[Establishment and Validation of an Animal Model of Abdominal Aortic Aneurysm in Beagles Through Vascular Patch Angioplasty and Elastase Infusion]. / äººå·¥è¡€ç®¡è¡¥ç‰‡æˆå½¢ç»“åˆå¼¹åŠ›è›‹ç™½é ¶çŒæ³¨æ³•æž„å»ºæ¯”æ ¼çŠ¬è ¹ä¸»åŠ¨è„‰ç˜¤åŠ¨ç‰©æ¨¡åž‹åŠå»ºæ¨¡æ•ˆæžœéªŒè¯.

Objective: To evaluate the effect of an abdominal aortic aneurysm (AAA) animal model established in beagles by way of vascular patch angioplasty combined with elastase infusion. Methods: A total of 60 beagle dogs were included in this study. Among them, 10 beagles were assigned to a control group to obtain normal abdominal aortic wall tissue, while the other 50 underwent vascular patch angioplasty combined with elastase infusion in order to establish the AAA disease model. In order to evaluate the outcome of modeling, abdominal vascular ultrasonography was performed 14 days after the modeling surgery was performed and ultrasound and computed tomographic angiography (CTA) were performed 28 days after the modeling surgery. The criterion for evaluating modeling success is that the maximum diameter of the abdominal aortic aneurysm is 50% greater than the diameter of the normal abdominal aorta below the renal artery. A total of 20 beagles of the modelling group and 5 control beagles were sacrificed 35 days after the modeling surgery and infrarenal abdominal aortic wall tissues were harvested. Then, hematoxylin and eosin (H&E) staining, Masson's trichrome staining, and elastic van Gieson (EVG) staining were conducted to observe the pathology features of abdominal aortic wall tissues. Results: A total of 50 beagles underwent the AAA modeling procedures, with the average operative and anesthesia time being (119.4±18.9) and (137.4±15.8) minutes, respectively, the average blood loss volume being (43.6±7.7) mL, the average abdominal aorta block time being (39.7±5.3) minutes during the modeling surgery, and the average abdominal aorta diameter measured during the surgery being (6.5±0.4) mm. Intraoperative mortality was 0%. Mortality within 30 days after the surgery was 2% (1 out of the 50 beagles). Postoperative ultrasound and CTA results revealed that the success rate of AAA modeling was 100%. Pathology examination suggested that the animal model rather successfully simulated the pathophysiologic changes associated with human AAA in regard to the morphological and pathological changes. Conclusion: Vascular patch angioplasty combined with elastase infusion can be used to successfully establish AAA model in beagles. The AAA modeling method described in our report demonstrates stability and reliability in aneurysm formation effect and the surgical procedures are easy to replicate. The method integrates the advantages of previous animal modeling methods and can be used to study the pathogenesis of AAA.

Endovascular and Surgical Management of Intact Splenic Artery Aneurysm.

OBJECTIVE: This study aims to reveal the experience with endovascular and surgical management of intact splenic artery aneurysms in our single center. METHOD: Between January 2011 and June 2017, 42 patients with intact splenic artery aneurysm were enrolled in this study. Twenty patients undergoing surgical intervention were classified as the surgical group, and 22 patients who received endovascular repair were categorized as the endovascular group. Demographic data, preoperative comorbidities, and anatomical characteristics of aneurysms were collected and analyzed. Details of interventions, perioperative outcomes, and follow-up results were evaluated and compared between the 2 groups. RESULTS: Forty-two patients with a mean age of 53.4 ± 11.6 years were enrolled in this study, and 44 aneurysms were repaired. Thirty-nine (92.9%) patients were asymptomatic, and 3 (7.1%) patients were symptomatic. The diameter of splenic artery aneurysms was 3.3 ± 1.6 cm, and the shape was mostly saccular. In the surgical group, the common methods used were splenic artery aneurysm resection (9 patients), followed by splenic artery aneurysms resection and splenectomy (6 patients), splenic artery aneurysm resection and arterial reconstruction with end-to-end anastomosis (3 patients), and laparoscopic splenic artery aneurysm resection coexisting with splenectomy (2 patients). In the endovascular group, the exclusive means was embolization with coils. The technical success rates in both open repair and endovascular repair were 100%. The 30-day mortality was nil, and no severe complication was found in the early time except that 1 patient suffered multiple splenic abscess in the endovascular group after embolization. Endovascular repair had significantly shorter surgery time (82.5 ± 27.6 vs 191.9 ± 62.7 min, P < 0.001) and hospital stay (5.6 ± 3.1 vs 10.8 ± 5.2 days, P < 0.001) compared with open repair. The median follow-up period in this study was 34.5 (interquartile range 16.8-60.8) months. Two sac reperfusions were detected during the follow-up in the endovascular group, and patients needed new embolization. No late deaths were found in the follow-up period, and the freedom from reintervention in the endovascular group at 1 and 3 years postoperatively was 95.5% and 82.4%, respectively. In addition, the freedom from reintervention in the surgical group at both 1 year and 3 years postoperatively were 100%. No significant differences were observed in late survival and reintervention between open repair and endovascular repair. CONCLUSIONS: Open repair and endovascular repair were equally feasible, safe, and effective for intact splenic artery aneurysm. Endovascular repair is less invasive accompanied with an obvious decrease in surgery time and rapid recovery with a short hospital time.

Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair.

OBJECTIVE: This study evaluated the clinical influence of distal entry tears in acute type B aortic dissection (ATBAD) after thoracic endovascular aortic repair (TEVAR). METHODS: From August 2009 to December 2014, the clinical outcomes of 130 patients who underwent TEVAR for ATBAD were retrospectively analyzed. According to whether distal entry tears existed after TEVAR, patients were divided into group A (n = 25, absence of distal entry tears) and group B (n = 105, presence of distal entry tears). We evaluated clinical outcomes, including mortality and morbidity in early and late follow-up, as well as aortic remolding. Late aortic events were defined as aortic dissection-related events occurring >30 days from the initial TEVAR procedures, which consisted of endoleak, retrograde type A aortic dissection, aortic enlargement, late rupture, repeat dissection, and stent-induced new entry tear. RESULTS: The study comprised 130 patients (114 men [87.7%] and 16 women [12.3%)] with a mean age of 53.71 years. The 30-day mortality was 3.1%, and early morbidity included type I endoleak, 3.1%, organ failure, 3.8%; stroke, 3.1%; spinal cord ischemia, 0%; and early rupture 1.5%. The overall survival rate by Kaplan-Meier analysis at 1, 3, and 5 years was 93.8%, 89.5%, and 79.2%, respectively. There were no significant differences in early morbidity and 30-day mortality and late survival between group A and group B. However, group A had a significantly lower rate of late aortic events than group B (P = .028 by log-rank test). Meanwhile, group A had better aortic remolding than group B in complete thrombosis of the thoracic aorta at 12 months postoperatively (100% vs 83.5%; P = .029). CONCLUSIONS: This study demonstrated that TEVAR for ATBAD had low perioperative morbidity and mortality and satisfactory midterm outcome. Distal entry tears increase the occurrence of late aortic events and inhibit aortic remolding but do not have a significantly negative effect on late survival. Repairing all entry tears to restore single-lumen blood flow and enhance false lumen thrombosis might benefit selected patients.

Long-term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm.

BACKGROUND: This study aimed to evaluate the feasibility and efficacy of endovascular treatment for mycotic abdominal aortic aneurysm (AAA) with long-term follow-up time period. METHODS: Patients with mycotic AAA treated with endovascular aortic repair between January 2009 and December 2017 were included in this study. The preoperative and long-term outcomes during follow-up were reviewed and analysed. RESULTS: Sixteen patients (12 males and four females with a mean age of 57.6 ± 14.1 years) were included in this study. The technical success rate was 100%. There were no preoperative mortalities, and one instance of deep venous thrombosis during hospitalization was recorded. The median follow-up time period was 41.2 (interquartile range 24.8-69.7) months, and the late mortality rate was 12.5%. Three (18.8%) patients presented with reinfection during follow-up. One patient presented with abdominal abscess and recurrent juxtarenal aortic aneurysm at 40 months post-operatively, and he received hybrid surgery and abdominal debridement and drainage. One patient developed staphylococcal bloodstream sepsis at 3 months post-operatively and the other patient developed Salmonella bloodstream sepsis at 9 months post-operatively. Pathogenic bacteria were consistent with the previous results. They both recovered after 2 months of intravenous antibiotic treatment. At present, all three patients are still alive without endograft infection and receiving outpatient follow-up. The aneurysm diameter decreased by more than 5 mm among five patients and remained stable in 10 patients at 1 year post-operatively. CONCLUSION: Endovascular aortic repair is a feasible and effective method of treating mycotic AAA with an acceptable reinfection rate from our single-centre experience.