OBJECTIVETo discuss the availability of endovascular stent-graft exclusion in giant and long-segment thoracic aortic aneurysms.

METHODSEndovascular stent-graft exclusion was performed on 3 male patients with giant and long-segment thoracic aortic aneurysm. Multiple stent-grafts were connected as a long stent-graft to repair these thoracic aortic aneurysms, of which one with 28 cm in length and 7.3 cm in maximum diameter was excluded by 4 stent-grafts with different diameters and same length of 130 mm. The preliminary bypass between right common carotid artery and left common carotid artery or left common carotid artery and left subclavian artery was performed on 2 patients.

RESULTSThree patients underwent the operation successfully, and achieved the good results. There was no endoleak at the conjunction of stent-grafts in 2 cases, and a little endoleak in 1 case, which disappeared 1 year after operation. One case presented temporal cerebral ischemia, which disappeared after 1 month.

CONCLUSIONSThe endovascular deployment with multiple stent-grafts connection is a safe, mini-invasive and effective therapeutic method for giant and long-segment thoracic aortic aneurysm, but long-term outcomes will be gotten after the follow-up study.

Aged ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVETo discuss the safety, feasibility, efficacy and problem of endovascular repair (EVR) for ruptured aortic aneurysm (RAA).

METHODSFourteen patients with RAA were obtained diagnosis and anatomic data of proximal and distal neck through magnetic resonance imaging and CT. The patients with hypotension were accepted anti-shock treatment. Stent-grafts were deployed in proper position of RAA under X-ray fluoroscopic.

RESULTSThe time from rupture to operation was 50 min to 21 d. Three cases had plenty of blood in left pleural cavity and 2 cases were done under bleeding shock condition. Five cases with RAA were fixed by bifurcated stent-grafts and others by straight stent-grafts. Follow-up term was 1 month to 38 months. One with ruptured thoracic aortic aneurysm died 4 h later after operation, another one died of left thoracic cavity infection 9 months later, and others lived well without complication.

CONCLUSIONThe EVR is a safe, efficient and feasible method. It will be a potential alternative to treat RAA in future, but more suitable for RAA with better proximal and distal landing zones.

Adult ; Aged ; Aortic Rupture ; diagnosis ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Femoral Artery ; surgery ; Humans ; Limb Salvage ; Peripheral Vascular Diseases ; surgery ; Stents

OBJECTIVETo evaluate the technical feasibility of juxtarenal abdominal aortic aneurysm (AAA) repair with fenestrated endovascular stent-graft

METHODSA 64-year-old male was diagnosed with juxtarenal AAA with severe coronary artery stenosis, fenestrations was customized according to precise helical CT data to accommodate visceral and renal arteries. Under general anesthesia and dynamic supervision of digital subtraction angiography (DSA), juxtarenal AAA was excluded with the customized fenestrated stent-graft and balloon expandable mini stent-grafts were deployed into bilateral renal arteries respectively.

RESULTSAfter operation, DSA showed the patency of the super mesenteric artery, bilateral renal arteries and left hypogastric artery, no endoleak was found. The serum creatinine decreased slightly after operation. CT angiography revealed favorable morphology of the stent-graft without tortuosity, migration, disjoint and endoleak 10 days after the operation and patency of super mesenteric artery, bilateral renal arteries and left hypogastric artery.

CONCLUSIONSThe placement of customized fenestrated endovascular stent-graft is a feasible option for juxtarenal AAA.

Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Feasibility Studies ; Humans ; Male ; Middle Aged ; Stents

To find out which biomaterial had the best biocompatibility, we compared the acute phase reaction of common biomaterials preparing for vascular grafts with the material of polyurethane modified by silk fibroin (SF-PU(1:1)). After transplanted the materials of dacron, polyterafluoroethylene (e-PTFE), polyurethane (PU), SF-PU(1:1) in rat muscle for one week, we studied the influence of different biomaterials on the histocompatibility by using rat acute toxicity test, test of local reaction in muscle, tissue section staining, WBC and PLT count. As a result, dacron had the worst histocompatibility. The other biomaterials had slight local inflammatory reaction. The WBC and PLT was nearly the same with the blank except dacron. e-PTFE, pure PU and SF-PU(1:1) had the better histocompatibility than traditional dacron. Especially SF-PU(1:1) had the best histocompatibility. Because of the better physical properties and histocompatibility of SF-PU( 1:1), the prospect of preparing small-diameter vascular grafts with SF-PU was cheerful.
Acute-Phase Reaction ; Animals ; Biocompatible Materials ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; Female ; Fibroins ; chemistry ; Implants, Experimental ; Macromolecular Substances ; chemistry ; Male ; Materials Testing ; methods ; Muscle, Skeletal ; physiology ; Polyurethanes ; chemistry ; Prosthesis Design ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo determine the safety and efficacy of total percutaneous endovascular abdominal aortic aneurysm repair using the Perclose ProGlide suture-mediated closure system.

METHODSFrom May 2008 to April 2010, 36 abdominal aortic aneurysm patients were undergone total percutaneous endovascular repair. There were 30 male and 6 female patients with a mean age of 68 years. Endografts used included 3 Endurant endografts, 13 Talent endografts, and 20 Zenith endografts. Prior to insertion of the introducer sheath, two ProGlides were pre-set to 18 to 24 F access sites and one to 14 to 16 F access sites. At last, suture the arteriotomy by tying down knots of the ProGlide following removal of the sheath. Technical success, complications, and procedure and access closure times were evaluated. Follow-up protocol consisted of computed tomography angiograms performed at 3, 6, 9, 12 months, and annually thereafter.

RESULTSTwenty patients were operated under local anesthesia and 16 patients under general anesthesia. A total of 68 femoral arteries were closed with 128 devices. Thirty-eight vessels were with 2 devices, while 8 arteries required 3 devices and 2 arteries required 4 devices for hemostasis and an additional 20 vessels only required a single device. Sixty-three (63/68, 92.6%) vessels were closed successfully. Two vessels converted to open closure. Three vessels complicated with hematomas without surgical procedure. The mean follow-up was (12±3) months. There was one asymptomatic femoral artery dissection 3 months after operation.

CONCLUSIONSTotal percutaneous endovascular abdominal aortic aneurysm repair is safe and effective. But it should be performed at hybrid operating room where can convert to open procedure if necessary.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Suture Techniques ; instrumentation ; Treatment Outcome

OBJECTIVETo review the experience of various positions aortic replacement by four branch prosthesis vessel.

METHODSFrom August 2003 to May 2005, we finished aortic procedures with four branch prosthesis vessel for 142 patients, aged (44 +/- 12) (22-78) years, weighted (72 +/- 20) kg (49-130 kg). We performed ascending aorta and total aortic arch replacement for 85 cases during right axillary artery cannulation for cardiopulmonary bypass and selected antegrade cerebral perfusion. 38 patients underwent one-stage total thoracoabdominal aortic replacement during deep hypothermic bypass and subsection circulatory arrest. 8 patients underwent one-stage total or subtotal aortic replacement during deep hypothermic bypass and selected antegrade cerebral perfusion and subsection circulatory arrest. We performed totally aortic arch replacement without utilizing cardiopulmonary bypass and hypothermic for 11 cases.

RESULTSThe mortality was 4.2%. Cerebral complications occurred in 16 (11.3%). 2 patients suffered from permanence spinal cord dysfunction. 4 patients suffered from temporary spinal cord dysfunction.

CONCLUSIONThe four branch vessel prosthesis can be used on aortic surgery dexterously. The approach may shorten she time of aortic arrest and arterial construction.

Adult ; Aged ; Aneurysm, Dissecting ; mortality ; surgery ; Aneurysm, False ; mortality ; surgery ; Aortic Aneurysm ; mortality ; surgery ; Blood Vessel Prosthesis ; standards ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Heart Arrest, Induced ; methods ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate

OBJECTIVETo report the initial clinical experience of endovascular thoracic branched stent grafts in the treatment of aortic arch dissections involving the left subclavian artery.

METHODSFrom February 2004 to June 2004, 14 patients were cured with the endovascular thoracic branched aortic stent-grafts made by Beijing YuHengJia SciTech Co. All patients had Stanford type B aortic dissection with the entry tears just beyond the origin of the left subclavian artery by an average distance of 8.7 mm. The branched stents were consisted of the aortic section and the branched section. The diameter of the stents was 15% to 20% larger than the diameter of the landing zones of native arteries. The repair procedure was performed in angiography laboratory. The branched stent grafts were delivered under fluoroscopic guidance and implanted into the aortic arch including the left subclavian artery.

RESULTSFourteen branched stent-grafts and 2 additional flexible stent-grafts were delivered successfully in all 14 cases. The entry tears were excluded completely, and the truth lumen of the dissection was revealed to the normal diameter in all patients. Neither peripheral complication nor death occurred. All 14 patients had recover the normal life.

CONCLUSIONIt demonstrates that it is possible to apply the technical feasibility of endovascular thoracic branched aortic stent graft to repair the intimal tear of dissection just beyond the left subclavian artery.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVE: To explore the effect of a new triple-branched aortic arch covered stent graft on DeBakey Type I aortic dissection, and to assess its efficacy in comparison with traditional surgery. METHODS: From January 2010 to November 2010, 38 patients of DeBakey Type I aortic dissection were treated surgically in the Second Xiangya Hospital of Central South University, in which 16 operations used triple-branched aortic arch covered stent grafts (stent graft group, SG group), 22 operations used traditional 4 sides branches aortic arch grafts (arch graft group, AG group). RESULTS: Compared with AG group, the cardiopulmonary bypass time[(138.1± 56.42) vs (179.21± 67.64) min], the clamp time [(98.56±28.08) vs (134.36±46.46) min] and the selective cerebral perfusion time[(27.3±14.76) vs (48.74±18.22) min] in SG group were obviously shortened(P<0.05). The volume of drainage 24 hours after operation in SG group also reduced[(608.93±308.15) vs (899.04±437.79) mL](P<0.05). The SG group had a lower rate of recurrent laryngeal nerve injury (6.25% vs 27.3%) and duration of hospitalization[(16.15±6.68) vs (21.18±12.69) d](P<0.05). During a following-up period of 14 to 24 months,reexamination of aortic CT angiography showed that the triple-branched aortic arch covered stent graft expanded well, and attached to the wall satisfactorily, while the corresponding false lumen of the aortic artery disappeared and the distal false lumen was filled with thrombus. The life quality of patients were good. CONCLUSION The new triple-branched aortic arch covered stent graft is appropriated for most patients with DeBakey Type I aortic dissection. Its use can simplify the aortic arch procedure,decrease the operation risk and has satisfactory results in early and middle stage after operation.
Adult ; Aneurysm, Dissecting ; surgery ; Aorta, Thoracic ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Cardiopulmonary Bypass ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

UNLABELLEDOBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.

METHODSTo perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.

RESULTSThirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.

CONCLUSIONSEndovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome