不同方法制作犬腹主动脉瘤模型的比较

目的：探讨用于检验带膜记忆合金支架血管腔内搭桥治疗动脉瘤的模型。方法：分别以实验动物腹直肌后鞘、Ｄａｃｒｏｎ补片、不同口径的Ｄａｃｒｏｎ人血管及球囊导管材料,采用四种不同手术方法制作腹主动脉瘤模型。结果：１１例动物１０例模型制作成功,１例死亡,１月后造影检查发现９例的动脉瘤模型形态满意,１例动脉脉瘤扩张程度较差。结论;以腹阗甩垢鞘为材料制作动脉瘤模型具有取材方便,操作简便、不易漏血、无异物反应的优     

胸主动脉瘤手术不同体外循环方式的应用

目的探讨不同部位不同病变程度的胸主动脉瘤手术体外循环方式的选择.方法体外循环下行胸主动脉瘤手术23例,其中升主动脉瘤21例,包括 Debakey Ⅰ型夹层动脉瘤9例;降主动脉瘤2例,包括 Debakey Ⅲb型夹层动脉瘤1例.全身中低温体外循环17例,浅低温左心转流2例,左心转流合并全身中低温体外循环1例,深低温停循环上腔静脉逆行脑灌注3例.结果手术死亡1例,死亡率4.3%.因术前合并左心衰,肾衰术后1h死于急性左心衰竭.术后并发症2例,肺部感染1例,肢体功能障碍并肾功能异常1例,经积极治疗均恢复.3例停循环者除1例术后1h死于左心衰另两例均于术后3～6h清醒,无神经系统并发症.结论根据主动脉瘤患者病情严重程度,病变部位的不同,选择适当的体外循环方式,避免循环、中枢神经系统等并发症是手术成功的关键.     

Intramural hematoma of the aorta： a case report

Aortic intramural hematoma (IMH) has become accepted as a variant form of classic aortic dissection. In contrast to classic dissection, IMH is characterized by hematoma within the wall of the aorta, which gives the aortic wall an appearance of focal thickening without a demonstrable intimal flap.     

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta

Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.

     

Arachnoid cyst complicated with an inner aneurysm: case report

The arachnoid cyst complicated with an inner aneurysm and intracystic hematoma is rarely encountered.In 2005,we treated such a patient by craniotomy through the left pterion approach.The possible causes of the intracystic hematoma and the reasons of the delay of the diagnosis are discussed.     

多发结核性腹主动脉瘤一例

结核性主动脉瘤相当少见,自1895年以来文献报道仅50余例,平均发病年龄50±16岁,其中88%为假性动脉瘤,且多为单发,而多发性主动脉假性动脉瘤仅4例.治疗结核性主动脉假性动脉瘤必须是抗结核治疗与手术治疗相结合,一经确诊,应及早手术治疗,瘤体的大小不是决定是否需要手术的决定因素.本例患者为70岁,男性,确诊肺结核后经不规范抗结核治疗后出现间断腹痛,经血管造影诊断为多发结核性腹主动脉假性动脉瘤, 在腹主动脉腹腔干开口上方可见最大径约5 cm×6 cm的假性动脉癌,基底约3.3 cm;在腹主动脉肠系膜上动脉水平背侧及肾动脉腹侧可见各有1个假性动脉瘤,直径均约1 cm.在抗结核治疗与控制感染同时,一期手术时对已破裂的较大之腹主动脉假性动脉瘤行腔内隔绝术;在二期手术前,腹主动脉较小之动脉瘤即发生破裂,但患者家属放弃治疗,最终患者死于消化道大出血.     

Hypertrophic cardiomyopathy with apical left ventricular aneurysm: a case report

Morphological diversity is one characteristic of hypertrophic cardi omyopathy (HCM), but it is not common that HCM is associated with apical left ve ntricular aneurysm (LVA) without evidence of a coronary artery lesion. We repor t on such a case and review the pathogenesis, manifestations and diagnostic meth ods by collecting the few available papers published on this topic.     

Hypertrophic cardiomyopathy with apical left ventricular aneurysm: a case report

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无痛型主动脉夹层动脉瘤破裂死亡一例的误诊分析

[背景 ]无痛型主动脉夹层动脉瘤罕见 ,在临床上易误诊 ,常需进行尸检确定 .[病例报告 ]以头晕、双下肢乏力 ,偶伴有胸闷、气急为主诉而入院的老年患者 1例 ,入院诊断为I级高血压、冠状动脉性心脏病、心律不齐、脑梗死 ,给予降压、扩冠、对症等治疗 .入院第 3d在卫生间突然死亡 ,通过尸检发现死因为主动脉夹层动脉瘤破裂 .[讨论 ]主动脉夹层动脉瘤破裂主要通过尸检分析确诊 ,但也可通过进行彩色B型超声波、CT、核磁共振检查来减少误诊 .     

延伸移植物后撤式释放法治疗胸主动脉夹层动脉瘤腔内隔绝术中近端内漏

目的 总结腔内隔绝术治疗Stanford B型胸主动脉夹层动脉瘤某些特殊情况下近端内漏的治疗方法,比较延伸移植物(cuff)延伸释放法和后撤释放法的价值。方法 2001年以来,stanford B型胸主动脉夹层动脉瘤腔内隔绝术中发生近端内漏6例,分别采用向近端延伸法和后撤法植入cuff封闭内漏。结果 3例采用延伸法,其中1倒采用1枚cuff,1例采用5枚cuff,均完全封闭内漏;1例采用1枚cuff封闭不完全,带漏返回。3例采用后撤法,各用l枚cuff一次性将近端内漏消除。结论 主动脉弓远端或降主动脉近端成角明显时,如腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤术中发生近端内漏,采用后撤法植入cuff是一种效果满意的方法。     

自制髂动脉分支装置治疗腹主动脉瘤腔内修复术后髂动脉瘤1例

髂动脉分支装置（iliac branch device, IBD）是专为髂动脉分叉设计的分支支架,为主-髂动脉瘤、孤立性髂动脉瘤腔内治疗时重建髂内动脉血流的理想解决方案。北京大学人民医院血管外科利用自制的一枚IBD,成功治疗腹主动脉瘤腔内修复术（endovascular aneurysm repair, EVAR）后髂动脉瘤1例,其设计及植入较既往报道［1-3］均有独到之处,现将病例分享如下。     

主动脉夹层动脉瘤的手术治疗体会

目的 通过总结该院心脏外科手术治疗主动脉夹层动脉瘤病例的临床资料，探讨手术适应证的把握，改进相关体外循环技术和脑保护技术。方法 2000年4月-2006年5月，共行主动脉夹层动脉瘤手术31例，Stanford A型24例，B型7例。其中急诊手术9例，择期或限期手术22例。18例A型夹层动脉瘤在深低温、停循环（或低流量）的条件下进行手术，其余6例是在浅低温体外循环下进行，其间进行经右锁骨下动脉插管的选择性脑灌注和大剂量糖皮质激素脑保护。B型夹层动脉瘤全部在全身麻醉下进行手术操作。结果 A型夹层动脉瘤的手术死亡率16．7％；2000-12003年手术死亡率为23．5％（4／17），2004年-2006年5月手术死亡率为14．3％（2／14）（P〈0．05）；急诊手术死亡率为44．4％（4／9），非急诊手术死亡率为9．1％（2／22）（P〈0．01）。结论 Stanford A型夹层动脉瘤的手术死亡率远低于非手术治疗的死亡率；近3年深低温停循环结合右锁骨下动脉灌注和大剂量糖皮质激素脑保护、降主动脉记忆合金支架等新技术、新方法的应用，大幅度降低死亡率和围手术期并发症发生率；急诊手术本身也是影响手术死亡的一个危险因素。     

腔内修复治疗主动脉弓降部病变33例

目的总结应用血管腔内修复术治疗主动脉弓降部病变的初步经验。方法 2007年7月至2011年9月福建医科大学附属协和医院心血管外科对33例主动脉弓降部病变患者实施血管腔内修复术(endovascular aneurysm repair,EVAR)治疗,其中男性24例,女性9例,年龄28～81(61.3±19.5)岁,包括累及弓部分支的B型主动脉夹层19例,主动脉弓降部真性动脉瘤7例,主动脉弓降部假性动脉瘤3例,主动脉弓穿透性溃疡3例,主动脉食管瘘1例。所有患者均实施了血管腔内修复,其中12例先进行解剖外旁路手术,16例1期直接覆盖左锁骨下动脉,2例使用覆膜支架近端开槽技术保留左锁骨下动脉,3例使用"烟囱"技术重建左锁骨下动脉或左颈总动脉。结果全组均取得技术成功。术后1例因脑梗塞伴肺炎、肾功能衰竭不治,其余均痊愈出院。30例随访2～52个月,均恢复正常生活。3例出现头晕等窃血表现,在1个月内缓解。术后随访CT血管造影(computerized tomographic angiography,CTA)示:主动脉支架无移位,6例原有内漏已消失,无新的内漏发生,夹层假腔或动脉瘤腔内已有血栓形成,远端夹层假腔无明显扩大,旁路人工血管及"烟囱"支架通畅。结论应用血管腔内修复术治疗主动脉弓降部病变有满意的近期疗效,是治疗此类病变的重要方法。     

Endovascular repair: alternative treatment of ruptured abdominal aortic aneurysm

Background As an alternative to open aneurysm repair, endovascular ruptured abdominal aortic aneurysm （rAAA）. The aim of this study was outcomes of EVAR for rAAA. aortic repair （EVAR） has been applied to to evaluate the immediate and long-term Methods From July 1997 to September 2007, 20 men and six women with rAAA （median age, 68 years） were treated with EVAR. Most patients with suspected rAAA underwent emergency computed tomographic angiography （CTA）. The procedure was performed under general or local anesthesia. Endovascular clamping was attempted in hemodynamically unstable patients. Bifurcated endografts and aorto-uni-iliac （AUI） endografts with crossover bypass were used. Patients had CT scan prior to discharge, 3, 6, 12 months after discharge, and annually thereafter. Results Time between diagnosis and EVAR ranged from 1 hour to 5 days. EVAR was performed under general anesthesia in 21 patients, and under local anesthesia in five patients. Endovascular aortic clamping was performed in four patients. There was no conversion to open surgery during EVAR. Stent-graft insertion was successful in all patients. One patient died during EVAR from acute myocardial infarction. Ten patients had systolic blood pressure 〈80 mm Hg. Eleven patients received a blood transfusion. Mean aneurysm size was （47±12） mm. Mean ICU stay was （8±3） days, mean hospital stay （18±6） days, and mean procedure time （120±32） minutes. The 30-day mortality was 23% （6/26 patients）, and major morbidity 35% （9/26 patients）. Early endoleak occurred in 8/26 patients （31%）. The mean follow-up was （18±7） months. No patient demonstrated migration of the stent-graft. Conclusions EVAR is a safe and effective option for treatment of acute rAAA, independent of the patient＇s general condition. Immediate and mid-term outcomes are favorable, but long-term outcome is unknown. Multi-center studies are necessary to establish the role of EVAR for rAAA.     

“三明治”技术保留内脏动脉四分支治疗胸腹主动脉瘤

1病例资料患者,女,43岁,因"腹部隐痛3周加重1周"于2014年4月9日收治入院。患者3年前因突发胸背部疼痛于我院胸心外科诊断为:马凡综合征、主动脉夹层(Stanford A型),急诊行主动脉弓全弓置换+支架象鼻术(直径28mm)。术后恢复好,口服华法林抗凝(3.75mg/d),国际标准化比值维持在2~3。1年前行心脏永久性起搏器植入术。3周前腹部隐痛,逐渐加重,CT提示象鼻支架远端降主动脉假腔未完全血栓化,近膈肌段假腔扩张,腹主动脉真性动脉瘤,动脉瘤最大直径     

主动脉疾病腔内介入治疗15例体会

目的: 总结腔内修复术治疗主动脉疾病的经验、体会,探讨主动脉疾病介入治疗的适应证及操作要点。方法: 在气管插管全麻下进行,8例主动脉夹层患者采用直径34~42 mm覆膜支架封堵降主动脉近端破裂口,其中1例支架覆盖左锁骨下动脉;6例腹主动脉瘤中1例采用直型支架腔内隔绝,其余均采用分叉型支架经双股动脉置放成功;1例早期主髂动脉硬化性闭塞症患者采用预先扩张主髂动脉狭窄段,置入分叉型人工血管支架。结果: 全组无手术死亡,腔内隔绝术后造影显示假腔及瘤腔均消失;2例I型内漏,随访半年后消失,假腔内部分血栓形成。1例主动脉夹层患者手术后1年突然死亡。结论: 腔内隔绝术治疗主动脉疾病安全、可行、有效,适应证不断扩展。     

Multiple coronary aneurysms in a patient with neurofibromatosis type 1: case report and intravascular ultrasound of aneurysm

A 54 year old woman with neurofibromatosis type 1 (NF-1) was found to have multiple coronary aneurysms. Intraoperative intravascular ultrasound (IVUS) revealed severe coronary disease proximal to the aneurysm that had not been apparent angiographically. An IVUS picture of one of the giant coronary aneurysms is also shown. The vascular manifestations of neurofibromatosis and the causes of coronary aneurysms are reviewed.     

降主动脉夹层动脉瘤手术治疗1例报告

降主动脉夹层动脉瘤在临床上较为少见。近来我院收治1例降主动脉夹层动脉瘤患者,对患者行胸主动脉切除＋人工血管重建术,取得了成功,现报告如下。1 临床资料病人女,54岁,因左上腹、腰背部疼痛2 d于2002年6年17日入院。查体：血压21.3/14.7 kPa,心肺未见异常,腹平软,左     

Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm and sustained ventricular tachycardia: a case report and literature review

The case is a 54-year-old man with hypertrophic cardiomyopathy, mid-ventricular obstruction, apical aneurysm, and recurrence sustained monomorphic ventricular tachycardia (VT). A coronary angiogram revealed myocardial bridging located in the middle of the left anterior descending coronary artery (LAD), and the left ventriculogram showed an hour-glass appearance of the left ventricular cavity. There was a significant pressure gradient of 60 mmHg across the mid-ventricular obliteration at rest. A successful myectomy of the inappropriate hypertrophy myocardium and excision of the apical aneurysm were performed. Pathologic analysis demonstrated fibrosis in the apical aneurysm and thickened and narrowed vessels in the adjacent area. During the follow-up of eighteen months, the patient remained clinically stable and free from arrhythmic recurrence.