Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience / 世界急诊医学杂志（英文）

@#BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS: A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed. RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS: In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an effective therapeutic option for TAD.

Thoracic Endovascular Aortic Repair Following Axillo-Femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Renal Ischemia / 日本心臓血管外科学会雑誌

A 71-year-old male was admitted to our institution because of right leg pain and paleness, accompanied by sudden chest-back pain. The right femoral artery was not palpable. The reticulated cyanosis appeared on the right leg. Contrast enhanced computed tomography (CT) revealed an acute type B aortic dissection (TBAD) extending from the descending thoracic aorta to the left common iliac artery and right external iliac artery. The intimal tear was located at thoraco-abdominal aorta. There was a severe stenosis of the true lumen at bilateral common iliac arteries because of the dynamic compression caused by the extended false lumen. Blood to the right leg was not supplied from the dissected iliac artery, the peripheral circulation was maintained by collateral flow. The patient was diagnosed acute TBAD complicated with lower limb ischemia. An emergent right axillary artery-bifemoral arteries bypass was carried out for malperfusion of lower extremities. The symptoms in the lower limbs disappeared immediately. The bilateral femoral arteries were well palpated. However, 4 days later, uncontrollable severe hypertension and anuria appeared suddenly. Contrast enhanced CT revealed the stenosis of true lumen at bilateral renal arteries and an exacerbation of stenosis of true lumen at abdominal aorta. Emergent thoracic endovascular aortic repair (TEVAR) for entry closure was performed to improve the renal function and prevent mesenteric ischemia. Postoperative contrast enhanced CT revealed the complete closure of the entry tear and dilatation of the true lumen at the descending and abdominal aorta. At the bilateral renal arteries, the blood flow improved. The renal function recovered and mesenteric ischemia did not occurred. In this report, we presented a case of acute TBAD complicated with lower limbs ischemia and late onset acute ischemic renal failure. We first performed the right axillary artery-bifemoral arteries bypass grafting, after that we had to perform TEVAR to close the entry tear. One-stage emergent TEVAR should be considered for acute TBAD with the dynamic compression at the level of abdominal aorta in future.

Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. Methods    From 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. Results    Surgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion     This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.

Minimally invasive hybrid surgery for Stanford B aortic dissection involving the aortic arch / 中华胸心血管外科杂志

Objective:To investigate the effect and safety of one-staged hybrid surgery in the treatment of complicated Stanford B aortic dissection.Methods:246 consecutive patients who underwent one-staged hybrid technique with complicated type B aortic dissection (cTBAD) between January 2014 and July 2020 were retrospectively reviewed. The perioperative mortality and morbidity of the hybrid technique was assessed and the early results of follow up were evaluated.Results:The mean age of patients was(57.1±11.2)years old, and 175 (71.1%) were male. There were 166 cases of left common carotid artery-left subclavian artery vessels bypass + TEVAR (A group), operation time(62±8)min, post-operated hospitalization(5.2±1.3)days; 62 cases of right common carotid artery-left common carotid artery vessels bypass+ left common carotid artery-left subclavian artery vessels bypass + TEVAR (B group), operation time(88±12)min, post-operated hospitalization(6.1±1.8)days; 18 cases of debranch + TEVAR, operation time(236±36)min, post-operated hospitalization(8.8±2.1)days. 246 patients underwent hybrid procedure successfully (The technique success rate was 100%). 1 patient(0.4%)with traumatic aortic dissection (with cerebral trauma) died after operation 7 days. The average follow-up period was 5 years(30.3±7.1)xmonths. 236 patients(96%) without endoleak, 10 patients(4%)with proximal endoleak, 5 patients with regular follow-up, 5 patients with surgical treatment during one year (3 patients with re-TEVAR; 2 patients with opening operation); 25 patients(10.2%)incision hematomas, all these patients settled with closely observing and conservative treatment, and all these patients without reintervention. The rate of second intervention was 2% (5/246) the patency of bridging vessel was 99.7% (343/344). There was no paraplegia and stroke during perioperative period.Conclusion:One-staged hybrid surgery has a good short-term and med-term efficacy and safety for complicated Stanford B aortic dissection.

The long-term outcomes of one-stage hybrid procedure for aortic arch pathologies / 中华胸心血管外科杂志

Objective:To analyze the long-term outcomes of hybrid arch repair(HAR) treating aortic arch pathologies.Methods:Between January 2009 and January 2018, 87 consecutive patients underwent HAR for aortic arch pathologies at Beijing Anzhen Hospital. 76 were males. 2 cases were in zone 0, 46 cases were in zone 1, and 39 cases were in zone 2. The zones of the aortic arch were defined following the Ishimaru classification.Results:Five(5.7%) operative death occurred. 13 patients(19.1%) died during the follow-up. The overall survival rate was 88.4%, 83.3%, 83.3%, 49.8% at 1, 3, 5, 10 year, respectively. Multivariate Cox proportional risk analysis showed that stroke( HR=20.626, 95% CI: 2.698-157.685, P=0.004) was an independent risk factor for short-term death. Stroke( HR=16.234, 95% CI: 4.103-64.229, P<0.001) and spinal cord infury( HR=11.060, 95% CI: 2.150-56.893, P=0.004) were independent risk factors for long-term death. Conclusion:In conclusion, HAR could be an alternative procedure for the patients that are not suitable for open repair under the premise of strict control of indications. In the future, the risk assessment system and uniform operational indications for HAR should be further established.

Endovascular repair of complex aortic arch lesion with application of recanalize left subclaivian artery in intracavitary / 中华胸心血管外科杂志

Objective:To investigate the effect of different ways of reconstruction of left subclavian artery (LSA) in the treatment of complex aortic arch lesions.Methods:The clinical data of 34 patients with complex thoracic aortic disease undergoing intracavitary LSA reconstruction in our center from January 2019 to February 2020 were retrospectively analyzed. The distance of proximal healthy landing zone of all patients, including 29 aortic dissections involving LSA, 3 penetrating aortic ulcer and 2 thoracic aortic aneurysms, was less than 15 mm. Among them, 16 cases were treated with chimney technique, 16 cases were implanted with single branched stent-graft, 2 cases were received with left common carotid artery and LSA in situ fenestration.Results:The operation success rate of all 34 patients was 100%. One case was changed from in situ fenestration to chimney stenting. Followed up for 1-12 months, there were no death, cerebral ischemia, paraplegia and other postoperative complications. CTA review showed that the main and branch stents were in good shape, the patency rate of LSA branch stents was 100% and no endoleak occurred at 1 and 3 months after operation. The muscle strength and arterial blood pressure of bilateral upper limbs of all patients were basically the same.Conclusion:There is no consensus for the treatment of complex aortic arch lesions, so we need to customize the personalized plan and select the appropriate LSA reconstruction method in order to reduce the incidence of complications.

Analysis of clinical characteristics and prognostic risk factors in patients with Stanford type B aortic dissection complicated with hypertension / 中华危重病急救医学

Objective:To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension.Methods:Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients.Results:Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [ OR and 95% CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [ OR and 95% CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. Conclusions:The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.

A Case of Staged Hybrid Repair for Subacute Type B Aortic Dissection in a Patient with Shaggy Aorta / 日本心臓血管外科学会雑誌

In aortic surgery involving shaggy aorta, surgical strategy to avoid embolism is crucial for each case. We applied the frozen elephant trunk technique to a patient with shaggy aorta. A 79-year-old man was admitted to our hospital for conservative treatment of acute Type B aortic dissection. Dissecting aneurysms of the aortic arch and descending aorta were shown to have rapidly dilated according to CT three weeks later. Preoperative contrast CT showed an ulcerated shaggy aorta from the aortic arch to the mid portion of the descending aorta. To utilize the benefit of the stent compared with the classical elephant trunk technique, we proposed that the frozen elephant trunk technique would be helpful in prevention of embolism. We therefore planned total arch replacement with the frozen elephant trunk technique and performed thoracic endovascular aortic repair. We employed the frozen elephant trunk technique in the first operation and balloon protection of the superior mesenteric artery and the renal artery in the second operation. The patient had an uneventful postoperative course without thromboembolism. The frozen elephant trunk technique may be helpful for patients with shaggy aorta to avoid thromboembolic events.

Efficacy of Thoracic Endovascular Aortic Repair for Recurrent Hemoptysis of Bronchial-Pulmonary Artery Fistula Resistance to Several Bronchial Artery Embolization / 日本心臓血管外科学会雑誌

An 84-year-old woman treated for tuberculosis in childhood presented to our emergency department with chronic cough and massive hemoptysis. Contrast-enhanced computed tomography (CT) on admission revealed a bronchial-pulmonary artery fistula (BPAF) for which she underwent bronchial artery embolization (BAE) and developed hemoptysis postoperatively. Contrast-enhanced CT on admission revealed a connection between the right coronary and a bronchial artery, suggesting coronary-to-bronchial artery communication. Hemoptysis persisted despite coiling of a branch of the right coronary artery. Therefore, we were consulted to perform thoracic endovascular aortic repair (TEVAR), which we performed as a semi-emergency. She did not show hemoptysis or paraplegia postoperatively and was discharged on postoperative day 40. TEVAR is effective for a BPAF in patients in whom BAE cannot control hemoptysis.

Treatment strategy selection of Marfan syndrome combined with thoracoabdominal aortic diseases / 中国胸心血管外科临床杂志

@#Objective    To summarize the surgical treatment plan and experience of patients with Marfan syndrome complicated with Stanford type B aortic dissection, and to explore the treatment strategy selection. Methods    A retrospective analysis was conducted on 27 patients with Marfan syndrome complicated with thoracoabdominal aortic diseases who were treated in the department of cardiovascular surgery of our hospital from January 2013 to June 2019, including 13 males and 14 females, with an average age of 32.2±8.6 years. According to the patients' conditions, 19 of them received single pump-assisted blood transfusion combined with total thoracoabdominal aortic replacement (TAAAR), and 8 received thoracic endovascular aortic repair (TEVAR) in critically ill and pregnant patients. The patients were followed up in the outpatient clinic, and the thoracoabdominal aortic CT angiography was reexamined at 3 months, 6 months, 12 months and annually. The outcome of surgery, the incidence of intermediate cardiovascular adverse events, defined as the reoperation due to aortic or cardiac diseases, and intermediate survival rate were studied. Results    All 27 patients successfully completed the operation, the operation time was 60-852 (395.10±222.60) min, the spinal cord ischemia time was 14-26 (19.33±3.44) min, and the abdominal viscera ischemia time was 16-23 (19.83±1.94) min. Eight patients of TEVAR were all operated in acute phase and 19 patients of TAAAR in chronic phase. Two early postoperative deaths occurred in TEVAR patients. One died of puerperal infection and multiple organ dysfunction after cesarean section at the same time. After TEVAR, type A dissection re-ocurred in one patient. The family member gave up the treatment, and the patient died of the dissection ruptured after cesarean section. During the average follow-up of 47.6±36.7 months, 1 patient died of cerebrovascular accident and 9 patients were reoperated for adverse cardiovascular events, including 4 in TEVAR and 5 in TAAAR. Conclusion    TAAAR is the first choice for the treatment of Marfan syndrome combined with thoracoabdominal aortic diseases. TEVAR is easy to operate, with a low incidence of early mortality and complications, but has the risk of internal leakage and avulsion, and a high reoperation rate in the middle stage, so it can be used for high-risk elderly patients not suitable for open surgery, or as a bridge therapy for emergency patients before open surgery.

"J. D" technique: A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair / 中国胸心血管外科临床杂志

@#Objective    To report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR). Methods    Twenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D" technique (a group B). The clinical efficacy of the two groups was compared. Results    In the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups. Conclusion    The "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.

Aortic rupture during endovascular repair of a postoperative coarctation pseudoaneurysm in an adult: Emergency lifesaving stent graft implantation

We present a case with aortic rupture during an operation of thoracic endovascular aortic repair of an anastomotic pseudoaneurysm. This happened after the use of a low-pressure remodeling balloon inside the covered part of the deployed endografts. It was successfully treated with a second more centrally in the aortic arch-implanted endograft with full coverage of the left subclavian artery orifice. This patient had a history of surgically operated aortic coarctation.

Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair in a Patient with Bovine Aortic Arch / 日本心臓血管外科学会雑誌

Retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) is a lethal complication. A 54-year-old woman with bovine aortic arch presented with dilatation of the descending aorta due to chronic type B aortic dissection. She underwent TEVAR in zone 2 for closure of the entry site just below the origin of the left subclavian artery. On the day after TEAVR, she showed right hemiparesis, and was diagnosed with cerebral infarction on MRI and RTAD on CT. She underwent an emergent operation. The entry was at the proximal end of the bovine trunk, where the edge of the bare stent stuck out. We performed partial arch replacement with entry resection. Her postoperative course was uneventful. She was transferred to another hospital for rehabilitation 37 days after the surgery.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.Methods The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.Results There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent.The success rate of device release was 100％,the success rate of operation was 100％,and there were no intraoperative deaths.Postoperative complications occurred in 2 cases:one proximal stent tear dissection required open surgery,one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months.CTA examination in 16 patients 30 days after surgery,found 1 patient with type Ⅲ endoleak.CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necessitating distal stent implantation.Conclusion The branch TEVAR technique is effective method to reconstruct the arch branched artery.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective@#To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.@*Methods@#The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.@*Results@#There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent. The success rate of device release was 100%, the success rate of operation was 100%, and there were no intraoperative deaths. Postoperative complications occurred in 2 cases: one proximal stent tear dissection required open surgery, one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months. CTA examination in 16 patients 30 days after surgery, found 1 patient with type Ⅲ endoleak. CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necess itating distal stent implantation.@*Conclusion@#The branch TEVAR technique is effective method to reconstruct the arch branched artery.

The beneficial enlightenment of thoracic endovascular aortic repair for traumatic type B aortic dissection with long-term follow-up of single center / 中华胸心血管外科杂志

Objective To evaluate the long-term clinical effect of Thoracic endovascular aortic repair (TEVAR) for traumatic Type B aortic dissection,and to provide a reference for the next stage treatment.Methods Twenty-one patients with traumatic Stanford type B aortic dissection treated in our center from December 1999 to June 2012 were retrospectively analyzed for the treatment effectiveness and follow-up results.The average age of 21 Traumatic Type B aortic dissection patients was 42.7 years (range:19 to 67 years).Men accounted for 85.7％ (18/21).80.9％ (17/21) of the dissection were caused by car accident,4 were due to falling accident from high places.There were 7 cases of hypertension,4 cases of diabetes,4 cases of hyperlipidemia,2 cases of chronic ischemic heart disease,14 cases of pneumothorax,8 cases of rib fracture,3 cases of craniocerebral trauma / neuropsychiatric symptoms,and 1 patient with shock.The median time from onset to treatment was 5 days (range:1-73 days).There were 16 cases (≤14 days) in the acute phase,2 cases (15-60 days) in the subacute phase,and 3 cases (＞ 60 days) in the chronic phase.There was no patient in super acute phase in the study group (0-24 hour).Results The perioperative mortality was 9.52％ (2/21) for the patients traumatic type B aortic dissection,4.76％ (1/21)for those with postoperative endoleaks;2-year and 5-year survival rates were 90.48％ and 85.71％.Conclusion Intracavitary treatment of traumatic Stanford B type aortic dissection is effective and has good long-term clinical benefit,which provides a guidance for future clinical treatment of traumatic type B aortic dissection.

Clinical effect of thoracic endovascular aortic repair for Stanford type B aortic dissection / 中国医师进修杂志

Objective To summarize the clinical efficacy of thoracic endovascular aortic repair (TEVAR) in the treatment of Stanford type B thoracic aortic dissection. Methods The clinical data of 80 patients with Stanford type B aortic dissection who had underwent TEVAR in cardiac surgery of the First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2017 were analyzed retrospectively. Among them, there were 56 males and 24 females. The effect of operation and postoperative complications were observed. The diameters of different aortic levels before and after TEVAR were compared in order to understand the aortic remodeling after TEVAR. Results All 80 patients were operated successfully. A total of 87 stents were implanted, of which 2 stents were placed in 7 patients. Four patients died 30 days after operation, 3 of whom were diagnosed as dissection rupture before operation and underwent emergency TEVAR. The cause of death was massive hemorrhage due to re-rupture of dissection. One patient complicated with massive cerebral infarction before operation died of respiratory failure. Six months after operation, CTA showed that the diameter of the aortic true lumen at the level of the left subclavian artery, the maximum diameter of the tumor and the level of the diaphragm significantly increased: (30.1 ± 3.5) mm vs. (24.4 ± 4.2)mm, (33.4 ± 5.1) mm vs. (24.9 ± 6.2) mm,(26.1±4.9) mm vs. (19.3 ± 3.1) mm; all P values＜0.01, and the false lumen significantly decreased: (3.5 ± 1.7) mm vs. (11.2 ± 5.7) mm, (9.1 ± 2.4) mm vs. (18.3 ± 5.9) mm, (6.2 ± 1.3) mm vs. (14.7 ± 5.2) mm, all P values＜0.01. There was no significant difference in the overall diameter of aorta before and after operation (P > 0.05). Conclusions The treatment of Stanford type B aortic dissection with TEVAR has significantly good short-term clinical efficacy, which is less traumatic and quick to recover. However, the long-term efficacy remains to be observed.

Preoperative CT angiography and intraoperative X-ray image registration algorithm for thoracic aortic endovascular repair / 中国组织工程研究

BACKGROUND: Thoracic aortic endovascular repair is an important method for treating aortic dissection and thoracic aortic aneurysm. The success of the operation depends on whether the stent graft is placed in the correct position. However, when the stent is implanted, the aorta in the intraoperative X-ray image is invisible, so the operation is difficult and the risk is high. Registration of preoperative CT angiography and intraoperative X-ray images can help doctors place stents and increase success rates. OBJECTIVE: To propose a preoperative CT angiography and intraoperative X-ray image registration algorithm for thoracic aortic endovascular repair. METHODS: Firstly, digital reconstruction images of CT angiography and bone CT were performed under different virtual perspectives, and the two were superimposed to obtain a digital reconstruction image library under various angles of position and orientation for intraoperative X-ray images. Secondly, we proposed a deep neural network based on branch decoding structure. Using digital reconstruction image library training, the position and attitude parameters of intraoperative X-ray images could be estimated to obtain CT angiography and intraoperative X-ray images. The spatial positional relationship was obtained. Finally, according to the pose parameters of the X-ray image in the CT angiography coordinate system, the thoracic aorta image in the CT angiography was re-projected and superimposed into the intraoperative X-ray image to navigation assistance for the doctors. RESULTSANDCONCLUSION: (1) The experimental results show that the root mean square error of the proposed algorithmis reduced by 17%comparedwiththe traditional algorithmsof gradient correlation and mode strength. (2) In the dual-branch code structure network, the parameter estimation error is reduced to 30% of the network without branching structure in the digital reconstruction image test set. (3) In the experimental X-image experiment, the root mean square error is also reduced by2%.

A Case Report after Two Years of Total Debranching and Endovascular Repair for Kommerell Diverticulum / 日本心臓血管外科学会雑誌

A 78-year-old woman with abnormal shadows on computed tomography (CT) was given a diagnosis of right-sided aortic arch and Kommerell diverticulum (KD), accompanied by aberrant left subclavian artery. Although no symptoms were observed, the maximum diameter of the aneurysm was 63 mm, and surgical intervention was chosen because of the possibility of rupture. At first, a 4-branched blood vessel prosthesis with a side branch was anastomosed to the ascending aorta. Next, after reconstructing the cervical branches, a Conformable GORE® TAG® (W.L. Gore and Associates, 34 mm×200 mm) was inserted from the side branch and expanded in the range of Zones 0 to Th 7. Finally, ALSA coil embolization was performed. She was discharged on postoperative day 36, and at her 2-year follow-up, she was doing well, with shrinkage of Kommerell diverticulum.

Research advances in the aortic remodeling after thoracic endovascular aortic repair therapy of Stanford type B aortic dissection / 中华外科杂志

Aortic dissection is one of the most common vascular emergent disease. Thoracic endovascular aortic repair (TEVAR) therapy which created the new era of treatment of Stanford type B aortic dissection (TBAD) has gradually replaced the surgical treatment and becomes the gold standard for treatment of TBAD. Aortic remodeling after TEVAR is the key factor to evaluate the mid-term survival rate and successful treatment of the aortic dissection victims. However, there are few studies on aortic remodeling and lack of unified criteria to evaluate it. This article was to summarize the domestic and abroad research advances which focused on the morphological changes, the regularity, and the evaluation criteria of aorta remodeling after TEVAR.