Willis覆膜支架治疗颈内动脉海绵段假性动脉瘤与瘘

目的 探讨使用Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘的可行性、有效性。方法 回顾性分析2013年1月到2017年12月收治的15例颈内动脉海绵窦段假性动脉瘤和1例颈内动脉海绵窦瘘的临床资料,均采用Willis覆膜支架置入术治疗。结果 术后即刻血管造影显示病变完全消失,载瘤动脉通畅。术后死亡2例;其余14例术后随访6~24个月,均恢复正常工作,DSA或CTA随访未见复发,但1例放疗病人出现颈内动脉海绵窦段慢性闭塞。结论 Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘成功率高,操作简单。     

分支支架技术在弓部分支血管重建中的应用及评价

分支支架技术在腔内治疗累及主动脉弓的主动脉瘤或主动脉夹层中,更符合正常解剖结构的修复,国内外进行了大量研究。国内包括头端连接式分支支架、分叉拼接式分支支架,由于设计缺陷及释放方式问题,临床试验失败;国外包括日本的Inoue一体化分支支架,临床试验亦失败。Cook公司的“内烟囱”分支支架、Bolton Medical公司的大窗内烟囱分支支架、Gore公司的内潜望镜分支支架、Medtronic公司的突起开窗连接式分支支架,正在进行临床试验,但均未获得上市批准。Castor分支支架是国际上首款获得国家级审批并可作为商品销售的分支支架,由海军军医大学附属长海医院血管外科与上海微创公司联合研发。其支架的一体化设计及输送释放系统的安全性及精准性设计使其获得了良好的临床应用结果。但Castor分支支架为单分支支架,其应用仍有一定的局限性,要完全解决主动脉弓部病变仍需要进一步的研究。多种技术的结合可能是未来5年内解决主动脉弓部病变问题的发展方向。     

Current role of endovascular therapy in Marfan patients with previous aortic surgery

The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.     

Aortic Stent-Graft Infection Following Septic Complications of a Kidney Stone

A 73-year-old man was treated because of a renal pelvis blowout of the left kidney for which he received a nephrostomy catheter without antibiotic prophylaxis. Almost a year previously this patient had undergone endovascular repair of a symptomatic infrarenal abdominal aorta aneurysm. Four weeks after the diagnosis and treatment of the ruptured renal pelvis, a new computed tomography scan and ultrasound-guided fine needle aspiration confirmed the diagnosis of infected aortic stent-graft. An extra-anatomic axillo-uniiliac bypass and graft excision was performed. Two weeks after discharge the patient returned to the hospital with an occlusion of his left renal artery and died of renal failure. This is the first time an infected aortic stent-graft after a renal pelvis blowout has been reported. Although infections of aortic stent-grafts occur rarely, one should be aware of the possibility in aortic stent-graft patients undergoing abdominal procedures without antibiotic prophylaxis.     

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAAs) treated with suprarenal stent-grafts. Two sample patients with AAA undergoing multislice CT angiography pre- and postsuprarenal fixation of stent-grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium were simulated in the segmented aorta models: a single wire crossing centrally, a single wire crossing peripherally, a V-shaped wire crossing centrally, and multiple wires crossing peripherally. The blood flow pattern, flow velocity, wall pressure, and wall shear stress at the renal arteries pre- and post-stent-grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4, 1.0, and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20–30% in most of the situations when the stent wire thickness increased to 1.0 and 2.0 mm. Of the four types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm. In conclusion, our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent-grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of patients treated with suprarenal stent-grafts to ensure long-term safety of the suprarenal fixation.     

Endovascular Stent-Graft and First Rib Resection for Thoracic Outlet Syndrome Complicated by an Aneurysm of the Subclavian Artery

Purpose: To report our experience with a combined endovascular and surgical approach for arterial thoracic outlet syndrome (TOS) complicated by an aneurysm of the subclavian artery.

Methods: We treated three consecutive patients suffering from arterial thoracic outlet syndrome complicated by an aneurysm of the subclavian artery by the use of a stent-graft and a first rib resection. These patients were reviewed retrospectively.

Results: At a mean follow-up of 37.3 months all patients were free of symptoms without late complications. Conclusions: Endovascular stent-grafting followed by decompression of the costoclavicular space is an attractive alternative to the conventional surgical approach of complicated arterial TOS.     

血管内带膜支架置入治疗主动脉夹层的临床研究

主动脉夹层（aortic dissection,AD）是一种高危险、高死亡率的血管性疾病,其年发病率在1／10万左右,如未经治疗,死亡率极高。1994年Dake等…进行了主动脉腔内带膜支架置入术（endovascular stent-graft placement,EVSGP）,为主动脉夹层的治疗开创了一条微创而有效的治疗方法。我院自2005—2008年,采用血管内带膜支架置入治疗主动脉夹层,取得了较好的疗效,报道如下。     

主动脉夹层动脉瘤带膜支架血管腔内隔绝术的围手术期监护

目的观察主动脉夹层动脉瘤(DebadeyⅢb型)带膜支架血管腔内隔绝术的临床疗效和围手术期的监护效果。方法10例患者术前给予绝对卧床、降血压、镇痛等综合治疗。患者均在全麻下行主动脉夹层动脉瘤带膜支架血管腔内隔绝术。结果10例患者手术均成功,随访4~12个月,临床症状消失,恢复正常生活。结论早期诊断、及时恰当的治疗、手术前及手术后严密的观察和精心护理是降低病死率的关键。