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目的 探讨支架型人工血管治疗主动脉夹层的临床效果。方法 2001年3月至2003年9月间，应用支架型人工血管治疗Ⅲ型夹层44例和Ⅰ型主动脉夹层1例。45例主动脉夹层共应用56个支架型人工血管行近侧内膜破口封堵，1例同时行远侧内膜破口手术关闭，1例远侧破口以分叉的支架型人工血管封闭。结果 所有病人均获得技术成功。围手术期死亡2例，1例术后12h后死于脑出血，1例术后10d死于假腔破裂；1例手术后半年死于细菌性心内膜炎。结论 支架型人工血管行Ⅲ型主动脉夹层和破口在降主动脉的Ⅰ型主动脉夹层破口封堵术较传统手术安全，其远期疗效需进一步观察。     

Endovascular stent-graft placement for nonaneurysmal infrarenal aortic rupture: a case report and review of the literature

Penetrating atheromatous ulceration of the infrarenal aorta is a rare entity. There are few reported cases of this lesion, and most of the published data is in regards to the thoracic aorta. Spontaneous rupture of a nonaneurysmal noninfected atherosclerotic infrarenal aorta is a rare event. We report the eleventh case of this occurrence and present the first reported case of endovascular stent-graft placement in treating this entity. We review the literature regarding ulcerative disease of the aorta and specifically discuss the published data on spontaneous rupture of the nondilated, noninfected infrarenal aorta secondary to penetrating atheromatous ulceration.     

Endovascular stent-graft treatment of thoracic aortic dissection

Endovascular stent-graft implantation technique is a newly developed, effective and less invasive method in treating thoracic aortic dissection (TAD). Our study was designed to further verify the feasibility, the efficacy, and safety of this technique. We present a 4-year follow-up report of endovascular stent-graft treatment over 36 cases of acute TAD patients and 40 cases of chronic TAD patients. The mortality and comorbidity rates were evaluated thoroughly. In our study, the deployment of the stent-grafts was successfully performed in 75 cases. The hospital cumulative 30-day mortality rate was 1.3%. The instant endoleak rate was 15.8% (12 patients). All endoleaks were successfully treated with a second stent. All patients in local anesthesia were transported to the general ward after the intervention and were discharged from hospital within 1 week. Our preliminary results showed endovascular stent-graft implantation technique offered good peri-operative morbidity and mortality rates. Stent-graft placement over TAD produced a low incidence of spinal cord ischemia, cardiac and pulmonary complications, less hospital stay, less blood transfusion and became the first choice of TAD patients in our department.     

DeBakey Ⅰ型主动脉夹层动脉瘤的血管腔内治疗

目的探讨血管腔内治疗DeBakeyⅠ型主动脉夹层动脉瘤的方法。方法对7例DeBakeyⅠ型主动脉夹层动脉瘤进行血管腔内治疗。7例均行磁共振血管造影、CT和动脉造影检查确诊。内膜撕裂口均位于升主动脉,距冠状动脉开口2．5-6．0cm,距右头臂干开口0．5-4．0cm。2例通过左颈总动脉置入带膜支架,术前行左锁骨下动脉-左颈总动脉间内转流术以保证左颈总动脉血供。5例通过右股总动脉置入带膜支架,其中2例先行左锁骨下动脉-左颈总动脉-右颈总动脉人工血管旁路术。结果全组均手术成功。3例第1枚支架释放后仍有较多内漏,即再放入第2枚支架,交错重叠于第1枚支架内面而成功封闭撕裂口,消灭内漏。除1例术后1个月因急性上消化道大出血死亡外,其余6例存活。6例的假腔均有血栓形成,无内漏,无新的夹层动脉瘤形成。结论DeBakeyⅠ型主动脉夹层动脉瘤的血管腔内治疗是可行、微创和有效的。病例选择应注意撕裂口距冠状动脉开口的距离。     

介入治疗支气管动脉瘤1例并文献复习

目的 报道介入治疗支气管动脉瘤1例,结合文献复习提高对此病的认识.方法 67岁男病人,术前胸部影像学检查确诊纵隔型支气管动脉瘤合并结核性胸膜炎,在DSA透视下行经导管支气管动脉栓塞术及胸主动脉带膜支架置入术联合介入手术.结果 术后造影显示动脉瘤被成功隔绝,支架贴壁良好,无内漏发生.结论 血管内介入治疗支气管动脉瘤方法简单,疗效确切.     

带膜支架腔内修复联合解剖外旁路术治疗Stanford A型主动脉夹层

目的探讨带膜支架腔内修复联合解剖外旁路术对Stanford A型主动脉夹层的临床效果。方法通过建立各种解剖外旁路来重建无名动脉、左颈总动脉或左锁骨下动脉以延长锚定区,然后一期或分期行带膜支架主动脉腔内修复术;可采取颈动脉入路或股动脉入路来完成主动脉腔内修复术。结果全组34例中升主动脉夹层8例,主动脉弓部夹层26例,除1例术中死亡外,其余33例均成功接受带膜支架主动脉腔内修复术。30d病死率为8．8％（3／34）,内漏发生率为11．8％（4／34）,脑梗死发生率为5．9％（2／34）。随访6—70个月,平均24．5个月,2例失访。结果显示假腔内完全血栓形成16例,部分血栓形成13例。结论带膜支架腔内修复联合解剖外旁路术为Stanford A型主动脉夹层提供了一种新的治疗方法,具有微创、安全性较高,并发症较少的特点,但应注意适应证的选择。     

腔内修复术治疗胸腹主动脉夹层动脉瘤

目的 介绍血管内支架技术治疗胸腹主动脉夹层动脉瘤的经验。方法 对2000年10月－2001年6月间6例胸腹主动脉夹层动脉瘤的治疗经过进行回顾性分析。结果 6例均为男性,年龄42－72岁。Standford A型胸腹主动脉夹层动脉瘤1例,B型5例。其中5例经行腔内人工血管支架修复成功,1例中转腹主动脉夹层开窗手术。术后1例发生髂外动脉夹层破裂,行腹主动脉夹层开窗人工血管移植术;1例术后3d因严重心肌梗塞抢救无效死亡。5例随访1－9个月,情况良好。结论 腔内人工血管治疗主动脉夹层动脉瘤简化了手术操作,减小了手术风险。腹主动脉夹层开窗手术是治疗主动脉夹层的辅助手段。     

Endovascular treatment of venous sinus thrombosis: a case report and review of the literature

Dural venous sinus thrombosis (DVST) is a pathological phenomenon resulting from vascular occlusion of the cerebral venous sinuses. The mainstay of therapy for DVST is anticoagulation but more aggressive interventional therapies must be considered when medical therapy fails. A case is presented of a patient who was diagnosed with DVST, medically treated immediately but continued to deteriorate. Invasive endovascular therapies ultimately obliterated the thrombi in her sinuses. A brief review of the literature is reported.     

Endovascular treatment of chronic type A dissection

Type A aortic dissection is usually treated with standard surgery, requiring cardiopulmonary bypass and sometimes deep hypothermia. Besides the well-established procedure, mortality and complications are considerable. Using the knowledge and lessons learned from the endovascular treatment of descending aortic diseases, emerging reports describe new approaches to the condition, using endovascular stent-grafts. This report describes an endovascular treatment of a chronic type A aortic dissection without cardiopulmonary bypass and avoiding thoracotomy.     

Splenic artery dissection: a case report and review of the literature.

Spontaneous arterial dissection may occur in a dramatic fashion and is often fatal if treatment is not instituted promptly. Diagnosis may be particularly difficult when cases of arterial dissection appear in unusual locations. We report a rare case of atraumatic dissection of the splenic artery that occurred in a 66-year-old male patient, who was admitted with acute severe epigastric and substernal pain, which worsened on inspiration. On admission, his physical examination was unremarkable, and he was hemodynamically stable. After excluding cardiopulmonary catastrophes and aortic dissection as a cause, a left retroperitoneal mass was found on arteriography to be a contained rupture of a splenic artery dissection. The patient underwent urgent resection of the splenic artery with preservation of the spleen. Splenic artery dissection is a rare condition. Only 11 cases have been previously published in the literature, and all of these cases were diagnosed after death. Successful management depends on consideration of the diagnosis, especially when other more common disease processes have been excluded.     

Endovascular treatment of a post-traumatic tibial pseudoaneurysm and arteriovenous fistula: case report and review of the literature

Here we report a rare case of a 74-year-old man with a pseudoaneurysm of the anterior tibial artery and a concomitant arteriovenous fistula (AVF). The patient was admitted because of increasing pain following the formation of a large mass located in the anterior mid-portion of the calf after a moderate non-penetrating blunt trauma. A polytetrafluoroethylene-covered stent was placed over the origin of the pseudoaneurysm, with complete exclusion of the pseudoaneurysm and disappearance of the AVF. One year after the procedure the mass had completely disappeared and the vascular anatomy of the calf is well preserved.     

Aortoesophageal fistula: alternatives of treatment case report and literature review.

Aortoesophageal fistula (AEF) remains as a life-threatening condition with a high rate of morbidity and mortality. It is usually related to aortic or esophageal disease, and less commonly foreign body ingestion. In spite of several strategies for treatment, there is little consensus regarding the optimal management of this entity. In this paper, we present our experience in successfully managing one patient with AEF by performing open surgical repair. We also include a discussion on criteria for selecting the most appropriate alternative of treatment: open or endovascular repair, based on a review of the literature currently available in MEDLINE.     

Medical management of spontaneous celiac artery dissection: case report and literature review

Spontaneous visceral artery dissections are a rare occurrence. Here we report a case of spontaneous celiac artery dissection that was treated without surgery.     

Spontaneous popliteal artery dissection: a case report and review of the literature

Spontaneous arterial dissection of a peripheral artery involving an extremity is a rare event. We report a case of atraumatic, nonaneurysmal dissection of the popliteal artery that occurred in a 62-year-old man who was admitted with progressive right lower-extremity claudication. Preoperative arteriography was suggestive of arterial dissection, and surgical treatment was undertaken before irreversible ischemia developed. Intraoperatively, a dissection of the popliteal artery was observed, and the patient underwent femoral-popliteal bypass grafting with the ipsilateral, greater saphenous vein and the popliteal artery was ligated distal to the dissection. Spontaneous dissection limited to the popliteal artery has not previously been reported in the literature. Successful management depends on consideration of the diagnosis, particularly when other, more common diseases have been excluded.