therapy ; Female ; Glasgow Coma Scale ; Humans ; Postoperative Complications ; etiology ; therapy ; Tomography, X-Ray Computed

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

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease ; Aged ; Aneurysm, Dissecting/complications/*therapy ; *Angioplasty, Balloon ; Female ; Humans ; Ischemia/etiology ; *Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/etiology ; *Stents

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.
Abdominal Pain/etiology/radiography ; Aneurysm, Dissecting/*therapy ; Aneurysm, Ruptured/prevention & control ; Celiac Artery/*injuries ; Hematoma/etiology/radiography ; Hemorrhage/etiology/radiography ; Humans ; Male ; Middle Aged ; Retroperitoneal Space ; Rupture, Spontaneous/therapy ; *Stents ; Tomography, X-Ray Computed/adverse effects

No abstract available.
Aneurysm, Dissecting/diagnosis/*etiology/physiopathology/therapy ; Anticoagulants/therapeutic use ; Aortic Aneurysm/diagnosis/*etiology/physiopathology/therapy ; Behcet Syndrome/*complications/diagnosis/drug therapy ; Cerebral Infarction/diagnosis/etiology ; Diffusion Magnetic Resonance Imaging ; Echocardiography, Doppler, Color ; Electrocardiography ; Hemodynamics ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; *Sinus of Valsalva/physiopathology/ultrasonography ; Thrombosis/diagnosis/drug therapy/*etiology/physiopathology ; Ventricular Septal Rupture/diagnosis/*etiology/physiopathology/therapy

Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Computed Tomography Angiography ; methods ; Conservative Treatment ; methods ; Coronary Angiography ; methods ; Coronary Vessels ; diagnostic imaging ; pathology ; Electrocardiography ; methods ; Heart Injuries ; complications ; Humans ; Magnetic Resonance Imaging, Cine ; methods ; Male ; Multimodal Imaging ; methods ; Myocardial Infarction ; diagnosis ; etiology ; therapy ; Treatment Outcome ; Wounds, Nonpenetrating ; complications