The endovascular repair of aortic dissection: early clinical results of 178 cases
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.
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ABSTRACT: Type B dissection has traditionally been managed medically if uncomplicated and surgically if associated with complications. This practice has resulted in most centers reporting significant morbidity and mortality if open repair is required. In the setting of malperfusion, operative repair has been conjoined with fenestration or visceral stenting to improve outcomes. Endovascular stent grafts seem to offer an attractive alternative in the acute complicated type B dissection, with reduced mortality and morbidity, particularly paralysis, compared with open repair. It is reasonable to consider endovascular stent grafts as another tool in managing dissection, but to recognize that open surgical repair still plays an important role, and that the data that define indications and outcomes are still emerging.
Available from: David B Enfield
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ABSTRACT: This paper uses the NCAR Community Atmospheric Model to show the influence of Atlantic warm pool (AWP) variability on the summer climate and Atlantic hurricane activity. The model runs show that the climate response to the AWP's heating extends beyond the AWP region to other regions such as the eastern North Pacific. Both the sea level pressure and precipitation display a significant response of low (high) pressure and increased (decreased) rainfall to an anomalously large (small) AWP, in areas with two centers located in the western tropical North Atlantic and in the eastern North Pacific. The rainfall response suggests that an anomalously large (small) AWP suppresses (enhances) the midsummer drought, a phenomenon with a diminution in rainfall during July and August in the region around Central America. In response to the pressure changes, the easterly Caribbean low-level jet is weakened (strengthened), as is its westward moisture transport. An anomalously large (small) AWP weakens (strengthens) the southerly Great Plains low-level jet, which results in reduced (enhanced) northward moisture transport from the Gulf of Mexico to the United States east of the Rocky Mountains and thus decreases (increases) the summer rainfall over the central United States, in agreement with observations. An anomalously large (small) AWP also reduces (enhances) the tropospheric vertical wind shear in the main hurricane development region and increases (decreases) the moist static instability of the troposphere, both of which favor (disfavor) the intensification of tropical storms into major hurricanes. Since the climate response to the North Atlantic SST anomalies is primarily forced at low latitudes, this study implies that reduced (enhanced) rainfall over North America and increased (decreased) hurricane activity due to the warm (cool) phase of the Atlantic multidecadal oscillation may be partly due to the AWP-induced changes of the northward moisture transport and the vertical wind shear and moist static instability associated with more frequent large (small) summer warm pools.
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