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.

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

OBJECTIVETo apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia, a modified crawford procedure were prospectively evaluated.

METHODSUsing modified shunting and cross-clamping techniques, modified Crawford repair in 13 thoracoabdominal aorta patients were performed in the Vascular Division at Peking Union Medical College Hospital. TAA Crawford classification: 1 type I, 2 type II, 2 type III and 3 type IV TAA. Debakey classification: 1 type I, 4 type III (including 2 ruptured aneurysms), and 1 aortic coarctation.

RESULTSThirteen procedures were performed successfully. One died of ventricular fibrillation just before completing the operation. Surgical mortality rate was 7.7% (1/13). Postoperative complications included 1 acute necrotic pancreatitis, 1 ARDS, 1 paraplegia, 1 acute renal failure, and 2 thoracic cavity bleeding. Total complication rate was 53.8% (7/13).

CONCLUSIONSFractionated-clamping in thoracoabdominal aortic aneurysm repair is our modified Crawford procedure and aortic bypass. Clinical results demonstrate that our procedure decreased surgical mortality and major complication rate, and also alleviated viscera ischemic injury. Fractionated-clamping in aorta replacement is a practical procedure for TAA repair under general anesthesia at normal temperature.

Adult ; Aged ; Aortic Aneurysm, Abdominal ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Female ; Humans ; Male ; Middle Aged

This is a report of 13 cases of surgically corrected ruptured aneurysm of the aortic sinus of Valsaha. The simultaneous trans-venous and trans-arterial catheterization and cineangiogram are the best diagnostic procedures. In 12 cases, the aneurysm originated from the right coronary sinus and only one from the noncoronary sinus. Eleven aneurysms ruptured into the right ventricle and 2 into the right atrium. Eight cases were associated with ventricular septa1 defect and 5 with aortic regurgitation. In three cases the Hancock porcine valve replacement was done. There was no surgical mortality.
Adolescent ; Adult ; Aortic Aneurysm/surgery* ; Aortic Rupture/diagnosis ; Aortic Rupture/surgery* ; Child ; Female ; Heart Catheterization ; Human ; Male ; Sinus of Valsalva/surgery*

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Endovascular Procedures ; methods ; Humans

Aortic Dissection/surgery* ; Aortic Aneurysm, Thoracic/surgery* ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Treatment Outcome

OBJECTIVE: To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis. METHODS: Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed. RESULTS: Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed. CONCLUSIONS Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.
Aortic Aneurysm, Abdominal ; surgery ; Aortic Valve Stenosis ; surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Stents ; Treatment Outcome

Aortic dissection during cardiopulmonary bypass for aortic aneurysm surgery is a rare complication. If unrecognized in early time, it would be a fatal consequence. Neurological sequelae remain a well-recognized complication of cardiac surgery. Monitoring of cerebral oxygenation may be a useful technique for identifying vulnerable periods for the development of neurological injury. We report the experience of the decreasing left radial blood pressure and left rSO2 which caused by retrograde aortic dissection during the ascending aortic aneurysm replacement surgery.
Aortic Aneurysm ; Blood Pressure ; Cardiopulmonary Bypass ; Oxygen ; Thoracic Surgery

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