| Part one Comparative study of type B aortic dissection curativeeffect between TEVAR and conservation treatmentObjectiveComparative analysis of the curative effect, aortic remodeling and false lumenpatency between TEVAR and conservative treatment of Stanford B aortic dissection,to explore the best therapeutic strategy for Stanford B aortic dissection.MethodRetrospective analysis of clinical data in January2009~December2012at theFirst Affiliated Hospital of Zhengzhou University, conservative or endovasculartreatment245cases of patients with type B aortic dissection. Conservative treatmentgroup42cases, endovascular repair group203cases. Statistical analysis mortality,complications and aortic remodeling situation during hospitalization and follow-upperiods of each group respectively. The chi-square test and Fisher’s exact probabilitymethod is adopted to compare mortality, complications and Postoperative situation ofeach group, T test to compare aortic remodeling between two groups, Kaplan-Meiermethod to calculate the cumulative survival rate in both groups, The log-rank testsurvival rate between the two groups.ResultIn addition to age, maximum diameter of false and true lumen, there are noanother statistical difference between the two groups before treatment. False lumenpostoperative thrombosis rate and lost rate, TEVAR group is greater than conservative treatment group, the difference was statistically significant.The cumulative survivalrate there was no statistically significant difference between the two groups.ConclusionTEVAR group has greater curative effect and false lumen thrombosis rate in thetreatment of type B aortic dissection, compare to the conservation group. But bringthe corresponding surgical complications at the same time, and can’t improve thesurvival rate of patients.Part two Lumen prosthesis in the treatment of type B aorticdissection surgery timing of clinical researchObjectiveAnalysis to explore the operation timing and The factors influencing the curativeeffect when Use of TEVAR for Stanford type B aortic dissection.MethodRetrospective analysis of clinical data of205cases in January2009~December2012at the First Affiliated Hospital of Zhengzhou University, acute surgical group102cases, subacute surgical group69cases and chronic surgical group34cases.Statistics of each group during surgery and postoperative follow-up period of efficacyand mortality, to explore the best operation time of type B aortic dissection.ResultIn terms of perioperative complication rates between the three groups, acutesurgical group is greater than the other two groups, and the difference was statisticallysignificant. The maximum diameter and thrombus rates of false lumen postoperativebetween the three groups, chronic surgical group is greater than the other two groups,and the difference was statistically significant. ConclusionTEVAR treatment of Stanford type B aortic dissection near middle curativeeffect is satisfied, and subacute phase of type B aortic dissection treatment effect isbest.Part three TEVAR joint chimney technology treatment for theStanford type B aortic dissection with insufficient stent anchoringarea close to the heartObjective:Explore value of the chimney technology for Stanford type B aortic dissectionwith insufficient stent anchoring area close to the heart.MethodRetrospective analysis of clinical data of196cases who were treated withTEVAR or chimney technology in January2009~December2012at the FirstAffiliated Hospital of Zhengzhou University, TEVAR with chimney stenting group23cases, simple TEVAR treatment group173cases. The chi-square test and Fisher’sexact probability method is adopted to compare mortality, complications andPostoperative situation of two groups.ResultCompare to simple TEVAR treatment group, TEVAR with chimney stentinggroup has a higher fistula incidence rates and Postoperative Complications rates. Butthere were no significant mortality was found between two groups. Conclusion: Inthe treatment of aortic dissection with insufficient proximal anchoring area, chimneytechnology can rebuilt the important branch, and the operation have merit of simple,small trauma and satisfied follow-up effect. chimney technology is a transitionaltechnique, and it need more innovative instrument to be applied in clinical to expandendovascular operation’s indications with less complications. Part four Sleeve type branch aortic coated stents in aortic archmodel experimentObjectiveSleeve type branch aortic coated stents (independent research and development)was applied in aortic arch model to explore the operability of release process ofsleeve type branch aortic coated stents.Methodrelease sleeve type branch aortic coated stents of author’s self-making in theaortic arch model under vitro look, assess the operability of release process of sleevetype branch aortic coated stents.ResultTotal tested20times, and all stents were released successfully, the success ratewas100%. The whole experiment process was smooth, and the operation was simple.Stents and sleeve branch was easy to control and release.Conclusionsingle-piece Sleeve type branch aortic coated stents can been implantedsuccessfully, and it has good maneuverability, and high technical success rate.Part five Sleeve type branch aortic coated stents in pig aortaexperimentsObjectiveDiscusses the operability, safety and technical success rate of one-piece sleevebranch aortic coated stents applied in animals experimental. MethodTake pigs for animal model, application single-piece sleeve aortic coated stentsTEVAR operation in pig aorta. Observe the success rate, corresponding complicationsof TEVAR.ResultThe animal experiment were implemented six times, five times successfully,83.3%success rate. There were no significant complications between intraoperativeand postoperative period.ConclusionThe results of animal experiments demonstrate that the single-piece sleeve aorticcoated stents is reasonable designed, compliance, easy to volume manufacturing,operability, high success rate and good security. |
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