BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft ...BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.展开更多
BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulatio...BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.展开更多
Objective:To report a numerical research on the effect of a renal artery arising from false lumen(FL)on the treatment outcome of thoracic endovascular repair(TEVAR)for complicated type B aortic dissection(TBAD).Method...Objective:To report a numerical research on the effect of a renal artery arising from false lumen(FL)on the treatment outcome of thoracic endovascular repair(TEVAR)for complicated type B aortic dissection(TBAD).Methods:The original patient-specific model with the right renal artery(RRA)partially supplied by the FL(TFM)was reconstructed from its postoperative computed tomography images.Two additional models were reconstructed by artificially modifying the RRA either fully arising from the FL(CFM)or true lumen(CTM).Computational fluid dynamics(CFD)simulations were performed.Results:First,for all the models,the flow splits to all the visceral arteries were much less than those of a healthy aorta.Second,the flow split to RRA in the CFM and in CTM was the least and largest respectively.Third,in TFM,the pressure gradient between the true lumen(TL)and FL was negative at the proximal FL and the entire FL was full of active blood flow.In the contrast,in CTM and CFM,the pressure differences between the two lumens remained positive and little flow was present in FL.Finally,both TL and proximal FL of this particular patient expanded and the diameters of all visceral arteries decreased at one-year follow-up.Conclusions:Compared to a healthy aorta,a renal artery arising from FL following TEVAR would result in severe visceral ischemia including RA and superior mesenteric artery(SMA).In addition,our numerical simulation of the postoperative hemodynamics of this particular patient perfectly matched with its TL remodeling,FL expansion and contraction of the visceral arteries at one-year follow-up,and a patient-specific CFD simulation may be adopted to obtain information on visceral perfusion after endovascular repair for TBAD patients.展开更多
基金Supported by National Natural Science Foundation of China,No.81600375
文摘BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
基金Supported by Huanhua Talent for Discipline Backbone of Sichuan Provincial People’s Hospital,No.SY2022017Science Fund for Distinguished Young Scholars of Sichuan Province,No.2021JDJQ0041+1 种基金Sichuan Science and Technology Program,No.2020YFQ0060National Natural Science and Technology Foundation of China,No.81800274.
文摘BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.
基金This work was supported by grants from National Natural Science Foundation of China(81770471,12072214,1802253)Sichuan Provincial Department of Science and Technology Application Basic Project(2018YYJC,2019YJ0026).
文摘Objective:To report a numerical research on the effect of a renal artery arising from false lumen(FL)on the treatment outcome of thoracic endovascular repair(TEVAR)for complicated type B aortic dissection(TBAD).Methods:The original patient-specific model with the right renal artery(RRA)partially supplied by the FL(TFM)was reconstructed from its postoperative computed tomography images.Two additional models were reconstructed by artificially modifying the RRA either fully arising from the FL(CFM)or true lumen(CTM).Computational fluid dynamics(CFD)simulations were performed.Results:First,for all the models,the flow splits to all the visceral arteries were much less than those of a healthy aorta.Second,the flow split to RRA in the CFM and in CTM was the least and largest respectively.Third,in TFM,the pressure gradient between the true lumen(TL)and FL was negative at the proximal FL and the entire FL was full of active blood flow.In the contrast,in CTM and CFM,the pressure differences between the two lumens remained positive and little flow was present in FL.Finally,both TL and proximal FL of this particular patient expanded and the diameters of all visceral arteries decreased at one-year follow-up.Conclusions:Compared to a healthy aorta,a renal artery arising from FL following TEVAR would result in severe visceral ischemia including RA and superior mesenteric artery(SMA).In addition,our numerical simulation of the postoperative hemodynamics of this particular patient perfectly matched with its TL remodeling,FL expansion and contraction of the visceral arteries at one-year follow-up,and a patient-specific CFD simulation may be adopted to obtain information on visceral perfusion after endovascular repair for TBAD patients.
