Percutaneous stenting of acquired thoracic aorta occlusive disease.

We report on successful treatment of acquired atherosclerotic coarctation of the thoracic aorta with self-expanding stents via percutaneous approach. The technique and equipment used in the case are discussed.     

Endovascular solutions for diseases of the thoracic aorta

Technology is proceeding at a very brisk pace. Harnessing that technology for clinical use is both a challenge and an opportunity. This combination of surgical and interventional methods has allowed for improved clinical outcomes in certain complex aortic problems. This article explores and discusses new techniques used in detection and treatment of diseases of the thoracic aorta.     

Radiography of diseases involving the aortic valve and thoracic aorta

This article presents the plain radiographic findings in a variety of conditions that affect the aortic valve and thoracic aorta. For many of the lesions presented in this article, the diagnosis can readily be made by using digital subtraction angiography, computed tomography, and echocardiography. The use of these modalities in conjunction with the chest radiographic findings is emphasized.     

Duplex scanning in the diagnosis of diseases of the thoracic aorta

In the Department of Vascular Surgery, A. V. Vishnevsky Institute of Surgery, USSR Academy of Medical Sciences, Duplex scanning was used to examine 40 patients. It was demonstrated that 20 patients had aneurysms of the arch and descending thoracic aorta; 4, dissecting aneurysms of Types I and III; 5, aortic coarctation; 11 patients had thoracic aorta aneurysms resected. The optimal point for scanning in the diagnosis of aneurysms and coarctation of the thoracic aorta is the jugular fossa. The diagnostic value of the duplex scanning in the detection of aneurysms of the arch and descending thoracic aorta amounted to 90%, that of aortic coarctation, 100%. The technique is noninvasive and highly informative, assessing the results of surgical therapy of thoracic aorta abnormalities in late periods following operation.     

Stent-graft repair in acute and chronic diseases of the thoracic aorta

Thoracic aortic endografting has demonstrated encouraging mid-term results and attracts growing acceptance as a valuable treatment option for chronic aneurysmal disease. The emerging role of endovascular strategies for management of acute thoracic aortic pathologies is even more exciting considering the sobering results of open repair. Although it is accepted that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft interventions remains to be defined as the medical community awaits solid long-term data and better devices. While some indications and scenarios such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture have shown to benefit from stent-graft treatment, other scenarios are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.     

Transesophageal echocardiography in the diagnosis of diseases of the thoracic aorta: part II-atherosclerotic and traumatic diseases of the aorta

Transesophageal echocardiography (TEE) has provided an accurate new window for the evaluation of diseases of the thoracic aorta. Experience with TEE has led to an increased recognition of atherosclerosis of the thoracic aorta as a source of cerebral and systemic embolism. Certain features of aortic plaque morphology detected by TEE may prove to have prognostic and therapeutic significance. The intraoperative assessment of thoracic aortic atherosclerosis by TEE may guide modifications in surgical techniques and aortic manipulations that reduce the incidence of perioperative neurologic complications. TEE has also become a valuable tool for the diagnostic evaluation of patients with blunt chest trauma. The precise role of TEE in the management of these disorders is currently under investigation.     

人造血管覆盖支架成功治疗胸主动脉瘤9例报告

目的 :报告 9例人造血管覆盖支架治疗胸主动脉瘤的结果。方法 :手术暴露股动脉 ,送入带距离标记的pigtail进行主动脉造影以确认人造血管覆盖支架的直径和长度。送入 30 0cm长的AmplatzSuperStiff导丝 ,切开股动脉 ,沿导丝送入人造血管覆盖支架 ,准确定位后 ,将收缩压降到 70～ 80mmHg(1mmHg =0 .133kPa) ,快速退出鞘管 ,释放人造血管覆盖支架 ,主动脉造影检查效果 ,最后缝合股动脉。结果 :共治疗了 9例降主动脉瘤 ,真性动脉瘤 4例 ,溃疡 1例 ,假性动脉瘤 1例 ,夹层 3例。除 1例夹层未能完全封闭假腔外 ,其余均隔绝动脉瘤获得成功 ,无 1例发生严重并发症 ,遇到的主要问题有 :1 动脉瘤非常靠近左锁骨下动脉 ,未能严密覆盖动脉瘤 ,发生了轻微的内漏 ;2 目前使用的人造血管输送系统比较硬 ,1例在主动脉弓部难以释放 ;3 测量不准 ,1例人造血管覆盖支架稍短 ,出现了轻微的内漏 ;4 夹层动脉瘤的治疗主要是封堵入口 ,1例入口和出口距离仅有 3～ 4cm ,故未能完全封闭假腔。结论 :置入人造血管覆盖支架可以隔绝真性动脉瘤 ,封堵夹层动脉瘤和假性动脉瘤入口 ,治疗效果好 ,操作简单 ,并发症少 ,出血少 ,恢复快。     

Endografts (or stent-grafts) and diseases of the descending thoracic aorta

The endovascular treatment of aorta diseases with S-Graft is considered as an alternative to surgery, especially interesting in patients with severe comorbidities. Indeed, the mid-term morbidity and mortality are comparable to surgery in relatively large series, and S-Graft implantation appeared as a safe, less invasive and efficient treatment for different affections of the thoracic aorta. This article reviews technical aspects, indications and results of endovascular repairs of thoracic aorta lesions. We will also assess the advantages and limitations of S-Graft therapy.     

Current management of liver diseases and the role of multidisciplinary approach

Liver is an organ having extremely diversified functions, ranging from metabolic and synthetic to detoxification of harmful chemicals. The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management. Several studies have investigated liver function, dysfunction and clinic. This editorial work discusses new ideas, challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases. In one hand the discussions have carried out on the involvement of extracellular vesicles, Na⁺/H⁺ exchangers, severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections, Drug-induced liver injury, sepsis, pregnancy, and food supplements in hepatic disorders. In the other hand this study has discussed hepatocellular carcinoma algorithms and new biochemical and imaging experiments pertaining to liver diseases. Relevant articles with an impact index value > 0 from reference citation analysis, which is an open multidisciplinary citation analysis database based on artificial intelligence technology, have served for the study’s argumentation. This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.     

Percutaneous stents for the treatment of stenosis of descending aorta

Stenotic processes of the descending aorta lead to a transstenotic gradient with either risk of proximal hypertension especially affecting the cerebral circulation combined with the risk of distal malperfusion. This article describes the technique of percutaneous stenting of suprarenal aortic stenosis in two patients with different genesis of aortic obstruction in whom operative correction was refused due to elevated surgical risk. The first patient (female, 38 years) suffered from aortic stenosis at the thoracoabdominal level revealing a residual lumen of 3 mm. The second patient (male, 71 years) had a chronic type B aortic dissection and developed dynamic compression of true lumen and thus peripheral malperfusion. Both patients were treated successfully with percutaneous implantation of self-expanding stents. During the follow-up of 6 and 10 months, respectively, both patients were free of any symptoms. The technique of percutaneous stenting of static and dynamic stenotic processes of the aorta led to excellent mid-term results. Long-term results of large patient cohorts are not available yet; however, all patients subjected to such a palliative procedure should be followed in structured registries in an effort to standardize the concept and develop therapeutic recommendations.     

Surgical treatment of aneurysms of the abdominal and thoracic aorta

The danger of an arteriosclerotic abdominal aortic aneurysm is clearly related to the size of the aneurysm. From available clinical data it seems logical to recommend elective surgical excision and graft replacement of abdominal aneurysms 6 cm or greater in diameter because of the considerable danger of rupture of untreated aneurysms of this size. Although small aortic aneurysms do rupture, most patients with small abdominal aneurysms may be safely followed with examination at regular intervals. Surgery is reserved for those who demonstrate evidence of aneurysm expansion. The operative mortality rate for elective surgical excision of abdominal aortic aneurysms is by no means negligible but has probably diminished recently to levels of approximately 5% in the hands of experienced surgeons. Achievement of an operative mortality rate in this range requires sensible case selection, expeditious operative management and skillful postoperative care with particular attention to problems of hypoxemia in the early postoperative period.Patients with ruptured abdominal aortic aneurysms require immediate aneurysm resection for survival. Of those patients with ruptured abdominal aneurysms who reach the hospital alive, approximately 60% should be salvaged at present by emergency surgery.The prognosis of the patient with a thoracic aortic aneurysm depends upon the etiology of the aneurysm. Syphilitic aneurysms of the thoracic aorta are now fortunately rare but appear to have a high incidence of rupture. The prognosis of patients with arteriosclerotic aneurysms, which characteristically involve the descending thoracic aorta, appears to be considerably better than that of patients with aneurysms of the abdominal aorta for unknown reasons. Since the removal of thoracic aneurysms ordinarily requires extracorporeal bypass and is associated with an operative mortality rate in the range of 20%, considerable judgment must be exercised in case selection for elective resection of such aneurysms.The surgery of dissecting aneurysms of the thoracic aorta has recently been modified by the widespread acceptance of antihypertensive drug therapy for acute dissection. Surgery may be reserved, hopefully on an elective basis, for those patients with significant aortic valvular insufficiency, significant aneurysmal dilatation of the dissected aorta, or symptomatic involvement of a major aortic branch in the dissection.     

Percutaneous interventions of the aorta

Coarctation of the aorta includes a wide array of anatomical and pathophysiological variations that may cause important long-term morbidity and mortality. Percutaneous techniques, such as balloon dilation and stenting, allow clinicians to safely decrease or abolish most gradients along the aorta, albeit with limitations. Proper patient selection and interventional technique allow clinicians to obtain an adequate stretch or therapeutic tear of the vessel wall, but should avoid complications, such as an excessive tear, dissection, aneurysm formation or rupture. The interventional technique is tailored by patient characteristics such as age, size and growth potential, by characteristics of the lesion such as degree of narrowing, length, angulation(s) and by local regulations.