减速伤所致主动脉假性动脉瘤的诊治分析

目的 总结减速伤所致主动脉假性动脉瘤的诊治经验。方法 回顾性分析8例本病的l11临床症状、影像学表现及传统经胸手术和血管腔内带膜支架植入术的疗效。结果 8例均经影像学检查确诊。未经手术2例中1例死亡，1例失访，传统经胸手术2例和血管腔内带膜支架植入4例手术均获成功，术后恢复良好。结论 治疗减速伤患者时要警惕并发假性动脉瘤，影像学检查可明确诊断。传统经胸手术的疗效明确，而血管腔内带膜支架植入创伤口、疗效好、并发症少。     

血管腔内移植物治疗大动脉疾病的探讨

目的探讨以血管腔内移植物为主的血管腔内疗法治疗胸或胸腹主动脉疾病的疗效和存在问题。方法治疗包括夹层动脉瘤、真性和假性胸主动脉瘤、主动脉减速伤和缩窄患者共137例。主要病变的最低部位在腹腔动脉和肠系膜动脉之间。除血管腔内治疗法外,尚辅以腹主或髂动脉-肠系膜上动脉、或腋动脉-左颈总动脉等架桥术。结果发生急性内脏动脉缺血而急症开腹手术2例。早期漏7例。围手术期死亡6例(4．4％)。随访1～43(平均11)个月,发现后期内漏2例、血管腔内移植物部分断裂1例。DeBakeym型夹层治疗后发生Ⅰ型夹层病变1例。后期死亡5例(4例与腔内移植物无关,1例为多发性动脉瘤复发),失访11例,115例存活。结论以血管腔内移植物治疗高风险的大动脉病变相对安全有效,具有发展前景;但器材有待改进、远期疗效有待观察。     

主动脉支架移植物感染的诊治体会（附4例报道）

目的 探讨主动脉支架移植物感染的诊断和治疗方法.方法 回顾性分析1998～2008年期间我科收治的4例主动脉腔内治疗术后发生支架移植物感染患者的临床资料.结果 2例患者原手术为胸主动脉腔内修复术,2例为腹主动脉瘤腔内修复术.4例感染患者临床均有非特异性发热表现,CT检查均有感染征象,2例细菌培养为猪霍乱沙门菌.实施清创引流联合抗感染治疗2例,单纯行抗感染治疗2例,均获得成功,随访期间无再感染发生.结论 支架移植物感染发生率低但产生的后果严重,结合影像学检查可提高诊断的准确性,在合适的患者中可以实施保留移植物的保守治疗.     

微创外科治疗升、降主动脉和弓部疾病的探讨

目的:探讨大动脉疾病的微创治疗。方法:以腔内移植物或开窗法治疗全主动脉夹层动脉瘤3例、主动脉弓部动脉瘤、主动脉减速伤和弓降部动脉瘤各1例。结果:治疗均获成功。随访12～30个月,无一例发生远期内漏、移植物移位和其他它并发症。结论:微创法为高风险的大动脉病提供了良好的前景。     

腔内隔绝术治疗主动脉夹层

目的探讨腔内隔绝术治疗主动脉夹层的价值。方法采用进口支架型移植物对14例主动脉夹层患者行腔内隔绝术治疗。结果14例中13例术后DSA造影均显示破口被成功封闭,1例植入裸支架显示假腔缩窄。术后5例CTA及2例MRA显示假腔内血栓形成。无术中严重并发症及术中死亡。结论腔内隔绝术治疗主动脉夹层明显简化了手术操作,减小了手术风险,疗效确切。尤其是在StanfordB型主动脉夹层中有较大应用价值。     

腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤146例临床分析

目的 探讨StanfordB型主动脉夹层动脉瘤腔内治疗的手术指征、术前评估方法、手术操作技巧、并发症防治原则及临床应用前景。方法 对146例行Stanford B型主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管造影(CTA)或磁共振血管造影(MRA)对主动脉夹层动脉瘤进行评估,术中在数字减影血管造影(DSA)监视下经股动脉或髂动脉将移植物导入胸主动脉封闭夹层裂口。结果 术中移植物成功释放145例,1例移植物无法释放而转行开胸手术。119例仅使用移植物封闭夹层近端裂口,26例同时封闭夹层近端及远端裂口,46例远端夹层裂口旷置。围手术期死亡6例,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症。术后11个月猝死1例,2例分别于术后14、24个月再发Stanford A型胸主动脉夹层动脉瘤而行升主动脉人工血管置换术(Bentall手术),其余患者未出现与夹层动脉瘤及手术相关的并发症。结论 腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法,短期的随访结果表明该技术安全、有效。内漏是该方法的主要并发症并可能导致术后患者死亡,远期疗效有待继续随访。     

腔内隔绝术治疗腹主动脉瘤(附5例报告)

目的探讨腹主动脉瘤腔内隔绝术的适应症及其并发症的防治。方法对5例患者采用经股动脉植入支架-人造血管复合移植物,对腹主动脉瘤进行腔内隔绝术。结果5例手术均获成功,无任何并发症发生。结论腔内隔绝术治疗腹主动脉瘤具有简捷、微创、并发症少、术后恢复快等优点,为治疗本病的首选方法。     

烟囱技术在保留主动脉弓上分支动脉中的应用

<正>主动脉弓部相关疾病的外科治疗非常具有挑战。虽然相关的手术技术、麻醉以及重症监护措施已取得明显进步,但传统的开放手术仍可能导致相当高的死亡率和并发症发生率~([1])。目前,随着对主动脉疾病的深入认识、影像学技术的发展和腔内移植物设计的改进,主动脉腔内治疗已成为多数主动脉疾病的首选术式。但因受限于主动脉弓形态和弓上分支血管灌注的需要,主动脉弓一直被认为是主动脉腔内     

13例腹主动脉腔内移植物感染的诊断及外科治疗

目的:探讨腹主动脉腔内移植物感染（vascular endograft infections,VEGI）的诊断及外科治疗方式。方法:回顾性分析2015年1月至2021年1月北京大学人民医院血管外科行外科手术治疗的13例腹主动脉腔内移植物感染患者的临床资料。结果:13例患者均行腋-双股动脉人工血管转流术+腹主动脉移植物切...     

主动脉疾病腔内治疗的进展与前景

1990年阿根廷医生Parodi的首次成功的经股动脉植入腔内移植物治愈一例腹主动脉瘤 ,在此后 10余年中 ,腔内技术的发展使主动脉疾病的治疗模式发生了巨大的改变 ,例如腹主动脉瘤的治疗 ,在发达国家的多数血管外科中心利用腔内移植物进行的腔内隔绝术已经替代了一半以上的开腹手术 ,在主动脉夹层和胸主动脉瘤的治疗中 ,腔内技术的使用也日益普及。1　腹主动脉瘤腔内隔绝术1.1　移植物的分类腹主动脉瘤的腔内隔绝术按照使用移植物的结构可分为以下三型 :直管型、分叉型、腹主 单支髂动脉型 (见图 1) ,其中直管型由于适应证较为狭窄和继发内漏…     

Combining laparoscopic and endovascular techniques to improve the outcome of aortic endografts. Hybrid techniques

Aortic endografting can be performed with a high initial success rate yet with the need for lifelong surveillance because of numerous long term problems. Among these graft migration, typ II endoleaks and endotension require treatment to prevent abdominal aortic aneurysm (AAA) rupture. We describe our experience with laparoscopic clipping of lumbar arteries and the inferior mesenteric artery (IMA) to prevent Type II leaks as well as with different banding procedures. Several ways to perform active graft fixation are described. Since we believe that active downsizing of the aneurysm reduces some of the intermediate term problems we go a step further and evacuate the thrombus to downsize the aneurysm to prevent longitudinal shrinkage. Laparoscopic techniques can also be used to obtain direct vascular access. This permits insertion of a thoracic endograft directly into the aorta in patients with diseased iliac vessels. Endovascular aneurysm repair (EVAR) insertion under laparoscopic navigation without contrast dye in cases with renal insufficiency is described. We describe our technique of total laparoscopic conversion after failed endografting. Future perspectives and preliminary experience with an aortic stapler are discussed.     

Traumatic innominate artery transection

Blunt innominate artery injury is a rare but often lethal complication of severe deceleration trauma. We report the case of a 38-year-old man with such an injury who was successfully operated on an emergency basis. In cases of brachiocephalic vessel trauma, a high index of suspicion in chest deceleration injuries may lead to a proper investigative process and an accurate diagnosis. Clinical signs as blood pressure gradient between the arms and widening of the mediastinum on chest X-ray is highly suggestive of trauma of the thoracic aorta and its great vessels. A chest CT scan may contribute to the diagnosis and can rule out major trauma of the aorta, but the procedure of choice for the definite diagnosis is usually the angiography. Subsequent early repair is favorable to avoid complications and fatal events. Cardiopulmonary bypass use in selected cases favors the outcome.     

主动脉疾患误诊为下肢动脉血栓栓塞九例分析

目的 分析主动脉疾患误诊为下肢动脉血栓栓塞的原因,总结经验教训.方法 回顾性分析9例主动脉疾患误诊病例的临床表现、误诊误治情况及确诊方法.结果 9例均初诊为下肢动脉血栓栓塞.其中3例急诊行Fogarty导管取栓术,术后通过三维CT血管造影(3-dimensional CT angiography,3DCTA)检查明确诊断;另6例于术前行3DCTA而确诊为主动脉疾患.本组中5例为主动脉夹层累及髂股动脉,其中1例主动脉夹层患者放弃治疗后1 d死亡;另1例主动脉夹层患者拒绝治疗,离院后失访;3例成功施行腔内修复术.1例为腹主动脉瘤腔内附壁血栓脱落,施行动脉瘤切除术.其余3例为Leriehe综合征合并急性主动脉末端血栓形成,施行主髂动脉旁路术.本组无围手术期死亡,治疗后患肢缺血均改善.结论 主动脉疾患也可引起急性下肢缺血,易被误诊为肢体动脉血栓栓塞,影像学检查能够确立正确诊断.     

十例腹主动脉损伤的诊疗体会

目的探讨腹主动脉损伤发生的原因及诊疗方法。方法回顾性分析1995-2004年间收治的10例腹主动脉损伤的临床资料。本组10例,男6例,女4例。病因主要包括医源性损伤5例、刀刺伤3例、火器伤1例、交通肇事1例。仅3例术前行腹主动脉造影、增强CT等影像学检查;7例经综合临床判断直接手术治疗。结果10例患者分别采取单纯修补、人工血管移植等术式。存活8例,死亡2例,均死于延误诊断,休克过重而持久。1例因合并髂静脉损伤,虽经血管重建,术后遗留轻度患肢水肿。结论快速诊断、迅速建立有效静脉通路输血补液,紧急剖腹止血是抢救成功的关键。术中应注意全面探查,视伤情尽量采用简单而合理的术式。     

Limited acute dissections of the abdominal aorta. Report of five cases.

Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta was made in five cases without aneurysmal dilation or leakage and with virtually no ischaemia. All patients presented with an atypical painful abdominal syndrome and the diagnosis was made by computed tomography. Only one patient, suffering persistent pain was treated by resection and graft interposition of the infrarenal aorta. All the others were treated conservatively and kept under close follow-up. Two of them died from intercurrent disease. The remaining three patients are doing well after 30 and 42 months conservative treatment and 43 months after surgery respectively. A non-complicated dissection of the abdominal aorta must be considered in the differential diagnosis of atypical painful abdominal syndromes. In cases of persistent pain, progression, ischaemia, aneurysmal dilatation or leakage, surgical treatment is mandatory. In uncomplicated cases conservative treatment is recommended, similar to the principles of management for dissections of the descending thoracic aorta.     

Remodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study

AIM: Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. METHODS: All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. RESULTS: A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. CONCLUSIONS: The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.     

Early stent fracture and collapse of a Zenith TX2 thoracic stent graft used for traumatic aortic rupture

Structural failure and collapse of thoracic stent grafts may cause fatal complications that are easily overlooked on follow-up imaging. A young man with multiple injuries from a motorcycle crash was treated with endografting for an aortic transection. The clinical course was initially satisfactory but deteriorated one week after the injury and the patient died two weeks later. Autopsy and retrospective assessment of chest X-rays revealed early fractures and collapse of the stent graft that had been overlooked and may have contributed to the lethal outcome. The design of thoracic stent grafts needs to be improved for treatment of traumatic aortic transection. Careful follow-up of these patients is warranted.     

Repair of injuries to the thoracic aorta and great vessels: Auckland, New Zealand 1995-2004

BACKGROUND: Traumatic injury to the aorta and great vessels is a surgical emergency with survivors who reach hospital typically having suffered multiple injuries. There are several diagnostic and treatment options available, with new modalities emerging to challenge the gold standards. A review of recent trends in management of these injuries in Auckland, New Zealand was carried out and patient outcomes assessed. METHODS: The charts of patients admitted to Auckland and Green Lane Hospital's cardiothoracic intensive care unit, with a diagnosis of injury to the thoracic aorta or great vessels since 1995 were retrospectively reviewed. Imaging techniques, injury types and treatment methods were analysed along with survival and neurological morbidity. RESULTS: In the study period our unit operated on 29 cases of traumatic rupture of the thoracic aorta or great vessels. Digital subtraction angiography and more recently, multidetector computed tomography scanning have been used to diagnose the injury. Twenty-seven injuries were to the aorta and two to the innominate artery. The 30-day survival rate of those reaching the operating theatre was 90%. There was one case of postoperative hemiparesis and five cases of recurrent laryngeal nerve injury, but none of spinal cord ischaemic injury. Endoluminal stent grafting was carried out for one patient, without complication. CONCLUSIONS: Good survival rates exist for those who reach surgery for traumatic rupture of the aorta or great vessels. Multidetector computed tomography scanning is an alternative to digital subtraction angiography, potentially reducing treatment delay. In addition endoluminal grafting as opposed to open repair has been reported as a safe technique. The injury remains a surgical emergency requiring urgent diagnosis and transfer to an equipped cardiothoracic unit for definitive treatment.