Aortic lesions involving branch vessels have always been a great challenge for vascular surgeons. Endovascular repair are growing to take place of traditional open repair for less invasion and lower complication rates. Despite rapid developments in endovascular instruments have been achieved in the last decade, and endovascular techniques such as fenestration stents have been applied in the treatment of aortic lesions involving branch vessels. However, endovascular repairing aortic lesions involving branch vessels remains being restricted by rigorous indication selection as well as requirements of advanced experiences and sophisticated skills. Recently, several studies about treating aortic lesion involving branch vessels with multi-layer bare stents have been reported, the primary results were encouraging and brought new visions for the management of such disease. More approving clinical evidences about the safety and efficacy of multi-layer stents are anticipated.
Aorta ; pathology ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Prosthesis Design ; Stents

With the increasing application of endovascular stent-graft in the treatment of aortic dissection, there are still some problems and controversies in the selection of the stent-graft oversizing. This review summarized the latest research in the study of the baseline and measurement in stent-graft oversizing selection, the relationship between stent-graft oversizing and prognosis and the selection of stent-graft oversizing in different patients with different conditions, providing a reference for the endovascular stent-graft oversizing selection in the treatment of aortic dissection.
Aneurysm, Dissecting ; Aortic Aneurysm ; Aortography ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Humans ; Prognosis ; Stents

We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.
Atherosclerosis ; Blood Vessel Prosthesis Implantation ; Humans ; Vascular Diseases

BACKGROUNDMost of endovascular stent-graft modifications to preserve side branch must be customized according to extensive pre-operative assessment, which may not be possible in many hospitals and emergency settings. The study was to develop a novel stent-grafts system that would allow in situ "fenestration", with less reliance on preoperative imaging.

METHODSThe magnitude of pressure difference (PD) between left subclavian artery (LSA) and aortic arch were measured in 12 experimental pigs. Changes of PD before and after LSA was covered were analyzed respectively. The novel stent graft was made by multi-dimensional and multiple textiles forming technology. According to the PD measurement in pigs, we evaluated the feasibility of the stent-graft in a mock circulation system.

RESULTSIn pigs, the blood pressure of aortic arch was significantly higher than that of LSA after it was covered (P < 0.001) and PD was (42.78 ± 5.17) mmHg. After target vessel was covered and when PD between the LSA and aorta reached the magnitude measured in pigs, contrast media oozed from the cranny of graft to the LSA, which was generated by sliding and deformation of yarns of novel stent-graft.

CONCLUSIONSThe study proposes the design of pressure difference-induced perforation aortic stent-grafts system and verifies that the PD between LSA and aortic arch is high enough to allow in situ "fenestration" by stent graft made by multi-dimensional and multiple textiles forming technology.

Animals ; Aorta, Thoracic ; surgery ; Blood Pressure ; physiology ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Prosthesis Design ; Subclavian Artery ; Swine

Chimney technique is an assistive technology of endovascular aortic repair, which is used to reconstruct the vital branch vessel invaded by aortic pathology. In chimney technique, most of the commercial aortic stent-graft can be used, and covered branch stent-graft is recommended to decrease the risk of type I a endoleak. The suggested oversizing for aortic stent-graft and branch stent-graft is 15% and 5% respectively, and the length of overlapping between stent-grafts should be more than 2 cm. Type I a endoleak is the main concentration, appropriated oversizing and overlapping are important precautions theoretically. Anticoagulation therapy post-operation is crucial in preventing restenosis of the chimney stent-graft.
Aorta ; pathology ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endoleak ; prevention & control ; Endovascular Procedures ; Humans ; Prosthesis Design ; Stents

Arteries ; surgery ; Arteriosclerosis Obliterans ; surgery ; Bioprosthesis ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; Humans ; Lower Extremity ; blood supply ; surgery

OBJECTIVETo analyse the diagnostic and therapeutic aspects of carotid body tumor (CBT).

METHODSSeven patients with CBT had been hospitalized between 2003 and 2006. The clinical data was analyzed retrospectively. The preoperative evaluation included angiography in 7 patients. Most of them had an asymptomatic cervical lateral mass. Only one patient had the hoarseness and buckling and was given radiation therapy alone. Six of seven patients with carotid body tumour underwent surgery. Simple tumor excision was accomplished in 4. Carotid artery resection with the tumor was required in 2 patients and in the both, interposition of a 7 mm polytetrafluoroethylene graft was performed . During the resection, temporary carotid shunt was required in the two patients.

RESULTSAll tumors by surgery were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in one case. In the follow-up period of 2 months to 2 years, no recurrent disease occurred. The patient's tumor who accepted radiotherapy was in the stable stage under the half year follow up, and the follow up would be further continued.

CONCLUSIONSWith non-invasive investigation and arteriography it was possible to obtain an early and precise diagnosis. The surgical management was the major treatment of these tumors. The pattern of operation should be chosen according to the relation of tumor and carotid. The decision to perform simple tumor excision or additional arterial resection was based on diagnostic preoperative and after the arterial resection the polytetrafluoroethylene graft would be used for carotid reconstruction.

Adult ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Carotid Body Tumor ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

Numerical simulation of stent deployment is very important to the surgical planning and risk assess of the interventional treatment for the cardio-cerebrovascular diseases. Our group developed a framework to deploy the braided stent and the stent graft virtually by finite element simulation. By using the framework, the whole process of the deployment of the flow diverter to treat a cerebral aneurysm was simulated, and the deformation of the parent artery and the distributions of the stress in the parent artery wall were investigated. The results provided some information to improve the intervention of cerebral aneurysm and optimize the design of the flow diverter. Furthermore, the whole process of the deployment of the stent graft to treat an aortic dissection was simulated, and the distributions of the stress in the aortic wall were investigated when the different oversize ratio of the stent graft was selected. The simulation results proved that the maximum stress located at the position where the bare metal ring touched the artery wall. The results also can be applied to improve the intervention of the aortic dissection and the design of the stent graft.
Arteries ; Blood Vessel Prosthesis Implantation ; Cardiovascular Diseases ; Computer Simulation ; Finite Element Analysis ; Humans ; Prosthesis Design ; Stents

Endovascular aortic arch repair remains challenging due to the complicated anatomy and the involved vital branches. Off-label techniques emerged during the last decade, including endografts with parallel stents (known as Chimney, Periscope, Sandwich), surgeon-modified endografts, and various other reported techniques. fenestration of standard endografts represents another off-label endovascular means to maintain perfusion to aortic side branches located in the excluded area. Its principle is based on fenestration of an endograft following its deployment inside the vascular system. As data are emerging regarding fenestration, the aim of this article is to review recent progress of technical descriptions, and clinic results of fenestration from the available literature.
Aorta, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Prosthesis Design ; Stents ; Treatment Outcome

Angioplasty, Balloon ; Blood Vessel Prosthesis Implantation ; Humans ; Ischemia ; surgery ; Knee ; blood supply ; surgery ; Treatment Outcome