On February 21, 2011, a team led by Prof. Guo Wei of our vascular surgery department successfully completed the first abdominal aortic open-window stenting procedure in China. This procedure isolated the aneurysm while preserving the blood supply to the visceral branch arteries, bringing hope to patients who cannot use traditional endoluminal grafts.
Abdominal aortic aneurysms tend to occur in the elderly population, and once they appear, they progress toward rupture, so they should be treated as soon as they are diagnosed. Currently, the most common treatment methods are traditional open surgery and endoluminal isolation. Open surgery is a huge incision, bleeding, traumatic, and has a high mortality and postoperative complication rate. Most elderly patients cannot tolerate this treatment. Compared with traditional open surgery, minimally invasive endoluminal isolation discards the disadvantages of general anesthesia, open abdomen and blocking the aorta, resulting in much less trauma, much shorter operative time and no blood transfusion for most patients. In addition, patients recover quickly after surgery, they can eat the night of surgery and get out of bed the next day, and the complication rate and mortality rate are significantly reduced, so that many patients who cannot tolerate traditional surgery have a chance to be cured.
In our clinical work, we often encounter patients with high-risk abdominal aortic aneurysms who are unable to undergo surgery due to the complex anatomical conditions of the aneurysm and the limitations of existing stents and technology, and who have been transferred to multiple hospitals, often delaying the patient’s condition. Prof. Guo Wei pointed out that most of the currently used intracavitary grafts in the abdominal aorta are bifurcated structures, which are not suitable for abdominal aortic aneurysms affecting the blood flow of the branches of the visceral arteries, and in recent years, windowed stents for such aneurysms have started to appear abroad.
This type of stent is characterized by a “window” with a membrane that corresponds precisely to the visceral artery, so that the “window” is aligned with the corresponding visceral artery during the release of the stent, and the “window” is repositioned in the visceral artery through the “window”. During the stent release process, the “window” is aligned with the corresponding visceral artery, and through the “window”, a small diameter bare stent is implanted in the visceral artery to prevent stent displacement, thus ensuring the blood supply to each visceral artery.
In order to ensure the success of the surgery and minimize complications, a thorough treatment plan is necessary. After the patient was admitted to the hospital, the team led by Prof. Guo Wei conducted a comprehensive assessment of the patient’s physical condition, precisely measured and repeatedly studied the aneurysm morphology, made precise measurements of the caliber and length of the overlapping stent, the location of the “window”, the size of the “window”, etc., and made a tailor-made vascular stent for the patient from abroad. The successful implantation of the windowed stent was based on a series of advances in clinical experience, digital subtraction contrast technology, and interventional equipment, and is a major advancement in the field of interventional surgery. The further development of this technology will allow for the application of interventional treatment for arterial coarctation and aneurysm in almost any part of the body.
The success of this procedure is the first of its kind in China, bringing a blessing to patients and filling a new chapter in the history of endoluminal vascular surgery interventions in China.
In-depth report Vascular Surgery Department of PLA General Hospital is the first in China to complete the “open window technique” for the endoluminal treatment of complex abdominal aortic aneurysm
What is abdominal aortic aneurysm?
It is a limited dilatation of the abdominal aorta with a diameter more than twice normal.
Danger: Mortality rate exceeds 80% after rupture of the aneurysm.
There are two ways to treat abdominal aortic aneurysm.
Traditional surgery
Endoluminal repair
Problems of traditional surgical treatment
Huge surgical trauma
Long surgical time
Not suitable for senior patients
Long hospitalization time
Slow post-operative recovery
Many post-operative complications
High surgical mortality
Conventional endoluminal repair
Advantages
Less traumatic, faster recovery
Low mortality rate
Problems
Only suitable for good anatomical conditions of abdominal aortic aneurysms
Difficult for lesions in adjacent renal arteries
The “open-window technique” – a new option for endoluminal treatment
New open-window stent for the abdominal aorta
According to the anatomical location of the patient’s visceral artery, a “window” is designed on the stent vessel to match the visceral artery, and when used, the “window” is aligned with the superior mesenteric artery and the left and right renal arteries respectively, thus ensuring the visceral blood supply.
”Challenges of the “open window technique
Good design: requires individualization of the lesion
Precise technique: accurate alignment of each “window” with the visceral artery is required
Limited accumulation: only a few centers in the world perform it, and there is still a gap in China
Surgery site
”Complete intracavitary reconstruction of both renal arteries and superior mesenteric artery by “open window technique
Intracavitary reconstruction of the right renal artery
Intracavitary reconstruction of the left renal artery
After reconstruction of both renal and superior mesenteric arteries
On February 21-22, 2011, the Department of Vascular Surgery of PLA General Hospital completed three cases of “open-window technique” for complex abdominal aortic aneurysm, the highest age was 86 years old, and two cases were patients with severe renal artery insufficiency. The surgery was a complete success and the postoperative recovery was satisfactory.
This is the first clinical case of intracavitary reconstruction of visceral artery by “open-window technique” in China, marking a new era of intracavitary aortic repair technology in China.
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