Objective To compare clinical curative effects of open surgery （OS） or endovascular repair （EVAR） for patients with abdominal aortic aneurysm （AAA） in China. Data sources We performed a comprehensive search of b...Objective To compare clinical curative effects of open surgery （OS） or endovascular repair （EVAR） for patients with abdominal aortic aneurysm （AAA） in China. Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010. Study selection According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis. Results We analyzed a total of 2862 patients with 1757 undergoing OS （OS group） and 1105 undergoing EVAR （EVAR group）. There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group （P 〈0.01）. Low-limb ischemia, however, was more common in the EVAR group （P 〈0.05）. The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group （P 〈0.01）. In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group （P 〈0.01）. The overall late mortality rate was higher in the OS group （P 〈0.01）, especially non-aorta-related late mortality and mortality during the fourth to the sixth year （P 〈0.01）. Conclusions EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.展开更多
Acute type B aortic dissection(TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserv...Acute type B aortic dissection(TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair(TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.展开更多
Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospin...Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid （CSF） pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.展开更多
文摘Objective To compare clinical curative effects of open surgery （OS） or endovascular repair （EVAR） for patients with abdominal aortic aneurysm （AAA） in China. Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010. Study selection According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis. Results We analyzed a total of 2862 patients with 1757 undergoing OS （OS group） and 1105 undergoing EVAR （EVAR group）. There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group （P 〈0.01）. Low-limb ischemia, however, was more common in the EVAR group （P 〈0.05）. The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group （P 〈0.01）. In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group （P 〈0.01）. The overall late mortality rate was higher in the OS group （P 〈0.01）, especially non-aorta-related late mortality and mortality during the fourth to the sixth year （P 〈0.01）. Conclusions EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.
文摘Acute type B aortic dissection(TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair(TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.
文摘Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid （CSF） pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.
