Preliminary analysis of self-made false lumen embolization device in the treatment of chronic Stanford type B aortic dissection / 国际外科学杂志

Objective:To analyze the early outcomes of self-made false lumen embolization device for occlusion the false lumen in chronic Stanford type B aortic dissection.Methods:A retrospective study analyzed 10 patients, there were 9 males and 1 female, with an average age of (52±10) years, aged from 39-69 years. Those 10 patients were diagnosed with chronic Stanford type B aortic dissection between June 2020 and July 2023, which presented with persistent false lumen backflow in the thoracic aortic segment, and persistent dilation or rupture of dissected aneurysms in our center. False lumen occlusion was performed using self-made false lumen embolization device. Primary endpoints index were technical success rate and clinical success rate. Secondary endpoints observation index were 30-day mortality and morbidity.Results:Over a mean 6-month follow-up (range 0-32 months) in 10 patients, the technical success rate was 90%. One patient occurred minor false lumen backflow in the intraoperative angiography and it exceeds the embolization device, but it was disappeared through conservative treatment during follow up period. The clinical success rate was 90%, 9 patients attained completely thrombosed at the thoracic segment while another 1 patient was manifested as partially thrombosed in false lumen. There were no intraprocedural death cases and 1 patient occurred paraparesis during perioperative period.Conclusion:It was a safe, effective and easy to achieve in the treatment of chronic Stanford type B aortic dissection using self-made false lumen embolization device, especially it is suitable for patients with chronic Stanford type B aortic dissection required emergent handling in the setting of rupture.

Clinical application of excimer laser ablation in lower extremity arterial ischemic diseases / 国际外科学杂志

Objective:To evaluate the therapeutic effect of excimer laser ablation (ELA) in the treatment of lower extremity arterial ischemic diseases.Methods:The clinical data of 44 patients with lower extremity ischemic diseases treated with ELA in the People′s Hospital of Xinjiang Uygur Autonomous Region from December 2020 to April 2021 were analyzed retrospectively. Among the 44 patients, there were 29 patients in lower extremity arteriosclerosis obliterans (ASO), including 3 patients with femoral artery stent occlusion. 8 patients of diabetes foot (DF) and 7 patients of thromboangiitis obliterans (TAO). Observation indicators include target vascular patency rate, amputation rate, vascular reintervention rate and mortality rate. The measurement data were expressed as mean ± standard deviation ( ± s), one-way analysis of variance was used for inter-group comparison, and paired sample t-test was used for intra-group comparison. The Chi-square test was used for comparison between count data. Results:The success rate of operation was 100% in 44 patients. The rate of major amputation in ASO group was 10.3%, while the other two groups had a major amputation rate of 0. The minor amputation rates of the three groups were 6.9%, 25.0% and 28.6%, respectively. The vascular reintervention rate was 10.3% in ASO group, 12.5% in DF group and 0 in TAO group. The 1-year mortality rate in the ASO group was 10.3%, while the other two groups had a mortality rate of 0. The 2-year mortality rate of the three group were 31.0%, 12.5% and 0, respectively.Conclusion:For the treatment of lower extremity arterial ischemic diseases, ELA is safe and effective, but the curative effect need to further clarify by large sample and long-term clinical follow-up observation.

Analysis of influencing factors on post-treatment in-stent stenosis of intracranial aneurysm using Pipeline embolization device / 中华放射学杂志

Objective:To evaluate the incidence, clinical significance and influencing factors on in-stent stenosis(ISS) after treatment of intracranial aneurysms by Pipeline embolization device(PED).Methods:A retrospective analysis was conducted on the clinical data of 161 patients with intracranial aneurysms treated with PED at the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from April 2015 to July 2021. PED was implanted into the parent artery through the femoral artery approach after general anesthesia. The first DSA follow-up duration time and imaging data were collected, and the patients were divided into ISS group and non-ISS group accordingly. The degree of aneurysm occlusion was evaluated by O′Kelly-Marotta(OKM) grading scale. Univariate and multivariate logistic regression analysis were applied to identify the factors related to ISS.Results:A total of 179 PED were employed in 161 patients with 168 aneurysms. Eighty-eight (52.38%) aneurysms were treated by PED only, and 80 (47.62%) aneurysms by PED combined with coiling. After a median follow-up of 6 (5, 7) months, 31(18.45%) aneurysms had ISS within the PED, of which 16(9.52%) cases were with mild stenosis (<50%), 13 (7.74%) were with moderate stenosis (50%-75%), and 2(1.19%) were with severe stenosis (>75%). All patients with ISS showed no relevant clinical symptoms. One (0.60%) patient with ISS underwent balloon angioplasty. Univariate analysis showed that the stent diameter, aneurysm location, triglyceride level, the diameter of distal parent artery, and the diameter of proximal parent artery were associated to ISS. Further multivariate logistic regression analysis showed the stent diameter (OR=0.332, 95%CI 0.191-0.578, P<0.001) and triglyceride level (OR=1.641, 95%CI 1.034-2.605, P=0.036) were independent factors of ISS. Conclusions:ISS is a common benign complication after PED treatment. The current results suggest that small stent diameter and high triglyceride level are independent factors of ISS.

Preliminary exploration of endovascular treatment for cerebral infarction caused by middle cerebral artery stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery / 中华神经科杂志

Objective:To evaluate the necessity, safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery (MCA) stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods:The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed. A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected. The preoperative and postoperative clinical imaging characteristics, perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results:After the endovascular treatment, the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation, and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation. The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation. No stroke, transient ischemic attack (TIA) and death occurred during the perioperative period. The time of clinical follow-up was 360 (322, 495) days, and there were no stroke, TIA or death occurring in the corresponding artery. All the 6 patients underwent imaging follow-up, of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography. The lumen of the target vessels showed patency in all patients.Conclusions:With rigorous imaging evaluation, endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.

Effect of High-Concentration Uric Acid on Nitric Oxide / 中国医学科学院学报

Uric acid (UA) is the final product of purine metabolism in human body,and its metabolic disorder will induce hyperuricemia (HUA).The occurrence and development of HUA are associated with a variety of pathological mechanisms such as oxidative stress injury,activation of inflammatory cytokines,and activation of renin-angiotensin-aldosterone system.These mechanisms directly or indirectly affect the bioavailability of endogenous nitric oxide (NO).The decrease in NO bioavailability is common in the diseases with high concentration of UA as an independent risk factor.In this review,we summarize the mechanisms by which high concentrations of UA affect the endogenous NO bioavailability,with a focus on the mechanisms of high-concentration UA in decreasing the synthesis and/or increasing the consumption of NO.This review aims to provide references for alleviating the multisystem symptoms and improving the prognosis of HUA,and lay a theoretical foundation for in-depth study of the correlations between HUA and other metabolic diseases.

Factors analysis on success rate of endovascular recanalization for non-acute long segmental internal carotid artery occlusion / 中华放射学杂志

Objective:To investigate the risk factors related to successful endovascular recanalization for non-acute long segmental occlusion of internal carotid artery and propose a strategy for selecting proper candidates for such procedure.Methods:From January 2018 to October 2022, 120 consecutive patients with non-acute long segmental internal carotid artery occlusion received the first intended endovascular recanalization treatment in the First Affiliated Hospital of Zhengzhou University. Potential variables including epidemiology, symptomatology, angiographic morphology and interventional techniques were retrospectively analyzed. Univariate and multivariate logistic regression analyses were made to investigate the independent risk factors for successful recanalization. Four types were divided according to the existence of tapered stump and ophthalmic artery flow reversion based on DSA images: A: tapered stump (-), ophthalmic artery flow reversion (-); B: tapered stump (-), ophthalmic artery flow reversion (+); C: tapered stump (+), ophthalmic artery reversion (-); D: tapered stump (+), ophthalmic artery (+). Investigation of the relationship between procedure success rate and group dividing was performed.Results:Totally 120 patients were all included. The technical success rate was 75.83% (91/120). The periprocedural complication rate was 9.17% (11/120), including 4 (3.33%) intracranial hemorrhagic events, 1 (0.83%) ischemic stroke event, 1 (0.83%) microcatheter perforation, 3 (2.75%) cavernous carotid fistulas, 2 (1.67%) iatrogenic dissections. None of these complications led to severe neurological damage or death. Through multivariate logistic regression, tapered stump (OR=4.10, 95%CI 1.19-14.16), retrograde filling of ophthalmic artery (OR=3.16, 95%CI 1.13-8.88), only cervical segment occlusion of internal carotid artery (OR=10.78, 95%CI 2.08-55.74) were the independent risk factors associated with higher technical success rate. All cases were divided into A-D four types considering the tapered stump and reversed ophthalmic flow existing or not. Technical success rates in A-D types were 30.00% (3/10), 66.67% (8/12), 70.00% (28/40), 89.66% (52/58) respectively, and the complication rates of the four types were 10.00% (1/10), 8.33% (1/12), 17.50% (7/40), 3.45% (2/58). Multivariate logistic regression showed group pattern was the independent factor on technical success rate (OR=3.72, 95%CI 1.42-9.77).Conclusions:Tapered stump, reversed ophthalmic artery flow and pure extracranial artery occlusion are the independent factors for technical success rate. Group pattern which covered the tapered stump and reversed ophthalmic artery flow is also related to technical success rate. However, the results need further confirmation with the prospective trial and a larger sample.

Advances in surgical treatment of internal iliac artery aneurysms / 国际外科学杂志

The internal iliac artery originating from the common iliac artery is an important branch, and communicating with the branches of the abdominal aorta, such as lumbar artery and sacral median artery, forming rich collateral circulation and nourishing the blood supply of gluteal muscle and pelvic floor viscera. Surgical intervention is recommended when the maximum diameter of internal iliac artery aneurysms>2 cm. A variety of treatment modalities are available, particularly, endovascular technique has been successfully applied in the clinical treatment of internal iliac artery aneurysms, which can significantly improve the cure and reduce complications and deaths. This article reviews the previous literature and summarizes the progress of internal iliac artery aneurysms treatment.

Clinical analysis of excimer laser atherectomy in the treatment of diabetic foot with infrapopliteal arteriopathy / 中国医师杂志

Objective:To explore the clinical efficacy of excimer laser atherectomy (ELA) in the treatment of diabetic foot with infrapopliteal arteriopathy.Methods:The clinical data of 36 patients (40 limbs) with diabetic foot complicated with inferior knee artery disease treated by ELA in Xinjiang Uygur Autonomous Region People′s Hospital from December 2019 to May 2021 were analyzed retrospectively. The success rate of ELA in the treatment of diabetic inferior genicular artery disease, ankle-brachial index (ABI), limb salvage rate and Visual Analogue Scale (VAS) score at 3 days and 3 and 6 months after operation was observed.Results:All the 36 patients were operated successfully, including 2 cases of flow-limiting dissection, 2 cases of arterial embolism and 1 case of hematoma at the puncture point. The ABI of patients 3, 6 months after operation was significantly higher than that before operation (all P<0.05), and the VAS score 3, 6 months after operation was significantly lower than that before operation (all P<0.05). The rate of limb (toe) salvage were 92.5%(37/40), 82.5%(33/40) at 3 d, 3 months and 77.5%(31/40) at 6 months after operation. Conclusions:ELA is safe and effective in the treatment of diabetic foot infrapopliteal arteriopathy, and the recent efficacy is fair.

Management strategy of iliac artery difficulty in abdominal aortic aneurysm endovascular repair / 国际外科学杂志

Objective:To explore the strategies for the treatment of difficult iliac artery approach in endovascular repair of abdominal aortic aneurysm.Methods:The clinical data of 275 patients with abdominal aortic aneurysm who underwent endovascular surgery at the Department of Vascular Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2010 to March 2019 were retrospectively analyzed, and the general clinical data such as age, gender, and comorbidities of the patients were recorded. The resource index was to carry out corresponding measures to perform surgery for patients with difficult access, analyze the incidence of the type of difficult access, treatment measures and effects.Results:Two hundred and seventy-five patients underwent endovascular repair, 78 of them (28.3%) had difficulty in accessing the iliac artery, including 29 cases (10.5%) with mild iliac artery stenosis, 7 cases (2.54%) with severe stenosis, and 3 cases with occlusion ( 1.09%), 39 cases (14.2%) were twisted. For patients with vascular twist, super-hard guide wire was used to correct iliac artery angulation. For patients with iliac artery stenosis, balloon dilation was performed. For severe stenosis, the artificial blood vessel was passed through the lateral peritoneum. After road transplantation, stent placement and other treatments were successfully performed endovascular repair.Conclusions:Pathway vascular disease can cause difficulties in endovascular treatment of abdominal aortic aneurysms. Endovascular repair can be successfully performed after corresponding treatments according to different difficulties, and the long-term patency rate is good.

Preliminary clinical application of a double-tube flexible ureteral access sheath / 中华泌尿外科杂志

The placement of the flexible ureteroscopic sheath during lithotripsy may injure the ureter. We have developed a double-tube flexible ureteral access sheath. Thirteen patients with renal calculi were treated with double-tube and flexible sheath in one stage. CT examination of 13 cases showed that the ureter was normal. The double-tube flexible ureteral access sheath makes the operation of sheathing easy, safe and effective.

Flow diversion combined with coil embolization in treatment of intracranial aneurysms: an efficacy analysis / 中华神经医学杂志

Objective:To explore the efficacy of flow diversion combined with coil embolization in treatment of intracranial aneurysms.Methods:The clinical data of 110 patients with intracranial aneurysms treated by flow diversion in our hospital from April 2015 to September 2019 were retrospectively analyzed. In these patients, 48 were treated by flow diversion combined with coil embolization and 62 were treated by flow diversion alone; the efficacy and safety of patients from the two groups were compared.Results:Blood flow diversion was successfully implanted into all 110 patients, with technical success rate of 100%. Immediate complete occlusion rate in the flow diversion combined with coil embolization group (16.7%) was significantly higher than that in the flow diversion group (1.6%, P<0.05). There was no significant difference in the incidence of perioperative complications between flow diversion combined with coil embolization group and flow diversion group (4.17% vs. 4.84%, P>0.05). During the mean follow-up of 6.72±3.80 months, modified Rankin scale (mRS) scores of patients in the flow diversion combined with coil embolization group were all 0; one patient had mRS score of 1, one patients had mRS scores of 2, and 60 patients had mRS score of 0 in patients from the flow diversion group; no significant difference was noted between the two groups ( P>0.05). Patients in the flow diversion combined with coil embolization group had significantly higher rate of complete aneurysm occlusion than those in the flow diversion group (88.3% vs. 66.1%, P<0.05). Conclusions:Flow diversion is an effective and safe strategy in treatment of intracranial aneurysms. Flow diversion combined with coil embolization can effectively promote early healing of aneurysms in selective patients.

Comparison of intracranial venous pressures in patients with idiopathic intracranial hypertension under awake setting or general anesthesia / 中华神经医学杂志

Objective:To investigate the changes of mean venous sinus pressure (MVP) and trans-stenosis pressure gradient in patients with idiopathic intracranial hypertension (IIH) under awake setting and general anesthesia.Methods:Thirty-eight patients with IIH accepted venous sinus stent implantation in our hospital from January 2010 to January 2020 were chosen in our study; their clinical data were analyzed retrospectively. The manometry results of these 38 patients were recorded under awake setting and general anesthesia before stenting; MVP and trans-stenosis pressure gradient were obtained and compared.Results:MVP in the superior sagittal sinus, torcular, transverse sinus and sigmoid sinus showed no significant difference between patients under awake setting and general anesthesia ( P>0.05). Mean trans-stenosis pressure gradient in patients under awake setting ([22.784±7.606] mmHg) was significantly higher as compared with that in patients under general anesthesia ([18.388±8.992] mmHg, P<0.05). Conclusion:Mean trans-stenosis pressure gradient in patients under awake setting is higher as compared with that in patients under general anesthesia, and selection for venous sinus stent implantation should be decided by trans-stenosis pressure gradient in patients under awake setting.

Application of percutaneous mechanical thrombectomy combined with catheter directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis / 国际外科学杂志

Objective:To investigate and compare the efficacy and safety of percutaneous mechanical thrombectomy (PMT) combined with catheter directed thrombolysis and catheter directed thrombolysis alone in the treatment of acute lower extremity deep venous thrombosis.Methods:Retrospective analysis of clinical data of 69 patients with acute lower extremity deep venous thrombosis who met the inclusion criteria of this study from January 2018 to December 2018 in department of vascular surgery, People′s Hospital of Xinjiang Uygur Autonomous Region was performed. There were 35 males and 34 females, with an average age of 59 years and an age rang of 20 to 80 years. Patients were divided into PMT combined catheter directed thrombolysis treated group ( n=38) and catheter directed thrombolysis treated group ( n=31) according to different methods of intra-luminal thrombolysis. The thrombolysis time, dosage of urokinase, thrombotic clearance rate, perimeter difference of suffered limb, and total number of adverse events during perioperative period between two groups were recorded. At 1 month, 3 months, and 6 months after discharge, patients underwent an ultrasonographic examination of lower extremity vessels to check and evaluate residual thrombolysis and thrombosis recurrence by outpatient review. The quantitative data in the two groups were expressed as mean±standard deviation( Mean± SD), t test was used for comparison between groups. Enumeration data in the two groups were expressed as percentage (%) and χ2 test was used for comparison between groups. Results:The thrombolysis time of PMT combined catheter directed thrombolysis treated group and catheter directed thrombolysis treated group were (3.7±2.1) d and (5.2±2.1) d, respectively. The differences between the two groups were statistically significant ( P=0.005). The dosage of urokinase were respectively (225.0±122.3)×10 4 units and (315.8±108.6)×10 4 units, the differences were statistically significant ( P=0.001). PMTⅠ, Ⅱ, Ⅲ thrombus clearance rate in patients with PMT combined catheter directed thrombolysis treated group were 18.4% (7/38), 73.7% (28/38), 7.9% (3/38), while 16.1% (5/31), 77.4% (24/31), 6.5% (2/31) were observed in patients with catheter directed thrombolysis treated group, with no statistically significant difference between the two groups ( P= 0.803, P=0.720, P=0.818). After a period of 48h thrombolytic therapy, the cross-section diameters of suffered thigh and calf were (2.16±0.87) cm and (1.38±0.66) cm in PMT combined catheter directed thrombolysis treated group respectively. While the cross-section diameters of suffered thigh and calf were (1.21±0.59) cm and (1.02±0.49) cm in catheter directed thrombolysis treated group respectively. The differences in the cross-section diameters of suffered thigh and calf were statistically significant after a period of 48h thrombolytic therapy ( P<0.001, P=0.014). Three cases (7.89%) had occurred adverse events during perioperative period in PMT combined catheter directed thrombolysis treated group, while there were 4 cases (12.90%) in catheter directed thrombolysis treated group, with no statistically significant difference between two groups ( P=0.692). The six month follow-up rate of PMT combined with catheter directed thrombolysis treated group was 71.05%(27/38), while that of the catheter directed thrombolysis treated group was 64.52% (20/31), with no statistically significant difierence between the two groups ( P=0.532). During the six month of follow-up, the recurrence rate of thrombus in PMT combined catheter directed thrombolysis treated group (3/27, 11.11%) was lower than those patients in catheter directed thrombolysis treated group (3/20, 15.00%), with no statistically significant difference between the two groups ( P=0.693). Conclusions:Compared with catheter directed thrombolysis treated group, PMT combined catheter directed thrombolysis treated group has a similar clinical efficacy for treatment of acute lower extremity deep venous thrombosis. PMT combined catheter directed thrombolysis treated group has advantages of reducing dosage of urokinase, shortening duration of thrombolysis time and relieving the swelling of suffered limb in a short time rather than catheter directed thrombolysis treated group. It shows a great result in the short term follow up.

The use of Enterprise stent in treating symptomatic intracranial atherosclerotic stenosis : follow-up observation results / 介入放射学杂志

Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.

Application of three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions in the follow-up of intracranial artery stenting / 中华放射学杂志

Objective To explore the value of three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE)magnetic resonance for postoperative follow-up of intracranial artery stent. Methods The clinical and imaging data of 19 patients with intracranial atherosclerotic stenosis after stent implantation were collected retrospectively from April 2017 to April 2018 in the Department of Neurology, First Affiliated Hospital of Zhengzhou University. 3D-SPACE sequence magnetic resonance examination was performed within 3 days after digital substraction angiography (DSA). Double-blind readings of DSA and MRI images were performed by two physicians, and the degree of lumen stenosis in the stent was measured by the WASID study method. The intra-group correlation coefficient was used to evaluate the consistency of the DSA and 3D-SPACE sequence measurements between the two physicians.The sensitivity, specificity, positive predictive value, and negative predictive value of 3D-SPACE sequence measurement results were evaluated using DSA as the gold standard. Paired sample t test was used to compare the difference in the degree of stenosis between the 3D-SPACE sequence and the DSA. Results Good inter-observer agreement was noted between the two physicians. The ICC value of DSA was 0.903 (P<0.01), and the ICC value of the 3D-SPACE sequence was 0.875 (P<0.01). With DSA as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of the 3D-SPACE sequence in the diagnosis of stent stenosis were 100.0％, 80.0％, 81.8％, and 100.0％, respectively. The average stenosis degree in the stent measured by DSA was (51.7 ±19.2)％, and the 3D-SPACE sequence was (55.5 ± 18.9)％. The difference was not statistically significant (t=1.675, P=0.111). Conclusions 3D-SPACE sequence magnetic resonance imaging can be used as a non-invasive imaging method for follow-up after intracranial stenting.

MR imaging features of vessel walls at the beginning of the middle cerebral artery in patients with moyamoya disease: a follow up study / 中华神经医学杂志

Objective To investigate the MR imaging features and changes of arterial walls at the beginning of the middle cerebral artery in patients with moyamoya disease during the natural course.Methods Nineteen patients with moyamoya disease,admitted to our hospital from January 2014 to December 2015,were chosen prospectively in the study.The MR imaging manifestations and clinical symptoms of the initial vascular walls of the unilateral middle cerebral artery in each patient were observed.Results Two patients were classified as Suzuki grading Ⅱ,9 were classified as Suzuki grading Ⅲ,and 8 were classified as Suzuki grading Ⅳ.The maximum cross-sectional area of patients with moyamoya disease was (5.7±1.4) mm2,and the maximum thickness was (0.9±0.2) mm;15 patients showed wall non-enhancement,two showed wall slight enhancement,and two showed wall obvious enhancement.Concentric thickening was noted in 17 patients and eccentric thickening in two.Two patients with Suzuki grading Ⅲ presented concentric thickening and slight enhancement;two patients with Suzuki grading Ⅲ presented concentric thickening and obvious enhancement;one patient with Suzuki grading Ⅱ and one with Suzuki grading Ⅳ presented eccentric thickening and non-enhancement;one patient with Suzuki grading Ⅱ,5 with Suzuki grading Ⅲ and 7 with Suzuki grading Ⅳ presented concentric thickening and non-enhancement.After the follow up for a median time of 38.7 months,the maximum cross-sectional area was (5.5±1.2) mm2 and the maximum thickness was (1.0±0.3) mm,which showed no significant differences as compared with those at admission (P＞0.05).Two patients with Suzuki grading Ⅱ progressed to Suzuki grading Ⅲ (the vessel wall developed from non-enhancement to slight or obvious enhancement).No obvious differences in Suzuki grading,enhancement or thickening styles were noted in the other patients during the follow up.Six patients had recurrent cerebral ischemia during follow-up,4 were with wall enhancement,and two were with wall non-enhancement.Conclusions Patients with moyamoya disease at Suzuki grading Ⅱ-Ⅳ commonly present concentric thickening without enhancement.Moyamoya disease progresses slowly,a few patients with moyamoya disease may present enhancement when it is in progress,and patients with wall enhancement are more likely to have recurrent attack of cerebral ischemia.

Clinical application analysis of inferior vena cava filter / 国际外科学杂志

Objective@#To explore the clinical application indications, filter selection and filter removal techniques of inferior vena cava filter.@*Methods@#Retrospective analysis of the clinical data of 108 cases of inferior vena cava filter implantation in the Department of Vascular Surgery, People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to February 2019 was performed. One hundred and eight patients with inferior vena cava filter were eligible for filter placement, including 50 males and 58 females; the average age was 59 years, and the age ranged from 23 to 90 years. Different types of inferior vena cava filters were selected according to the patient's condition, the location of the thrombus, the type of surgery and the prognosis of the disease. In this study, lower extremity vascular ultrasound was performed by the outpatient in 2 weeks after the filter placement, 1 month after the operation, 2 months after the operation, and 3 months after the operation. The inferior vena cava filter was recovered by a catcher. Loop technology, Loop and biopsy forceps were used for patients with difficult filter recovery. After removal of the filter, the angiography confirmed the integrity of the inferior vena cava wall. Observe whether the filter was completed, deformed, broken and whether there was thrombus in the filter.@*Results@#The removal of inferior vena cava filter was performed in patients with no free floating thrombus or fresh thrombus in popliteal, femoral, iliac and inferior vena cava confirmed by ultrasound. In this group, 108 patients with inferior vena cava filter implantation included 11 patients anticoagulant contraindications, 11 patients with pulmonary embolism, 5 patients with floating thrombosis in iliac vein, femoral vein or inferior vena cava, 35 patients with acute deep venous thrombosis of lower extremity received catheter-directed thrombolysis or percutaneous mechanical thrombectomy, 46 patients with abdominal, pelvic or lower extremity surgery for acute deep venous thrombosis of lower extremity and high risk factors of pulmonary embolism. One hundred and three patients received retrievable inferior vena cava filters and 5 patients received temporary inferior vena cava filters. Ninety-two patients were followed up successfully in this group. In 74 patients, the filter trap was recovered using a catcher, and the inferior vena cava filter of 12 patients were successfully removed by Loop technology and Loop with biopsy forceps.The success rate of the filter removal was 93.5%. After removal of the filter, angiography of inferior vena cava showed smooth wall, blood flow patency and no extravasation of contrast agent. The removal filters have normal shape, no fracture and no deformation.@*Conclusions@#Operators should strictly observe the indication of inferior vena cava filter placement, master a variety of filter removal methods to improve the success rate of filter removal and maximize the benefit of patients with inferior vena cava filter implantation.

Progress in the treatment of lower extremity arteriosclerosis obliterans with intracavitary volume reduction / 国际外科学杂志

Arteriosclerosis obliterans(ASO) of lower limbs is a common vascular disease in clinic. The main treatment methods of ASO include medical treatment, surgical treatment and endovascular treatment. Endovascular therapy has been widely used in clinical treatment because of its small trauma and rapid recovery. Endovascular therapy includes percutaneous transluminal angioplasty and intraluminal volume reduction. Intravascular volume reduction has become the focus of the development of endovascular therapy. It is a prerequisite for the treatment of ASO to master various intraluminal therapy methods. This article focuses on the progress of intracavitary volume reduction therapy in ASO.

Cause analysis and treatment of reoperative metabolic and bariatric surgery:A report of 54 cases / 中国实用外科杂志

OBJECTIVE: To explore the cause and treatment of bariatric and metabolic surgery reoperation. METHODS: A retrospective analysis was conducted on the clinical data of 54 patients underwent reoperative metabolic and bariatric surgery in Department of Bariatric and Metabolic Surgery,the First Affiliated Hospital of Jinan University from November 2000 to December 2018, and the reasons and surgical techniques of reoperation were analyzed. RESULTS: Causes of reoperation included inadequate weight loss/weight regain in 22 cases(40.7%),adhesive intestinal obstruction in 5 cases(9.3%),mesenteric hernia in 5 cases(9.3%),gastroesophageal reflux in 4 cases(7.4%),anastomotic leakage4 cases(7.4%),anastomotic ulcer bleeding in 3 cases(5.6%),anastomotic stenosis in 3 cases(5.6%),postoperative intraabdominal bleeding in 3 cases(5.6%),recurrent diabetes in 2 cases(3.7%),severe dumping syndrome in 2 cases(3.7%),anastomotic error in 1 case(1.9%). Reoperation methods mainly included Roux-en-Y gastric bypass in 30 cases(55.6%),sleeve gastrostomy in 10 cases(18.5%),hernia repair in 5 cases(9.3%),exploratory laparotomy hemostasis in 4 cases(7.4%),gastroscopic balloon dilatation in 2 cases(3.7%),restoration surgery in 1 case(1.9%),revisional banded gastric bypass with GaBP ring in 1 case(1.9%), hiatal hernia repair in 1 case(1.9%). A total of 54 patients underwent reoperation with a follow-up period of 1 to 102 months. Among them, 42 patients were followed up,and 12 patients were lost to follow-up(follow-up rate of 77.8%). Among the 42 patients who were followed up, 41 of them achieved good results after surgery, and the symptoms and signs were relieved to various degrees. CONCLUSION: The most common cause of reoperative metabolic and bariatric surgery is inadequate weight loss/weight regain.The choice of reoperation method depends on the primary surgical procedure, the cause of failure, and the intraoperative condition.

Clinical application analysis of inferior vena cava filter / 国际外科学杂志

Objective To explore the clinical application indications,filter selection and filter removal techniques of inferior vena cava filter.Methods Retrospective analysis of the clinical data of 108 cases of inferior vena cava filter implantation in the Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to February 2019 was performed.One hundred and eight patients with inferior vena cava filter were eligible for filter placement,including 50 males and 58 females;the average age was 59 years,and the age ranged from 23 to 90 years.Different types of inferior vena cava filters were selected according to the patient's condition,the location of the thrombus,the type of surgery and the prognosis of the disease.In this study,lower extremity vascular ultrasound was performed by the outpatient in 2 weeks after the filter placement,1 month after the operation,2 months after the operation,and 3 months after the operation.The inferior vena cava filter was recovered by a catcher.Loop technology,Loop and biopsy forceps were used for patients with difficult filter recovery.After removal of the filter,the angiography confirmed the integrity of the inferior vena cava wall.Observe whether the filter was completed,deformed,broken and whether there was thrombus in the filter.Results The removal of inferior vena cava filter was performed in patients with no free floating thrombus or fresh thrombus in popliteal,femoral,iliac and inferior vena cava confirmed by ultrasound.In this group,108 patients with inferior vena cava filter implantation included 11 patients anticoagulant contraindications,11 patients with pulmontary embolism,5 patients with floating thrombosis in iliac vein,femoral vein or inferior vena cava,35 patients with acute deep venous thrombosis of lower extremity received catheter-directed thrombolysis or percutaneous mechanical thrombectomy,46 patients with abdominal,pelvic or lower extremity surgery for acute deep venous thrombosis of lower extremity and high risk factors of pulmonary embolism.One hundred and three patients received retrievable inferior vena cava filters and 5 patients received temporary inferior vena cava filters.Ninety-two patients were followed up successfully in this group.In 74 patients,the filter trap was recovered using a catcher,and the inferior vena cava filter of 12 patients were successfully removed by Loop technology and Loop with biopsy forceps.The success rate of the filter removal was 93.5％.After removal of the filter,angiography of inferior vena cava showed smooth wall,blood flow patency and no extravasation of contrast agent.The removal filters have normal shape,no fracture and no deformation.Conclusions Operators should strictly observe the indication of inferior vena cava filter placement,master a variety of filter removal methods to improve the success rate of filter removal and maximize the benefit of patients with inferior vena cava filter implantation.