Objective To introduce the experience of treating 85 cases of stanford type B aortic dissection by endovascular implantment of stent-grafts，to provide more clinical evidence for endovascular repairment for stanford B type aortic dissections.Methods Imaging examination by computed tomography angiography （CTA） were done to obtain anatomical detail of dissection. Stent-grafts were implanted under the guide of DSA in all cases. The patients were followed-up for 3 months，6 months，12 months，and then annually by CTA examination to observe the complications and morphological changes of the aneurysm.Results The technical success rate was 95.3%（81/85），and the clinical success rate was 91.8%（78/85）. Eight patients died after operation in hospital，who were all in acute phase，and no patients of chronic phase died，there had statistic differences （P＜0.05）. The perioperative complications’ incidence of endovascular repair which happened in patients of acute phase was higher than that patients of chronic phase （38.2% vs.13.3%，P＜0.05）. Left subclavian artery were covered completely for 13 cases，and partially covered for 22 cases，there was no obvious cerebralvascular insufficiency. There were 41 patients of whom other tears which were not covered during operation exsited at abdominal aortic and one year following-up showed that at those section thromblization of false cavity was not clear. The rest of patients whose abdominal aortic didn’t exist tears hadn’t new tears appeared.Conclusions Regardless in the acute or chronic stage，endovascular therapy is an effective mathod of treating stanford type B dissection. However，implanting stent-grafts have a higher security in chronic period than doing that in acute period. If the right carotid artery，vertebra and Willis ring are smoothly，there is little need to set up a by-pass to left subclavian artery before endovascular repairment. For those patients that other uncovered tears exited，following-up should be a must，and further strategy should be studied and prepared in advance.
Objective
To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak.
Methods
Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary.
Results
Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement.
Conclusion
The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.
Objective To find out the follow-up results of early in-stent restenosis (ISRS) and develop effective way to improve clinical treatment and precaution of restenosis. Methods The data from a registry of 51 consecutive patients who underwent elective carotid artery angioplasty and stenting （CAS） at our institution between Jan. 2003 and Sept. 2005 were retrospectively reviewed. Complete data for 37 of these patients were available. All patients underwent duplex ultrasound scanning in follow-up period, which was used to determine the degree of restenosis. Results CAS was performed in 37 patients， 8.1% (3/37) were women. Mean age was (70.5±5.9) years. Mean time of follow-up was (12.2±7.7) months. Sixteen (43.2%) caces of ISRS （gt;30%） were found by color duplex ultrasound scanning， but only 1 (2.7%) ISRS was found gt;50%; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS （P=0.037, P=0.016）. Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.
ObjectiveTo investigate the value of different minimally invasive surgical techniques, stent placement, laparoscopic surgery, and sustained-releasing 5-fluorouracil, in solving intestinal obstruction due to colorectal cancer. MethodsFrom May 2000 to May 2010, total 68 patients with obstructed colorectal cancers in three centers were treated in two ways in terms of the stage: The first, patients with resectable tumors underwent colorectal stent placement as a ‘bridge to surgery’ guided by enteroscope under X-ray. After clinical decompression and bowel preparation, laparoscopic radical resection was performed. The second, patients with unresectable tumors underwent rectal stent placement just for palliation. Sustained-releasing 5-fluorouracil was implanted into the local cancerous intestinal tract through stent walls. ResultsFifty-one of 52 patients underwent laparoscopic radical resection successfully following stent placement, while one failed and died during follow-up 93 d postoperatively. Forty patients with successful laparoscopic surgery were followed up in 3 to 36 months (with an average of 15 months) without tumor planting in the incision, postoperative local recurrence or anastomotic stricture. Fifteen unresectable patients and one high-risk, intolerable patient underwent rectal stent placement and implantation of sustained-releasing 5fluorouracil. During follow-up 3 to 24 months (with an average of 14 months), 11 died, who survived for (350±222) d (range 101-720 d), and 5 were still alive for 3 to 13 months (with an average of 9 months) without intestinal obstruction. ConclusionsLaparoscopic surgery combined with stent placement is an effective and safe procedure for resectable obstructed colorectal cancer. For unresectal obstructed rectal cancer, rectal stent placement combined with sustained-releasing 5-fluorouracil can prolong survival time avoiding colostomy.
Abstract: Objective To examine the cell viability and hemodynamic functions of the stented homograft valves preserved in liquid nitrogen. Methods Cell viability of the stented homograft valve preserved in liquid nitrogen after 3 months of preservation (experimental group，n=6) was examined using flow cytometer. Fresh homografts served as control group (n=6). We prepared three sorts of stented homograft valve(21#, 23#, 25#) preserved by liquid nitrogen. In vitro pulsatile flow tests were performed on valves of two groups. Effective opening area EOA),transvalve pressure gradient and regurgitation ratio were recorded at various flow volume, and compare with Perfect bioprosthetic valve. Results The results revealed that the death ratio of endothelial cell was 10.24%±1.71% in the experimental group, and 9.09%±2.72% in the control group (P=0.441). The death ratio of smooth muscle cell was 8.76%±1.82% in the experimental group, and 7.84%±0.59% (P=0.178) in the control group. The death ratio of total cell was 8.79%±1.44% in the experimental group, and 7.40%±0.49% in the control group (P=0.072). There were no significantly differences between two groups. The transvalve pressure gradient of two groups of valve depended on the flow volume, and increased with the flow volume increasing. The transvalve pressure gradient of the stented homograft valve was higher than that of Perfect valve. Regurgitation ratio of the stented homograft valve was bigger than Perfect valve’s. EOA had an increasing character when flow volume increased. EOA of the stented homograft valve was smaller than that of Perfect valve’s. Conclusion Liquid nitrogen can offer the benefit of cell viability of the stented homograft bioprosthetic valves. The stented homograft valve has salisfactory hemodynamic functions.
Objective To identify the short ( lt;30 days) and intermediate ( 30 days to 6 months) benefits and risks of tracheobronchial stents in patients with malignant airway stenosis. Methods 55 cases with malignant airway disease who underwent tracheobronchial stents placement from January 2006 to May 2008 were followed up for 6 months. The efficacy rate, complication rate, reintervention rate, and survival were analyzed. Results There were 61 self-expanding metal stents placed in 55 patients with malignant disease, with no intraoperative mortality. The immediate efficacy rate was 100% , the short-term( lt;30 days) efficacy rate was 94. 5% , and the survival rate in 6 months was 32. 7% . The complications included tumor ingrowth, excessive granulation tissue, stent migration, and restenosis. A total of 14 cases of complicationswere observed, in which two occurred during the short-term period ( lt; 30 days ) and the remaining complications occurred after 30 days. Conclusions Tracheobronchial stents can improve symptoms immediately for the patients with unresectable malignant central airway obstruction with fairly safety. The benefit of airway stents is particularly seen in the short-termperiod and the complications occur mainly after 30 days.
Objective To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction of rectal cancer. Methods Twenty-one patients with acute and chronic rectal obstructions from malignant causes underwent stent placement. After rectal stent was slenderized in ice water, it was inserted into the strictured rectum by hand or sigmoidoscope. Nitinol mesh stent were deployed in hot water. Results Eighteen patients who had underwent rectal stent placement achieved clinical decompression within 5 hours. Colostomy underwent in 3 patients due to stent failure. Eighteen patients with stent were followed-up, 14 cases died in 56-720 days and 4 other cases were still alive without intestinal obstruction in 2-15 months. Conclusion Nitinol mesh stent may be useful in the management of terminal or high-risk surgical patients for palliative purposes shuning colostomy. Palliation of stent combined with chemotherapy and immunotherapy can be performed to improve survival.
Objective To evaluate the cl inical effect of percutaneous transluminal angioplasty (PTA) and PTA and stenting (PTAS) in treating multilevel arteriosclerosis obl iterans (ASO) of lower extremities. Methods Between January 2007 and October 2009, 29 cases of multilevel ASO of lower extremities were treated with PTA or PTAS. There were 17 males and 12females with an average age of 71 years (range, 56-83 years). The cl inical manifestations were l imbs numb with cold sensation, intermittent claudication (lt; 100 m), and 19 patients had rest pain. According to Fontaine stages classification, there were 7 cases of stage II, 14 cases of stage III, and 8 cases of stage IV. Concomitant diseases included hyperl ipidemia in 13 cases, diabetes in 6 cases, hypertension in 12 cases, chronic heart failure in 5 cases, chronic obstructive pulmonary disease in 3 cases, cerebral infarction in 5 cases, and toe ulcer in 15 cases. The preoperative ankle/brachial index (ABI) was 0.28 ± 0.13. Results In 3 cases of below knee lesions for the guide wire puncturing through the artery wall, 1 case gave up, and 2 cases continued recanal ized other arteries without serious bleeding compl ications. After operation, cerebral infarction occurred in 1 case, pulmonary infection in 2 cases, and groin puncture site hematoma in 2 cases. All patients were followed up 3 to 36 months. Limb skin temperature was significantly improved, and intermittent claudication disappeared or claudication distance lengthened, rest pain disappeared or significantly reduced in 27 patients (30 l imbs). The wound of amputee achieved good heal ing in 2 cases (2 l imbs). In 27 patients undergoing endovascular treatment, the postoperative ABI was 0.72 ± 0.19, showing significant difference when compared with the preoperative one (P lt; 0.05). Conclusion The PTA and PTAS treatment for multilevel ASO of lower extremities is a safe and effective option, and the short-term effect is good. Different treatments should be chosen according to the location and length of vascular occlusion.
Objective To summarize the progress of endoscopic diagnosis and therapy for pancreatic cancer. Methods Domestic and international publications online involving progress of diagnosis and therapy for pancreatic cancer by using endoscope in recent years were collected and reviewed. Results Recently, early diagnostic rate of pancreatic cancer increased with the development of endoscope and endoscopic technique such as endoscopic ultrasound, endoscopic ultrasound-guided fine needle aspiration, peroral pancreatoscopy, optical coherence tomography, ERCP, and cytology in pancreatic juice. Furthermore, varied therapies such as endoscopic ultrasound guided celiac plexus neurolysis, implantation of iodine 125-particles or pancreatic duct/bile duct stents were performed by endoscope for advanced pancreatic cancer. Conclusion Early diagnostic rate and novel therapeutic alternative of pancreatic cancer are supplied by digestive endoscopy.
Objective To discuss the clinical effect and value of stent placement combined with mechanical aspiration thrombectomy for acute iliofemoral venous thrombosis with iliac vein occlusion. Methods From October 2004 to December 2011， interventional treatment were performed in 273 patients with acute iliofemoral venous thrombosis and iliac vein occlusion， including left side of 235 cases and right side of 38 cases. Antegrade femoral vein under local anesthesia， an 8-14F catheter was inserted into iliofemoral vein with the guidance of guide wire to aspirate thrombus directly， 53 patients used 18-24F large lumen sheath to aspirate thrombus. As for the femoralpopliteal vein thrombus， a “cross sheath” was inserted to affected iliac vein with the help of guide wire capture technique， a guide wire was introd-uced to popliteal vein， then a Fogarty balloon catheter was inserted and extracted thrombus to iliac vein， mechanical aspiration thrombectomy was performed again. After iliofemoral vein thrombus were removed completely， percutaneous transluminal angioplasty （PTA） and stenting were performed for stenosis or occlusion displayed by venography. Results Thrombus removal were completely cleared （degreeⅢ） in 219 cases （80.22%）， partly cleared （degreeⅡ） in 49 cases （17.95%）， and minimal cleared （degreeⅠ） in 5 cases （1.83%）. The effect of stent placement：were cured in 235 cases （86.08%）， excellent in 29 cases （10.62%）， mild in 2 cases （2.57%）， and invalid in 7 cases （0.73%）. Total effective rate was 99.27% （271/273）， the average days in hospital was 7.5 days. Tumescence and pain of affected limb disappeared or relieved after interventional therapy for 1-2 days. The followe up effect：3-6 months， 7-12 months， 13-24 months， and 25-36 months after treatment of iliac vein patency were 94.87%，93.73%，87.08%，and 84.13% respectively. Conclusion Mechanical aspiration thrombectomy combined with stent placement for acute lower extremity deep venous thrombosis and iliac vein obstruction is an effective and safe treatment for its notable therapeutic effect and the short hospitalization time.
