Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.
Aneurysm, Dissecting/surgery* ; Aortic Aneurysm, Thoracic/surgery* ; Aortography ; Blood Vessel Prosthesis Implantation ; China ; Endovascular Procedures ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVE: Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography.METHODS: CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA.RESULTS: Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia.CONCLUSION: It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.
Angiography ; Aorta, Thoracic ; Aortography ; Catheterization ; Catheters ; Cerebral Angiography ; Clavicle ; Deglutition Disorders ; Diverticulum ; Humans ; Korea ; Prevalence ; Punctures ; Radial Artery ; Subclavian Artery ; Subclavian Vein ; Thoracic Vertebrae

PURPOSE: Conventional computed tomography (CT) is the gold standard method for case planning for endovascular aortic aneurysm repair (EVAR). However, aortography with a marking catheter is needed for measuring the actual length of an aneurysm. With advances in imaging technology, a 3-dimensional (3D) workstation can obviate the need for the aortography. The objective of this study was to determine whether a 3D workstation could obviate the need for aortography for EVAR. MATERIALS AND METHODS: One vascular surgeon and 1 interventional radiologist retrospectively assessed axial CT scans and reformatted the 3D CT scans by using the iNtuition workstation (TeraRecon Inc., San Mateo, CA, USA) for 25 patients who underwent EVAR. Four measurements of diameter and length were obtained from each modality. The actual length of an aneurysm for the proper graft was decided by 2 observers by reviewing the aortography with a marking catheter. RESULTS: The measurements from the 2 modalities were reproducible with intraobserver correlation coefficients of 0.89 to 1.0 for conventional CT and 0.98 to 1.0 for 3D workstation. Interobserver correlation coefficients were 0.29 to 0.95 for conventional CT and 0.85 to 0.99 for the 3D workstation. The length of the aneurysm for proper main graft coincided in 18 and 14 patients according to the conventional CT scan and in 21 and 18 patients according to the 3D workstation, respectively. CONCLUSION: The interobserver agreement in planning EVAR was significantly better with the iNtuition 3D workstation. But aortography with a marking catheter may still be needed for selecting the proper graft.
Aneurysm ; Aortic Aneurysm* ; Aortic Aneurysm, Abdominal* ; Aortography ; Catheters ; Endovascular Procedures ; Humans ; Intuition ; Methods ; Retrospective Studies ; Tomography, X-Ray Computed ; Transplants

OBJECTIVETo attempt to produce highly accurate three-dimensional (3D) printed models of aortic aneurysm models aid complicated preoperative planning in endovascular repair procedures.

METHODSFrom October 2012 to May 2014, six patients with complicated aortic aneurysms (one aortic arch aneurysms, one thoracoabdominal aortic aneurysms and four juxtarenal abdominal aortic aneurysms) accepted preoperative contrast-enhanced CT angiography (CTA) scans for procedural planning, 4 male and 2 female, average age 64 years (range 52 to 73 years). All the CTA data were processed with FitMe 3D image processing software to get the modified 3D reconstruction pictures and computer language that can be identified by the 3D printer. With the fused deposition modeling technology, the highly accurate models were got to make preoperative endovascular planning.

RESULTSAll the patients' models were printed before operations. By the guidance of models, the endovascular procedure plans were drawn up. Three patients were performed extracorporeal simulating operations with the models and four patients' endovascular operations were guided by the models during the intraoperative time. The procedure technique success rate was 100%. No serious complications and patients dead during the perioperative period.

CONCLUSIONThe technology of 3D printed highly accurate models of aortic aneurysm models is feasible and can help to make preoperative endovascular planning for improving the safety of complicated procedures.

Aged ; Aortic Aneurysm ; diagnosis ; pathology ; Aortic Aneurysm, Abdominal ; diagnosis ; pathology ; Aortic Aneurysm, Thoracic ; diagnosis ; pathology ; Aortography ; Blood Vessel Prosthesis Implantation ; methods ; Endovascular Procedures ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Preoperative Period ; Software ; Tomography, X-Ray Computed

Aortic Aneurysm, Thoracic ; complications ; diagnostic imaging ; Aortography ; Contrast Media ; adverse effects ; Coronary Artery Bypass ; Cross Infection ; diagnostic imaging ; Fatal Outcome ; Female ; Humans ; Iohexol ; adverse effects ; Kidney Failure, Chronic ; complications ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; ST Elevation Myocardial Infarction ; surgery ; Sepsis ; etiology ; Stevens-Johnson Syndrome ; etiology ; Surgical Wound Dehiscence ; diagnostic imaging ; Tomography, X-Ray Computed

No abstract available.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*complications/diagnosis ; Aortography/methods ; Duodenal Obstruction/diagnosis/drug therapy/*etiology ; Gastrointestinal Agents/therapeutic use ; Humans ; Male ; Risk Factors ; Syndrome ; Tomography, X-Ray Computed

Carbon dioxide (CO2) is a colorless, odorless gas which occurs naturally in the atmosphere and human body. With the advent of digital subtraction angiography, the gas has been used as a safe and useful alternative contrast agent in both arteriography and venography. Because of its lack of renal toxicity and allergic potential, CO2 is a preferred contrast agent in patients with renal failure or contrast allergy, and particularly in patients who require large volumes of contrast medium for complex endovascular procedures. Understanding of the unique physical properties of CO2 (high solubility, low viscosity, buoyancy, and compressibility) is essential in obtaining a successful CO2 angiogram and in guiding endovascular intervention. Unlike iodinated contrast material, CO2 displaces the blood and produces a negative contrast for digital subtraction imaging. Indications for use of CO2 as a contrast agent include: aortography and runoff, detection of bleeding, renal transplant arteriography, portal vein visualization with wedged hepatic venous injection, venography, arterial and venous interventions, and endovascular aneurysm repair. CO2 should not be used in the thoracic aorta, the coronary artery, and cerebral circulation. Exploitation of CO2 properties, avoidance of air contamination and facile catheterization technique are important to the safe and effective performance of CO2 angiography and CO2-guided endovascular intervention.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction ; Aorta, Thoracic ; Aortography ; Atmosphere ; Carbon Dioxide* ; Carbon* ; Catheterization ; Catheters ; Coronary Vessels ; Endovascular Procedures ; Hemorrhage ; Human Body ; Humans ; Hypersensitivity ; Phlebography ; Portal Vein ; Renal Insufficiency ; Solubility ; Viscosity

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

Endovascular repair has gradually become the mainstream treatment of aortic dilatation disease. However, endovascular therapy requires sufficient landing zone both in the proximal and distal region of aortic lesion. A large proportion of aortic dilatation lesion was excluded from traditional endovascular therapy due to the visceral artery involvement or being too close to the orifice of viceral artery. Recently, with the adoption of chimney technique, sandwich technique and hybrid technique and the advent of fenestrated and branched stent graft expand the application of endovascular repair technology, rendering these specific type of aortic disease gradually got the chance to endovascular surgery. Different technology has its own characteristics and scope. The surgeons should make their own judgment and selection based on the specific characteristics of lesions, their experience and accessibility to special equipment and other related factors.
Aorta ; pathology ; Aortic Diseases ; surgery ; Aortography ; Arteries ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To assess perfusion patterns on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes and to assess whether the extent of perfusion defect can be used in the severity assessment of PHT. MATERIALS AND METHODS: Between March 2007 and February 2011, DECTA scans of 62 consecutive patients (24 men, 38 women; mean age, 58.5 +/- 17.3 [standard deviation] years; range, 19-87 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) maximal velocity of tricuspid regurgitation jet (TR Vmax) above 3 m/s on echocardiography performed within one week of the DECTA study. Perfusion patterns of iodine map were divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic and multiple peripheral wedging patterns. The extent of perfusion defects (PD), the diameter of main pulmonary artery (MPA) and the ratio of ascending aorta diameter/MPA (aortopulmonary ratio, APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters. RESULTS: Common perfusion patterns of primary PHT were DH (n = 15) and NL (n = 12). The perfusion patterns of secondary PHT were variable. On the correlation analysis, in primary PHT, TR Vmax significantly correlated with PD, MPA and APR (r = 0.52, r = 0.40, r = -0.50, respectively, all p < 0.05). In secondary PHT, TR Vmax significantly correlated with PD and MPA (r = 0.38, r = 0.53, respectively, all p < 0.05). CONCLUSION: Different perfusion patterns are observed on DECTA of PHT according to the causes. PD and MPA are significantly correlated with the TR Vmax.
Adult ; Aged ; Aged, 80 and over ; Aorta/physiopathology ; Aortography ; Female ; Humans ; Hypertension, Pulmonary/physiopathology/*radiography ; Male ; Middle Aged ; Pulmonary Artery/physiopathology/*radiography ; Pulmonary Circulation/physiology ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Tricuspid Valve Insufficiency/physiopathology/radiography ; Young Adult