Objective To evaluate the short-term clinical effectiveness and feasibility of thoracic endovascular aortic repair(TEVAR) with in situ laser fenestration.Methods 24 patients who received TEVAR and in situ laser fenestration from January 2017 to March 2017 were retrospectively reviewed.Include 24 patients,19 males,5 females,with an average age of (54.00 ± 13.58) years old.The clinical data,including post-operative symptoms,hospitalization days,the success rate,postoperative complications,30-day fatality ratio,the patency rate of branch stents,endoleak,etc.Results The mean hospitalization time was(12.81 ±4.18) days.32 aortic arch branch vessels were treated using in situ laser fenestration,30 succeed in laser fenestration,surgical success rate was 93.8％.One case with postoperative paraplegia recovered after treatment,another one with the left common carotid incision hematoma recovered too.The incidence of operation-related complications was 8.3 ％.After the surgery 1 patient died,30-day fatality ratio of 4.2％.Imaging surveillance with computed tomography angiography(CTA) was performed one month later after the operation,the patency rate of branch stents was 100％,one case was found endoleak.Conclusion For revascularizating aortic arch branch vessels during TEVAR,in situ laser fenestration has an excellent successful rate and short-term curative effect,while the long-term surveillance is needed.

Objective To explore the biomechanical mechanism of pseudoaneurysm formation at the anastomotic site of vascular patch and the inhibitory effect of transforming growth factor(TGF β1)hydrogel on aneurysm.Methods The vascular patch model and the pseudoaneurysm model were constructed separately,and the two-way fluid-structure interaction method was used to numerically simulate the blood-vessel wall dynamic response at the anastomosis.Based on the analysis of mechanical parameters such as postoperative blood velocity,vessel wall shear stress and aneurysm wall displacement,the mechanisms of postoperative pseudoaneurysm formation and inhibition were studied.Results The numerical simulation results showed that the wall shear stress increased when the blood flowed through the front end of the patch.When the pseudoaneurysm has been formed after surgery,the aneurysm wall became significantly thicker following the injection of TGF β1 hydrogel into the aneurysmal wall,and the intratumoral shear stress and the aneurysmal wall displacement were decreased.Conclusion Pseudoaneurysms are easy to form at the front end of the anastomosis after surgery,and the injection of TGF β1 hydrogel into the aneurysm wall can effectively inhibit the formation and progression of pseudoaneurysm.The numerical simulation study provides a numerical basis for the mechanical mechanism study of the formation and progression of pseudoaneurysm after patch angioplasty.