Humans ; Vascular Diseases ; surgery ; Vascular Surgical Procedures ; methods

Aortic Aneurysm, Abdominal ; therapy ; Humans

OBJECTIVETo review the recent progress of multilayer stents in treating arterial aneurysms and to draw an initial conclusion about its paradigm.

DATA SOURCESPubMed database and ELSEVIER database were searched with the keywords "cardiatis" or "multilayer stent" for relevant articles from January 2008 to September 2012. Relevant websites (provided by Cardiatis) were also involved in the review process.

STUDY SELECTIONWell-controlled, relatively large-scale, retrospective studies as well as meaningful individual cases were all selected as materials.

RESULTSA total of 23 articles were involved in this review. The newly introduced Cardiatis multilayer stent aims at creating an active flow-modulating barrier between normal blood flow and aneurismal sac, which can induce thrombosis within aneurismal sac and preserve collateral circulation at the same time. Currently, it has been applied for complicated aneurysms located in different segments of the arterial system.

CONCLUSIONThis new concept of multilayer uncovered stent offers a promising alterative in the treatment of arterial aneurysms. However, a further large-scale clinical and hemodynamic study is required to evaluate the long-term effects.

Aneurysm ; physiopathology ; therapy ; Databases, Factual ; Hemodynamics ; physiology ; Humans ; Retrospective Studies ; Stents

OBJECTIVETo investigate thoracic aortic longitudinal elastic strength in β-aminopropionitrile (BAPN) treated rat model of aortic dissection (AD).

METHODSTwenty-nine young rats (Sprague-Dawley) were divided into tow groups, control group (n = 12) and BAPN group (n = 17). Seventeen rats were treated with 0.25% BAPN mixed in feed for 6 weeks. All the rats were sacrificed in the end of experiment and aorta was harvested for biomechanical and pathological study. Longitudinal elastic strength and stress were detected and analyzed by material testing machine. Elasticity modulus as well as maximum stretching length, draw ratio, maximum load, maximum strength, and maximum extensibility was calculated according to the analysis with thickness and area of aortic media.

RESULTSNine BAPN-treated rats died of aortic dissecting aneurysm rupture during the experiment. The diameter of the aneurysms was (6.33 ± 1.17) mm and the length was (9 ± 5) mm. The maximum diameter significantly increased in BAPN-induced rats with AD (group B2) compared with without AD (group B1) and control group ((6.49 ± 1.20) mm vs. (1.45 ± 0.11), (1.25 ± 0.26); F = 165.257, P = 0.001 and 0.000, respectively), but there was no significance between group B1 and control group (P = 0.108). Thickness and area of aortic media in BAPN-induced rats significantly increased compared with control group (F = 27.277 and 27.153, P = 0.000 and 0.000, respectively), but there was no significance of area between group B1 and B2 (P = 0.540). Maximum stretching length, draw ratio, maximum load, maximum strength maximum extensibility and elasticity modulus were significantly decreased from group B2, group B1 to control group (P < 0.01, respectively).

CONCLUSIONSThis study built a successful model of AD. Biomechanical analysis and the decrease of maximum stretching length, draw ratio, maximum load, maximum strength maximum extensibility and elasticity modulus may explain the formation of AD partly.

Aminopropionitrile ; pharmacology ; Aneurysm, Dissecting ; chemically induced ; Animals ; Aorta ; pathology ; physiopathology ; Biomechanical Phenomena ; Disease Models, Animal ; Elastic Modulus ; Male ; Rats ; Rats, Sprague-Dawley

Child ; Humans ; Kidney Neoplasms ; complications ; surgery ; Male ; Thrombectomy ; methods ; Vena Cava Filters ; Vena Cava, Inferior ; pathology ; Wilms Tumor ; complications ; surgery

BACKGROUNDEndovascular stent-grafting is widely used to treat thoracic aortic dissection. However, little information is available regarding outcome following simultaneous exclusion of multiple tears. This report details eight years of experience using simultaneous multi-tear exclusion for treatment of Stanford type B thoracic aortic dissection resulting in successful aortic remodeling without adverse events.

METHODSFrom September 1998 to January 2006, 29 type B thoracic aortic dissection patients (24 men, 5 women; 27 chronic, 2 acute; mean age 58 years, range 45 - 77 years) were treated by simultaneous multi-tear exclusion in our center. Magnetic resonance angiography was used as the preoperative evaluation method. Different kinds of stent-grafts were used. The patients were followed up with contrast-enhanced spiral computed tomography at 6 months postoperatively and yearly thereafter.

RESULTSTwenty-nine surgeries were completed successfully using at least 2 stent-grafts per patient (range: 2 - 6, mean: 2.7). No major procedure-related complications, such as rupture, paraplegia, aortic branch ischemia or cerebral infarction, were observed. During follow-up, favorable remodeling of the aorta was observed.

CONCLUSIONSThe mid-term result of thoracic aortic dissection with simultaneous multi-tear exclusion was satisfactory. With the improvement of stent-grafts, simultaneous multi-tear exclusion should find wider application and become an optimal strategy for thoracic aortic dissection.

Aged ; Aneurysm, Dissecting ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; pathology ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVETo discuss the safety and feasibility of aneurysm repair in vitro and renal revascularization and renal autogenous transplantation for complex renal artery aneurysm in solitary kidney.

METHODSA complex hilar renal artery aneurysm involving the bifurcation of renal artery and its branches in a solitary left kidney was diagnosed by computed tomography angiography (CTA). After temporary nephrectomy, aneurysm repair in vitro and renal revascularization were done with the kidney protected by hypothermia and continuous perfusion with preservation solution, and then the kidney was replanted into the right iliac fossa.

RESULTSThe operation was done successfully and there were no significant perioperative complications. Although a serum creatinine level temporarily exceeded above 200 micromol/L after the surgery, it recovered gradually within half a month. CTA two weeks later demonstrated patent reconstructed renal arteries and its branches and patent renal vein in the right iliac fossa, and also a patent reconstructed ureter.

CONCLUSIONSThis technique is safe and feasible to manage complex renal artery aneurysm in solitary kidney and provide an alternative for similar complex renal diseases.

Aneurysm ; surgery ; Humans ; Kidney ; blood supply ; pathology ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Renal Artery ; pathology ; surgery ; Transplantation, Autologous ; Treatment Outcome

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

OBJECTIVETo evaluate the effect of the diameter of abdominal aortic aneurysm (AAA) on endovascular exclusion (EVE) and its results.

METHODSFrom March 1997 to June 2007, 429 AAA patients were treated with endovascular stent-graft exclusion. According to the maximal diameter of abdominal aortic aneurysm, the patients were divided into two groups: group A (diameter < 55 mm, n = 274) and group B (diameter > or = 55 mm, n = 155). The diameter of AAA, involvement of iliac artery, length, diameter and distortion of aneurismal neck in the two groups were recorded and compared retrospectively.

RESULTSPatients in group B were significantly older than group A (73.7 vs 71.1 years, P < 0.05). More patients in group B was complicated with coronary artery disease than those in group A (P < 0.05). The mean diameter of AAA in group A was (46.6 +/- 6.8) mm, and (66.8 +/- 11.2) mm in group B (P < 0.05). Proximal aneurysmal necks were shorter, wider and more tortuous in group B than those in group A (P < 0.05). Extraperitoneal approach, embolism of inner iliac artery and reconstruction of another inner iliac artery and stretch technique were more applied in group B. There were more endoleak during operation in group B and more stent-grafts were used. There was significant difference in morbidity rate between the two groups, while no statistic difference in mortality. And in group B, there were a high rate of endoleak and secondary intervention post operation.

CONCLUSIONSThe diameter of AAA affects EVE and its results. In small aneurysms, EVE carries better outcome than in big aneurysms.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; pathology ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo review the methods about resolving the difficulties of entering into the aortic dissections' true lumen in endovascular graft exclusion.

METHODSThe patients who had Stanford B type thoracic aortic dissection and been treated with endovascular graft exclusion from September 1998 to February 2004 were reviewed. The operations performed under DSA surveillance. In the operation, the wire was difficult to enter into the true lumen of the aortic dissection in 28 cases, and was wrong into the false lumen then into the true lumen in 4 cases. Five methods were used to resolve these problems, including catheter smoking technique, different position projection, left brachial artery puncture proximal guide-wire floating technique, arterial choice of entering into the true lumen and guide-wire transfixion between proximal and distal.

RESULTSThe method of catheter smoking technique was used in 32 cases, different position projection in 12 cases, left brachial artery puncture proximal guide-wire floating technique in 10 cases, arterial choice of entering into the true lumen in 28 cases, and guide-wire transfixion between proximal and distal in 2 cases. The wires were ultimately successful to enter the true lumen and the stent-grafts excluded successfully the tears of the aortic dissections in 32 cases.

CONCLUSIONThe difficulty of entering into the true lumen and the wrong way into the false lumen could lead to losing the operation, even a disaster. The problem could be resolved by some methods of endovascular techniques.

Aged ; Aneurysm, Dissecting ; surgery ; Angiography, Digital Subtraction ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies