Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery / 华中科技大学学报（医学）（英德文版）

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery / 华中科技大学学报（医学）（英德文版）

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

Endovascular aneurysm repair in high-surgical-risk abdominal aortic aneurysm patients: initial and long-term results / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients.</p><p><b>METHODS</b>From July 1997 to July 2011, 120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry. There were 96 male and 24 female patients, aged from 52 to 95 years with a mean of 74 years. Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3, 6, 9, 12 months, and annually thereafter. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement.</p><p><b>RESULTS</b>Mean aneurysm diameter was (57 ± 8) mm. Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five type I endoleaks, twenty-five type II endoleaks and one type III endoleak occurred during the perioperative period. The technical success rate was 95%. Operative mortality was 2.5%. The survival rates at 1-, 3- and 5-year were 92%, 75% and 43% respectively. The mean follow up was (36 ± 3) months. Primary and secondary patency rates at 3 year were respectively 97% and 100%. Secondary intervention rate was 10% (12/120) at 5 year. The reasons included endoleaks for 7 patients, stent-grafts fracture for 2 patients, stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients.</p><p><b>CONCLUSIONS</b>Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.</p>

Surgical treatment of peripheral arterial aneurysms: a report of 35 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment strategies of peripheral arterial aneurysms.</p><p><b>METHODS</b>Thirty-five cases were reviewed from July 1998 to December 2007, and 28 cases were male, 7 cases were female. Eleven cases were popliteal artery aneurysms, 15 cases were femoral artery aneurysms, 4 cases were extracranial carotid aneurysms and 5 cases were subclavian artery aneurysms. All cases had either open procedures or endovascular procedures.</p><p><b>RESULTS</b>Surgical open procedures were performed on 24 cases, and endovascular procedures were performed on 11 cases. The perioperative complication rate were 16.7% (4/24) and 0% for open and endovascular groups respectively. The average follow-up time was 41 months (7 months to 8 years). The accumulative five year patency were 61% and 48% for surgical grafts and stent grafts respectively. Two cases died of diseases and one had stroke during follow-up.</p><p><b>CONCLUSIONS</b>Surgical open repair is still standard procedure for most peripheral arterial aneurysms and endovascular repair may have its own advantage for high risk patients.</p>

Endovascular repair: alternative treatment of ruptured abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As an alternative to open aneurysm repair, endovascular aortic repair (EVAR) has been applied to ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.</p><p><b>METHODS</b>From July 1997 to September 2007, 20 men and six women with rAAA (median age, 68 years) were treated with EVAR. Most patients with suspected rAAA underwent emergency computed tomographic angiography (CTA). The procedure was performed under general or local anesthesia. Endovascular clamping was attempted in hemodynamically unstable patients. Bifurcated endografts and aorto-uni-iliac (AUI) endografts with crossover bypass were used. Patients had CT scan prior to discharge, 3, 6, 12 months after discharge, and annually thereafter.</p><p><b>RESULTS</b>Time between diagnosis and EVAR ranged from 1 hour to 5 days. EVAR was performed under general anesthesia in 21 patients, and under local anesthesia in five patients. Endovascular aortic clamping was performed in four patients. There was no conversion to open surgery during EVAR. Stent-graft insertion was successful in all patients. One patient died during EVAR from acute myocardial infarction. Ten patients had systolic blood pressure < 80 mm Hg. Eleven patients received a blood transfusion. Mean aneurysm size was (47 +/- 12) mm. Mean ICU stay was (8 +/- 3) days, mean hospital stay (18+/- 6) days, and mean procedure time (120 +/- 32) minutes. The 30-day mortality was 23% (6/26 patients), and major morbidity 35% (9/26 patients). Early endoleak occurred in 8/26 patients (31%). The mean follow-up was (18 +/- 7) months. No patient demonstrated migration of the stent-graft.</p><p><b>CONCLUSIONS</b>EVAR is a safe and effective option for treatment of acute rAAA, independent of the patient's general condition. Immediate and mid-term outcomes are favorable, but long-term outcome is unknown. Multi-center studies are necessary to establish the role of EVAR for rAAA.</p>

Ligation and resection of the inferior vena cava during surgical removal of the retroperitoneal tumors involving the inferior vena cava: feasibility and safety assessment / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the feasibility and safety of excising or patching the inferior vena cava (IVC) without replacement in patients with primary retroperitoneal tumors (PRPT) involving the IVC.</p><p><b>METHODS</b>A retrospective analysis was conducted in 116 consecutive patients with PRPT presented to our Hospital between December 2007 and December 2008. IVC involvement was found in 11.2% of the cases, and in 93 cases receiving surgical tumor removal, the complete resection rate was 93.55%. According to the location of IVC involvement by the PRPT, the cases were classified into 3 groups with IVC involvement in the segment from the second hepatic portal vein to the renal vein (segment A), the segment on the bilateral renal vein plane (segment B), and the segment from the caval bifurcation to the renal vein (segment C).</p><p><b>RESULTS</b>The most common vascular involvement occurred in segment C (61.54%, 8/13), and 2 cases presented with segment A involvement and 2 had segment B involvement. All the 3 segments of IVC were involved in 1 case. Five cases with IVC involvement received IVC patching only, and 4 had resection or ligation of the segment C of the IVC, and resection of the segment A and B of the IVC was performed in 2 and 1 case, respectively. One patient received complete resection of whole IVC involved. All patients recovered smoothly and were discharged.</p><p><b>CONCLUSION</b>The infrarenal IVC can be ligated or resected safely without reconstruction. Combined resection of the bilateral renal vein and segment B of the IVC may result in renal insufficiency. IVC involvement and occlusion between the second hepatic portal and renal veins can be ligated safely without affecting the renal function.</p>

The feasibility study of endovascular reconstruction of aortic arch with modular branched stent-graft system in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair.</p><p><b>METHODS</b>After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed.</p><p><b>RESULTS</b>Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and artery rupture of left subclavian respectively during operation. In the eight successful cases, two proximal type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed.</p><p><b>CONCLUSION</b>It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.</p>

Mid-long term complications of endovascular repair in aortic diseases and its secondary interventional strategies / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and effects of secondary intervention for mid-long term complications of endovascular repair (EVR) in aortic diseases.</p><p><b>METHODS</b>From May 1999 to Jun 2007, 21 patients with mid-long term complications after EVR were treated in our center. Of these cases, 15 cases received first EVR for abdominal aortic aneurysm (AAA), 3 cases for thoracic aortic aneurysm (TAA) and 3 cases for aortic dissection (TAD). The mid-long term complications included 11 cases of type I endoleak, 4 cases of type II endoleak, 2 cases of type III endoleak and 4 cases of migration of stent grafts. Proximal or distal extensions were used for type I and III endoleak in 9 cases. Fenestrated, scallop and bifurcated stent grafts were used to reconstruct the aortic arch in 3 cases. Emboli technique was used in treating type II endoleak. Thrombectomy and bypass technique were used in 4 cases with stent graft limb occlusion. One ruptured AAA accepted open surgery.</p><p><b>RESULTS</b>Secondary endovascular technique were undergone in 20 (95.2%) cases. One case died in 30 days after the secondary intervention and endoleak remained after the secondary operation in 5 cases. Three cases died of the secondary intervention.</p><p><b>CONCLUSIONS</b>Endoleak and limb occlusion were the chief mid-long complications after EVR. Secondary endovascular technique can be used in most cases and carries great challenges in aortic arch lesions.</p>

Treatment of left subclavian artery in endovascular repair of thoracic aortic aneurysm and thoracic aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD).</p><p><b>METHODS</b>In 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover.</p><p><b>RESULTS</b>DSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg.</p><p><b>CONCLUSIONS</b>EVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.</p>

The endovascular repair of aortic dissection: early clinical results of 178 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection.</p><p><b>METHODS</b>From June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation.</p><p><b>RESULTS</b>10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later.</p><p><b>CONCLUSION</b>The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.</p>

The endovascular repair of ruptured aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the safety, feasibility, efficacy and problem of endovascular repair (EVR) for ruptured aortic aneurysm (RAA).</p><p><b>METHODS</b>Fourteen patients with RAA were obtained diagnosis and anatomic data of proximal and distal neck through magnetic resonance imaging and CT. The patients with hypotension were accepted anti-shock treatment. Stent-grafts were deployed in proper position of RAA under X-ray fluoroscopic.</p><p><b>RESULTS</b>The time from rupture to operation was 50 min to 21 d. Three cases had plenty of blood in left pleural cavity and 2 cases were done under bleeding shock condition. Five cases with RAA were fixed by bifurcated stent-grafts and others by straight stent-grafts. Follow-up term was 1 month to 38 months. One with ruptured thoracic aortic aneurysm died 4 h later after operation, another one died of left thoracic cavity infection 9 months later, and others lived well without complication.</p><p><b>CONCLUSION</b>The EVR is a safe, efficient and feasible method. It will be a potential alternative to treat RAA in future, but more suitable for RAA with better proximal and distal landing zones.</p>

Prevention and management of frequent complications after endovascular repair of infrarenal abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To prevent and manage frequent complications after endovascular repair of infrarenal abdominal aortic aneurysm (AAA).</p><p><b>METHODS</b>The data of 71 cases of infrarenal abdominal aortic aneurysm (AAA) treated by endovascular repair were analysed retrospectively. The reasons, managements, results and prognosis of frequent complications were investigated.</p><p><b>RESULTS</b>Seventy-one cases of infrarenal AAA were treated by endovascular repair with 100% success rate. There was no surgical conversion to open aneurysm repair. There were 8 cases of primary endoleak, 1 case of nervous complication and acute thrombosis. An average follow-up period was 26 +/- 5 months. Three persistent endoleaks and 4 secondary endoleaks were found during the follow-up period. The endoleak rate was 9.8% (7/71) within 1 month postoperatively and mortality rate was 1.3% (1/71). Total mortality rate was 4.2% (3/71). Two patients died from acute myocardial infarction and one from acute heart failure.</p><p><b>CONCLUSIONS</b>Endovascular treatment of abdominal aortic aneurysm is technically feasible and can effectively exclude aortic aneurysms from the circulation. Endoleak is a chief complication after endovascular repair of infrarenal AAA.Additional procedures and follow up are very important. Endoleak with enlarged aneurysm should be treated actively.</p>

The change of blood supply pattern in visceral arteries of Stanford B dissection after endovascular repair / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the change of blood supply pattern in visceral arteries of Stanford B dissection. The visceral arteries include celiac trunk (CA), superior mesenteric artery (SMA) and renal artery (RA).</p><p><b>METHODS</b>By retrospectively analysing the clinical data of 52 cases with Stanford B dissection, the blood supply pattern of visceral arteries was confirmed by aortography and the changes before and after endovascular repair were compared.</p><p><b>RESULTS</b>After repair: the stenosis lesions disappeared in 7 cases supported by true channel completely but one. Twenty-two visceral arteries supported by true and false channel simultaneously recovered true channel chiefly but one. One recovered true channel chiefly and one had no change in 2 visceral arteries supported by false channel completely. Four recovered true channel chiefly and one had no change in 5 visceral arteries without blood support. 88.9% blood support got better and 11.1% blood support had no change in 36 damaged visceral arteries after endovascular repair.</p><p><b>CONCLUSION</b>Blood support from true and false channel simultaneously is the chief pattern in the injured visceral arteries before repair; Endovascular repair technique is benefit to recovering the blood support of true channel.</p>