目的 对比普通球囊重建与忽略股浅动脉重建(nSFA)方案治疗股浅动脉(SFA)病变的远期疗效、安全性和治疗费用.方法 回顾性分析2014年1月至2016年4月收治的106例SFA重度狭窄/闭塞患者(115条患肢)临床资料,分为nSFA组(n=47,55条患肢)和经皮腔内血管成形术(PTA)组(n=59,60条患肢).比较两组患者Rutherford分级改善率、生存率、保肢率以及主要不良事件发生率、治疗费用和住院时间.结果 两组患者基线资料和病变特征具有可比性.nSFA组失访1例.nSFA组、PTA组随访时间分别为60(22,77)个月、60(1,76)个月.两组患者近期Rutherford分级改善率、生存率和保肢率差异均无统计学意义(P>0.05).nSFA组患者远期Rutherford分级改善率、围手术期主要不良事件发生率、肢体相关主要不良事件发生率、治疗费用、住院时间均优于PTA组,差异有统计学意义(P<0.05).结论 SFA重度狭窄/闭塞患者nSFA治疗方案与PTA重建SFA方案相比,远期疗效和安全性较好,治疗费用较低,尤其对于膝下动脉流出道较好的SFA多节段闭塞患者.

临床资料患者,女,36岁,自由职业者.因"间断头痛3年余"入院.患者述3年前每逢情绪波动后出现视物模糊、重影,约30 min后感搏动性头痛,以双侧颞部为著,伴间断性疼痛侧血管突出感,持续1h后可自行好转,2h后基本缓解,整个发作过程中无畏光、畏声、恶心呕吐等异常,类似发作约5～6次,未予以特殊治疗.10 d前就诊于当地医院,行头颅MRI报告多发皮层及皮层下的点状长T1长T2异常信号,考虑为脱髓鞘病变,头颅磁共振血管成像(magnetic reso-nance angiography,MRA)未见异常,遂来我院门诊,为进一步诊治收住院.

目的 探讨腔内修复对小真腔Stanford B型主动脉夹层(TBAD)患者合并脏器缺血的临床效果.方法 收集60例行胸主动脉腔内修复术(TEVAR)的小真腔TBAD患者临床资料,对所有患者均随访12个月,根据有无脏器缺血将患者分为A组(n=16,合并脏器缺血)和B组(n=44,未合并脏器缺血).比较两组患者的术前实验室指标(乳酸、C反应蛋白、尿素氮、血肌酐、谷丙转氨酶、天门冬氨酸氨基转移酶、D-二聚体)、术前影像学特征(锁骨下动脉后缘真腔直径、肾动脉水平真腔直径、腹主动脉分叉真腔直径、原发破口直径、继发破口直径、肺动脉水平真腔直径、膈肌水平直径、破口个数)、围手术期结果及随访结果.结果 A组患者的血肌酐、谷丙转氨酶、天门冬氨酸氨基转移酶、D-二聚体水平均高于B组患者,差异均有统计学意义(P<0.05).A组患者的原发破口直径大于B组患者,继发破口直径、肺动脉水平真腔直径、膈肌水平直径均小于B组患者,破口个数少于B组患者(P<0.05).A组患者的住院时间短于B组患者,肺动脉水平真腔直径扩大和膈肌水平真腔直径扩大高于B组患者(P<0.05).两组患者内瘘、支架移位和截瘫的发生率比较,差异均无统计学意义(P>0.05).结论 对于术前出现脏器缺血的小真腔Stanford B型患者,行TEVAR可获得良好的主动脉真腔重塑效果,疗效确切.

Background Congenital aortic coarctation (CoA) associated with aortic rupture is a rare but extremely lethal condition. In pregnant patients, the condition becomes very risky. Case presentation We presented a case of a pregnant (20 weeks gestation) patient with CoA associated with ruptured aortic pseudoaneurysm who was successfully rescued using a novel hybrid strategy. Conclusions This hybrid approach may be a life-saving bridging intervention in patients with CoA associated with devastating complications, such as ruptured aneurysms, especially with extremely narrowed access.

Purpose::To analyze the efficacy and outcome of percutaneous thoracic endovascular aortic repair (TEVAR) in patients with traumatic blunt aortic injury in our single-center.Methods::From January 2014 to December 2018, a total of 89 patients with traumatic blunt aortic injuries were treated with emergency TEVAR in our center. Their clinical data such as demographics, operative details and postprocedure outcomes were analyzed retrospectively in this study using SPSS 20 software. Continuous variables were expressed as mean and standard deviation or median and interquartile range. Categorical variables are expressed as the numbers and percentages of patients.Results::The median age of the patients was 37 years, and 76 (85.4%) were males. All the patients were involved in violent accidents and combined with associated injuries. Two patients died while awaiting the operations and 87 patients underwent emergency percutaneous TEVAR, with a 100% technique success. The mean time interval from admission to operating room was (90.1 ± 18.7) min, and the mean procedure time was (54.6 ± 11.9) min. Eighty (92.0%) patients were operated on under local anesthesia, while other 7 (8.0%) patients were under general anesthesia. Two cases underwent open repair of the femoral arteries because of the pseudoaneurysm formation of the access vessels. A total of 98 aortic covered stent grafts were deployed, of which 11 patients used two stent grafts (all in dissection cases). The length of the stent was (177.5 ± 24.6) mm. The horizontal diameter of aorta arch at the proximal left subclavian artery ostium was (24.9 ± 2.4) mm, the proximal diameter of the covered stent was (30.5 ± 2.6) mm, and the oversize rate of proximal site was (22.7 ± 4.0)%. The proximal landing zone length was (14.1 ± 5.5) mm. The left subclavian artery ostium was completely covered in 5 patients and partially covered in 32 patients. No blood flow reconstruction was performed. The overall aortic-related mortality was 2.25% (2/89). Among 87 patients, the median follow-up time was 24 months. Postoperative computed tomography angiography scans demonstrated no residual pseudoaneurysm, hematoma or endoleak. One patient complained of mild left upper limb weakness during follow-up due to left subclavian artery occlusion. Neither late death, nor neurological or other complications occurred.Conclusion::Emergency percutaneous endovascular repair is a less invasive and effective approach for the treatment of traumatic blunt aortic injuries. Long-term results remain to be further followed.

OBJECTIVE:To facilitate the analysis and diagnosis of X-ray coronary angiography in interventional surgery, it is necessary to extract vessel from X-ray coronary angiography. However, vessel images of angiography suffer from low quality with large artefacts, which challenges the existing vascular technology.METHODS:In this paper, we propose a ávessel framework to detect vessels and segment vessels in angiographic vessel data. In this framework, we develop a new matrix decomposition model with gradient sparse in the tensor representation. Then, the energy function with the input of the hierarchical vessel is used in vessel detection and vessel segmentation.RESULTS:Through experiments conducted on angiographic data, we have demonstrated the good performance of the proposed method in removing background structure.CONCLUSION:We evaluated our method for vessel detection and segmentation in different clinical settings, including LAO/RAO with cranial and caudal angulation, and showed its competitive results compared with eight state-of-the-art methods in terms of extensive qualitative and quantitative evaluation.SIGNIFICANCE:Our method can remove a large number of background artefacts and obtain a better vascular structure, which has contributed to the clinical diagnosis of coronary artery diseases.

Graft aneurysm after ascending aorta to abdominal aorta bypass is a rare complication of repair of coarctation of the aorta. We present a case of an aneurysm measuring 75 mm in diameter at the midportion of the prosthetic graft in a 33-year-old man. To prevent aneurysm rupture, redo ascending-to-abdominal aortic bypass was performed through an upper ministernotomy and upper midline laparotomy. No postoperative complications occurred. The patient was successfully discharged on postoperative day 6. Although ascending-to-abdominal aortic bypass can achieve long-term patency, the prosthetic graft still has the rare risk of aneurysm formation, as highlighted in this case. Early diagnosis and timely management of this rare complication are essential in preventing aneurysm rupture.

目的:探讨一体式分叉型覆膜支架应用于介入治疗孤立性髂动脉瘤(IIAAs)的安全及有效性.方法:回顾性分析本中心自2011年8月至2016年7月,共7例男性患者,年龄49～ 82岁,平均年龄(69±10.5)岁,因IIAAs接受一体式分叉型覆膜支架介入治疗.其中单侧病变3例;双侧病变4例,4例合并髂内动脉瘤.6例患者使用Microport Aegis-B一体式分叉型覆膜支架,1例使用Powerlink一体式分叉型覆膜支架,远端共使用9枚髂动脉延长支架.1例患者行髂内动脉预栓塞以避免Ⅱ型内漏.术后分别于1、6、12个月及以后每年一次行临床及影像随访.结果:7例患者均成功置入一体式覆膜支架,技术成功率为100％.一体式支架主体近端直径为24～ 26 mm,长度为80～ 90 mm.6例患者单侧髂内动脉开口覆盖,1例患者双侧髂内动脉开口覆盖,无盆腔及臀肌缺血发生,围术期无严重并发症发生.平均随访时间(32.5±19)个月(12～70个月).患者随访期内无支架移位,无支架相关死亡等严重并发症.1例随访内发现轻度Ⅱ型内漏.结论:一体式分叉型覆膜支架治疗ⅡAAs安全有效,近中期疗效满意,特别是对于近端锚定区不足或双侧受累的患者有其独到特殊的应用优势.

目的 探讨主动脉缩窄(CoA)合并症及CoA外科术后并发症介入治疗的可行性.方法 2009年6月至2016年12月北京安贞医院6例CoA合并急性主动脉综合征或CoA外科术后并发假性动脉瘤患者接受介入治疗.男5例,女1例;年龄44～56(50.3±5.01)岁.患者术前均经主动脉CT血管造影(CTA)确诊.根据患者主动脉解剖及病理生理特点制定介入治疗方案,4例患者(2例主动脉缩窄合并B型主动脉夹层,1例主动脉缩窄合并穿通性溃疡,1例外科术后缩窄复发合并假性动脉瘤),行胸主动脉腔内修复术(TEVAR)治疗;1例患者CoA外科术后吻合处假性动脉瘤形成采用TEVAR,并对外科姑息的缩窄进行栓塞;1例CoA合并B型主动脉夹层,外科先行升主动脉至降主动脉人工血管转流,再对缩窄处进行封堵.结果 介入治疗技术成功率100％.围术期无并发症发生.随访10～60个月,无主动脉相关死亡和再次介入或外科手术干预治疗.结论 解剖条件合适的CoA合并症或CoA外科术后并发假性动脉瘤患者可首先尝试TEVAR治疗.解剖条件不合适的CoA合并B型主动脉夹层患者可行复合手术.此类患者应根据解剖及病理生理特点个体化选择手术方式及介入器材.

BACKGROUND: Thoracic aortic endovascular repair is an important method for treating aortic dissection and thoracic aortic aneurysm. The success of the operation depends on whether the stent graft is placed in the correct position. However, when the stent is implanted, the aorta in the intraoperative X-ray image is invisible, so the operation is difficult and the risk is high. Registration of preoperative CT angiography and intraoperative X-ray images can help doctors place stents and increase success rates. OBJECTIVE: To propose a preoperative CT angiography and intraoperative X-ray image registration algorithm for thoracic aortic endovascular repair. METHODS: Firstly, digital reconstruction images of CT angiography and bone CT were performed under different virtual perspectives, and the two were superimposed to obtain a digital reconstruction image library under various angles of position and orientation for intraoperative X-ray images. Secondly, we proposed a deep neural network based on branch decoding structure. Using digital reconstruction image library training, the position and attitude parameters of intraoperative X-ray images could be estimated to obtain CT angiography and intraoperative X-ray images. The spatial positional relationship was obtained. Finally, according to the pose parameters of the X-ray image in the CT angiography coordinate system, the thoracic aorta image in the CT angiography was re-projected and superimposed into the intraoperative X-ray image to navigation assistance for the doctors. RESULTSANDCONCLUSION: (1) The experimental results show that the root mean square error of the proposed algorithmis reduced by 17%comparedwiththe traditional algorithmsof gradient correlation and mode strength. (2) In the dual-branch code structure network, the parameter estimation error is reduced to 30% of the network without branching structure in the digital reconstruction image test set. (3) In the experimental X-image experiment, the root mean square error is also reduced by2%.

消化道出血是临床常见急症,临床上根据失血量与失血速度将消化道出血分为慢性隐性出血、慢性显性出血和急性出血 [1].急性大量出血一般界定为短时间(1 ～ 2h)内超过 800ml 或占总循环血量 20％以上的出血,死亡率约为 10％.60 岁以上患者消化道出血死亡率为 30％ ～ 50％,高于中青年患者.抗血小板药物是治疗冠状动脉粥样硬化性心脏病的基础药物,其广泛使用虽然有效降低了心脑血管疾病的发生率,但与阿司匹林和非甾体类抗炎药有关的消化道出血的发生率却逐年上升 [2-3].心脏机械瓣膜置换的风湿性心脏病患者术后需要长期服用抗凝血药物进行辅助治疗,继而引发的消化道出血可能危及生命 [4].消化道出血的治疗临床上多采用止血或手术切除病变组织,但长期抗栓治疗的患者消化道动脉性出血应用止血药物多难以控制;患者因大量失血、休克等造成生命体征极不稳定而无法耐受外科手术;当以出血为首发症状,病因和出血部位不清楚的前提下更是无法进行外科手术治疗 [5-6].介入性血管内栓塞是血管腔内介入技术的一种,因其创伤小,治疗速度快,栓塞前可通过血管造影明确出血部位,疗效确切等优势而常被应用于内脏动脉性出血的急诊处理.本文主要论述抗栓治疗患者发生非静脉曲张性出血的介入治疗.

Objective To discuss the discovery of stent graft mis-deployed into false lumen during aortic dissection treatment and re-deployment.Methods Retrospective analysis of the data of deployment of the stent-graft into the false lumen in the initial treatment of aortic dissection between January 2013 to December 2017.Of the five cases,there were three males and two females,range from 28 to 52 year old.Two patients,suffered from acute Stanford type A aortic dissection,with aortic surgical replacement and circulatory elephant trunk technique,displayed the visceral ischemia and internal environment disorder postoperatively.An emergency CT angiography showed that the deployed stent-graft was in the false lumen.Another two cases with sub-acute Stanford type B aortic dissection underwent TEVAR.The stent-grafts were put in the false lumen intra-operatively,one patient with pregnancy-induced hypertension suffered from acute Stanford type B aortic dissection.An emergency endovascular repair was set under general anesthesia to deal with this problem.New stent-graft was utilized to correct the blood flow into true lumen via flap fenestration or secondary intimal tear.Results The successful rate of this operation was 100％.Time of surgery spanned from 45 minutes to 120 minutes,and blood loss was estimated to be from 50 ml to 100 ml.Five stent grafts were placed with 160 mm length and 6 mm taper and one was 120 mm length and 10 mm taper.Patients were observed in ICU for three days and discharged from hospital after seven days.No complications such as paraplegia,visceral ischemia,etc occurred.Postoperative aortic CTA one month later showed no complications,such as endoleak,etc.The stents were in ideal position,with fluent blood flow of aorta and major visceral artery.Conclusions Deployment of the stent-graft in the false lumen is a rare and critical complication in the treatment of aortic dissection.In addition to clinical manifestations and laboratory tests,aortic CTA could identify this complication quickly and accurately.Endovascular repair was recommended as primary treatment of choice,which could re-direct the blood flow into true lumen via flap fenestration or secondary intimal tear technology quickly and effectively.

目的 探讨同期腔内修复治疗胸、腹主动脉病变的安全性及可行性.方法 回顾性分析2014年6月至2016年3月间诊断为胸主动脉合并腹主动脉病变且同期行胸主动脉腔内修复术(TEVAR)及腹主动脉腔内修复术(EVAR)的13例患者临床资料.所有患者均为男性,平均年龄(66.8±8.2)岁.其中胸主动脉瘤伴腹主动脉瘤4例,胸主动脉穿通溃疡伴腹主动脉瘤5例,胸主动脉穿通溃疡伴髂内动脉瘤1例,胸主动脉穿通溃疡伴腹主动脉夹层1例,胸主动脉夹层伴腹主动脉瘤2例.局部麻醉下同期行TEVAR、EVAR,术后1周、1个月、3个月、6个月及术后每年定期随访.结果 13例患者均成功接受同期TEVAR及EVAR手术,所有患者术后均未出现由于脊髓缺血所致的截瘫症状.手术时间(177.7 ±48.5) min,术后住院(3.1±1.6)天,围术期死亡1例,术后随访6～24个月,除1例患者支架远端发生内漏需再次介入干预外,其余患者支架均无内漏及移位.结论 同期行TEVAR联合EVAR手术安全、可行,术后密切监测下肢运动功能及神经系统体征,必要时行脑脊液引流及激素冲击等措施,能够有效降低术后截瘫的发生.

CASE PRESENTATION: A 38-year-old right-handed woman presented to the hospital with subtle right facial palsy and global aphasia of 4 days' duration. She found that she had aphasia when she suddenly woke up at midnight and reported a headache lasting for several hours. She had no fever, vomiting, seizures, or limb paralysis. She had had migraines with an occasional visual aura for > 10 years. She was not taking any medication and was a nondrinker and nonsmoker. She had no other significant medical background and family history.

目的:探讨以单纯升主动脉扩张为主要表现的大动脉炎的病例特点,旨在提高对该病的早期识别.方法:对1例以单纯升主动脉扩张为主要表现,而无其他动脉及其分支狭窄闭塞的大动脉炎患者,进行病例分析并文献复习.结果:患者以“发热、咳嗽、胸背疼痛”入我院呼吸与危重症医学科,经除外感染性疾病,并完善相关动脉血管检查发现:升主动脉增宽,降主动脉近段、右侧无名动脉、左侧颈总动脉、左侧锁骨下动脉近段管壁增厚水肿,考虑“多发性大动脉炎”转入风湿免疫科给与口服激素免疫抑制剂治疗,症状改善.3个月后电话随诊,病情稳定未进展.经文献检索国外类似报道5例,复习文献发现:计算机断层扫描血管成像(CTA)、磁共振血管成像(MRA)、血管多普勒检查和正电子发射计算机断层/计算机断层扫描(PET/CT)可用于早期诊断及炎症活动的评估,术前及术后的免疫抑制治疗是手术成功的关键.结论:单纯以升主动脉扩张为首发表现,而无其他血管狭窄闭塞的TA病例临床少见.疾病多处于早期,且伴有血管炎性活动;大血管检查发现早期管壁的炎症水肿、增厚是管腔狭窄出现前做出诊断大动脉炎的最重要依据,应仔细甄别,以免漏诊.规范的激素及免疫抑制治疗是改善预后的关键因素.

Objective The purpose of the study was to assess the distal aorta changes and prognosis after total arch replacement combined with stented elephant trunk implantation(Sun’s procedure) for Marfan patients with Stanford type A aortic dissection involving the aortic arch. Methods Between February 2009 and February 2014, 47 Marfan patients(38 males, 9 females) with Stanford type A aortic dissection involving the aortic arch underwent Sun’s procedure. Mean ages(32.43±7.96) years(ranged from 19 to 50 years). According to whether the growth rate of the distal aortic diameter is more than 5 mm/year or not after the first year, the data it was divided into the improve group(29 cases) and the progressive group(18 cases). The residual false lumen thrombosis and the diameter of the distal aorta were evaluated by CT date. Results All patients were survived and discharged after Sun’s procedure. The mean follow-up period was 1 years.The survival rate was 97.9%(46/47)and 1 patients died. The total recover of the distal aorta was achieved in12 patients(25.5%)after procedure. The reoperation of total thoracoabdominal aortic replacement rate of the distal aorta was 8.5%(4/47) and the reoperation interval was(9.88±2.84) month(6-12 month). Complete thrombus formation around the stented elephant trunk was observed in 85.1%(40 of 47). The annual rate of growth of the distal aorta were: the descending aorta segment of stented elephant trunk(0.00±3.41) mm, the diaphragm level(1.14±2.20)mm , the renal artery level(0.97±2.15)mm. Complete thrombus formation around the stented elephant trunk of theprogressive group was lower thanthe improvegroup(72.2% vs 93.1% , P=0.089). The reoperation rate of total thoracoabdominal aortic replacement surgery of the progressive group was higher than the improve group(22.2%vs 0, P=0.017). The incidence of aortic rupture risk of the progressive group was higher than the improve group(5.6% vs 0, P=0.383). The diameter of the distal aorta after Sun’s procedure of the progressive group was higher than the improve group after 1 year: the descending aorta segment of stented elephant trunk end(40.17±7.09)mm vs(27.86±6.77)mm(P<0.001), the diaphragm level(42.17±9.91)mm vs(27.48±7.14) mm(P<0.001), the renal artery level(38.22±6.90) mm vs(24.00±6.18) mm(P<0.001), the difference was statistically significant. Conclusion Using Sun’s procedure for Marfan patients with Stanford type A aortic dissection involving the aortic arch would promote false lumen thrombosis of stented elephant trunk and aortic remodeling and delay the time interval of the reoperation. The Marfan patients in progressive group which the diameter of the distal aortic growth rate was more than 5mm /year , should be actively carry out rigorous monitoring of the distal aorta and prevention of aortic rupture risk events. Key words: Marfan syndrome type A aortic dissection Sun's procedure distal Aorta

Objective:As one of the imaging manifestation of the intramural aortic hematoma(IMH),the clinical study of the IMH with intramural blood pools was less.The study through comparison of intramural blood pools with ulcer-like projection(ULP) and penetrating atherosclerotic aortic ulcer(PAU),learning these lesion's image features and clinical prognosis.Better of IMH image study performance was identified,and the clinical treatment strategy provides the basis for the selection of.Methods:June 2014 to June 2015,admitted consecutively to our hospital for 123 cases only received conservative treatment by drug with IMH,including 31 cases in first onset of follow-up found aortic intramural hematoma with intramural blood pools for A group,22 cases were found to have aortic intramural hematoma with ulcer-like projections for the control group B,18 cases found IMH with penetrating ulcer as control group C.All patients underwent CTA follow-up.Results:Patients in the IBP group were significantly better than the PAU group and the ULP group,but most of the patients were followed up for 17/31 (55％).Groups between the absorption of hematoma and follow-up complications did not differ significantly.Aortic related complications of aortic dissection (n =1) in 8 patients,tumor like dilatation 6,aortic rupture (n =1) underwent surgery or aortic surgery treatment,the remaining 12 patients (continuous pain n =4,the pathological changes were significantly increased n =3,the number of lesions significantly increased the n =1) underwent surgical treatment.Three groups of patients with an average follow-up period of 12 months,no aortic related death occurred.Conclusion:aortic intramural hematoma with intramural blood pools in the lesion size,depth,number,size of the break withulcer-like projection and penetrating ulcer image science exist obvious differences,clinical prognosis was better than that of ulcer-like projection and penetrating ulcer,but there is still a poor prognosis,clinical should pay attention to.

Objective To investigate the value of iFlow in hemodynamic evaluation of type B aortic dissection.Methods A total of 39 patients with type B aortic dissection undergoing thoracic endovascular aortic repair(TEVAR) from January to March 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled.Digital subtraction angiography (DSA)examination was performed during operation;the iFlow software was used for image process to acquire color coded blood flow chart.The peak time of true lumen and false lumen was measured and the correlation between peak time and distance of measuring points was analyzed.Results In 37 patients who successfully had the examination,the peak time had no significantly differences among 4 measuring points of true lumen(P ＞ 0.05);the peak time of false lumen measuring points was (3.4 ± 1.3),(3.8 ± 1.4),(4.0 ± 1.4),(4.5 ± 1.3) s,respectively;there were statistically significant differences among 4 measuring points (F =3.920,P ＜ 0.05).The peak time of true lumen and false lumen increased with distance of measuring points of descending aorta(r2 =0.034,0.075;P ＜0.05).The general peak time of true lumen was (2.9 ±0.8)s;the general peak time of false lumen was (3.9 ± 1.4) s;there was a significant difference of blood flow velocity between true lumen and false lumen(P ＜ 0.01).Conclusion iFlow can be used for hemodynamic evaluation of type B aortic dissection.

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment.

Objective To analyze the effects of endovascular repair for Stanford B aortic dissection with one-stent graft implantation and two-stent graft implantation on aortic remodeling.Methods Totally 100 patients with Stanford B aortic dissection who had endovascular repair from January 2012 to December 2013 in Beijing Anzhen Hospital,Capital Medical University had one-stent graft implantation (one-stent group,50 cases) and two-stent graft implantation (two-stent group,50 cases).The aortic diameter was measured at proximal landing zone and distal landing zone,the application of chimney technique or vascular reconstruction technique was base on the condition of proximal landing zone.Aortic morphological changes were analyzed before and after operation.Results All patients were successfully operated.The mean length of aortic coverage in one-stent group was significantly shorter than that in two-stent group[(191 ± 14) mm vs (261 ±7) mm] (P ＜0.01).The mean cone angle of holder in one-stent group was significantly less than that in two-stent group [1.9 (0.0,4.0) mm vs 9.0 (8.0,10.0) mm] (P ＜ 0.01).The stent thrombus 3 month after operation was 88.0％ (88/100) in all patients;there was no significant difference between one-stent group and two-stent group [92.0％ (46/50) vs 84.0％ (42/50)] (P ＞ 0.05).Aortic diameters at proximal landing zone,left atrial horizontal,diaphragm horizontal and renal artery horizontal had no significant differences between groups(P ＞ 0.05).The aortic diameter at distal landing zone,aortic true lumen diameters at left atrial horizontal,diaphragm horizontal,renal artery horizontal and aortic true lumen diameter/false lumen diameter rate(R1) at renal artery horizontal in two-stent group were significantly less than those in one-stent group before treatment[(11 ±4) mm vs (14 ± 4) mm,(11.8 ± 2.6) mm vs (13.7 ± 3.4)mm,(12±4)mmvs (14±4)mm,(8.5±2.7)mmvs (10.8±2.9)mm,(0.7 ±0.4) vs (0.9±0.4)] (P ＜ 0.05);aortic true lumen diameters and aortic true lumen diameter/false lumen diameter rate (R2) had no significant differences between groups after operation (P ＞ 0.05).Dilation rates of aortic true lumen at left atrial horizontal,diaphragm horizontal,renal artery horizontal and the value of R2/R1 in two-stent group were significantly higher than those in one-stent group [(2.0 ± 0.5) ％ vs (1.7 ± 0.4) ％,(1.7 ± 0.5) ％ vs (1.4 ± 0.6) ％,(1.50 ± 0.50) ％ vs (1.10 ± 0.20) ％,(1.9 ± 0.8) vs (1.3 ± 0.7)] (P ＜ 0.05).Two-stent group had 1 case of transient paraplegia and the symptom was alleviated after cerebrospinal fluid drainage.One-stent group had 1 case of mild proximal inner leakage.There were no death and malperfusion complications during 3 months after operation.Conclusions Both endovascular repair for Stanford B aortic dissection with one-stent and two-stent implantation are effective.Two-stent implantation is good for aortic true lumen dilation in patients with tenuity of aortic artery.