[The endovascular repair of aortic dissection: early clinical results of 178 cases].
ABSTRACT To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection.
From June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation.
10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later.
The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.
- Asian cardiovascular & thoracic annals 09/2007; 15(4):275-7. DOI:10.1177/021849230701500401
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ABSTRACT: Endovascular repair by stent graft has been developed as a safe and less-invasive treatment for descending thoracic and abdominal aortic diseases. In case of involvement of the aortic arch, the challenge in endovascular repair is to maintain blood flow to the brain and upper extremities. Several studies have been done trying to repair this difficult part of the aorta with different stent grafts, and we have developed a new stent-graft device for aortic arch reconstitution. We implanted the new device in canine models to test its feasibility. The new stent graft was composed of three components: parts I and II were both bifurcated, one with long, narrow limb and the other short and wide, and part III was a tubular component. Ten adult hybrid dogs were operated with the new stent-graft procedure, and eight were successfully implanted with the stent grafts. The technical success rate was 80% (8 of 10). Five dogs survived for 3 months without obvious cerebral, visceral or limb ischaemia. Autopsies showed that the implanted stent grafts were patent and the vital side branches of aortic arch were well preserved. Our study demonstrates that it is possible to reconstruct aortic arch with the new branched stent grafts. The advantage of this device is that it is modular, more adaptable and surgical bypass could be possibly avoided.European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 04/2009; 37(5):560-5. DOI:10.1016/j.ejvs.2009.01.017 · 3.07 Impact Factor
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ABSTRACT: The objective of this study was to summarise data about endovascular stent-graft placement for patients with type B aortic dissection (type B-AD) in China. All published series in Chinese on endovascular stent-graft placement for type B-AD from 1999 through 2008 were identified. Thirty-five studies, involving a total of 1498 patients, were included in this review. Procedure success was reported in 89.4+/-1.7% of the patients. Overall complications were reported in 16.6+/-1.2% of the patients. Major complications were reported in 1.7+/-0.2%, with neurological complications in 0.5+/-0.1%. In-hospital mortality was 2.0+/-0.4%. The mean follow-up was 24.0+/-16.1 months. Endovascular stent-graft placement is technically feasible with high procedure success and relatively low complication rate in selected patient groups with type B-AD. Both short- and mid-term outcomes appear to be favourable.European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 04/2009; 37(6):646-53. DOI:10.1016/j.ejvs.2009.02.010 · 3.07 Impact Factor