Chronic dissecting aneurysm of the thoracic aorta following minor blunt trauma

A 64-year-old man admitted for treatment of a thoracic aneurysm had experienced severe back pain 10 years earlier after falling heavily on his forearms. From the night following the fall, hoarseness and pleuritic chest wall pain continued for about 3 months. Preoperative imaging showed a chronic dissecting aneurysm near the aortic isthmus. The patient's history suggested that the fall 10 years before surgery was the most likely cause.     

腔内修复术治疗胸主动脉夹层动脉瘤

目的 探讨应用支架人工血管行腔内修复术治疗胸主动脉夹层动脉瘤的临床效果.方法 回顾性分析采用腔内修复术治疗胸主动脉夹层动脉瘤32例患者的临床资料.男26例,女6例;平均年龄61岁.术前根据CTA结果 确诊,并对病变部位及解剖条件进行评估.手术在DSA监控下进行,全麻或局麻,应用Telent 8例(美敦力公司),国产支架24例(2例上海微创,22例北京裕恒佳).结果 7例破口距左锁骨下动脉开口＜1.0 cm,3例将覆膜支架跨过左锁骨下动脉开口将其封闭后,夹层动脉瘤消失,无上肢及脑缺血症状.治愈31例,死亡1例.31例夹层动脉瘤患者随访3～56个月均健在,其中5例CTA复查有内漏存在.结论 EVAR手术为夹层动脉瘤的治疗开辟了一个新的方法 ,具有比传统手术并发症少、病死率低等优点.在Stanford B型夹层动脉瘤的治疗中,EVAR可代替传统的开胸手术.     

Rupture of a dissecting thoracic aortic aneurysm into the pulmonary artery: successful surgical repair

A rare complication of dissecting thoracic aortic aneurysms is rupture into a cardiac chamber or great vessel with fistula formation. A case of congestive heart failure caused by a chronic DeBakey type I dissecting aortic aneurysm that ruptured into the pulmonary artery is reported. Surgical repair involved closure of the fistula followed by graft replacement of the ascending aorta and transverse aortic arch. A review of the literature revealed no previous reports describing successful repair of this lesion. A clinical picture consistent with concomitant aortic dissection and biventricular heart failure, especially when a continuous cardiac murmur is present, suggests the diagnosis of an aortopulmonary arterial fistula caused by a ruptured dissecting thoracic aortic aneurysm. Various imaging studies confirm the diagnosis.     

胸主动脉夹层动脉瘤介入治疗的护理配合

目的总结胸主动脉夹层动脉瘤介入治疗的护理配合的经验。方法从2003年1月-2006年3月对10例证实胸主动脉夹层动脉瘤的住院病人通过介入方法进行腔内隔绝术的治疗和配合护理进行回顾性分析。结果本组10例支架置入成功,病人术中无严重并发症发生,术程时间短。结论通过介入方法对胸主动脉夹层动脉瘤进行腔内隔绝的治疗和护理配合,其成功率高,本组无死亡病历发生,并发症少,安全,近期疗效好。     

A case report of chronic traumatic dissecting aneurysm of the thoracic aorta]

A 63-year-old male, who sustained a blunt chest trauma in a traffic accident, was referred to our hospital for his traumatic aneurysm. An operative repair was undertaken 3 months after the trauma. The descending aorta was dissected along 5 cm, and its diameter was about 6 cm. Graft replacement was performed under the left heart bypass by using the BioMedicus centrifugal pump. He is doing well 3 years after the operation.     

Surgical repair of localized dissecting aneurysm originating from the infrarenal abdominal aorta

Aortic dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Localized dissections originating from the infrarenal abdominal aorta are extremely rare. We report a rare case of localized dissecting aneurysm originating from the infrarenal abdominal aorta in a 62-year-old man. Open surgical repair was successfully performed without any complications.     

Chronic dissecting aorta aneurysm: a medical or surgical disease?

The surgical results obtained in 40 cases of chronic dissecting aorta aneurysm are reported and compared with the results obtained in medically treated cases. Improved results with improved surgical techniques are described and the superiority of surgical treatment as opposed to medical treatment is stressed. Although mortality is decreasing, it is still very high and many surgical problems remain unsolved.     

Late thoracic aortic dissecting aneurysm following balloon angioplasty for recoarctation after subclavian flap aortoplasty in childhood--successful surgical repair under circulatory arrest.

Balloon angioplasty is universally accepted presently as the primary therapeutic strategy for recoarctation following surgery during infancy and early childhood. This report concerns a 26-year-old lady with cephalobrachial hypertension on beta-blocker who presented with left sided chest pain since 3 months, having undergone surgery for coarctation in early childhood and balloon angioplasty at 17 years of age. Chest X-ray showed prominent aortic knuckle. CT scan chest showed features of residual coarctation with "double-barrelled" upper thoracic aorta of 5cm diameter. Surgery consisted of interposition graft repair of distal arch and upper thoracic aorta under total circulatory arrest through posterolateral thoracotomy leading to excellent recovery.     

胸主动脉夹层动脉瘤腔内隔绝术后血小板减少的临床分析

目的　观察胸主动脉夹层动脉瘤腔内隔绝术 (endovascular graft exclusion,EVGE)后血小板改变 ,分析血小板减少的原因 ,并探讨降低血小板减少幅度的措施。　方法　对 12 4例胸主动脉夹层动脉瘤患者成功施行了EVGE,并于术前 ,术后 2小时 ,术后 1、2、3、4、7和 14天连续采集周围静脉血标本 ,观察血小板计数的变化。　结果10 6例 (85 .5 % )术后出现血小板计数减少 ,血小板减少幅度为术前水平的 30 .3%～ 6 9.3%。第 1～ 2天最低 ,为 (89.5 2± 19.4 7)× 10 9/ L (P<0 .0 5 ) ,此后逐渐回升。出现继发性血小板增多 5 1例。　结论　 EVGE后血小板减少常见 ,其发生原因较多 ,移植物、内皮损伤、肝素、血小板滞留、失血和输血是血小板激活和减少的主要因素。采取适当的措施 ,可能有助于降低血小板减少的幅度 ,避免术后发生出血并发症。