Guo Dq

Endovascular Stent-Graft Repair of Mycotic Aneurysms of the Aorta: A Case Series with a 22-Month Follow-Up

BackgroundThe purpose of the present study was to present a single-institution series of patients with mycotic aneurysms of the aorta treated with endovascular stent-graft technology, and to report the efficacy and short-term durability of this repair.MethodsA retrospective review of seven consecutive patients with mycotic aneurysms of the aorta treated with stent-graft between May 2006 and July 2007. Patients were diagnosed based on typical appearance of imaging together with a positive bacteriology culture or clinical evidence of infection. A bifurcated, aorto-uni-iliac (AUI) stent-graft and cuff were used in the endovascular repair after infection control. The follow-up protocol included regular clinical examination, hematologic tests, and computed tomography scans at 3, 6, 12, and 24 months.ResultsEndovascular aneurysm repair (EVAR) was performed successfully in the seven patients (all men, median age 56 years), with complete exclusion of the aneurysms. Five of the patients had infrarenal aortic aneurysms, and the other two had descending thoracic aortic aneurysms. The median hospital stay was 22 days, with no hospital deaths. No paraplegia or other major complications occurred. The patients remained well, with no evidence of graft infection at a mean follow-up of 22.7 months (range: 17–26 months). A significant reduction in the diameter of the aneurysm sac was noted on computed tomography scans in all the patients at 1 year (mean: 6.5 mm; range: 3–40 mm).ConclusionsEndovascular stent-graft treatment represents an alternative treatment with acceptable short-term outcomes for patients with mycotic aneurysms of the aorta.

Endovascular therapy for stanford type B aortic dissection in 102 cases.

OBJECTIVEnTo share our experience of 102 cases of endovascular therapy for Stanford type B aortic dissection.nnnMETHODSnMultiple imaging diagnostic modalities were used preoperatively to obtain the anatomical parameters of the aortic dissection. Stent grafts were implanted using digital subtraction angiography and intravascular ultrasound guidance. Follow-up computed tomography angiography 1 week and 1 year postoperatively was used to evaluate treatment efficacy and reveal complications such as endoleak, migration and fracture of the stent graft.nnnRESULTSnClinical success was achieved in 101 cases (99.0%); one patient (1.0%) died within the perioperative period. Neither postoperative paraplegia nor conversion occurred. Endoleak occurred in 18 cases (17.6%).nnnCONCLUSIONnEndovascular therapy for Stanford type B aortic dissection is less invasive and leads to less severe complications and shorter hospital stay compared with traditional surgery. The short- and mid-term efficacy are persuasive, but further follow-up is required to determine long-term efficacy.

Comparison of beraprost and ticlopidine in Chinese patients with chronic peripheral arterial occlusion: a multicenter, single-blind, randomized, controlled study

BACKGROUNDnChronic peripheral arterial occlusion (CPAO) is a progressive disease that is associated with a variety of symptoms, the 4 most common being a sensation of coolness in the limbs, intermittent claudication (in which pain occurs on walking), limb pain (which occurs spontaneously at rest), and ischemic leg ulcers. Beraprost sodium is an oral prostaglandin I2 analogue that may ameliorate these symptoms.nnnOBJECTIVEnThe aim of this study was to compare the efficacy and tolerability of beraprost sodium and ticlopidine hydrochloride in the treatment of patients with CPAO in China.nnnMETHODSnIn this multicenter, single-blind, controlled study, patients with CPAO were randomly assigned to receive beraprost 120-μg tablet TID or ticlopidine 500-mg tablet BID, both administered orally. The clinical efficacy of the drugs was assessed using the 4 main symptoms of CPAO. Ankle-brachial index (ABI) also was measured as a clinical pharmacologic procedure. Adverse events were assessed throughout the study.nnnRESULTSnA total of 124 patients (96 men, 28 women; mean [SD] age, 65 [12] years) were enrolled in 3 hospitals. Data from 119 patients (93 men, 26 women; mean [SD] age, 65 [12] years) were included in the efficacy analysis (64 and 55 patients in the beraprost and ticlopidine groups, respectively). Although all 4 symptoms of CPAO were ameliorated after 3 and 6 weeks of treatment with both drugs, only the cool sensation was significantly improved with beraprost compared with ticlopidine at 6 weeks (P<0.05). ABI was significantly increased with both beraprost and ticlopidine at 6 weeks versus baseline (P<0.001 and P<0.01, respectively), suggesting that this pharmacologic action may have led to their beneficial effect on various symptoms. The tolerability analysis included 123 patients (65 and 58 patients in the beraprost and ticlopidine groups, respectively). The numbers of patients who (1) experienced adverse events (AEs), (2) experienced adverse drug reactions, and (3) withdrew due to AEs were significantly smaller in the beraprost group than in the ticlopidine group (P<0.001, P<0.05, and P<0.05, respectively).nnnCONCLUSIONSnIn this study population of patients with CPAO, beraprost ameliorated cool sensation in the limbs, intermittent claudication, limb pain, and ischemic/leg ulcers. Beraprost was more efficacious in relieving CPAO symptoms and was better tolerated than ticlopidine. Beraprost may be useful for the treatment of patients with CPAO, but more studies are needed.