Background The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two stra...Background The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge.Methods Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type Ⅲ dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases. Results Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA.Conclusions Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.展开更多
目的研究淫羊藿总黄酮(total flavonoids of Epimedium,TFE)对四氧嘧啶所致糖尿病小鼠离体胸主动脉舒缩功能的影响及其可能机制。方法雄性昆明种小鼠腹腔注射四氧嘧啶诱导糖尿病,对照组小鼠注射等体积的生理盐水。将成模小鼠按血糖值分...目的研究淫羊藿总黄酮(total flavonoids of Epimedium,TFE)对四氧嘧啶所致糖尿病小鼠离体胸主动脉舒缩功能的影响及其可能机制。方法雄性昆明种小鼠腹腔注射四氧嘧啶诱导糖尿病,对照组小鼠注射等体积的生理盐水。将成模小鼠按血糖值分为模型组、淫羊藿总黄酮低剂量组、淫羊藿总黄酮高剂量组。给药2周后,测空腹血糖(FBG)、超氧化物歧化酶(SOD)和丙二醛(MDA)。并观察各组小鼠胸主动脉对苯肾上腺素(phenylephrine,Phe)缩血管作用的反应,对乙酰胆碱(ACh)、硝普钠(SNP)舒血管作用的反应,同时体外加药观察药物的舒血管作用。结果 TFE能显著降低糖尿病小鼠FBG,使SOD活性升高、MDA含量降低,糖尿病小鼠胸主动脉的内皮依赖性舒张得到明显改善。结论淫羊藿总黄酮可能通过降低血糖、抗氧化等途径对糖尿病小鼠血管内皮损伤起到保护作用。展开更多
文摘Background The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge.Methods Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type Ⅲ dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases. Results Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA.Conclusions Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.
文摘目的研究淫羊藿总黄酮(total flavonoids of Epimedium,TFE)对四氧嘧啶所致糖尿病小鼠离体胸主动脉舒缩功能的影响及其可能机制。方法雄性昆明种小鼠腹腔注射四氧嘧啶诱导糖尿病,对照组小鼠注射等体积的生理盐水。将成模小鼠按血糖值分为模型组、淫羊藿总黄酮低剂量组、淫羊藿总黄酮高剂量组。给药2周后,测空腹血糖(FBG)、超氧化物歧化酶(SOD)和丙二醛(MDA)。并观察各组小鼠胸主动脉对苯肾上腺素(phenylephrine,Phe)缩血管作用的反应,对乙酰胆碱(ACh)、硝普钠(SNP)舒血管作用的反应,同时体外加药观察药物的舒血管作用。结果 TFE能显著降低糖尿病小鼠FBG,使SOD活性升高、MDA含量降低,糖尿病小鼠胸主动脉的内皮依赖性舒张得到明显改善。结论淫羊藿总黄酮可能通过降低血糖、抗氧化等途径对糖尿病小鼠血管内皮损伤起到保护作用。
