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Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair(TEVAR) in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% (5/27) of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.
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A total of 33 patients with isolated lilac artery aneurysms, 19 males and 14 females, who received treatment between January 1997 and June 2007, were retrospectively analyzed. Among these patients, 29 suffered from unilateral iliac artery aneurysm and 4 from bilateral iliac artery aneurysm. Under general anesthesia, all patients were subjected to aneurysmectomy, followed by vascular prosthesis implantation for vascular reconstruction. Results revealed that among 4 cases of bilateral iliac artery aneurysm, there was 1 case who was subjected to aorta-bilateral femoral artery vascular prosthesis implantation, and there were 3 cases who underwent aorta-bilateral lilac artery vascular prosthesis implantation; among 29 cases of unilateral lilac artery aneurysm, there was 1 case receiving aorta-common lilac artery vascular prosthesis implantation, 3 cases undergoing iliac-femoral artery vascular prosthesis implantation, 21 cases subjected to common-external iliac artery vascular prosthesis implantation, and 4 cases undertaking common -common lilac artery bypass. Color Doppler ultrasonic examination, spiral CT angiography, or digital subtraction arteriography was performed 3, 6 months, 1, 3, 5, 8, and 10 years after surgery. The mean follow-up time was 5 years. Three cases died of acute cerebral infarction, myocardial infarction, and traffic accident 3, 6, and 2 years after surgery, respectively. The remaining cases well survived as determined by no recurred Uiac artery aneurysm, anastomotic stoma stenosis or lower limb ischemia found. These results indicated that aneurysmectomy and subsequent vascular prosthesis implantation remained a good and primary means for treatment of isolated iliac artery aneurysm under the present medical condition.
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BACKGROUND: Effective drugs for improving vascular elasticity and revascularization are few for treating Leriche syndrome (chronic lower extremities ischemia) induced by abdominal aortic occlusion.Vascular outflow tract reconstruction in vascular prosthesis transplantation can rapidly improve blood supply in the distal extremities.OBJECTIVE: To evaluate the biocompatibility and outcome of vascular prosthesis transplantation for the treatment of Leriche syndrome.DESIGN: Controlled study before and after surgery.SETTING: Department of General Surgery of General Hospital of Chinese PLA and Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital.PARTICIPANTS: Sixty-two patients and sixteen patients with Leriche syndrome were enrolled in this study,who were respectively from Department of General Surgery of General Hospital of Chinese PLA between January 1995 and January 2007 and from Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital between January 2001 and January 2007.The subjects were 66 males and 12 females,whose age ranged from 46-75 years (averagely 58 years) and onset time from 6 months-8 years (averagely 2 years and 6 months).Informed consents were obtained from all patients.METHODS: After general anaesthesia or epidural anesthesia,vascular bypass was performed,including aortofemoral bypass in 63 cases and aortoiliac bypass in 15 cases.Vascular prostheses included polytetrafiuoroethylene (FIFE)vascular prosthesis in 18 cases and polyester vascular prosthesis in 60 cases.PTFE vascular prosthesis (Gore,USA) is a kind of inert material with low biological response.Its fibers with micropores arrange irregularly.Polyester vascular prosthesis (Intervascular,France) is a kind of knitting polyester products,which is made from high-purity cattle collagen Ⅰ with high biocompatibility.To inlay heparin molecules that can retain 4 weeks into the surface of vessels coated with collagen can prevent thrombogenesis and inhibit hyperplasy of smooth muscle cells (SMC).The type is IGK1608;internal diameter of the bole is 16 nun; internal diameter of the branch is 8 mm.Therapeutic prescriptions were approved by Hospital's Ethics Committee.Follow-up was performed for 3 months-5 years by vascular Color Doppler Sonography,spiral CT angiography (SCTA) three-dimensional reconstruction or digital subtraction angiography (DSA) in hospital.MAIN OUTCOME MEASURES: Biocompatibility of vascular prosthesis and outcome of vascular prosthesis transplantation.RESULTS: Three months after vascular prosthesis transplantation,thrombus was not detected on vascular anastomosis and in vascular prosthesis by Color Doppler Sonography and SCTA.Seventy-seven patients were followed up for over one year,and their stomas were unobstructed.Seventy-six patients were followed up for over five years,and the patency rate of stomas was 89% (68/76).No changes in blood plaque,lencocyte count,haematoglobin or liver and kidney function were found after transplantation.Seven days after surgery,affected extremities with ischemic symptom were improved.Three months later,ischemic symptom disappeared.CONCLUSION: With good biocompatibility of vascular prosthesis,vascular prosthesis transplantation in the treatment of Leriche syndrome has a good outcome following aortofemoral bypass and aortoiliac bypass.
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Objective To evaluate endovascular management for isolated iliac artery aneurysm (IIAA). Methods From May 1997 to Jan 2006, 15 IIAA cases underwent endovascular treatment, including 12 true aneurysms and 3 psudoaneurysms. There were 9 common iliac artery aneurysms (CIAA), 3 internal iliac artery aneurysms (IIAA) , and 3 external iliac artery aneurysms (EIAA). The average diameter was (5. 97?1. 49) cm (3. 5-9. 0 cm). IIAA was treated with metallic coils and CIAA/EIAA by stent-grafts. Results Unilateral internal iliac artery was preserved in 14 cases, and bilateral internal arteries were preserved in one case. Postoperative endoleak was found in 2 cases. There was no other major complications nor mortality. One case suffered buttock claudication because of internal iliac artery exclusion. The operation time was 1. 9?1. 1 h, blood loss was 126. 7?70. 1 ml. Patients were up and about after 2. 1?1. 1 d, hospital stay was 5.5?4.7 d. Conclusions Endovascular treatment is safe and effective for isolated iliac artery aneurysm. Internal iliac artery preservation and prevention of endoleak is of great importance.
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Objective To improve the safety and decrease the blood loss during resection of retroperitoneal tumour (RRT).[WT5”HZ]Method [WT5”BZ]We analysed retrospectively 54 patients whose blood loss were over 3?000?ml during RRT in our hospital from 1983 to 1998.The blood loss was over 5?000?ml each in 22 patients,and over 8?000?ml each in 7 patients, the maximum blood loss was 10?000?ml.[WT5”HZ]Result [WT5”BZ]Among the 54 patients whose blood loss were over 3?000?ml and up during RRT, 17 sank into shock and 2 of them died.[WT5”HZ]Conclusion [WT5”BZ]The preoperative evaluation and preparation are important to operative safety.We emphasize intraoperative management of massive bleeding during RRT.
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To summarize the experience of chronic ischemic disease in the lower limb using arteriovenous bypass in situ great saphenous vein without extirpation of venous valves.Methods: The operations of in situ great saphenous vein arterial bypass without venous valves extirpation had been done and the perioprative clinical manifestation had been observed in 11 patients with serious chronic ischemia of lower limbs.Results: The clinical manifestations of ll patients had been improved gradually.Conclusion: It may be a better operation of in situ great saphenous vein arterial bypass without venous valves extirpation,which is effective,simple,practicable,and deserved to be popularized in some cases.
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Objective: To investigate the effects of endothelin(ET) antisence oligoneuceotide and nitric oxide synthase (NOS)genetic transfection on the intimal hyperplasia of venous autografts.Methods: The external jugule veins were autografted into abdominal aorta arteries in 20 Wistar rats, which were divided evenly into experimental and control group at random. The transplanted veins of experimental group were immersed in the adenovirus-mediated eNOS gene solution for 15 minutes just before anastomosis and coated with ET antisence olioneucleotide glue gel just after anastomosis, while the control ones were only immersed the physiologic saline for 15 minutes but nothing to be coated. The transplanted vascular samples were taken at 2 weeks after operation. The intimal thinkness (IH), degree of restenosis(DR), expression of PCNA, ETmRNA, NOS mRNA were determined by histology, transcription polymerase chain reaction.Results: The IH, DR and the expressions of ETmRNA were decreased while the expressions of eNOS mRNA was increased contrary to control group.Conclusion: Transfection of ET antisence oligoneuleotide and NOS gene can inhibit the intimal hyperlisia of venouse autogrfts,it is a prospective and idea genetic prophylactic therapy to intimal hyperplasia.
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0.05). Body weight, blood pressure, blood routine test and blood biochemical parameters did not change in the two groups. Only mild side reactions of aescin was found and there was no dropout in the study group, whereas 7 patients dropped out in the control group due to the intolerance for the pressure. Conclusion Aescin has similar efficacy and fewer side effects compared with the compression stocking method in the treatment of chronic venous insufficiency.
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Objective To explore the surgical manipulation of inferior vena cava(IVC) invaded by retroperitoneal tumors(RPT) in order to raise the resection rate and improve the operative safety. Methods The clinical data of 41 cases undergoing resection of retroperitoneal tumor along with the reconstruction of IVC in our hospital from January 1990 to April 2003 were retrospectively analyzed. ResultsAll the patients were cured by operation. Management of IVC included partial excision and repairement(17 cases), partial IVC resection and right kidney excision(11 cases), partial excision and ligation(10 cases), partial excision and artificial vascular grafting(3 cases). ConclusionBUS, CT, MRI and selective angiography were essential for diagnosis and helpful for treatment. It is not an operative contraindication for RPT cases in which IVC was invaded. Resection and reconstruction of IVC is safe, effective and practical to raise the excision rate and decrease the recurrence rate.