ABSTRACT
Objective To assess the effectiveness of extra-anatomic prosthesis bypass in the retroperitoneum as a treatment for infected abdominal aortic aneurysms (iAAAs).Methods We retrospectively reviewed the records of 10 consecutive patients diagnosed with iAAAs and treated by an extraanatomic prosthesis bypass in the retroperitoneum over the past 7 years.All 10 patients were regularly followed up by outpatient observation after their discharge.Results Ten patients with iAAAs underwent an extra-anatomic prosthesis bypass in the retroperitoneum and debridement of the infected aneurysm.An emergency operation was performed for one patient who underwent concomitant gastrointestinal procedures for aortoduodenal fistula,the other 9 cases underwent an elective operation after an intravenous antibiotic therapy for 2-4 weeks.All 10 patients were definitely diagnosed by one or more sequential CT scans combining with other methods.All patients had at least a positive preoperative blood culture or intraoperative tissue culture during the perioperative period,including Salmonella in 5 cases,Burkholderia pseudomallei in 3 cases,Escherichia coli in 1 case,Klebsiella pneumoniae in 1 case.All patients were discharged in 4-6 weeks after their operations.Except 1 case who died 16 months after surgery,all other patients were alive and were free from graft infection during the follow-up period.Conclusions The extra-anatomic prosthesis bypass in the retroperitoneum for treating iAAAs are safe and effective.
ABSTRACT
Objective To explore the application of autologous bone marrow stem celI transplantation in the treatment of chronic ischemic disease of lower extremity and evaluate the effect.Methods Forty patients with chronic ischemic limbs were treated from January 2008 to April 2009.The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(GCSF),300?g /d,for 2-3 days.Then,200 mL of bone marrow was withdrawn from the iliac spine and the stem cells were obtained.After the bone marrow separation and purification,they were transplanted into the more severely ischemic limb.After the transplantation,they were foIlowed up by phone once a month for six months.The skin temperature,transcutaneous oxygen pressure(TcPO2),digital subtraction angiography(DSA)and ankle/brachial index(ABI)were rechecked at 6 months later,and the symptoms of pain,cold,numbness,intermittent claudication and physical signs of ulcer and gangrene were also evaluated.Results All of the 40 patients were followed-up.At 6 months post-transplantation,the various indices were compared with before transplantation.(1)The skin temperature and TcPO2 had significante improvement (P0.05).(3)DSA and all of the clinical symptoms showed general improvement in more than 60% of cases.(4)There were no serious complications.Conclusions Transplantation of stimulated autologous bone marrow stem cells is effective in the treatment of ischemic disease of lower limb,which is a simple,safe and effective treatment for ischemic disease of lower limb.