Background: This study aimed to explore risk factors leading to asymptomatic penetrating aortic ulcer (PAU) progression. Methods: This retrospective study reviewed the clinical data of patients who were diagnosed with asymptomatic PAU through incidental imaging findings and underwent imaging follow-up between August 2018 and July 2022. Patients were grouped according to ulcer progression. The risk factors for PAU progression were also analyzed. Results: Among 60 patients with PAU, 32 (53.33%) experienced PAU progression. The mean follow-up time was 555.72 +/- 407.60 days. Although there was no statistically significant difference in cancer incidence between the PAU progression group and nonprogression group (24 [75%] vs. 18 [64.28%], P- 0.409), the difference in antineoplastic therapy use between the progression and nonprogression groups was significant (19 [59.38%] vs. 7 [25.00%], P- 0.010). There was no difference in the aortic diameter at the PAU (20.68 +/- 4.16 mm vs. 20.70 +/- 5.28 mm, P- 0.990), PAU width (7.32 +/- 2.53 mm vs. 7.11 +/- 2.29 mm, P- 0.741), and PAU depth (4.13 +/- 1.26 mm vs. 4.08 +/- 1.41 mm, P- 0.880) between the 2 groups. In the progression group, the progression rates of aortic diameter at PAU, PAU width, and PAU depth were 2.16 +/- 4.28 mm/year, 5.91 +/- 14.49 mm/year and 2.87 +/- 5.87 mm/year, respectively. Binary logistic regression analysis showed that antineoplastic therapy was an independent predictor of PAU progression (P- 0.017; odds ratio, 4.144; 95% confidence interval, 1.290e 13.316). Conclusions: Antineoplastic therapy may contribute to the progression of asymptomatic PAU in this retrospective study with small number of patients. Patients with asymptomatic PAU who are receiving or have completed antineoplastic therapy should be more vigilant regarding PAU progression.

This study investigated the impact of maternal high-fat diet on vascular function and endothelial homeostasis in offspring. We found that offspring exposed to maternal high-fat diet exhibited elevated blood pressure, impaired abdominal aortic vascular function, and endothelial homeostasis imbalance. These changes were accompanied by increased levels of reactive oxygen species (ROS) and upregulation of pro-inflammatory cytokines (including IL-1β, TNF-α, IL-6, and IL-10). Treatment with NLRP3 or IL-1β inhibitors prevented the deterioration in vascular function, reduced endothelial NO production, and inflammation induced by maternal high-fat diet exposure compared to the control group. The findings suggest that during pregnancy, mitigating the vascular impairments in offspring induced by maternal high-fat diet can be achieved by inhibiting the NLRP3/IL-1β pathway.

本研究回顾性分析国内首例行达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建术患者的临床资料，该患者为39岁女性，因检查发现腹主动脉瘤1个月入院，结合患者对微创治疗及远期疗效的综合要求行达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建术。手术时间506 min，术中出血量约为1 200 ml，其中800 ml以自体血回收后回输，完成腹主动脉瘤切除人工血管重建后，腹主动脉人工血管充盈良好，近心端及远心端吻合口吻合良好，无明显渗血，远端髂动脉搏动良好，双侧足背动脉可触及搏动，无术中并发症发生。患者术后住院时间为8 d。患者术后随访半年，患者腹部切口及各戳卡孔愈合良好，腹部搏动性包块消失，生存良好。本研究提示达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建安全可行，近期疗效较好。

目的 分析腔内导管搅拌溶栓治疗伴下腔静脉及肝静脉新鲜血栓的布-加综合征(BCS)的安全性和有效性.方法 回顾分析我院22例BCS伴下腔静脉及肝静脉新鲜血栓患者的临床资料,患者均接受经导管搅栓溶栓、血栓抽吸及经皮血管成形术等腔内介入治疗.统计患者治疗后血栓清除及并发症发生情况.结果 21例患者下腔静脉及肝静脉新鲜血栓完全清除,1例患者溶栓后消化道出血,终止治疗,且随访期间失访.22例患者围术期均未出现肺栓塞症状.随访期间,21例患者下腔静脉及肝静脉血流通畅,无血栓形成、明显狭窄及肺动脉栓塞发生,患者临床症状及体征完全消失,11例植入支架的患者支架无明显移位或断裂.结论 腔内导管搅拌溶栓治疗BCS合并下腔静脉及肝静脉新鲜血栓安全有效,可有效清除下腔静脉及肝静脉新鲜血栓,避免肺动脉栓塞的发生.

Objective:To analyze the clinical effect of da Vinci robotic surgical system assisted splenic aneurysm resection and reconstruction.Methods:The clinical data of 2 cases of splenic aneurysm resection and revascularization assisted by the fourth generation da Vinci robot admitted to vascular surgery Department of Army Medical University from May to Oct. 2022 were collected by retrospective descriptive research method, and the intraoperative and postoperative conditions were observed. Follow up was conducted in the outpatient way to understand the splenic artery anastomosis of the patient. The follow-up period was up to Nov. 2022.Results:Both patients successfully underwent the fourth generation robot-assisted splenic aneurysm resection and reconstruction. The operation time of patient A was 280 minutes, including 30 minutes of vascular anastomosis. The operation time of patient B was 370 minutes, of which the vascular anastomosis time was 43 minutes. The splenic artery anastomosis was good from end to end, and there was no obvious blood seepage after release and occlusion. The intraoperative hemorrhage of patient A was 40 ml and that of patient B was 60 ml. There were no complications such as abdominal hemorrhage and infection during and after operation. Postoperative hospital stay was 5 days, postoperative review of the upper abdominal CT indicated that the splenic artery anastomosis was patency, spleen blood supply was good.Conclusions:Splenic aneurysm resection and vascular reconstruction assisted by da Vinci robotic surgical system is safe, feasible and effective in the near term.

Background: Although endovascular repair is used to treat penetrating aortic ulcers (PAUs), the indications for endovascular repair in PAUs remain controversial. The current study evaluated the mid-term results of endovascular repair for PAUs and further explored the endovascular indications for PAUs. Methods: We retrospectively reviewed the clinical data of patients who were diagnosed with PAUs and underwent endovascular repair in our department from October 2018 to August 2020. Endovascular indication included persistent or recurring symptoms, a maximum diameter of the PAU of greater than 20 mm, a maximum depth of the PAU of greater than 10 mm, an increase in the diameter of the aorta at the ulcer of greater than 10 mm annually, and multiple ulcers at the same or adjacent level of the aorta. Patient characteristics, anatomical parameters of the PAU, characteristics of endovascular repair and follow-up data were analyzed. Results: 15 patients were included in the study. 3 patients had PAUs in the aortic arch, 6 PAUs were in the descending thoracic aorta, 4 PAUs were in the abdominal aorta, and 2 PAUs were in the descending thoracic and abdominal aortas. The average age was 70.60 +/- 8.27 years. Eight patients were symptomatic. The average depth of the PAUs was 7.32 +/- 2.74 mm, and the average diameter was 15.03 +/- 6.10 mm. The average operation time was 95.60 +/- 33.11 min. Postoperative hospital stay was 3.33 +/- 0.61 days. A left subclavian artery chimney stent was implanted in 3 aortic arch cases and 1 occluded case without adverse symptoms during the follow-up period. A bifurcated stent graft was placed in 3 abdominal aorta cases and exhibited good patency during the follow-up period. The duration of follow-up ranged from 3 to 24 months. The follow-up results showed that all PAUs were treated satisfactorily by endovascular repair, and no endoleaks or stent graft-related complications occurred. Conclusion: Endovascular repair is a safe and effective treatment for PAUs, and it may be safely performed in elderly patients and patients with comorbidities. The endovascular indications for PAUs must be further studied and optimized.

To investigate the efficacy and prognostic factors of sorafenib targeted therapy for advanced liver cancer after interventional therapy, 100 patients with advanced liver cancer were selected and divided into two groups as the control group was treated with transcathetoarterial chemoembolization while the study group was treated with sorafenib in addition to transcathetoarterial chemoembolization. The clinical efficacy and adverse reactions were compared and the related factors affecting the prognosis were analyzed by single and multiple factors. Univariate analysis showed that there were statistically significant differences (p < 0.05) in hepatitis background, liver function Child-Pugh, BCLC staging, alpha-fetoprotein level and pancreatic atrophy. After multi-factor analysis, pancreatic atrophy, BCLC staging, alpha-fetoprotein level, Child-Pugh level of liver function and hepatitis background were the main risk factors for prognosis of patients after interventional surgery and the differences were comparable (p < 0.05). The therapeutic effect of the study group was better than the control group. The incidence of hand-foot skin reactions, diarrhea and adverse reactions in the study group was higher than the control group and there was no comparable difference (p > 0.05) in the incidence of abnormal liver function and hypertension between the two groups. The application of sorafenib targeted therapy in patients with advanced liver cancer after interventional surgery can significantly prolong the patient's survival, improve the prognosis, and improve the clinical efficacy.

Objective To detect the expression of high-mobility group protein A2 (HMGA2) in gastric cancer tissues, investigate its relationship with clinicopathological features and prognosis, and explore its role and underlying mechanism in regulating the invasion and proliferation of gastric cancer cells. Methods TCGA database, GTEx database and bioinformatics analysis tools (GEPIA, KM plotter) were used to analyze the expression of HMGA2 gene in gastric cancer and the survival time of patients. The expression of HMGA2 protein in gastric cancer and adjacent tissues was detected by immunohistochemistry, and the correlation between HMGA2 expression and the clinicopathological parameters and its effect on prognosis of gastric cancer patients were analyzed. After HMGA2 was knocked down in gastric cancer cell line MGC-803, and overexpressed in gastric cancer cell line SGC-7901, plate cloning and transwell assay were used to detect the proliferation and invasion ability, respectively. The invasion ability was detected again in the HMGA2 overexpressed SGC-7901 cells after knockdown of Snail1. Western blotting was employed to measure the expression changes of HMGA2 and epithelial to mesenchymal transition (EMT) markers in the cells. Results The bioinformatics analysis showed that the mRNA expression of HMGA2 was significantly increased in gastric cancer tissues compared with normal gastric tissues (P < 0.05). Immunohistochemistry also indicated that the protein level of HMGA2 was obviously higher in gastric cancer tissues than para-cancer tissues, and it was associated with TNM staging, lymph node metastasis and survival rate. The gastric cancer patients with high HMGA2 expression had statistically shorter total survival and relapse-free survival (P < 0.05). Knockdown of HMGA2 resulted in decreased proliferation and invasion ability in MGC-803 cells decreased (P < 0.05), while its overexpression led to enhanced proliferation and invasion ability in SGC-7901 cells (P < 0.05). However, knocking down Snail1 would cause the invasion of HMGA2-overexpressed SGC-7901 cells reduced (P < 0.05), and the expression level of E-cadherin up-regulated and those of N-cadherin and Vimentin down-regulated. Conclusion High HMGA2 expression is associated with poor prognosis of gastric cancer patients, and it may promote invasion and metastasis of gastric cancer cells by regulating Snail1.

目的 探究丹参注射液通过Nrf2/ARE通路对大隐静脉曲张的影响.方法 选择2016年1月至2017年12月于我院诊治的大隐静脉曲张患者810例,将其分为对照组(未治疗)、手术组(手术治疗)和丹参组(手术治疗联合丹参注射液注射治疗);观察3组患者色素沉着、浅静脉血栓、皮下硬结等并发症的发生情况,随访观察CIVIQ评分,Western blot法检测各组Nrf2/ARE蛋白含量,qRT-PCR法检测Nrf2/ARE mRNA表达量.结果 术后3个月对照组并发症发生率最高,手术组次之,丹参组最低,组间比较差异有极显著性统计学意义(P<0.01);与术后3个月比较,术后6个月对照组并发症发生率继续升高,手术组、丹参组明显降低,差异均有极显著性统计学意义(P<0.01).术后3个月对照组CIVIQ评分最高,手术组次之,丹参组最低,组间比较差异有极显著性统计学意义(P<0.01);与术后3个月比较,术后6个月对照组CIVIQ评分明显升高,手术组、丹参组明显下降,差异有极显著性统计学意义(P<0.01).超声检查结果显示,术后3个月,对照组闭塞和反流率最低,丹参组次之,手术组最高,3组比较差异有极显著性统计学意义(P<0.01);与术后3个月比较,术后6个月对照组闭塞和反流率明显下降,手术组、丹参组明显升高,差异有极显著性统计学意义(P<0.01).CT静脉造影显示,对照组静脉管腔内存在长短不一、持久的类圆柱形或圆柱形密度较低的造影区域,丹参组的静脉管腔不规则狭小情况明显少于手术组,组间比较差异有极显著性统计学意义(P<0.01).Western blot结果显示,丹参组Nrf2/ARE蛋白含量最高,手术组次之,对照组最低,3组比较差异有极显著性统计学意义(P<0.01).丹参组血液中Nrf2/ARE mRNA表达量最高,手术组次之,对照组最低,3组比较差异有极显著性统计学意义(P<0.01).结论 丹参注射液能够促进Nrf2/ARE的表达,抑制大隐静脉曲张的发展,对大隐静脉曲张有治疗作用.

Objective To explore the clinical efficacy of Da Vinci robotic surgical system assisted Inferior Vena Cava filter retrieval.Methods The retrospective descriptive study was conducted.The clinical data of the first patient in asia who underwent Da Vinci robotic surgical system assisted inferior vena cava filter retrieval in the department of vascular surgery of Southwest Hospital of Army Military Medical University in Jul.2019 were collected.The patient underwent retrievable inferior vena cava filter implantation two months ago,and failed to removal of inferior vena cava filters by endovascular measures and underwent inferior vena cava filter retrieval assisted by Da Vinci robotic surgical system.Observation indicators:intraand post-operative situations;follow-up and patients' survival.Follow-up using outpatient examination to detect the patients' postoperative survival and swelling reduction of affected extremity up to Aug.2019.Results Intra-and post-operative situations:patient underwent inferior vena cava filter retrieval using Da Vinci robotic surgical system successfully.Operation time was 326 minutes and estimated blood loss was 100 ml.After removal of inferior vena cava filter,the incision of inferior vena cava was anastomosed well without bleeding or stenosis.No intraoperative complications occurred.Duration of hospital stay after surgery was 3 days.Follow-up and patients' survival:patient was followed up for 1 month.The patient had a good survive without any complications.Conclusions The Da Vinci robotic surgical system is safe and feasible in inferior vena cava filter retrieval.

Objective To investigate the indications, therapeutic effects and safety of thoracic endovascular aortic repair for treatment of thoracic penetrating aortic ulcer. Methods We retrospectively analyzed clinical data of the patients diagnosed with penetrating thoracic aortic ulcer, who underwent thoracic endovascular aortic repair in our department between October, 2018 and May, 2019. The patients' age, lesion location and type, comorbidities, surgical methods, operation time, intraoperative blood loss, length of hospital stay, perioperative complications and follow-up data were analyzed. Results We analyzed the clinical data for 7 patients with a mean age of 70.29±7.54 years, including 3 patients with penetrating ulcers in the aortic arch and 4 with ulcers in the descending thoracic aorta. The mean depth of the penetrating aortic ulcers was 6.00±2.02 mm with a mean width of 12.07±5.26 mm and a mean length of 14.71±9.05 mm. The opration were completed smoothly in all the patients with a mean operation time of 90.00±32.53 min. A chimney stent was placed in the left subclavian artery in 3 cases. The patients were followed up for 1 to 7 months, during which the penetrating thoracic aortic ulcers were found to be effectively repaired in all the cases; endoleaks of any types or other complications occurred in none of the cases during the follow-up. Conclusion Thoracic endovascular aortic repair is safe and effective for treatment of penetrating thoracic aortic ulcer, and can be safely performed in elderly patients and patients with comorbidities.

Objective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting.Methods The retrospective descriptive study was conducted.The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected.The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein.Observation indicators:(1) intra-and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patient's postoperative survival and swelling reduction of affected extremity up to April 2019.Results (1) Intra-and post-operative situations:the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully.The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes.The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein,80 minutes of exposure time of iliac vein,40 minutes of great saphenous vein harvesting time,70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein,10 minutes of subcutaneous tunnel construction,90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein,60 minutes of suturing except vessel closure,102 minutes of preparation time,check and washing time).The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred.The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting.There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm.The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm,respectively.At the discharge time,the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission.The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm.No postoperative complications occurred.Duration of hospital stay after surgery was 3 days.(2) Follow-up and survival situations:the patient was followed up for 1 month,with good survival.The patient had swelling subsided of affected extremity.The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm.Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible,with good short-term outcomes.

The robotic surgical system has been widely used in surgeries in various fields for its advantages over human eyes and hands with a magnified, stereoscopic view, flexible manipulation and ability to filter tiny tremors. The application of the robotic surgical system in vascular surgery is still in its infancy, and many issues concerning the operation techniques and safety need to be explored, especially in terms of the indications, key techniques, standardized procedures and management of intra- and post-operative complications. Of greater importance are the promotion of clinical studies that compare robotic surgical system versus open or laparoscopic surgery in vascular surgery and the collection and analysis of the long-term follow-up data. The evidence obtained from these studies will facilitate the wide application of robotic surgical system in vascular surgery. In addition, the defects in the current robotic surgical system need be improved, such as the lack of tactile feedback, the large size of the mechanical arm, and the interference between the arms. The era of robotic surgery has come, which urges greater efforts in both technical development and clinical studies of the robotic surgical system.

Background Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents. Methods Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center. Results Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair. Conclusion There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.

目的 探讨Stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)治疗时机对患者生存时间及并发症的影响.方法 回顾性分析2011年1月至2013年12月采用TEVAR术连续治疗的123例Stanford B型主动脉夹层患者临床资料.根据发病至手术时间,将123例患者分为急性期组(32例,＜14 d)、亚急性期组(67例,15～90 d)、慢性期组(24例,＞91 d),术后随访24个月.结果 至随访结束,急性期、亚急性期、慢性期全因死亡率分别为12.5％、7.4％、25.0％ (P=0.085),主动脉夹层相关死亡率分别为9.4％、4.5％、16.7％(P=0.17),主动脉重塑率分别为75.0％、71.6％、33.0％,二次干预率分别为21.9％、17.9％、37.5％.结论 亚急性期Stanford B型主动脉夹层患者TEVAR术后主动脉重塑效果最好,并发症少,是治疗最佳时机.

Objective To evaluate the safety and efficiency of two-stage operation strategy for retrograde type A aortic dissection (RTAD).Methods Data of patients who were diagnosed with RTAD and underwent two-stage operation strategy in our center between January 2015 and January 2016 were reviewed.Coils combined with Onyx glue embolization was performed to create a thrombogenic environment in retrograde false lumen of the ascending aorta and aortic arch as the first stage operation,followed by thoracic endovascular aortic repair(TEVAR) with chimney technique as the second stage operation.Results Complete thrombosis in retrograde false lumen of the ascending aorta and aortic arch was found in all 9 patients before the second stage operation was performed.The rate of successful TEVAR was 100％,single chimney technique was performed in 6 patients to reconstruct the left subclavian artery and double chimney technique was performed in 3 patients to reconstruct the left common carotid artery.No morbidities,stent-grafts induced new dissection or deaths were found in hospital and during 12-month follow-up period.Conclusions The shortterm outcome of this study was satisfied.Inducing thrombosis of the retrograde false lumen to enhance proximal landing zone of TEVAR may offer a new optimal and safe treatment strategy for RTAD.

Objective To summary the experience of AngioJet mechanical thrombectomy for the treatment of acute deep venous thrombosis (DVT) of lower extremity.Methods Clinical data of 28 patients suffering from acute DVT of lower extremities treated by AngioJet mechanical thrombectomy were analyzed retrospectively from October 2013 to February 2015.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results Twelve patients were planted temporary vena cava filters.The average length of hospitalization was (3.9 ± 1.1) days.The average operation time was (1.2 ± 0.4) hours.The dosage of urokinase was (320 ± 120) × 104 U and heparin was (46 ± 10)mg during surgery.The average reduction of hemoglobin was (7.5 ± 2.6) g/L.Two patients (Grade Ⅰ thrombolysis) were converted to catheter-directed thrombolysis (CDT).There were 10 (35.7％) cases achieving grade Ⅱ and 16 (57.1％) cases achieving grade Ⅲ,respectively.Technique success rate were 92.9％.Minor bleeding events occurred in 2 patients.Nine (32.1％) patients had stents implanted.One year follow-up found patent deep venous in 26 (92.9％) patients and stent patency rate was 88.9％ (1/9).Two (7.1％) cases developed mild postthrombotic syndrome (PTS).Conclusion AngioJet is a safe and effective tool to treat acute DVT accelerating thrombolytic therapy,and reducing bleeding complications.

BACKGROUND:How to choose the proximal landing zone in endovascular interventions for a patient with a patent retrograde false lumen in dissection of the ascending aorta and aortic arch remains unclear. This study sought to report the safety and efficiency of inducing thrombosis of the retrograde false lumen to enhance a proximal landing zone to treat retrograde type A aortic dissection.METHODS:This study included 9 patients with retrograde type A aortic dissection treated with a 2-stage operation strategy between January 2015 and January 2016. Coil and Onyx glue embolization was performed to create a thrombogenic environment in the retrograde false lumen of the ascending aorta and aortic arch as the first-stage operation, followed by thoracic endovascular aortic repair (TEVAR) with the chimney technique as the second-stage operation.RESULTS:Complete thrombosis in a retrograde false lumen of the ascending aorta and aortic arch was found in all 9 patients before the second-stage operation was performed. The rate of successful TEVAR was 100%, with the single-chimney technique performed in 6 patients to reconstruct the left subclavian artery and the double-chimney technique performed in 3 patients to reconstruct the left common carotid artery. No morbidities, no stent graft-induced new dissection, or deaths occurred in the hospital and during the 12-month follow-up period. Positive morphological remodeling was evidenced in all cases.CONCLUSIONS:The short-term outcomes of the patients in this study were satisfactory. Inducing thrombosis of the retrograde false lumen to enhance the proximal landing zone for TEVAR may be a safe and effective approach to treating retrograde type A aortic dissection.