Xiaolong Wei

Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection

Endovascular repair continues to pose a formidable technical challenge in the cases of aneurysm, dissection, and proximal type I endoleak involving the aortic arch. During the process of covering the aortic arch by stent graft to achieve better sealing, maintaining blood flow to the vital supra-aortic branches is difficult. We present a case of successful endovascular treatment of secondary type I endoleak by a double-chimney technique in a 36-year-old woman who had previously undergone a complicated descending aortic dissection repair. This endovascular technology might offer a new option to simultaneously preserve the innominate artery and the left carotid artery for total reconstruction of the aortic arch.

Management of wide-based renal artery aneurysms using noncovered stent-assisted coil embolization

Objective: This study describes the safety and midterm efficacy of a noncovered stent‐assisted embolization (SAE) technique in treating patients with wide‐base renal artery aneurysms (RAAs). Methods: Between February 2011 and June 2014, 34 RAAs in 28 consecutive patients were treated with noncovered SAE in our center. Results: Technical success was 100%. During an average follow‐up of 19 months, the systolic and diastolic blood pressures were significantly decreased. Serum creatinine was significantly decreased, and the glomerular filtration rate was significantly increased at the 6 and 12 month follow‐up compared with the baseline. The aneurysm sac thrombosis ratio was obviously increased at 1, 6, and 12 months of follow‐up. Complications occurred in four patients, including one major, two minor, and one late complication. Computed tomography angiography or digital subtraction angiography demonstrated that the primary patency at 1, 6, and 12 months was 100%, 96%, and 100%, respectively, and primary assisted and secondary patency was 100%, without endoleaks. Conclusions: SAE can be safely and effectively performed in patients with wide‐based RAAs or those with critical anatomy. It showed a midterm reduction of blood pressure and improvement of renal function in RAA patients.

Relationship between serum cortisol level and degree of false lumen thrombosis in patients with uncomplicated type B aortic dissection

Partial thrombosis of the false lumen in uncomplicated type B aortic dissection (uTBAD) is associated with an increased late mortality risk. Whether the serum cortisol level can affect false lumen thrombosis in patients with uTBAD has not been well characterized. This study was performed on 87 patients with uTBAD. A curve-fitting method was used to analyze the relationship between serum cortisol and partial thrombosis of false lumen. Univariate and multivariate logistic regression analyses were used to identify false lumen partial thrombosis–associated serum cortisol. Curve-fitting’s result revealed a characteristic U shape, and 14.0 µg/dL was considered as the cutoff point for serum cortisol. The results of univariate and multivariate logistic regression analyses suggested that when trisecting the serum cortisol level into three parts, the low and high levels of serum cortisol could significantly affect the occurrence of false lumen partial thrombosis compared with the middle level. The odds ratio value of the low and high levels of serum cortisol was 6.12 and 4.65, respectively, in the univariate analysis, and 24.32 and 3.93, respectively, in the multivariate analysis. Low or high levels of serum cortisol might influence the natural result of uTBAD through affecting the false lumen thrombosis.

Veno-occlusive Disease

Vein occlusion refers to a type of diseases characterized by venous stenosis or occlusion. Its main clinical manifestations include poor distal venous return, swelling, and aching pain. To be specific, lower extremity deep venous thrombosis is relatively common. As soon as the thrombus drops, it can easily give rise to pulmonary embolism and other acute diseases. This chapter introduces the formation of lower extremity deep venous thrombosis as well as clinical manifestations, surgical process, and intraoperative observation points of Budd-Chiari syndrome.

Artery Occlusive Diseases

Arterial occlusions refer to a type of diseases mainly characterized by artery stenosis or occlusion. They are frequently seen in peripheral arteries, usually giving rise to the ischemia or necrosis of important distal tissues or organs, etc. With the advent of population aging, arteriosclerosis has become the pathogenesis basis of most occlusive diseases. This chapter mainly introduces clinical manifestations, endovascular surgery process, and intraoperative observation points of carotid artery stenosis, subclavian artery stenosis, renal artery stenosis, and lower extremity atherosclerotic occlusive disease.