[Endovascular treatment of a rare type of aortic arch aneurysm derived from the fourth aortic arch].

OBJECTIVE: To report a rare type of aortic arch aneurysm. METHODS: Three cases of aortic arch aneurysm derived from the fourth aortic arch were retrospectively analyzed. The pathogenesis and treatment of this type of aortic arch aneurysm were investigated. RESULTS: Most of the aneurysm body was located in the Z2 zone, which was the stem from the fourth aortic arch in the embryonic development period. All of the 3 cases could not be explained by common etiology. We speculated that the cause might be developmental anomaly of the fourth aortic arch. All the 3 aortic arch aneurysms were totally excluded with a covered stent. The technical success rate was 100%. Endoleak of type I was seen in one case, which was resolved in a later open surgery. During the follow-up, no type of complications was found. CONCLUSION: To the best of our knowledge, this is the first report of this type of aortic arch aneurysm. The cause may be developmental anomaly of the fourth aortic arch. Endovascular treatment of this type of aortic arch aneurysm is feasible.

[Management of prosthetic graft infection after lower limb arterial bypasses].

OBJECTIVE: To summarize the experience in management of prosthetic graft infection (PGI) after lower limb arterial bypasses and investigate optimal measures for prevention and treatment. METHODS: Records of 15 cases of PGI between January 2004 and December 2009 were retrospectively analyzed, including 14 male and 1 female with the average age of 64.8 years (ranged from 40 to 84 years). PGI occurred from 5 d to 59 months (average 6.4 months) after the last reconstructive procedures with symptoms as follow: nonhealing wound with vascular graft exposure in 8 cases, persistent sinus related to vascular graft with purulent secretion in 5 cases and without secretion in 1 case, and ill-incorporated graft with peri-graft fluid in 1 case. Broad-spectrum antibiotics were administrated in all PGI cases. Surgical treatments included local debridement and drainage in 4 cases (one death from postoperative acute myocardial infarction), local debridement and skin flap rotation in one case, complete removal of the occluded infected grafts in 8 cases including major amputation in 3 cases, removal of patent infected graft and extra-anatomic bypass with silver-bonded Dacron vascular graft in 1 case, and partial removal of patent infected graft without reconstruction in 1 case with a re-canalized stent-graft. RESULTS: Limb salvage was achieved in 9 cases, and 4 cases received major amputation. One case was failed to follow-up and one died of postoperative acute myocardial infarction. Initially 13 patients were followed and 2 died during follow-up (because of colon carcinoma and intracranial hemorrhage respectively). Eleven patients were followed for 1 to 70 months (average 22.3 months) including 8 cases with limb salvage and 3 with major amputation. Accumulative mortality rate, amputation rate, and graft occlusion rate were 20% (3/15), 26.7% (4/15), and 53.3% (8/15) respectively. CONCLUSIONS: PGI after lower limb arterial bypasses is a devastating complication with high risk of graft occlusion and amputation. Removal of the infected grafts may be mandatory for most cases, but local management for patent infected grafts may be recommendable for selected cases.

[Single-stage replacement of total aorta for type I dissection with renal failure].

OBJECTIVE: To investigate the feasibility of one-stage replacement of total aorta for patient with renal failure. METHODS: The patient was male, 43 years old. The type I aortic dissection was secondary to type III aortic dissection 4 months after endovascular treatment of descending aorta using stented graft 1 year ago. All important branches from aorta were irrigated by false lumen of dissection except left renal artery. The patient has been dialyzed because of renal failure before 5 months with low platelets. Single-stage replacement of total aorta from ascending aorta to iliac artery was successful under deep hypothermia and cardiopulmonary bypass. The operation lasted 12 h. Blood loss during operation was 9000 ml and infusion of blood and blood plasma 7300 ml (including 1500 ml of blood retrieval) and blood platelet 800 ml. RESULTS: Autonomic activity of four limbs was recovered 2 d after operation, and mind recovered 4 d after surgery. The intubation of trachea was extracted 1 week after operation. Re-check through CT showed all vascular prostheses and reconstructed visceral arteries and intercostal arteries were patent though no recovery of renal function. CONCLUSION: One-stage replacement of total aorta for patient with renal failure is feasible.

[Balloon dilation alone in treatment of arteriosclerotic stenosis or occlusions of femoropopliteal arteries].

OBJECTIVE: To evaluate the use and efficacy of balloon dilation in arteriosclerotic stenosis or occlusions of femoropopliteal arteries. METHODS: Thirty patients (27 men, 3 women, age from 44 to 78 years, mean 70) with arteriosclerotic stenosis or occlusion of femoropopliteal arteries received balloon dilation. Thirty-one balloons, which included 3 common balloons, 16 cutting balloons, 10 "deep" balloons and 2 small balloons, were used. Follow-up surveillance featured periodic physical examination and duplex scanning. RESULTS: In all 30 patients, the technique success was reached only with 6 minor dissections. Angiography after dilation showed that the treated vessels were all patent with a < 20% stenosis remaining in any given lesions. After treatment and over a follow-up of 1 to 17 months (mean 6 months), the symptoms were relieved and all treated vessels were patent except 1 patient (3.3%) who had a gangrene foot and received limb amputation. CONCLUSION: Balloon dilation has a comparative ratio of one-stage success and short-term patency. Some special balloons seem to have a promising future in the management of femoropopliteal arterial arteriosclerotic lesions.