AIM:To evaluate the clinical efficacy of an expanded polytetrafluoro-ethylene-covered Fluency stent compared with that of a polyethylene terephthalate-covered Wallgraft stent for the management of transjugular intrahe...AIM:To evaluate the clinical efficacy of an expanded polytetrafluoro-ethylene-covered Fluency stent compared with that of a polyethylene terephthalate-covered Wallgraft stent for the management of transjugular intrahepatic portosystemic shunt(TIPS)dysfunction.METHODS:A retrospective review of patients who underwent TIPS revision with stent-grafts between May 2007 and June 2011 was conducted.The patients were divided into two groups according to the stentgrafts implanted:the Fluency stent(Bard Incorporated,Karlsruhe,Germany)and the Wallgraft stent(Boston Scientific,Galway,Ireland).The primary patency rates were calculated and compared using the Kaplan-Meier method.RESULTS:A total of 73 patients were evaluated in this study:33 with Fluency stents and 40 with Wallgraft stents.The primary patency rates at 12 and 24 mo were 91% and 85%,respectively,in the Fluency stent group and 78% and 63%,respectively,in the Wallgraft stent group.The primary shunt patency rates after TIPS revision were significantly better with the Fluency stent than with the Wallgraft stent(P = 0.033).CONCLUSION:TIPS revision with the Fluency stent has higher medium-term patency rates than that with the Wallgraft stent.展开更多
目的:评估覆膜支架联合长裸支架在经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)中的应用价值.方法:对南华大学附属南华医院2012-01/2015-01 22例肝硬化食管胃底静脉曲张患者采用覆膜支架联合长裸支架行...目的:评估覆膜支架联合长裸支架在经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)中的应用价值.方法:对南华大学附属南华医院2012-01/2015-01 22例肝硬化食管胃底静脉曲张患者采用覆膜支架联合长裸支架行TIPS治疗.结果:TIPS治疗的技术成功率为100%,术前门静脉压力43.25 cm H2O±4.56 cm H2O(l cm H2O=0.098 k Pa)降至23.78 cm H2O±5.11 c m H2O(t=21.423,P<0.01).造影见食管胃底曲张静脉消失,术后患者肝功明显改善,食管胃底静脉曲张程度明显减轻,无急性肝衰竭病例发生.随访6-24 mo,术后6、12、24 m o的累积分流道通畅率分别为95.4%(21/22)、90.9%(20/22)、86.3%(19/22).无"盖帽"情况发生.结论:采用覆膜支架联合长裸支架套叠技术能明显提高分流道的通畅率,为门脉高压症患者的肝内门体分流提供了是一种安全、有效的治疗方法,具有重要的临床应用价值.展开更多
Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying arou...Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying around the fenestration as a result of the balloon angioplasty of the seal zone.This novel stent cuff design will also facilitate more complete biointegration of the devices,eliminate the hemodynamic variation as well as significantly reduce the possibility of a Type III endoleak.The feasibility of this concept is demonstrated by observations made from in-situ tests performed in a Beta endograft design.Flared cuffs made of poly(ε-caprolactone)supported with a weft-knitted polyester structure can be manufactured with various configurations to optimize the transition from the main body of the endograft,thus preventing the currently marketed designs’hemodynamic perturbation while also promoting endograft biointegration.This concept represents an evolution in branch graft design,which may enhance the long-term durability of customized fenestrations and open new applications for in-vivo graft fenestration in the near future.Further ongoing investigation to optimize its structure,X-ray opacity,fixation to the flared stent,and material biocompatibility are still required to build upon this concept’s proof.展开更多
基金Supported by National Natural Science Foundation of China,No. 30770984 and No. 81171444
文摘AIM:To evaluate the clinical efficacy of an expanded polytetrafluoro-ethylene-covered Fluency stent compared with that of a polyethylene terephthalate-covered Wallgraft stent for the management of transjugular intrahepatic portosystemic shunt(TIPS)dysfunction.METHODS:A retrospective review of patients who underwent TIPS revision with stent-grafts between May 2007 and June 2011 was conducted.The patients were divided into two groups according to the stentgrafts implanted:the Fluency stent(Bard Incorporated,Karlsruhe,Germany)and the Wallgraft stent(Boston Scientific,Galway,Ireland).The primary patency rates were calculated and compared using the Kaplan-Meier method.RESULTS:A total of 73 patients were evaluated in this study:33 with Fluency stents and 40 with Wallgraft stents.The primary patency rates at 12 and 24 mo were 91% and 85%,respectively,in the Fluency stent group and 78% and 63%,respectively,in the Wallgraft stent group.The primary shunt patency rates after TIPS revision were significantly better with the Fluency stent than with the Wallgraft stent(P = 0.033).CONCLUSION:TIPS revision with the Fluency stent has higher medium-term patency rates than that with the Wallgraft stent.
文摘目的:评估覆膜支架联合长裸支架在经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)中的应用价值.方法:对南华大学附属南华医院2012-01/2015-01 22例肝硬化食管胃底静脉曲张患者采用覆膜支架联合长裸支架行TIPS治疗.结果:TIPS治疗的技术成功率为100%,术前门静脉压力43.25 cm H2O±4.56 cm H2O(l cm H2O=0.098 k Pa)降至23.78 cm H2O±5.11 c m H2O(t=21.423,P<0.01).造影见食管胃底曲张静脉消失,术后患者肝功明显改善,食管胃底静脉曲张程度明显减轻,无急性肝衰竭病例发生.随访6-24 mo,术后6、12、24 m o的累积分流道通畅率分别为95.4%(21/22)、90.9%(20/22)、86.3%(19/22).无"盖帽"情况发生.结论:采用覆膜支架联合长裸支架套叠技术能明显提高分流道的通畅率,为门脉高压症患者的肝内门体分流提供了是一种安全、有效的治疗方法,具有重要的临床应用价值.
基金This work was supported by“the Fundamental Research Funds for the Central Universities”(2232019D3-16)(China)the 111 Project 2.0“Biomedical Textile Materials Science and Technology”(B07024)(China)+3 种基金the Shanghai Science and Technology Support Project(18441902600)(China)the Engineering Research Center of Technical Textiles Ministry of Education(China)the Department of Surgery at Laval University(Quebec,Canada)the Fonds de Recherche de chirurgie vasculaire of the CHU(Quebec,Canada).The generous gift of device,by Medtronic and Vascutek is greatly acknowledged.The authors extend their appreciation to Boyin Qin,Yvan Douville,Pascal Rheaume,and Raymond Labbe.
文摘Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying around the fenestration as a result of the balloon angioplasty of the seal zone.This novel stent cuff design will also facilitate more complete biointegration of the devices,eliminate the hemodynamic variation as well as significantly reduce the possibility of a Type III endoleak.The feasibility of this concept is demonstrated by observations made from in-situ tests performed in a Beta endograft design.Flared cuffs made of poly(ε-caprolactone)supported with a weft-knitted polyester structure can be manufactured with various configurations to optimize the transition from the main body of the endograft,thus preventing the currently marketed designs’hemodynamic perturbation while also promoting endograft biointegration.This concept represents an evolution in branch graft design,which may enhance the long-term durability of customized fenestrations and open new applications for in-vivo graft fenestration in the near future.Further ongoing investigation to optimize its structure,X-ray opacity,fixation to the flared stent,and material biocompatibility are still required to build upon this concept’s proof.
