出血性椎动脉夹层动脉瘤的血管内治疗

目的 探讨血管内治疗出血性椎动脉夹层动脉瘤的有效性和安全性.方法 回顾性纳入出血性椎动脉夹层动脉瘤患者,收集患者的一般临床资料、数字减影血管造影或头颈部CT血管造影图像、治疗方式以及门诊随访资料,分析血管内介入治疗的手术方式、围手术期常见并发症和临床疗效.结果 共纳入出血性椎动脉夹层动脉瘤24例,男性17例(70.8％),女性7例(29.2％),平均年龄(52.0±9.4)岁.22例(91.7％)行血管内介入治疗,包括闭塞载瘤动脉19例(79.2％)、支架辅助弹簧圈栓塞3例(12.5％),均获得技术成功,术后合并脑梗死1例.另2例(8.3％)采用保守治疗,均在住院期间发生再出血并死亡.介入治疗患者术后随访时间中位数15个月(范围5～50个月),转归良好18例(75.0％),无出血复发病例.结论 血管内闭塞载瘤动脉或支架辅助弹簧圈栓塞是出血性椎动脉夹层动脉瘤的一种安全和有效的治疗方法.     

彩色多普勒超声诊断主动脉夹层动脉瘤

目的 评价彩色多普勒超声诊断主动脉夹层动脉瘤的临床价值。方法对应用彩色多普勒超声诊断技术检查诊断的22例主动脉夹层动脉瘤患者进行总结分析。结果 经超声诊断的主动脉夹层动脉瘤与CT、MRI、DSA检查诊断的符合率分别为87．5％、83．3％、81．8％。检查方法、探测部位、所用切面影响诊断结果的准确性。结论 彩色多普勒超声检查对诊断主动脉夹层动脉瘤具有重要的临床价值。     

Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options

Vertebral artery dissection has been recognized as an uncommon cause of ischemic stroke. However, it is less well known as a cause of subarachnoid hemorrhage. Even if dissecting aneurysms of the vertebral artery are rare, their importance arise from their high morbidity and mortality with rebleeding occurring more often than in cases of saccular aneurysms. Dissecting aneurysms of the vertebrobasilar system are a complex entity which requires a rapid and effective treatment to prevent rerupture. The sole stenting technique stands as a promising approach, allowing to occlude the aneurysm while preserving the vessel patency and reconstructing the diseased segment.     

Group B streptococcal endocarditis in a neonate

Summary This is a case of bacterial endocarditis and dissecting aneurysm of the ascending aorta secondary to group B streptococcal (GBS) septicemia in a one-month-old infant girl who presented with meningitis. A large aortic vegetation and a large dissecting aneurysm of the root of the aorta were detected by two-dimensional (2D) echocardiography. Apparently the infant did not have any preexisting cardiac anomaly. She received intravenous ampicillin for six weeks. She also underwent successful surgery for the replacement of the ascending aorta with an aortic homograft. This occurrence reemphasizes the value of 2D echocardiography in detecting vegetations for endocarditis.     

Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery

Summary We here present 4 cases with dissecting aneurysm (DA) of the intracranial vertebral artery, who were followed up by repeat cerebral angiography and MRI. The patients consisted of 2 males and 2 females, and the mean age was 43 years. Two cases were associated with polyarteritis nodosa (PN) and hypertension, respectively. Three of the cases developed subarachnoid haemorrhage (SAH), while the other one suffered from lateral medullary syndrome.In cerebral angiography, pearl and string signs were revealed in all cases, while a double lumen indicating a true diagnostic sign of DA was demonstrated in only one case. Repeat angiography showed that a bleb formation with a bulging of the aneurysmal sac was seen in 2 cases, and an irregularity of the wall in one case. On the other hand in one case, the ectatic part shrank, while the stenotic part was restored.In magnetic resonance imaging (MRI), a hyperintensity mass on T 1-weighted image (T 1-WI) adjacent to flow void suggesting either an intramural haematoma or a linear shape hyperintensity on T1-WI were demonstrated in 3 cases. In the follow up MRI done in 2 cases, a serial change in the intensity from iso-intensity to hyperintensity on T 1-WI was observed in one case suggesting intramural haemorrhage, while an enlargement of the ectatic flow void was seen in the other case.Three of 4 cases were operated on by trapping of the aneurysms. One, who had systemic vascular diseases due to PN, and repeat angiography showed a regression of the aneurysm, was conservatively treated. The outcome was excellent in the 3 surgical cases, whilst the one medically treated case was also excellent without any rebleeding.In conclusion, repeat neuro-imaging procedures are strongly recommended to clarify the possibility of a spontaneous repair of the dissection, and to consider the surgical strategy for the lesion.     

Isolierte spontane Koronararterien-Dissektion

Summary A complete review of the literature on the disease entity isolated spontaneous coronary artery dissection (72 ascertained cases with our own three) is given. The emphasis is placed on differential diagnosis of coronary heart disease, particularly in young patients without typical atherosclerotic risk factors. Isolated spontaneous coronary artery dissection is defined as a spontaneously dissecting hematoma limited to one or more coronary arteries. Women are involved considerably more frequently than men (84% of cases). Mean age at onset of the disease is 41 years (range: 21–70 years). The main site of involvement is the left coronary artery (79% of cases). In one-third of the female patients there is a temporal relationship to pregnancy (peripartum coronary artery dissection). Three types can be differentiated by coronary arteriography. Less than one-third of the patients survive the first 24 h after acute onset of symptoms; attempts at emergency reperfusion of the ischemic myocardium by aortocoronary bypass surgery or thrombolytic therapy have not been successful.

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Abkürzungsverzeichnis ISKD isolierte spontane Koronararterien-Dissektion - RIA Ramus interventricularis anterior - i.c. intrakoronar - LH linkskoronarer Hauptstamm - R rechte Koronararterie - L Lumen - DK Dissektionskanal     

Progression of occluded internal carotid artery dissection to giant compressive pseudoaneurysm following gunshot wound

Pseudoaneurysm formation following gunshot wounds is associated with significant morbidity. The natural history and optimal follow-up strategy for penetrating injuries causing dissection remains poorly understood. We report a case of a giant compressive pseudoaneurysm that developed following recanalization of an occlusive internal carotid artery dissection sustained from a gunshot wound. This was detected on routine follow-up imaging six weeks later. The patient subacutely developed dysphagia and hoarseness initially felt to be caused by delayed injury to the laryngeal nerve because computed tomography angiography demonstrated no new pathology. The pseudoaneurysm was successfully treated using a covered stent graft. This case highlights the importance of close angiographic follow-up even in the setting of initial complete vessel occlusion, and the need for a high suspicion for pseudoaneurysm development in the setting of new compressive or neurologic symptoms in patients with potential vascular injury from gunshot wounds to the neck.     

手术治疗老年Stanford A型急性主动脉夹层的近期和远期疗效分析

目的:探讨外科手术治疗老年Stanford A型急性主动脉夹层(AAD)的近远期疗效。方法:回顾性分析2008年6月—2017年3月郑州大学第二附属医院心血管外科应用手术治疗的196例Stanford A型AAD患者资料,患者均采用全麻、深低温停循环加单侧选择性脑灌注技术进行外科手术治疗,其中33例患者年龄≥60岁(老年组),163例患者年龄60岁(年轻组),比较两组患者的临床资料和预后情况。结果:与年轻组比较,老年组男性患者比例低(45.5%vs.73.0%,P=0.000),De Bakey II型主动脉夹层发病率高(21.2%vs.6.7%,P=0.009);升主动脉置换+全弓置换+象鼻支架术应用比例低于年轻组(9.1%vs.28.2%,P=0.021)升主动脉置换+全弓置换+象鼻支架术应用比例减少(9.1%vs.28.2%,P=0.021),但单纯升主动脉置换比例增加(21.2%vs.2.5%,P=0.000),平均体外循环时间、主动脉阻断时间、手术时间均缩短(215.70 min vs.252.98 min,P=0.000;121.12 min vs.134.00 min,P=0.008;489.15 min vs.533.52 min,P=0.004);术后ICU停留时间延长(235.27 h vs.163.55 h,P=0.011),术后肾功能不全(21.2%vs.6.7%,P=0.009)、感染发生率(30.3%vs.9.8%,P=0.002)升高;术后生存率差异无统计学意义(P=0.1466)。全组病例分析显示,体外循环时间是AAD患者手术后院内死亡的危险因素(OR=0.987,95%CI=0.977~0.997,P=0.011),而年龄(OR=1.790,95%CI=0.651~4.921,P=0.259)与其他因素并非手术后院内死亡的危险因素。结论:对于老年AAD患者,根据夹层累及范围选择恰当的手术方式可以取得较满意的预后,术中尽可能缩短体外循环时间有助于提高手术疗效。     

Hybrid treatment of aortic arch disease

Introduction

The management of thoracic aortic disease involving the ascending aorta, aortic arch and descending thoracic aorta are technically challenging and is an area in constant development and innovation.

Objective

To analyze early and midterm results of hybrid treatment of arch aortic disease.

Methods

Retrospective study of procedures performed from January 2010 to December 2012. The end points were the technical success, therapeutic success, morbidity and mortality, neurologic outcomes, the rate of endoleaks and reinterventions.

Results

A total of 95 patients treated for thoracic aortic diseases in this period, 18 underwent hybrid treatment and entered in this study. The average ages were 62.3 years. The male was present in 66.7%. The technical and therapeutic success was 94.5% e 83.3%. The perioperative mortality rate of 11.1%. There is any death during one-year follow- up. The reoperation rates were 16.6% due 2 cases of endoleak Ia and one case of endoleak II. There is any occlusion of anatomic or extra anatomic bypass during follow up.

Conclusion

In our study, the hybrid treatment of aortic arch disease proved to be a feasible alternative of conventional surgery. The therapeutic success rates and re- interventions obtained demonstrate the necessity of thorough clinical follow-up of these patients in a long time.