Successful exclusion of subclavian aneurysms with covered nitinol stents

Two cases of percutaneous endoluminal exclusion of a subclavian aneurysm with a Dacron-coated nitinol stent are presented. One subclavian aneurysm followed trauma; the other was due to thoracic outlet stenosis which was caused by a cervical rib. In both patients the aneurysm was excluded successfully. The follow-up periods were 22 and 14 months, respectively. Stenoses at the stent graft occurred in both patients; one was treated by balloon angioplasty. In selected patients, endoluminal grafting could be an alternative to surgery; however, stent graft designs need to be improved and long-term follow-up is awaited.     

Covered exstrophy with incomplete duplication of the bladder

A rare exstrophy variant in a 1½-year-old girl is reported. The child had a wide, scar-like lesion over the lower central abdomen with divarication of the recti and a spread symphysis pubis. The underlying bladder was divided into two unequal chambers by a complete sagittal septum with only the right chamber communicating with the single urethra and the left draining by a vesicocutaneous fistula. Both kidneys were normal. The clitoris was bifid and the anus anteriorly placed. Preliminary surgical management consisted of dissection of the bladder from its prevesical covering, excision of the sagittal septum, and cystocystostomy. Postoperatively, the child had normal urinary continence. The literature is reviewed with special reference to the various forms of duplicate exstrophy.     

国产被覆自膨式金属内支架治疗恶性食管狭窄及食管-气管瘘

目的：评价国产被覆自膨式金属内支架治疗恶性食管狭窄及食管－气管瘘的效果和适用性。方法：利用DSA高清晰度X线电视造影、定位和监视释放。经口在0．038inch Amplatz直头导丝引导下，对食管癌引起的恶性狭窄12例置入单喇叭型；对癌性食管-气管瘘12例置入双喇叭型国产被覆自膨式金属内支架，随访3－10个月。结果：24个内支架一次性植入成功，患者可即刻吞食水，不再呛咳。结论：国产支架操作简单、 成功率高、安全、效果立竿见影，价值低廉能为众多患者接受。     

外伤性颈动脉海绵窦瘘血管内治疗及其并发症防治

目的探讨外伤性颈动脉海绵窦瘘(TCCF)血管内治疗的临床疗效、并发症产生的原因及防治措施。方法 2009年1月至2011年3月收治37例TCCF患者,单纯应用可脱球囊栓塞治疗31例,带膜支架植入治疗5例,1例未治疗自动出院。结果 36例患者全部血管内治疗成功,31例闭塞瘘口并保持颈内动脉通畅,5例行可脱球囊闭塞瘘口同时永久闭塞患侧颈内动脉;术中出现颈内动脉痉挛3例,术后脑缺血1例,高灌注3例,颈内动脉狭窄1例,均经对症治疗后均痊愈;2例术后第3天、第6天复发,再次行可脱球囊闭塞瘘口治愈。本组无手术死亡。术后随访2～6个月,均无瘘口再通,患者均恢复良好。结论单纯可脱球囊栓塞治疗TCCF效果良好,在可脱球囊治疗困难时,选用带膜支架植入治疗也是一个良好的选择;在降低血压情况下颈内动脉闭塞试验是评价能否可闭塞颈内动脉的金标准。预防并发症发生、处理好术后并发症可进一步提高治愈率。     

Remembering Dr. Jim Gillespie as a world adventurer, master surgeon, and invaluable mentor

Introduction

Polytetrafluoroethylene (PTFE)-covered transjugular intrahepatic portosystemic shunt (TIPS) stents purportedly provide superior patency. This study was undertaken to determine whether covered stents provide better long-term patency and outcomes after TIPSs.

Methods

Patients with portal hypertension undergoing TIPS at a large teaching hospital from 2001 to 2010 were studied. Median data are presented.

Results

Two hundred forty-six patients underwent TIPS; 70 received uncovered stents, and 176 received covered stents. Patients who received uncovered stents had more severely impaired liver function (41% were Child class C cirrhotics). The follow-up was longer with uncovered stents (48 vs 24 months, P < .01). Reinterventions for stenosis were undertaken in 33% with uncovered stents versus 19% with covered stents (P = .01). Shunt dysfunction occurred in 57% with uncovered stents versus 21% covered (P = .05). A deterioration of hepatic function occurred in 31% with uncovered stents versus 30% with covered (P = .32). Survival with uncovered stents was 31 months versus 33 months with covered stents (P = .55, Kaplan-Meier).

Conclusions

Covered stents may improve patency but do not mitigate postshunt hepatic dysfunction and do not improve survival.     

应用覆膜支架治疗恶性梗阻性黄疸

目的探讨应用覆膜支架治疗恶性梗阻性黄疸的安全性及防止胆道支架再狭窄的效果。方法对30例应用FLUENCY覆膜支架治疗的恶性梗阻性黄疸患者的技术成功率、安全性及预后进行随访分析。结果接受FLUENCY覆膜支架治疗的30例患者,技术成功29例,成功率为96.7%。2例患者术后出现胆道出血,经药物治疗后出血停止;5例患者术后出现不同程度的胆系感染。2例患者失访,28例患者接受3～18个月随访,其中出现支架再狭窄的有2例,为肿瘤向支架两端生长所致;1例患者术后3周支架脱落入肠管;3例减黄效果不佳(肝门区病变),出现反复胆系感染;1例患者术后支架成角闭塞,再次置入裸支架。结论 FLUENCY覆膜支架针对非肝门区恶性梗阻性黄疸的治疗是安全可靠的,可防止肿瘤向支架网眼内生长,提高支架远期通畅率。     

腔内隔绝术治疗成人巨大动脉导管未闭

目的 总结12 例腔内隔绝术治疗成人巨大动脉导管未闭的经验,评估其疗效.方法 回顾性分析2009 年4 月至2012 年10 月上海远大心胸医院12 例成人巨大动脉导管未闭行腔内隔绝术的临床资料,其中男性5 例,女性7 例,年龄18～56(34.2±13.5)岁.动脉导管肺动脉侧直径(19.2±4.5)mm,肺动脉收缩压(92.4±5.8)mm Hg,使用支架直径(34.8±3.0)mm.术后随访(17.8±10.5)个月.结果 术后造影显示11 例动脉导管完全封闭,1 例术中预留5 mm 残余分流.随访显示11 例动脉导管完全封闭,肺动脉压明显下降,1 例残余分流为双向分流.术后症状明显缓解.结论 腔内隔绝术治疗成人巨大动脉导管未闭近期疗效满意,是一种安全有效的方法.     

外伤性颈内动脉海绵窦瘘血管内个体化治疗145例疗效分析

目的：分析外伤性颈内动脉海绵窦瘘几种常见的血管内治疗方法,探讨其最安全有效的个性化治疗方案。方法：对145例外伤性颈内动脉海绵窦瘘进行回顾性分析,其中103例行可脱性球囊栓塞,5例行可脱落球囊结合弹簧圈栓塞,4例行可脱性球囊结合Onyx胶栓塞,1例行可脱性球囊结合覆膜支架栓塞,10例行弹簧圈栓塞,4例行弹簧圈结合Onyx胶栓塞,6例行Onyx胶栓塞,4例行覆膜支架置入,8例行颈内动脉闭塞。对各种治疗方法及结果进行总结和分析。结果：颈内动脉保持通畅137例（94．5％）,眼部并发症1例（0．7％）,颈内动脉狭窄1例（0．7％）,神经系统并发症2例（1．4％）,无相关手术死亡病例,随访3个月-3年,复发5例（3．4％）。结论：个体化的介入方案是治疗外伤性颈内动脉海绵窦瘘的理想方法,可脱性球囊是首选,可脱性球囊结合其他栓塞材料及单独使用其他栓塞材料是有效的补充,闭塞颈内动脉应是最后的选择。     

覆膜支架治疗创伤性颈内动脉假性动脉瘤

目的探讨用覆膜支架治疗创伤性颈内动脉假性动脉瘤的临床效果。方法覆膜支架治疗5例创伤性颈内动脉假性动脉瘤,并于3个月后对2例患者进行DSA复查。结果5例病人均获得良好治疗效果,动脉瘤不显影,载瘤动脉通畅,无并发症发生。结论血管内覆膜支架治疗创伤性颈内动脉假性动脉瘤是一种有效的治疗方法。