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The feasibility study of transjugular extrahepatic portacaval shunt

Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.

Analysis of the Treatment for Acute Stanford Type A Aortic Dissection in Primary Hospital

目的探討急性Stanford A型主動脈夾層的臨床特點、基層醫院救治策略及圍術期常見并發癥的處理措施。 方法回顧性分析遂寧市中心醫院2010年2月至2013年9月16例采用三分支主動脈支撐型覆膜支架重建弓部手術治療的Stanford A型主動脈夾層患者的臨床資料，其中男12例、女4例，馬凡綜合征1例，原發性高血壓病15例。分析其臨床特點、影像學表現及治療效果。 結果16例患者手術均成功。本組體外循環時間（202.2±50.4）min，升主動脈阻斷時間（94.6±16.9）min，深低溫停循環時間（11.5±7.4）min，選擇性腦灌注時間（40.6±6.8）min，術后胸腔及心包積液引流量（700.6±368.6）ml，重癥監護室停留時間3～26 d。住院期間死亡1例，于術后28 d突發遠端夾層破裂死亡。術后發生慢性心臟壓塞導致胸骨哆開1例，10例出現一過性精神障礙，5例并發急性腎功能不全，4例出現急性呼吸功能不全，3例出現急性肝功能不全。術后隨訪15例，門診及電話隨訪6～49個月；2例于術后1年隨訪中因其他慢性疾病死亡；其余13例均存活。 結論基層醫院采用三分支主動脈支撐型覆膜支架重建弓部手術治療急性Stanford A型主動脈夾層，簡化了手術方式，針對圍術期并發癥采取有效的治療措施可顯著提高患者生存率。

主動脈覆膜支架腔內隔絕術治療成人巨大動脈導管未閉

目的總結主動脈覆膜支架腔內隔絕術治療成人巨大動脈導管未閉（ PDA）的經驗，并對其療效進行評價。方法回顧性分析 2010年 9月至 2011年 8月青海省心腦血管病專科醫院 8例 PDA患者行主動脈覆膜支架腔內隔絕術治療的臨床資料，其中男 5例，女 3例；年齡（30.4±9.3）歲。主動脈造影顯示 PDA最窄內徑為（21.0±3.0）mm；肺動脈收縮壓（ 76.6±9.4）mm Hg。結果 8例患者中 7例一次性隔絕成功。術后即刻血管造影顯示 6例動脈導管完全封閉， 2例殘余少量左向右分流。術后 2周超聲心動圖及大血管 CT血管造影顯示：殘余分流消失，肺動脈收縮壓（ 43.5±7.2）mm Hg，顯著降低。術后左心室舒張期末內徑較術前明顯減小［（52.0±5.2） mm vs.（69.0±11.1）mm］。隨訪 8例，隨訪時間 1～ 11（7.2±1.1）個月，隨訪期間胸部 X線示：肺血明顯減少，心胸比率明顯減小。結論應用主動脈覆膜支架腔內隔絕術治療成人巨大 PDA是一種安全、有效的方法。

三分支覆膜支架行主動脈弓重建治療 Stanford A 型主動脈夾層效果的臨床隨訪

目的通過長期隨訪采用三分支覆膜支架重建主動脈弓治療 Stanford A 型主動脈夾層患者的臨床治療效果，評價三分支覆膜支架行主動脈弓重建的安全性和可行性。方法納入 2009 年 3 月至 2014 年 6 月我院心臟大血管外科應用三分支覆膜支架治療的 Stanford A 型主動脈夾層患者 17 例，其中男 11 例、女 6 例，年齡 35～72 歲。觀察其臨床療效及并發癥發生率以及術后 CT 隨訪結果。結果三分支主動脈弓覆膜支架治療組患者隨訪期間死亡 1 例。術后不同隨訪時間 64 排 CT 血管造影結果顯示支架血管位置滿意，支架打開完全，無扭曲及內漏發生。主動脈各分支血管血流通暢，無狹窄及閉塞。3 個月后隨訪觀察到有 8 例假腔血栓形成閉塞，6 個月后隨訪觀察到所有患者假腔全部血栓閉塞。3 年后隨訪觀察到支架穩定，未發生支架扭曲、變形或者斷裂情況，假腔消失。結論三分支覆膜支架重建主動脈弓治療 A 型主動脈夾層臨床效果可靠，值得推廣應用。

胸腹主動脈瘤Ⅳ型行外科及腔內微創術圍手術期護理

【摘要】　目的　總結對胸腹主動脈瘤IV型行血管外科和腔內微創術治療患者的護理要點及經驗。　方法　2007年11月-2008年1月對收治的1例胸腹主動脈瘤IV型行血管外科和腔內微創術患者，術前做好心理護理，控制血壓，完善術前相關檢查等；術后做好生命體征的監測、預防術后吻合口出血、支架移位、內漏、腸壞死、腎功能衰竭等并發癥發生的各項護理工作。　結果　患者無并發癥發生，痊愈出院，治療和護理效果滿意。　結論　圍手術期實施正確恰當的護理是保證手術和治療效果的關鍵。

Intracavitary isolation in the treatment of Stanford type A aortic dissection

ObjectiveTo explore the effect of using a stent graft to treat a Stanford type A aortic dissection with the ascending aorta in the cavity.MethodA retrospective review was made of the clinical data of a patient with Stanford type A aortic dissection admitted to Zhangye People’s Hospital Affiliated to Hexi University in December 2016.ResultsAfter the patient underwent general anesthesia aortic dissection and stent graft treatment, the dissection fracture completely disappeared. After 2 years of follow-up, the patient’s pseudocavity hematoma was completely absorbed. The operative time was 30 min and the blood loss was about 5 mL. There were no complications such as avulsion of dissection, internal leakage, cerebral infarction, myocardial infarction, nervous system, and other complications occurred.ConclusionFor Stanford type A aortic dissection with a tear located in the ascending aorta, intracavitary treatment with coated stent is feasible for ascending aortic dissection with good vascular conditions and tear location through accurate preoperative assessment.

Analysis of covered endovascular reconstruction of aortic bifurcation technique for aortoiliac disease

ObjectiveTo analyze the main points and advantages of covered endovascular reconstruction of aortic bifurcation (CERAB) technique in the treatment of complex aortic and iliac artery lesions. MethodThe data of the patient with bilateral common iliac artery stenosis and lower abdominal aortic calcification treated by CERAB technology in the Department of Vascular Surgery of West China Hospital of Sichuan University and the technology in combination with the characteristics of balloon-expandable covered stent were analyzed. ResultsThe lesions were successfully treated by CERAB technique. The stents of bilateral iliac arteries were in perfect shape and good adherence. The radiography of the abdominal aorta and bilateral internal and external iliac arteries were well displayed. ConclusionsFrom analysis results of this case, CERAB technology is effective and feasible in treatment of lesions at the bifurcation of the main aortic and iliac artery. The shape of aortic bifurcation is satisfactorily recovered. The key point for the successful implementation of this technology is balloon-expandable covered stent.

The Treatment of Traumatic Carotid Cavernous Fistula with Covered Stent

目的：探討覆膜支架治療外傷性頸內動脈海綿竇瘺（TCCF）的臨床治療經驗。方法：11例TCCF經血管內介入治療，1例外傷性頸內動脈海綿竇瘺患者復發，壓迫頸總動脈無效，行球囊閉塞頸內動脈及瘺口。結果：術后雜音立即消失，數天后結膜水腫消退，造影見瘺口完全閉塞，10例TCCF患者頸內動脈保持通暢。1例患者頸內動脈閉塞。無操作所產生的并發癥出現。結論：覆膜支架是處理TCCF的有效手段；瘺口再通可能與支架移位、貼壁不良有關。壓迫頸總動脈對再通瘺口的治療無效。

Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

ObjectiveTo evaluate clinical outcomes of thoracic endovascular aortic repair (TEVAR)for the treatment of Stanford type B aortic dissection (AD)and descending aortic aneurysm. MethodsClinical data of 20 patients with Stanford type B AD or descending aortic aneurysm who underwent TEVAR in West China Hospital from March to June 2013 were retrospectively analyzed. There were 19 male and 1 female patients with their age of 41-76 (58.3±10.2)years. Clinical outcomes were analyzed. ResultsAmong the 20 patients, 18 patients were successfully discharged, 1 patient refused further postoperative treatment and was discharged, and 1 patient died postoperatively. Sixteen patients (88.9%)were followed up for over 3 months. In all the patients during follow-up, true lumen diameter recovered within the scope of intravascular stents, and there was thrombosis in false lumen or aneurysm lumen. ConclusionTEVAR provides a new choice with significant advantages for the treatment of Stanford type B AD, especially for the elderly and patients with concomitant serious diseases, so it is worthy of clinical application.

創傷性主動脈夾層并發腎功能衰竭一例