A Multicenter Study of the Mid-term Outcomes of Patients with Uncomplicated Type B Aortic Dissection After Distal Porous Talos Stent-Graft Implantation.

BACKGROUND: The Talos stent-graft has extended length to improve aortic remodeling, and distal porous design to decrease the rate of spinal cord ischemia (SCI). This study retrospectively analyzed its mid-term outcomes for uncomplicated type B aortic dissection in a multicenter study. METHODS: The primary safety end point was 30-day major adverse events, including all-cause mortality, dissection-related mortality, conversion to open surgery, and device-related adverse events. The primary efficacy end point was treatment success at 12 months postoperation, defined as no technical failure or secondary dissection-related reintervention. The survival status of the patients was visualized using the Kaplan-Meier curve. Aortic growth was assessed at 4 levels, and SCI was evaluated at 12 months. RESULTS: 113 patients participated with a mean age of 54.4 (11.1) years and 71.7% (81/113) were male. The 30-day mortality was 0.9% (1/113), no conversions to open surgery or device-related adverse events were recorded. The 12-month treatment success rate was 99.1% (112/113), with no dissection-related reinterventions. There was no spinal cord or visceral ischemia at 12 months. At a median of 34 months follow-up, 9 further deaths were recorded and the 3-year survival rate was 91.7%. The percentage of aortic growth was 1.8% (2/111) at the tracheal bifurcation, 3.6% (4/111) below the left atrium, 6.0% (5/83) above the celiac artery, and 12.1% (9/74) below the lower renal artery. The total thrombosis rate of the false lumen at the stented segment was 80.5% (91/113). CONCLUSIONS: The results showed satisfactory results of Talos stent-graft in terms of safety and efficacy. More data are needed to confirm the long-term performance.

Safety and efficacy of thoracic endovascular aortic repair for acute Stanford type B aortic dissection with retrograde type A intramural hematoma.

OBJECTIVE: The aim of this study was to evaluate safety and efficacy of thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with retrograde type A intramural hematoma (TAIMH). METHODS: Patients with acute TBAD with retrograde TAIMH treated with TEVAR between January 1, 2014, to March 31, 2022, were retrospectively reviewed. Aortic diameter and distance were measured using the 3D Slicer image computing platform. Patients' characteristics, procedural, in-hospital and follow-up data, and aortic remodeling were analyzed. RESULTS: Fifty-two patients (average age, 52.6 years; 42 males [80.8%]) were included. The median interval from symptom onset to TEVAR was 11 days (interquartile range, 7.0-16.8 days). The maximal diameter of the ascending aorta (AA) was <50 mm, and the hematoma thickness in the AA was ≤10 mm in all patients. Both the in-hospital and 30-day mortality rates were 0%. The 30-day complication rate was 11.5%. The overall cumulative survival rates were 100% at 1 year, 97.1% at 3 years, and 92.6% at 5 years. Four of 52 patients (7.7%) developed retrograde type A aortic dissection at 10 days to 4 months postoperatively, and one of 52 patients (1.9%) developed an isolated AA dissection 4 months postoperatively; these five patients were treated and alive at late follow-up in March 2022. The rates of cumulative freedom from thoracic aortic re-intervention were 93.7% at 1 year and 90.7% at 5 years. Positive AA remodeling was observed in 92.3% (48/52) of patients during follow-up. The maximal diameter of AA (mean ± standard error of mean) at admission was 42.7 ± 0.8 mm, which decreased to 39.5 ± 0.9 mm at last follow-up. The maximal AA hematoma thickness at admission was 7.6 ± 0.3 mm, which reduced to 2.2 ± 0.9 mm at last follow-up. CONCLUSIONS: For selected patients of acute Stanford TBAD with retrograde TAIMH, endovascular repair may be a safe, effective, and durable alternative treatment, if the maximum diameter of the AA is <50 mm and the intramural hematoma thickness in the AA is ≤10 mm.

Comparative Effectiveness of Treatment Modalities for Complex Aortic Aneurysms: A Network Meta-Analysis of Observational Studies.

BACKGROUND: To conduct a network meta-analysis comparing multiple treatments for complex aortic aneurysms (CAAs). METHODS: Medical databases were searched on November 11, 2022. Twenty-five studies (5,149 patients) and four treatments (open surgery [OS], chimney/snorkel endovascular aneurysm repair [CEVAR], fenestrated endovascular aneurysm repair [FEVAR], and branched endovascular aneurysm repair) were selected. Outcomes were branch vessel patency, mortality, and reintervention at short- and long-term followup, and perioperative complications. RESULTS: Regarding branch vessel patency, OS was the most effective treatment and had higher 24-month branch vessel patency rates than CEVAR (odds ratio [OR], 10.77; 95% confidence interval [CI], 2.08-55.79). FEVAR (OR, 0.52; 95% CI, 0.27-1.00) and OS (OR, 0.39; 95% CI, 0.17-0.93) were better than CEVAR regarding 30-day mortality and 24-month mortality, respectively. Regarding 24-month reintervention, OS was better than CEVAR (OR, 3.07; 95% CI, 1.15-8.18) and FEVAR (OR, 2.48; 95% CI, 1.08-5.73). Regarding perioperative complications, FEVAR had lower acute renal failure rates than OS (OR, 0.42; 95% CI, 0.27-0.66) and CEVAR (OR, 0.47; 95% CI, 0.25-0.92) and lower myocardial infarction rates than OS (OR, 0.49; 95% CI, 0.25-0.97) and was the most effective treatment in preventing acute renal failure, myocardial infarction, bowel ischemia, and stroke, while OS was the most effective treatment in preventing spinal cord ischemia. CONCLUSIONS: OS might have advantages regarding branch vessel patency, 24-month mortality, and reintervention and is similar to FEVAR regarding 30-day mortality. Regarding perioperative complications, FEVAR might confer advantages in preventing acute renal failure, myocardial infarction, bowel ischemia, and stroke, and OS in preventing spinal cord ischemia.

Endovascular repair combined with adjunctive procedures in the treatment of tuberculous infected native aortic aneurysms.

OBJECTIVE: The present study aimed to analyze the experience of a single center and assess the efficacy and durability of endovascular aortic repair (EVAR) in patients with tuberculous infected native aortic aneurysms (INAAs). METHODS: All patients who underwent EVAR for INAAs between September 2014 and August 2021 were reviewed retrospectively. The primary end points were 30-day and overall mortality rates; the secondary outcomes included major complications, endoleak, recurrence, reintervention rate, and thrombosis of the pseudoaneurysmal sac. RESULTS: A total of 18 patients (average age, 61.3 years; 10 female [55.6%]) were identified. Fifteen patients (83.3%) had adjunctive procedures. Both the in-hospital and 30-day mortality rates were 0%. The overall cumulative survival rates estimated by Kaplan-Meier were 100% at 1 and 6 months, and 92.3% at 12 and 24 months, and 80.8% at 36 and 48 months. Type Ib and II endoleaks each occurred in 1 patient (5.6%) and resolved without treatment after 1 month. No graft infections, strokes, paraplegia, ischemic abdominal complications, or other major complications occurred. The overall rates of cumulative freedom from recurrence of aneurysm and reintervention were 83.9% and 81.8%, respectively, during the median follow-up period of 28.5 months (range, 1-72 months). The median time of administering antituberculosis drugs was 10.5 months (range, 2-44 months). CONCLUSIONS: EVAR combined with oral antituberculosis medication is effective and may be an appealing treatment option for patients with high-risk INAAs. Adjunctive procedures, including targeted drug delivery to the site of infection, could be a solution to further controlling the infection, but still needs further evaluation.

60.4 W continuous-wave single-frequency laser output from a two-stage Nd:YAG single-crystal fiber amplifier.

A Nd:YAG single-crystal fiber amplifier for the amplification of continuous-wave single-frequency laser end-pumped by a laser diode (LD) is investigated. With a two-stage amplification configuration, an output power of 60.4 W under the total incident pump power of 200 W is achieved, which is, to our knowledge, the highest power from a continuous-wave single-frequency laser achieved with a single-crystal fiber scheme. The extraction efficiency reaches 41.6% in the second amplification stage, which is comparable with Innoslab amplifiers. The beam quality factors M2 at the maximum output power in the horizontal and vertical direction are measured to be 1.51 and 1.38, respectively. The long-term power instability for 1 hour is 0.97%.

Early Results of a Novel Gutter-Free Chimney Stent-Graft System to Treat Aortic Arch Dissection: Single-Center Data from a Prospective Clinical Trial.

AIMS: Discuss the clinical value, technique characteristics, and early follow-up results of a newly designed gutter-free chimney stent-graft system for aortic arch pathology. METHODS AND RESULTS: About 13 patients with aortic arch dissection were enrolled in a clinical trial testing a novel gutter-free stent-graft between February 2019 and December 2020. All 13 patients were male, age 52.6±10.4 years. The implantation time was 14.0±6.9 minutes; total procedure time was 89.5±19.8 minutes. The volume of contrast was 79.6±7.2 ml. And 15 aortic stent-grafts were implanted, and all 13 patients had chimney branch stent-grafts implanted into the left subclavian artery (LSA). There were 3 (23.1%) cases of immediate type Ιa endoleak after thoracic endovascular aortic repair (TEVAR), and 7.7% type Ιa endoleaks occurred in delayed fashion. Survival at 2 years was 100%, and the 2-year patency of chimney stent-grafts was 100%. CONCLUSIONS: This study reports early success with good freedom from endoleak using a novel stent-graft designed for chimney TEVAR to treat aortic arch dissection. Postoperative survival and patency of the branch stent-grafts were excellent. Additional data from this multicenter clinical trial will be forthcoming.

Similar Midterm Clinical Outcomes and Aortic Remodeling in Bifurcated and Straight Aortic Stent Grafts Used to Treat Isolated Abdominal Aortic Dissection.

PURPOSE: The optimal treatment for isolated abdominal aortic dissection (IAAD) is currently unknown. We compared the effects of straight and bifurcated aortic stent grafts on postoperative aortic remodeling in patients with IAAD. MATERIALS AND METHODS: From February 2012 to December 2019, 57 patients with IAAD were treated using endovascular methods, including either a bifurcated or a straight aortic stent graft. The clinical features, risk factors, computed tomography angiograms, midterm follow-up results, and aortic remodeling of these patients were reviewed and analyzed. RESULTS: In total, 44 (77%) patients were treated with a bifurcated graft and 13 (23%) patients were treated with a straight graft. Patients treated with straight grafts had fewer common iliac arteries involved (38% vs 73%, p=0.023), the dissection length was shorter (76.3 ± 40.0 vs 116.2 ± 56.7 mm, p=0.011), and the preoperative aortic diameter (26.0 ± 5.6 vs 35.2 ± 12.1 mm) and the false lumen diameter (13.1 ± 5.2 vs 21.2 ± 11.3 mm) were smaller. During the procedure, there were 3 (5.3%) type I endoleaks, 1 (1.8%) surgical conversion and 1 (1.8%) partial renal artery coverage without perioperative mortality. Patients with straight grafts had shorter operative time (96.5 ± 24.4 vs 144.2 ± 49.0 minutes, p<0.0001). The median follow-up duration was 37.6 ± 21.0 (range = 3-89) months with 1 (1.8%) aortic-related death. Type A aortic dissection occurred in 1 (1.8%) patient. New descending aortic dissection occurred in 3 (5.3%) patients, and 1 patient advanced to type A aortic dissection 3 months later. Two (3.5%) patients had limb occlusion. There was no significant difference in aortic remodeling, survival, and freedom from all adverse events between the 2 treatment strategies. CONCLUSIONS: Endovascular treatment provides a safe, minimally invasive treatment for IAAD in midterm follow-up. Compression of the true lumen at the aortic bifurcation is the main concern after treatment with a bifurcated graft. Straight grafts are an excellent alternative for some patients, with the benefit of reduced procedural time, effective aortic remodeling, and excellent clinical prognosis. More experience is needed to offer clear recommendations for making treatment decisions as well as determine long-term effectiveness and durability.

Surface charge transition nano-theranostics based on ultra-small Fe3O4 nanoparticles for enhanced photodynamic and photothermal therapy against nasopharyngeal carcinoma.

Platinum-based concurrent chemo-radiotherapy is the most common strategy for the treatment of Nasopharyngeal carcinoma. However, low efficacy and side effects are the two major problems associated with this approach. Therefore, it is urgent need to explore novel therapeutic modalities to meet clinically standards. Photothermal therapy (PTT) and photodynamic therapy (PDT) are non-invasive and light trigger modalities received great attention to overcome the limitations and significantly improved cancer therapy. Here, we developed acidity surface charge transformable nanocluster (NCs) composed of Indocyanine green (ICG), Fe3O4, and Palmitoyl ascorbic acid (PA) with pH-responsive PEG-b-PAEMA-PDMA for enhanced synergistic PDT/PTT. NCs has the neutral hydrophilic surface helps to prolong blood circulation and instantly transformed to positively charged surface at tumoral acidic pH (6.5), which promoted the cellular uptake. Under laser irradiation (808 nm, 1 W/cm2), NCs produced PTT effect, concurrently it converts singlet oxygen (1O2) into H2O2, which can be further involved in Fenton reaction and produce toxic hydroxyl radical (•OH) enhances therapy efficacy. In vitro experiments on HNE-1 cancer cells showed improved intracellular uptake of NCs at low pH and simultaneously induced higher cytotoxicity medicated by synergetic PDT/PTT effect. In vivo therapeutic study revealed that NCs treatment under laser irradiation showed superior inhibition of tumor growth in HNE-1 tumor bearing mice model. Taken together, the present findings suggest that NCs could be used as "all in one" nano theranostic agent for enhanced PDT/PTT of cancer therapy.

Midterm Results of Retrograde In Situ Needle Fenestration During Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies.

PURPOSE: To evaluate the safety and feasibility of the in situ needle fenestration (ISNF) technique for reconstruction of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) of complicated aortic arch pathologies. MATERIALS AND METHODS: A retrospective review was conducted from January 2014 to December 2019 of 50 patients (mean age 60.2±11.1; 45 men) who underwent ISNF to revascularize the LSA during TEVAR. Twenty-one of the patients also required revascularization of the left common carotid artery (LCCA; n=19) and innominate artery (IA; n=2) using physician-modified in vitro fenestration. Overall, 73 supra-aortic branches were targeted for revascularization. RESULTS: ISNF was successful in 48 patients (96%); one LSA could not be stented and a tortuous LSA prevented the needle from fenestrating the graft. No perioperative major adverse event occurred. There were no type I and 4 type III endoleaks (8%), 3 of which occurred among the first 20 cases. Types II and IV endoleaks were found in 3 (6%) and 6 (12%) cases, respectively; all disappeared during a median follow-up of 15 months (range 3-66). One death (2%) occurred within 12 months due to cerebral hemorrhage. Two patients (4%) required open reinterventions at 6 and 62 months. CONCLUSION: ISNF for revascularization of the LSA during TEVAR seems to be feasible with acceptable midterm outcomes. The learning curve and evolving patient selection criteria affected technical success, complications, and the need for reinterventions. Long-term durability requires further evaluation.

Morphological Features of Aortic Arch Predicting the Risk for Acute Type B Aortic Dissection.

BACKGROUND: The purpose of the study is to elucidate the changes in aortic morphological parameters and identify the specific geometric risk factors associated with aTBAD. METHODS: A total of 167 patients in aTBAD group and 196 subjects in control group were enrolled in the study. The aortic morphological data were retrospectively analyzed by 3mensio Vascular software. The aortic morphological parameters include diameter, length, angulation, tortuosity and the type of aortic arch. Multivariable logistic regression models were developed to identify the significant predictors associated with the angulation, tortuosity and aortic arch type. The predictive capacity of the models was evaluated through the receiver operating characteristic (ROC) curve analysis. RESULTS: The diameters in the ascending aorta and aortic arch and the lengths in the ascending aorta and total aorta were significantly greater in aTBAD group. Besides, the angulation of the ascending aorta and aortic arch in aTBAD group increased significantly. The tortuosity of aortic arch and total aorta was significantly higher in aTBAD group. The prevalence of type III arch in aTBAD group was significantly higher than that in the controls. Multivariable models demonstrated that aortic arch angulation, tortuosity and type III arch were independent geometric predictors of aTBAD occurrence. Based on the ROC analysis, AUC of the risk prediction models was 0.977, 0.958 and 0.945, respectively. CONCLUSIONS: Besides the enlargement of the ascending aorta and aortic arch, incremental aortic arch angulation, tortuosity and type III arch configuration are valuable geometric risk factors that could enhance aTBAD incidence.

Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases.

OBJECTIVES: To characterize the clinical features, treatment, and prognosis of superior mesenteric artery aneurysms and provide evidence for clinical decision-making. METHODS: We retrospectively reviewed the diagnosis and treatment of 18 cases of superior mesenteric artery aneurysm admitted to our center from 2003 to 2020, including demographic data, risk factors, clinical manifestations, diagnosis, treatment strategies, and follow-up results. RESULTS: The average age of the patients was 49.1 years, and males accounted 83.3%. The development of the disease was associated with infection, hypertension, pancreatitis, and trauma, but no significant associations with atherosclerosis were noted by our results. Nine patients were diagnosed with true aneurysm, seven patients with pseudoaneurysm, and two patients with dissecting aneurysm. Rupture of aneurysm occurred in three patients (16.7%), and one of them died before surgery. The surgery success rate was 94.1%, and open surgery was performed on nine patients, endovascular surgery on three patients, and conservative treatment on three patients. The follow-up rate was 77.8% (14/18), and the average follow-up time was 48.2 months. The mortality and reintervention rate during follow-up was 0. The two-year patency rate of artificial vessels and covered stents was 50%. CONCLUSION: The clinical manifestations and features of superior mesenteric artery aneurysms vary between patients. Careful evaluation of vascular anatomy and personalized treatment strategy are critical in the management of superior mesenteric artery aneurysms. Midterm follow-up results of superior mesenteric artery aneurysms are satisfactory.

TAT peptide-modified cisplatin-loaded iron oxide nanoparticles for reversing cisplatin-resistant nasopharyngeal carcinoma.

As chemo-radiotherapy continues to increase the lifespan of patients with nasopharyngeal carcinoma (NPC), adverse reaction and drug resistance remain two major problems when using cisplatin (CDDP). In this study, we took the lead in designing a dual-mechanism anti-cancer system modified with cell-penetrating peptide on the surface of superparamagnetic iron oxide nanoparticles (SPION) to enhance CDDP delivery efficacy to NPC cells, especially CDDP resistant NPC cells. The combinatorial delivery of CDDP and iron oxide nanoparticles showed an unexpected effect on reversal of CDDP resistance due to the Fenton reaction with an average decrease in the half maximal inhibitory concentration (IC 50) of 85% and 94% in HNE-1/DDP and CNE-2/DDP resistant cells respectively compared to CDDP alone. On this basis, modification with TAT peptide (YGRKKRRQRRR) significantly improved tumor intracellular uptake, devoting to better curative effects and minimized side effects by reducing CDDP therapeutic doses. Furthermore, we specifically labelled CDDP with fluorescence for detection of intracellular nanoparticles uptake and mechanism research through drug tracing. This novel compound provides a promising therapy for reducing chemotherapy side effects and reversing CDDP-resistant nasopharyngeal carcinoma.

First experience with the double chimney technique in the treatment of aortic arch diseases.

OBJECTIVE: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases. METHODS: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia. All patients were observed after TEVAR with computed tomography scans at 2 weeks, at 3 and 6 months, and annually thereafter. RESULTS: In all patients, aortic arch lesions were covered, and supra-aortic branches were patent without morbidity. In 22 patients, the innominate artery (IA) and left common carotid artery were reconstructed with the proximal landing zone in zone 0; in 1 patient, the left common carotid artery and left subclavian artery were reconstructed. During the procedure, there were three (13.0%) type I endoleaks. Chimney stent graft migration occurred in one (4.3%) patient perioperatively; compression of a chimney stent graft occurred in one (4.3%) patient 4 days after TEVAR. There were no type II endoleaks or perioperative mortality. Median follow-up was 28.0 ± 19.8 (range, 3-84) months, with no TEVAR-related deaths. Partial compression of the chimney stent graft in the IA occurred at 3 months after TEVAR in one (4.3%) patient; three patients had persistent but asymptomatic type I endoleaks. CONCLUSIONS: TEVAR using a double chimney technique to reconstruct the supra-aortic branches provides a safe and minimally invasive alternative procedure associated with low postoperative mortality. The main perioperative complications include type I endoleak and compression of the chimney stent grafts in the IA. More experience with long-term results is needed to evaluate the effectiveness and durability of this advanced endovascular procedure.

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies.

PURPOSE: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. METHODS: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. RESULTS: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. CONCLUSION: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.

[Mid- and long-term result of celiac artery coverage in TEVAR treatment for aortic dissection].

OBJECTIVE: To observe the mid- and long-term result of intentional coverage of celiac artery in thoracic endovascular aortic repair (TEVAR) surgery for aortic dissection.
 Methods: We retrospectively analyzed 21 cases who received TEVAR with celiac artery coverage during the operation. The existence of collaterals between celiac artery (CA) and superior mesenteric artery (SMA) was confirmed by preoperative CT angiography (CTA) or digital substract angiography (DSA) for each patient. We used the stent-graft precisely above the orifice of SMA. Follow-ups were carried out at 2 weeks, 1 month, 3 months, 6 months, 1 year after the operation, and once per year thereafter.
 Results: No signs of visceral artery ischemic syptoms such as liver dysfunction, abdominal pain or distention were observed after the operation. There was no signs of spinal cord ischemia (SCI). Seven cases showed type II endoleak upon completion DSA but stopped automatically within 3 months. CTA in follow-ups showed thrombosis formation in false lumen.
 Conclusion: The intentional coverage of CA during the TEVAR for aortic dissection is safe and effective. The incidence of post-operative SCI or visceral artery ischemia is low. Type II endoleak is a major complication but it can be ceased automatically after medication.

Endovascular aortic repair combined with chimney technique in the treatment of stanford type B aortic dissection involving aortic arch.

BACKGROUND: In this study, we sought to explore the efficacy of endovascular aortic repair combined with the chimney technique in the treatment of Stanford type B aortic dissection involving the aortic arch. METHODS: Between June 2009 and June 2012, 41 consecutive patients were treated with chimney technique at our institute for aortic arch dissection with the primary entry tear adjacent to the orifices of the supra-aortic arteries. The chimney technique was used to reconstruct the left subclavian artery (n = 5) and the left common carotid artery (n = 34). Additionally, in 2 cases, the double chimney technique was used to simultaneously reconstruct the innominate artery and the left common carotid artery. RESULTS: Eight of the 41 patients had undergone emergent surgery. All the patients survived the surgery, and the mean follow-up period was 17.3 ± 6.1 months. None of the patients had type I endoleak. Four patients had type II endoleak, and 3 of them underwent implantation of the patent ductus arteriosus occluder in the left subclavian artery. Among these 3 patients, one patient who was pregnant with Marfan syndrome and pregnancy-induced hypertension required additional medication for recovery. None of the patients had any severe neurological complications, left ischemia of the subclavian artery, migration of the stent graft, or occlusion of the stent grafts. CONCLUSIONS: Thus, endovascular aortic repair combined with the chimney technique appears to be a feasible, safe, and effective treatment option for the management of Stanford type B aortic dissection involving the aortic arch.

[Operation experience of atypical ruptured abdominal aortic aneurysm].

OBJECTIVE: To evaluate and report surgical management and experience of atypical ruptured abdominal aortic aneurysm (RAAA). METHODS: Clinical data of 52 RAAA patients from May 2002 to February 2015 were retrospectively collected and analyzed. Thirty-three cases were included into this study based on atypical clinical presentation and etiology, including 6 infected RAAA, 5 inflammatory RAAA, 1 traumatic aortic rupture, 6 tuberculotic RAAA, 2 aoritc-vena cava fistula, 3 intestinal fistula and 5 spine erosion cases. Two of them refused operation during preparation, 19 of them received emergency open repair and 13 of them received endovascular aortic repair (EVAR) with 1 case converted to open surgery. RESULTS: The systolic blood pressure of atypical RAAA before operation was (88±16) mmHg (1 mmHg=0.133 kPa), duration time from admission to diagnosis making was (17±10) hours. Perioperative death occurred in 1 patient because of hemorrhagic shock induced acidosis. During follow-up for 3 to 72 months, no operation related complications occured, such as artificial graft infection. CONCLUSIONS: Emergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and comprehensive perioperative management are measures conducive to reduce the mortality rate of RAAA.

Comparative effectiveness of endovascular treatment modalities for de novo femoropopliteal lesions at long-term follow-up: A network meta-analysis of randomized controlled trials.

PURPOSE: To evaluate the best endovascular treatment for de novo femoropopliteal lesions at long-term follow-up through network meta-analysis of randomized controlled trials. METHODS: Medical databases were searched on September 17, 2023. 17 trials and 7 treatments were selected. Outcomes were primary patency, target lesion revascularization (TLR), major amputation and all-cause mortality at 3 and/or 5 years. RESULTS: Regarding 3-year primary patency, drug-eluting stents (DES) was the best and better than balloon angioplasty (BA; odds ratio [OR], 4.96; 95% confidence interval [CI], 2.68-9.18), bare metal stents (BMS; OR, 2.81; 95% CI, 1.45-5.46), cryoplasty (OR, 6.75; 95% CI, 2.76-16.50), covered stents (CS; OR, 3.25; 95% CI, 1.19-8.87) and drug-coated balloons (DCB; OR, 2.04; 95% CI, 1.14-3.63). Regarding 5-year primary patency, DES was the best and better than BMS (OR, 2.34; 95% CI, 1.10-4.99). Regarding 3-year TLR, DES was the best and better than BA (OR, 0.24; 95% CI, 0.13-0.44). Regarding 5-year TLR, DES was the best and better than BA (OR, 0.20; 95% CI, 0.09-0.42) and balloon angioplasty with brachytherapy (OR, 0.21; 95% CI, 0.06-0.74). Regarding 3- and 5-year major amputation, DCB was the best. Regarding 3-year mortality, DES was the best and better than CS (OR, 0.09; 95% CI, 0.01-0.67). CONCLUSIONS: DES was the best treatment regarding 3-year primary patency, TLR and mortality, and DCB was the best regarding major amputation. DES was the best treatment regarding 5-year TLR, and DCB was the best regarding primary patency and major amputation. DES and DCB should be given priority in treating femoropopliteal lesions.