Repair of descending thoracic aortic aneurysms with Ankura Thoracic Stent Graft

Objective

The aim of the study was to present the results for patients with atherosclerotic aneurysm of the descending thoracic aorta (DTA) treated with a novel thoracic stent graft.

Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases

IntroductionRates of aneurysm occlusion with the pipeline embolization device (PED) has varied widely in the literature from 55.7% to 93.3% at 6 months, which may reflect a difference in technique including sizing and number of devices used.Methods140 cases at our institution were retrospectively reviewed, and aneurysms treated with a single PED vs. multiple were compared.ResultsComplete aneurysm occlusion was achieved in 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up. Retreatment with an additional device was required in 7 (5.1%). Major and minor complication rate within 30 days was 1.4% and 5.0%, and at greater than 30 days was 0.8% and 3.1%.Patients treated with multiple PEDs had significantly higher rates of aneurysm occlusion at 6 months (92.9% vs. 75.6%, p = 0.017) and 12 months (98.4% vs. 81.1%, p = 0.014), with no difference in complications. The two groups were similar aside from a higher number of ophthalmic and paraophthalmic aneurysms treated with multiple PEDs (23.4% vs. 6.5%, p = 0.004; and 35.1% vs. 17.4%, p = 0.020), and more posterior communicating artery and recurrent aneurysms treated with a single PED (28.3% vs. 3.2%, p = 0.001; 23.9% vs. 8.5%, p = 0.031). The use of multiple PEDs was found to be an independent predictor of aneurysm occlusion in a multivariate analysis (p = 0.015).ConclusionsThe use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without added morbidity. This benefit is particularly appropriate for ophthalmic segment aneurysms, while more distal segments with eloquent perforating branches should be managed with caution.     

1例布鲁氏菌感染性腹主动脉假性动脉瘤患者的围手术期护理

总结1例布鲁氏菌感染性腹主动脉假性动脉瘤患者的围术期护理经验。护理要点：做好传染病患者的隔离防护管理和心理建设;手术前控制血压、疼痛和体温,卧床期间做好预防血栓指导;术后严格控制血压和腹内压,做好引流管护理,根据疾病特点做好腹壁疝、下肢动脉栓塞的观察护理和预防布鲁氏杆菌病复发指导。经过40 d精心治疗和护理,患者康复出院。微信、电话随访1年,患者恢复良好。     

Patients with end-stage renal disease have poor outcomes after endovascular abdominal aortic aneurysm repair

Objective

Although endovascular repair of abdominal aortic aneurysms (AAAs) has been demonstrated to have favorable outcomes, not all cohorts of patients with AAA fare equally well. Our goal was to investigate perioperative and 1-year outcomes in patients with end-stage renal disease (ESRD) on dialysis, who have traditionally fared worse after vascular interventions, to assess how ESRD affects outcomes in a large modern cohort of endovascular aneurysm repair (EVAR) patients.

Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports. Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.     

小脑前下动脉瘤11例临床分析

目的 总结小脑前下动脉瘤的临床和影像学特点，以及手术夹闭与介入治疗两种方法的治疗效果。 方法 回顾性分析首都医科大学附属北京天坛医院神经外科2012年1月-2019年12月收治的小脑前 下动脉瘤患者的基线信息、临床表现、动脉瘤特点、治疗方式和治疗效果。 结果 共收治11例小脑前下动脉瘤患者，其中显微外科手术夹闭动脉瘤5例，治愈率100%，术后2例 （40%）出现不完全性失语和手术侧面瘫，随访均无复发；介入治疗6例，5例（83.3%）完全栓塞动脉 瘤，其中2例（33.3%）闭塞动脉瘤远端载瘤动脉，1例（16.7%）栓塞治疗失败，术后1例（16.7%）出现 记忆力下降，1例（16.7%）出院1个月后动脉瘤破裂，并最终死亡。 结论 对于小脑前下动脉瘤，积极干预对于挽救患者生命意义重大，开颅手术夹闭和介入治疗都是 可选的治疗方式，两者均效果确切。     

Mid-term follow-up of percutaneous access for standard and complex EVAR using the ProGlide device

ObjectivesEndovascular Aneurysm Repair is an established treatment for abdominal aortic aneurysm which requires arterial access via the groin. Most centres perform percutaneous ultrasound-guided access into the common femoral artery for delivery of the stent graft. The profile of endovascular devices necessitates large sheath sizes, therefore formal closure of the arterial puncture site is required. Various percutaneous devices are available, with data lacking on efficacy and mid-term safety profile. We present outcomes from a single centre with the Perclose ProGlide? (Abbott Vascular Devices, CA, USA) suture-mediated system, using the well described “pre-close” technique.Materials & methodsData were collected from operative records and electronic medical records. Patients undergoing standard (EVAR) or complex (F/B-EVAR) aneurysm repair between March 2015 and September 2019 were included. Complications were recorded per-patient and per-groin procedure.Results266 patients were included; 182 (68.4%) standard infrarenal EVAR, 84 (31.6%) F/B-EVAR. There were a total of 484 groin procedures performed. Intraoperative Perclose ProGlide? success was 98.1% (per patient) or 99.0% (per groin procedure). 30-day groin complication rate was 6.1% (per patient) or 3.1% (per groin procedure). There were no pre- or peri-operative factors which predicted the occurrence of groin complications. The rate of groin complications was not related to sheath size.ConclusionsOur data support the use of percutaneous access with a pre-close technique for a variety of endovascular aneurysm repair procedures with both large- and small-bore access. The Perclose ProGlide? system provides excellent mid-term complication-free and reintervention-free outcomes for groin procedures.     

Factors related to microcatheter passage through the trans-cell approach using a low-profile visualized intraluminal support device: an in-vitro study

Background and purposeThe trans-cell approach using a low-profile visualized intraluminal support (LVIS) device is sometimes used for aneurysm coil embolization. However, factors related to microcatheter passage remain uninvestigated. We aimed to examine in-vitro factors related to microcatheter passage using the trans-cell approach with an LVIS.MethodsSilicone vessel models (inner diameter, 4 mm) were created with different bend segments and a 4-mm hole assuming an aneurysm neck on the side of the greater curvature. The LVIS Blue (4.5 × 32 mm) was deployed at the bend segment, and passability on the trans-cell surface was evaluated by passing the microcatheter along the micro guidewire. A total of 800 passage experiments were performed using two types of microcatheter, ten types of silicone vessel, four cell widths, five cells with the same LVIS device, and two micro guidewire directions in the aneurysm.ResultsThe Headway Duo microcatheter (35.5%, 142/400) tended to have better passability compared with the Headway 17 microcatheter (29.3%, 117/400) (p = 0.070). As the cell width and angle between the trans-cell surface and microcatheter direction increased, passability significantly increased (p = 0.027 and p < 0.001, respectively). There was no significant difference in passability when the micro guidewire was directed to the proximal side versus the distal side (p = 0.45).ConclusionsA large cell width and an obtuse angle between the trans-cell surface and microcatheter direction facilitated good passability. Although statistically marginal, microcatheters with small ledges and small tips had relatively good passability.     

Initial experience of follow up of patients after the endovascular treatment of abdominal aortic aneurysms using contrast-enhanced ultrasound

IntroductionAll patients who underwent the endovascular treatment of abdominal aortic aneurysm require regular check-ups for possible occurrence of endoleak and further growth of the aneurysm. Such check-ups are performed in most cases by CT imaging with the administration of a contrast agent which may cause allergies or impairment of renal functions. CT itself represents a significant radiation dose incurred by the patient. When contrast-enhanced ultrasound (CEUS) is used, patients are exposed neither to these risks nor to X-ray radiation.ObjectiveVerify the diagnostic recovery of contrast-enhanced ultrasound for the monitoring of patients after the endovascular treatment of abdominal aortic aneurysms.MethodSince January 2014 we have been qualifying patients for a prospective study. All patients who have been implanted a stent graft for the infrarenal aortic aneurysm since January 2014 and patients who were implanted a stent graft earlier but who have undergone a check-up since January 2014 are qualified for the study. These patients are always checked up after the surgery by CT angiography and CEUS as well. 16 patients have been qualified for the study so far. After the application of a stent graft we examine our patients before they are discharged from the hospital and 1, 6 and 12 months after the surgery. CEUS is performed by 2 physicians only.ResultsIn the 16 patients a total of 28 check-ups have been conducted (1 check-up without contrast medium). In 9 patients (13 CTA examinations and 12 CEUS) endoleak was proven (1 of the I-type, 8 of the II-type). In the case of 2 examinations consistency between CTA and CEUS was not proven – 7.4%. In one case the inconsistency concerned the type of endoleak and in the other case, CTA erroneously described endoleak which was not obvious from CEUS. When measuring the size of an aneurysm sack, we observed significant differences between CTA and CEUS (p < 0.001). The CEUS examination was assessable even in the case of obese patients.ConclusionWe have observed a 100% consistency in the result of 25 examinations which used both methods. Based on the comparisons between CEUS and CTAG performed so far, CEUS seems to be a reliable method which could be used within the framework of dispensary care for patients after endovascular aneurysm repair (EVAR). CEUS seems to be sensitive enough to detect endoleak. However, to be able to provide a reliable evaluation, a larger set of patients and longer-term experience are needed, specifically for the evaluation of the aneurysm sack size.