OBJECTIVETo evaluate the novel method of combinedly use of occluder and bare stent in the treatment of aortic dissection with distal tear at visceral branches.

METHODSFrom April 2010 to September 2012, 6 patients (5 male and 1 female patients, aged from 29 to 62 years, mean 47.2 years) were diagnosed as Stanford type B aortic dissection that been revealed by CT angiography. The main tears were sealed with stent-grafts firstly, and then the tears at the visceral branch area were evaluated that impossible to close spontaneously. Atrium septal defect occluder and ventricular septal defect were implanted at the tears with the anterior disc in false lumen, while the posterior disc in the true lumen. After that, the bare stents were implanted in the true lumen to pull the occluders on the aortic wall.

RESULTSAmong the 6 procedures, occluders were successfully implanted in 5 cases, and 1 failed anchoring at the tear, and the alternative method of coils embolization was applicated. After all the procedures, the immediate aortogrophy revealed that the false lumen disappeared in the 5 cases that occluders were used, and the visceral branches were all patent. No paraplegia, lesion of visceral organs or other complications occurred. All the cases were followed at least 5 months. There was one endoleak due to a non-sealed tear at the descending aorta, one new-occurred small tear in the descending aorta but with no communication to the false lumen.

CONCLUSIONSThe combinedly use of occluder and bare stent in the treatment of aortic dissection with tears at the visceral branch area is a sum of two simple technique plus each other. It is easily to master. The lesions at the aortic that ordinary stent-grafting incapable to seal are successfully solved then. The huge trauma of open or hybrid procedures are avoided.

OBJECTIVETo investigate the feasibility,safety and follow-up results of multiple stents parallel placement and reconstruction technique for treating giant vertebrobasilar dissecting aneurysms.

METHODSFive consecutive patients with giant fusiform vertebrobasilar dissecting aneurysms in Department of Neurology,Chinese People's Liberation Army General Hospital were retrospectively reviewed from April 2011 to October 2013. All patients were diagnosed vertebrobasilar dissecting aneurysms by MRI and digital subtraction angiography (DSA), the aneurysm size ranged 8.2-15.0 mm. All patients were treated by multiple stents parallel placement and reconstruction technique under general anesthesia. In the endovascular treatment process, 2-3 Solitaire or Neuroform self-expandable stents were parallel implanted in the maximum extension segment of the aneurysms to reconstruct the cavity of the aneurysm and solved the problem that the diameter of the intracranial stent is less than the diameter of the aneurysms. Multiple stents parallel placement can keep the stents stable in the cavity. The parallel stent can close the dissection as well as strengthen the aneurysm walls to alleviate the vessel pulsative compression of the brain stem. Furthermore, one of the parallel stents was selected for the main blood flow channel. Based on the main channel, telescope technique was used to completely covering the dissection. It can not only prevent the progress of dissection to normal regions, but also be helpful for blood flow channel reconstruction to reduce the hemodynamic disorders. All Patients received routine antiplatelet therapy before and after endovascular treatment.

RESULTSThe operative procedures were succeeded in all patients. Five patients were implanted 18 stents (3 stents in 3 patients; 4 stents in 1 patient; 5 stents in 1 patient; parallel 3 stents in 2 patients; parallel 2 stents in 3 patients). The signs and symptoms of brain stem and posterior group of cranial nerves improved significantly. All patients lived and worked normally and had no recurrent symptoms on follow-up of 6-24 months. All patients performed DSA reexamination at 6-12 months postoperation. The aneurysm size lessened in 2 patients and had no change in 3 patients.

CONCLUSIONSMultiple stents parallel placement and reconstruction technique for treating giant fusiform vertebrobasilar dissecting aneurysms is feasible and have good operation safety. It may control the dilatation of the aneurysm and reduce the probability of thrombosis or hemorrhage. It can improve the patients' clinical symptoms and quality of life in short term follow-up. The long term result need for further follow-up.

Aneurysm, Dissecting ; diagnosis ; surgery ; Aortic Aneurysm, Abdominal ; diagnosis ; surgery ; Female ; Humans ; Middle Aged

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

Acute Disease ; Aneurysm, Dissecting/surgery* ; Aortic Aneurysm/surgery* ; Hospitals ; Humans ; Retrospective Studies ; Treatment Outcome

The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement (n=3), aortic root replacement (n=43), hemi-arch replacement /total arch replacement+elephant trunk technique (n=32), thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36). In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1), respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2). Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.
Aneurysm, Dissecting/*surgery ; Aortic Aneurysm, Thoracic/*surgery ; Retrospective Studies ; Vascular Surgical Procedures/methods ; Young Adult

Aneurysm, Dissecting ; classification ; surgery ; Aortic Aneurysm ; etiology ; Dilatation, Pathologic ; Humans ; Stents ; adverse effects

With the development of radiologic intervention, the treatments of aortic dissection are getting more and more diversified. In recent years, Debakey Ill and Debakey I aortic dissection has been usually treated with endovascular graft exclusion, or combined surgical and endovascular treatment. It is therefore more important to evaluate the aorta and its complications after interventional treatments. Because multidetector-row computed tomography (MDCT) has advantages, such as short examination time, high spatial resolution, and simple operation, this modality has become a first choice of non-invasive methods for the follow-up of aortic diseases after the intervention. Now the MDCT presentations and their anatomic-pathologic features of aortic dissection after endovascular graft exclusion or combined surgical and endovascular treatment are reviewed in this article.
Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; pathology ; Blood Vessel Prosthesis Implantation ; Humans ; Multidetector Computed Tomography ; Stents

Aneurysm, Dissecting ; surgery ; Aorta, Thoracic ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Endovascular Procedures ; methods ; Humans ; Male ; Middle Aged

Since 2000 Dorros et al. reported the first case of type A aortic dissection (TAAD) treated with an endovascular repair, surgeons explored a novel treatment option for TAAD gradually. The application of endovascular repair for TAAD highlights some points below which should pay attention to because of the special anatomic location and morphological characteristics of ascending aorta: (1) customized treatment strategy based on the characteristics of patients; (2) pre-operation evaluation; (3) selection of the stent and delivery system; (4) selection of the access sites; (5) preservation of the coronary artery flow, aortic valve function and perfusion of the branch vessels; (6) accurate location of stent-graft; (7) mid-term and long-term follow-up. In a word, it's helpful to avoid misunderstanding in treatment and improve the safety of operation by grasping the indication and the technical points and making the customized treatment strategy based on the characteristics of patients.
Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Stents