[Clinical analysis of patients with lower extremity deep venous thrombosis complicated with inferior vena cava thrombus].

OBJECTIVE: To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences. METHODS: The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively. RESULTS: All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases. CONCLUSION: Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

[Diagnosis and surgical treatment of infectious abdominal aortic aneurysm].

OBJECTIVE: To explore the diagnosis and surgical treatment of infectious abdominal aortic aneurysm (IAAA). METHODS: All 3 IAAA patients at our department in 2010 underwent the combined procedures of axillary-bilateral femoral arterial bypass and IAAA resection. Their clinical data were collected and analyzed. RESULTS: There was no intraoperative death or complication. On average, the operative duration was 5 hours and the estimated blood loss 1500 ml. All patients received a 2-week post-operative regimen of antibiotics. And they recovered with healed incision in the first intention. No fever, abdominal symptom or intermittent claudication occurred during a 4-month follow-up period. CONCLUSION: Axillary-bilateral femoral arterial bypass plus IAAA resection is an effective surgical procedure for resecting IAAA, assuring arterial blood supply to lower limbs and preventing post-operative graft infections. The short-term therapeutic efficacy is satisfactory, but its long-term efficacy requires further follow-ups.

Lateral subfascial endoscopic perforating vein surgery as treatment for lateral perforating vein incompetence and venous ulceration.

BACKGROUND: The aim of this study was to evaluate the clinical results of lateral subfascial endoscopic perforating vein surgery (SEPS). METHODS: Our study was conducted from February 2002 to January 2007. Sixty-three patients with lateral incompetent perforating veins (IPVs) and venous ulceration were allocated to two groups. Group 1 comprised 31 patients (33 limbs) who underwent only routine surgery (saphenofemoral or saphenopopliteal ligation, stripping, phlebectomies, endovascular laser treatment [EVLT], medial SEPS, and skin grafting). Group 2 comprised 32 patients (35 limbs) who underwent our routine surgery with the addition of lateral SEPS. Bidirectional ultrasonography was performed before the operation, and 6 weeks, 6 months, and 1 year after surgery. Clinical score and disability score were collected at the same time. RESULTS: Twenty-nine (87.9%) of 33 limbs with active ulcers in group 1 healed, with recurrence in four (12.1%) limbs at follow-up at 25.9 +/- 10.0 months. All 35 limbs in group 2 healed, with recurrence in 0 (0.0%) limbs at follow-up at 25.4 +/- 10.1 months. Lateral SEPS could reduce the rate of recurrence of ulcers (Kaplan-Meier analysis). Patients in group 2 also showed improvement in clinical and disability scores, although they were not statistically significant differences (t test, p > 0.05). A significantly higher proportion of patients in group 1 had IPVs on the lateral aspect of the lower leg on ultrosonography imaging. CONCLUSIONS: Lateral SEPS could contribute to ulcer healing and reduce ulcer recurrence. The addition of lateral SEPS to routine surgery did reduce the number of IPVs. Lateral SEPS may be safe and effective for lateral perforating vein incompetence and venous ulceration.