Early Results of Endovascular Treatment of the Thoracic Aorta Using the Valiant Endograft

Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology. Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts. Data were retrospectively collected on 180 patients treated with the Valiant endograft at seven European centers between March 2005 and October 2006. The patient cohort consisted of 66 patients with thoracic aneurysms, 22 with thoracoabdominal aneurysms, 19 with an acute aortic syndrome, 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection. The overall 30-day mortality for the series was 7.2%, with a stroke rate of 3.8% and a paraplegia rate of 3.3%. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms (6.1%), thoracoabdominal aneurysms (27.3%), acute aortic syndrome (10.5%), chronic dissections (1.9%), and acute transections (0%). Adjunctive surgical procedures were required in 63 patients, and 51% of patients had grafts deployed proximal to the left subclavian artery. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology. Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity.     

杂交手术治疗累及弓部的Stanford B型主动脉夹层的疗效分析

目的:探讨杂交手术在治疗累及弓部的Stanford B型主动脉夹层（TBAD）中的有效性和安全性。方法:前瞻性描述性研究。纳入2020年1月—2021年9月蚌埠医学院第一附属医院血管外科确诊为累及弓部的TBAD患者。其中男16例,女5例;年龄32~81（59.7±12.9）岁。患者均采用外科转流术和胸主动脉腔内修复术相...     

Concurrent dissections of ascending aorta and right coronary artery during primary coronary angioplasty

We present a case of dissection in ascending aorta (AA) accompanying dissection of the right coronary artery (RCA) during transfemoral primary coronary angioplasty (PCA) for acute inferior myocardial infarction (MI). To our best knowledge, this is the first case of dissection both in AA and RCA during angioplasty for acute MI. The dissection in RCA was caused by balloon inflation during PCA. Most probably, an angiographically invisible retro-dissection in RCA resulted in the dissection in AA. A computed tomography (CT) confirmed the diagnosis of aortic dissection that was restrained in AA. The patient was treated conservatively. Five days after the event, a control CT demonstrated that the false lumen in AA disappeared and the dissection was healed entirely.     

A study of the vascularization of the auricle by dissection and diaphanization

The vascularization of the auricle is poorly documented, despite the developments in auriculotherapy and reconstructive surgery. The aim of this study was to describe its arterial distribution using two techniques: diaphanization and anatomical dissection. The study was conducted after intravascular injection of eight diaphanized auricles and ten that were dissected. Dissection showed that the auricle is vascularized by an anterior flow arising in the superficial temporal artery and also by a posterior flow arising in the posterior auricular artery in eight cases out of ten, and in the occipital artery in the remaining two. Diaphanization revealed the three-dimensional arterial distribution of preserved specimens. This technique has a didactic use to complement to standard anatomical dissection.     

Extensive iatrogenic coronary dissection during coronary angioplasty: a series of 19 consecutive patients

Purpose of the study

Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery.

Patients and methods

After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed.

Results

Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death (n = 1), coronary bypass (n = 2), myocardial infarction (n = 8), cardiogenic shock (n = 2) and circulatory assistance (n = 2).

Conclusion

Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable.     

基底动脉顶端动脉瘤相关手术入路显微解剖研究

目的 通过模拟翼点入路和颞下入路,观察到达基底动脉分叉部两种手术入路显露范围的差异,为临床基底动脉顶端动脉瘤手术入路的选择提供参考依据.方法 10例(20侧)成人尸头标本,显微镜下模拟翼点入路、颞下入路,解剖观察基底动脉顶端区域重要神经解剖结构之间的关系,明确到达基底动脉分叉部两种手术入路所暴露的视野范围.结果 头偏对侧30°角,经间隙Ⅱ对鞍区后部、基底动脉分叉部显露最充分,经间隙Ⅲ沿颅底视角由0°转向60°,其内侧缘可见度增大,外侧缘渐被颞叶遮挡,45°时间隙Ⅲ可使用面积最大；颞下入路在小脑幕切开前,可暴露中颅窝底、后床突、鞍背、基底动脉分叉部和大脑后动脉的后穿支动脉；切开小脑幕缘后可增加向下的视野暴露,扩大了脑桥中部外侧面视野.结论 翼点入路通过间隙Ⅲ暴露基底动脉分叉部更占优势,利于高于后床突且瘤顶端指向前上方动脉瘤的处理.颞下入路与翼点入路相比可缩短手术距离,可从侧方直视下观察基底动脉分叉部及P1段后方穿支动脉,利于对动脉瘤顶部指向后和后下方动脉瘤的处理.     

肝门部肿瘤超声切除的临床研究

目的 :对超声肝切除技术 (USD)在肝门部肿瘤切除中的应用进行临床研究和探讨。方法 :自 1991年 4月～ 1999年 3月 ,行超声肝切除术的肝门部原发肝癌患者 75例 (T组 ) ,同期 81例肝门部肝癌患者行常规肝切除手术 (C组 )。两组患者的年龄、性别分布及肝功能状况等主要临床资料无显著差异。对两组手术切除率、平均手术时间、住院死亡率、平均出血量和输血量、平均留院时间、并发症发生情况以及 1,3年生存率进行比较 ,评估手术技术的影响。结果 :两组患者均未出现手术死亡或术后住院死亡。T组手术切除率较C组有显著提高。T组的平均手术时间 (15 0± 10 .5min)明显少于C组 (2 36± 17.8min ,P <0 .0 1) ;T组的平均出血量(4 2 1± 13.1ml)和输血量 (36 4± 15 .9ml)与C组 (分别为 70 6± 2 3.0ml,5 48± 19.3ml)相比较有显著差异 (P <0 .0 1) ;平均留院时间T组 (8.2± 0 .47d)较C组 (14.1± 0 .6 0d)明显缩短 (P <0 .0 1) ,T组总并发症发生也较C组显著减少。统计显示 ,T组患者 1,3年生存率较C组显著提高 (P <0 .0 1)。结论 :超声肝切除技术由于可以选择性地暴露肝内管道组织 ,为肝门部肿瘤、大肝癌 ,尤其是侵犯大血管或胆道的肿瘤切除提供了一项新的途径。     

前列腺指裂术治疗小体积前列腺增生

目的评价前列腺指裂术治疗小体积前列腺增生（体积〈30g）致膀胱出口梗阻（BOO）的疗效。方法对36例小体积前列腺增生致BOO患者行前列腺指裂术,比较国际前列腺症状评分（IPSS）、最大尿流率（Qmax）及残余尿量（PRV）治疗前后变化,评价该术式疗效。结果所有患者均行前列腺指裂术。IPSS由术前14．19±5．35降至术后5．03±2．66（P〈0．001）,Qmax由术前Qmax（6．19±2．14）ml／s升至术后（17．71±4．10）ml／s（P〈0．001）,PRV由术前（50．58±14．84）ml降至术后（8．53±4．78）ml（P〈0．001）。共33例患者获随访,术后随访平均32个月（9—52个月）。结论前列腺指裂术是治疗小体积前列腺增生致膀胱出口梗阻较为理想的方法。     

The infra-optic course of the anterior cerebral arteries: an anatomic case report

Although variations of the anterior part of the cerebral arterial circle of Willis are quite well known, though some anomalies are exceedingly rare. In a 61-year-old female individual, on both sides the precommunicating parts of the anterior cerebral artery were found to course inferiorly to the ipsilateral optic nerves. This anomaly was associated with an agenesis of a left posterior communicating artery. The anatomic features, the possible high prevalence of associated aneurysms of the anterior communicating artery complex as well as implications for surgical planning or endovascular treatment are outlined and embryologic considerations and discussed.