To provide an adequate proximal landing zone, left subclavian artery (LSA) reconstruction has become an important part of thoracic endovascular aortic repair (TEVAR). This study evaluates the short and medium term efficacy of a novel unibody single-branched stent graft for zone 2 TEVAR. Fifty-two patients (mean age, 56 ± 10.9 years; 42 men) with distal aortic arch lesions requiring LSA reconstruction received unibody single-branched stents from September 2019 to March 2021. Computed tomography angiography was performed 6, 12, and 24 months after surgery to observe stent morphology, branch patency, endoleaks, stent-related adverse events, and changes in the diameter of true and false lumens. All stents were deployed adequately, and the technical success rate was 100%. The mean operation time was 121.8 ± 47.0 min. The mean postoperative hospital stay was 6.2 ± 3.7 days, and the mean follow-up was 16.8 ± 5.2 months (range, 12–24 months). During follow-up, there were no deaths and complications such as stent displacement or fracture, stenosis, fracture, occlusion, and type Ia endoleaks. The patency rate of the branched segment was 100%. In 42 patients with aortic dissection (AD), the true lumen diameter of the aortic isthmus was 29.4 ± 2.9 mm after surgery, significantly larger than before surgery (20.6 ± 5.4 mm, P < 0.05). Postoperative aortic isthmus false lumen diameter was significantly smaller than that before operation (6.1 ± 5.2 mm vs. 16.0 ± 7.6 mm, P < 0.05). The new unibody single-branched stent for zone 2 TEVAR is safe and accurate, and its efficacy is good in the short and medium term.
Background This study aimed to investigate the safety of direct innominate arterial (IA) cannulation using a pediatric arterial cannula to establish selective antegrade cerebral perfusion (ACP) during total arch replacement (TAR) for acute Stanford type A aortic dissection (ATAAD). Methods This retrospective study included patients with ATAAD who underwent TAR with the frozen elephant trunk (FET) technique between October 2020 and November 2021. Patients treated with direct IA cannulation using a pediatric arterial cannula for selective anterograde cerebral perfusion were included in the study. Results Of the 29 patients, 24 (82.8%) were male. The average age was 50.9 ± 9.47 years. Proximal repair included aortic root plasty (27 patients, [93.1%]) and Bentall surgery (2 patients, [6.9%]). Perioperative mortality and stroke rates were 3.4% and 6.9%, respectively. The mean lowest core temperature was 23.8 ± 0.74 °C and the mean ACP time was 25 ± 6.4 min. The aortic cross-clamp and cardiopulmonary bypass times were 141 ± 28 and 202 ± 29 min, respectively. There were no cases of IA injuries. Conclusion Direct IA cannulation using a pediatric arterial cannula is a simple, safe, and effective technique for establishing ACP during TAR with the FET technique for ATAAD and can avoid the potential complications of axillary artery cannulation.
Objective: The combination of pepsinogens (PG I/II) and gastrin-17 (G17) has been used to screen GC in many countries, without satisfactory levels of sensitivity or specificity. The aim of this study was to find a better marker and a new modality in screening early GC. Methods: We measured the serum levels of PG I/II, G17, and prealbumin (PA) from the serum of 481 healthy individuals, 407 benign gastric diseases (BGD), and 416 GC patients using a latex particle-enhanced turbidimetric immunoassay and Sandwich ELISA. Logistic regression analysis was used to obtain the sensitivity and specificity of the combined detection model. Results: When PA was combined with the other biomarkers, the sensitivity and specificity were significantly improved in the ROC curve. The combination of PA+G17+PGI+PGR was the best diagnostic combination for both early and late GC. The AUC, sensitivity, and specificity of the combination for discriminating between early GC and healthy individuals were 0.796, 72.1% and 74.2% respectively. For distinguishing patients with early GC from BGD, the AUC, sensitivity and specificity of the combination were 0.696, 66.7% and 65.4%, respectively. The combination of PA+G17+PGI+PGR improved both the sensitivity and the specificity of GC diagnosis compared with those of the traditional combination of G17+PGI+ PGII +PGR. Conclusion: PA is a valuable indicator for GC and interacts synergistically with PG and G17 in screening for early GC. The new combination platform PA+G17+PGI+PGR may be a potential way for the early screening of GC.
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