Efficacy of catheter-directed thrombolysis for non-acute deep venous thrombosis of the lower extremity / 中华普通外科杂志

Objective To evaluate the feasibility and efficacy of catheter-directed thrombolysis (CDT) for the treatment of non-acute (history ＞ 14 days) deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 63 patients of non-acute DVT of lower extremities treated by CDT and adjunctive angioplasty and stenting from July 2009 to August 2013 were analyzed retrospectively.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results A total of 63 limbs with DVT with a mean symptom duration of (22 ± 5) days were treated by a continuous combined with pulse-spray infusion of urokinase of (1.21 ± 0.69) million IU/d for (74 ± 21) hours.Significant recanalization was achieved in 77％ (48 of 63) of the treated limbs.After thrombolysis,percutaneous angioplasty was done for 15 residual lesions and stent placement was performed in 11 iliac veins and 1 femoral vein.Minor bleeding occurred in 6 (10％) patients,no patients suffered from major bleeding or symptomatic pulmonary embolism.During follow up (mean:15 ±6 months),the veins were patent in 45 (71％) limbs.15 (24％) limbs developed mild post-thrombotic syndrome (PTS),and none had severe PTS.Conclusions CDT combined with adjunctive angioplasty and stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity DVT.

Endovascular therapy based on Angiosome concept for critical lower limb ischemia / 中华普通外科杂志

Objective To evaluate the clinical value of endovascular therapy based on Angiosome concept in critical limb ischemia (CLI) patients.Methods A retrospective study was undertaken in 62 patients (62 limbs) diagnosed as critical limb ischemia (Rutherford class 5/6) and received percutaneous transluminal angioplasty from July 2011 to October 2013.Patients were divided into direct (35 patients) and indirect (27 patients) groups depending on whether feeding artery flow to the site of ulcer was successfully achieved or not based on the angiosome concept,and the between-group clinic outcomes including preoperative and postoperative ankle-brachial index (ABI),ulcer healing,and the rates of freedom from amputation were compared and analyzed.Results There were no significant difference between two groups for ABI pre-operatively (0.16 ±0.26 vs.0.15 ±0.28; P =0.885) and post-operatively (0.82 ± 0.26 vs.0.81 ±0.24; P =0.877).During follow-up,the healing rate of ischemia ulcer in patients without amputation at 1 year (91％ vs.74％ ; P =0.027) were significantly higher in the direct group than in the indirect group.There was no difference between two groups for healing time (162 ±49) d vs.(160 ±46) d; P =0.950).The rates of freedom from amputation at 1 year (84％ ±3％ vs.76％ ±4％ ; P =0.025) and 2 years (79％ ±4％ vs.72％ ±4％ ; P =0.031) were significantly higher in the direct group than in the indirect group.Conclusions Endovascular therapy based on Angiosome concept in CLI patient is an effective procedure with satisfactory clinic outcomes,contributing to healing of ischemia ulcer and increase amputation-free rate.

Femoral-deep femoral crossover bypass for unilateral iliofemoral arteriosclerosis obliterans / 中华普通外科杂志

Objective To evaluate the clinical results of femoral-deep femoral crossover bypass in the treatment of long-segment unilateral iliac artery occlusive disease.Methods From July 1995 to December 2010,40 patients (28 males,12 females,aged from 66 to 90,with mean age of 73) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were enrolled in this procedure.All patients suffered from unilateral common iliac,external iliac,common femoral,and superficial femoral arteriosclerosis obliterans.These patients were treated with femoral-deep femoral crossover bypass.Postoperative ankle-brachial index,blood flow velocity and patency rates in 5,7 and 10 years and limb salvage rates in 5,7 and 10 years were evaluated.Results There was no perioperative mortality nor extremity amputation.35 (87.5％ ) patients were followed-up from 1 to 13 years (mean 5.7 y).Anklebrachial index rose from preoperative 0.23 ± 0.10 to postoperative 0.55 ± 0.11 (t =15.91,P =0.000 ).Popliteal arterial velocity rose from preoperative ( 14 ±6) cm/s to postoperative (34 ± 10) cm/s (t =15.63,P =0.000) ; Tibial arterial velocity rose from ( 10 ±4) cm/s to (22 ±7) cm/s (t =15.71,P =0.000).The primary and secondary patency rates were 60.1％,44.3％,25.3％,and 93.5％,86.8％,57.9％ at 5,7 and 10 years,respectively.Limb salvage rates were 97.5％,95％,and 90％,at 5,7 and 10 years,respectively.Conclusions Femoral-deep femoral crossover bypass is safe and reliable in treating certain unilateral iliofemoral occlusive disease,especially for high-risk old patients or those who are not indicated for endovascular therapies or direct aortic approaches.

Popliteal artery local technique in superficial femoral artery antegrade subintimal recanalization / 中华普通外科杂志

Objective To evaluate popliteal artery local technique in superficial femoral artery antegrade subintimal recanalization.Methods From January 2009 to Dec 2011,550 limbs in 476 TASC (Trans-Atlantic Inter-Society Consensus) Ⅱ C/D cases underwent endo-therapy at our department.The success rate、operation time、symptom progress and follow up were analyzed retrospectively.Results In the 550 limbs,62 limbs received popliteal artery local technique directly.There was 9 technical failures.Procedures succeeded in 53 limbs(85.5％ ).The average operation time was (69 ±24) min,(1.8 ±0.6) stents were used and the main covered length was ( 33 ± 6) cm.Symptoms of 46 limbs was improved and unchanged in 6,amputation needed to be done in one limb.One year follow up accomplished for 39 limb.The 6 and 12 months patence rate was 87.1％ and 69.2％.For 488 limbs using traditional approach 378 achieved anti-grade recanalization,the average operation time was ( 89 ± 30) min,average (2.1 ± 0.6) stents were used and the main covered length is (31 ± 13) cm.Symptom in 300 limbs improved.The half and one year patence rate in 292 limbs was 92.1％ and 61.0％.Conclusions The popliteal artery local technique is as effective as with traditional approach and is time saving.

A study on treatment of visceral artery aneurysm / 中华普通外科杂志

Objective To evaluate open and endovascular procedures for the treatment of visceral arterial naeurysms.Methods Clinical data of 93 cases were reviewed from Jan 2001 to Jan 2011,including 47 males,and 46 females.Splenic artery aneurysm in 45 cases,superior mesenteric artery aneurysm in 15 cases,renal artery aneurysms in 10 cases,common hepatic artery aneurysm in 7,celiac artery aneurysms in 11 and gastroduodenal artery aneurysm in 5 cases.All cases had either open procedures or endovascular procedures after comprehensive evaluation.Results Surgical open procedures were performed on 34 cases,and endovascular procedures were performed on 59 cases.The perioperative complication rate were 52.9％ and 13.6％ for open and endovascular groups respectively.The mean follow-up time was 36.8 months ( 11 months to 10 years).1 -year survival rate and 5-year survival rate were 100％and 60.6％ in open surgery group,compared with 100％ and 84.5％ in endovascular group.Conclusions Endovascular repair is effective for visceral artery aneurysm with lower perioperative complication rate and better long-term survival rate.

Deep venous thrombosis cased by pelvic tumors / 中华普通外科杂志

Objective To summarize the clinical characteristics of and therapeutic approaches to deep venous thrombosis(DVT)caused by pelvic tumors,in the fact that some patients with pelvic tumors may present DVT as the first sign of the tumor. Methods The clinical data of 36 patients admitted between January 1997 and April 2009 suffering from pelvic tumor induced DVT were analvzed retrospectively.Result In all of these 36 patients,the occurrence of limb sweUing wag chronic and progressive with insidious onset.Regular DVT treatment Was given to 25 cases yielding no effect before the cause Was revealed.Ultrasound and CT were used for detection of the pelvic tumor.and compression of the iliac vein by the tumor was detected in an the cases.Pelvic tumor resection with iliac vein ligation was done in 29 cases(5 cases had iliac artery reconstruction with prothesis graft),in the remaining cases the pelvictumors were left untreated. Elastic stocking compression and venotropie preparations. microcirculation-improving agents were routinely applied in all the pafients.All the cases got improvement with different degrees.Conclusion DVT Call be a precursor of pelvic tumors.A thorough consideration of this posibility Is important when limb swelling Was chronic and progressive,or no improvement was observed after regular DVT treatment.Surgical resection of the pelvic tumors and conservative therapy of the involved limb is the therapeutic principle.

Diagnosis and surgical treatment of carotid body tumors in 70 patients / 中华普通外科杂志

Objective To evaluate diagnosis and surgical treatment of carotid body tumors.Methods It was retrospectively reviewed that the diagnostic approaches, surgical operation methods and its related complications in 70 carotid body tumor cases treated in our hospital from May 1986 to May 2008.Results Diagnosis was established by computer tomography angiography (CTA) or magnetic resonance angiography (MRA). Surgical excision was successfully performed in 63 cases with 72 tumours. There were no postoperative deaths. Two cases developed hemiplegia following surgery. Temporary cranial nerve palsy occurred in 17 cases while permanent nerve palsy occurred in 4 cases. Sixty-two cases were followed-up from 6 months to 5 years. There were no deaths in operative cases, with local tumor recurrence in 2 cases and 3 cases died due to remote metastasis. Conclusion CTA or MRA is sufficient for the diagnosis and preoperative assessment of carotid body tumor and its related structures. Surgical modality should be adjusted according to the relationship between the tumor and the carotid artery. Full exposure of the surgical area,careful control of intraoperative bleeding and persistent maintainance of blood flow to the brain are important measures for successful surgery.

Percutaneous transluminal angioplasty combined with autologous peripheral blood stem cells for lower extremity ischemia / 中华普通外科杂志

Objective To observe the clinical effect of percutaneous transluminal angioplasty (PTA)combined with autologous peripheral blood stem cells(PBSC)transplantation in the treatment of lower extremity ischemic disorders.Methods Fourty-two cases of lower extremity ischemic disorders in the treatment group were treated with PTA and autologous peripheral blood stem cells injection and 40 cases in control group were treated with PTA exclusively.Results All the procedures were successful.In treatment group,ABI improved from 0.32 ±0.11 to(at the 3rd month)and 0.49 ±0.13(at the 6th month)(t=-6.765,-6.040,P＜0.05)while TcPO_2 improved from(26.1 ± 2.3)mm Hg to(32.7 ±4.2)mm Hg(at the 3rd month)and(34.5 ±2.7)mm Hg(at the 6th month)(t=-8.901,-14.250,P＜0.05).In control group,ABI improved from 0.30 ±0.12 to 0.47 ±0.15 and 0.47 ±0.130=-5.631,-5.873,P＜0.05)while TcPO_2 increased from(25.9 ±2.4)mm Hg to(28.9 ±2.9)mm Hg(at the 3rd month)and(28.9 ± 2.1)mm Hg(at the 6th month)(t=-5.090,-5.389,P＜0.05).There was significant difference in TcPO_2 on follow-up between the two groups after the treatment(P＜0.05).Conclusion Autologous PBSC transplantation in combination of PTA was effective for the treatment of lower extremity ischemic disorders.PBSC injection helps to increase TcPO_2.

Quantitative analysis of intraluminal thrombus in abdominal aortic aneurysm with ultrasound integrated backscatter technique / 中国介入影像与治疗学

Objective To investigate the value of ultrasound integrated backscatter (IBS) in quantitative analysis of in-traluminal thrombus in abdominal aortic aneurysm (AAA).Methods IBS of intraluminal thrombus in 29 patients were measured,including All (average image intensity) and SDI (standard deviation of image intensity).Meanwhile,different echoes and characteristics of IBS in thrombus were compared and pathologic analysis was performed.Results ①Individual All value of homogenous thrombus differed remarkably,SDI value was low.There was no significant difference about All in homogeneous group and adjacent cavity group (P>0.05).All and SDI value in adjacent wall group were higher than those in other groups (P<0.01).②According to pathologic analysis,cellulose contents were abundant in adjacent wall group,but fewer in adjacent cavity group and homogeneous group.Conclusion IBS might be regarded as a sensitive and specific method and a quantitative basis for estimating and predicting the rupture risk of AAA.

Intraluminal thrombus in abdominal aortic aneurysms: distribution and influential factors in its formation / 解放军医学杂志

Objective To investigated the distribution of intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAAs), and to examine the influence of age, gender and aneurysm diameters on the ILT formation. Methods Morphological analysis of ILT in AAA of 103 consecutive patients was undertaken with helical CT angiography. ILT shape, distribution and thickness of ILT were recorded and analyzed in correlation with age, gender and aneurysm diameters. Results ILT were found in 66.9% of all the patients. ILT was always situated in the area away from the main axis of AAA. The incidence of ILT in female group (n=13) was much lower than that in male group (n=90) (15.5% vs 77.4%, P

MINI-TRAUMATIC ENDOVASCULAR THERAPY FOR STANFORD B AORTIC DISSECTION / 解放军医学杂志

This paper is to summarize our experiences in the operation indication and management of perioperative complications in treatment of Stanford B aortic dissection by using endovascular graft exclusion (EVGE). 32 patients underwent the procedure of EVGE . Various sizes of tubular grafts were introduced over the entry tear of aorta via the femoral artery. The procedure was technically successful in all patients. No Severe complication occurred during the perioperative period except one death due to heart infarction. These preliminary results suggest that EVGE is safe and efficient for Stanford B aortic dissection. EVGE is a method of first choice for the patients with this disease.

SURGICAL TREATMENT OF EXTRACRANIAL CAROTID ARTERY ANENURYSM / 解放军医学杂志

To assess the principles of perioperative management and prevention and treatment of postoperative complications of extracranial carotid artery aneurysm(ECAA),15 patients with ECAA received surgical treatment between 1988 and 2000.Among them,11 patients underwent aneurysmectomy with artery reconstruction,3 had resection of aneurysm and ligation of external carotid artery, and the other patient had aneurysmorrhaphy. No postoperative deaths or severe complications occurred except one patient with Horner's syndrome.Satisfactory results were achieved in 7 out of 8 patients within a 6 month to 7 year follow up period. The results showed that aneurysmectomy with artery reconstruction is a best operative procedure for extracranial carotid artery aneurysm. In order to prevent severe complications,such as brain ischemia and injury of cranial nerves, intensive perioperative management must be emphasized.

DIAGNOSIS AND TREATMENT OF 44 CASES OF KLIPPEL-TRENAUNAY SYNDROME / 解放军医学杂志

To assess the principles of diagnosis and management of Klippel Trenaunay Syndrome (KTS), ascending venography and PPG were used as the means of diagnosis for KTS. 18 cases received nonoperative therapy with elastic bandages or stockings, and 26 patients were operated on, including stripping of varicose vein, decompression of popliteal vein and segmental transplantation with valve to femoral or popliteal vein. The effective rate in the operative group was 73.1% (19/26),whereas the illness of 18 patients was stable with elastic support. Thirty one of 44 patients have been improved during 1～10 year follow up period . It is important that the indications and styles of operation must be carefully considered according to the clinical manifestations and venogram.

A STUDY ON PROMOTION OF REVASCULARIZATION BY INTRAARTERIAL ADMINISTRATION OF ANGIOGENIN IN A RABBIT LIMB ISCHEMIC MODEL / 解放军医学杂志

To study the effect of intraarterial bolus of recombinant human angiogenin (rhANG) on stimulating revascularization in a rabbit hindlimb ischemic model,the limb ischemic model was induced by ligation and excision of every branches of the femoral artery in 28 rabbits. On the 11th day after operation, various doses of rhANG (0,5,20 and 40 ? g) as a single bolus were administered intraarterialy via the catheters inserted into the bifurcation of the iliac artery. Revascularization and perfusion of the ischemic limb were compared in each animal postoperatively by using 99 Tc MAA perfusion scan, serial angiography and thigh muscle biopsy. Rabbits in the 20?g group and the 40?g group had significantly better revascularization and blood perfusion than the control group and the 5?g group.It is concluded that rhANG can promote blood purfusion, revascularization and recovery.

Changes of platelet and blood coagulating function during endovascular graft exclusion / 第二军医大学学报

Objective:To study the changes of platelet and blood coagulating function during endovascular graft exclusion(EVGE), providing reference for reasonable use of heparin and platelet. Methods:Using sonoclot analysis (SCT), 20 patients accepted EVGE were measured for ACT, clot rate, platelet function and hematocrit (HCT) and platelet count (PLT) after anesthesia induction(T 1), heparination(0.3 0.5 mg/kg)(T 2) and EVGE(T 3), respectively. The reasons for variability were analyzed. Results:ACT, clot rate and blood platelet function were normal at T 1. At T 2 ACT was prolonged [(289? 61.1) s,] clot rate and platelet function were decreased ( P

Surgical treatment of carotid artery stenosis (for 120 cases) / 中国普通外科杂志

Objective To evaluate the surgical treatment of carotid artery stenosis. MethodAccording to the level and degree of the stenosis, different operations were performed on 120 patients who suffered from the extracranial carotid stenosis. Treatment result was retrospectively reviewed. ResultSurgery was successful in all the patients. We performed carotid endarterectomy on 111 cases and other operations on 9 cases. The incidence of postoperative complications was low, especially for carotid endarterectomy. ConclusionCarotid endarterectomy is still the main therapy for the treatment of carotid artery stenosis with a satisfactory result.

Prevention of paraplegia after endovascular exclusion for Stanford B thoracic aortic dissection aneurgsm / 介入放射学杂志

Objective To assess the prophylactic measures of paraplegia and paralysis after endovascular graft exclusion(EVE) for Stanford B thoracic aortic dissections(TAD). Methods The records of 116 consecutive patients undergoing endovascular TAD repair from 1998 to 2001 were retrospectively reviewed. Steroids were administrated postoperatively in high risk patients likely to be candidates for paraplegia or paralysis. Results No paraplegia or paralysis occurred postoperatively in all cases, including the patient undengone selective spinal artery angiography (SSAA). Conclusions Transluminal repair can avoid spinal cord ischemia due to aortic cross-clamping, there is still a risk of spinal cord injury caused by occlusion of intercostal arteries under the cover of endograft. A combination of the prophylactic measures, including SSAA and steroids, have been able to reduce the risk of paraplegia and paralysis. A graft-stent of appropriate length is the key point fo this procedure.

Stent placement in the management of proximal endoleak after endovascular exclusion for abdominal aortic aneurysms / 介入放射学杂志

Objective To assess the value and safety of stent placement in treating proximal endoleak after endovascular exclusion for abdominal aortic aneurysms.Methods Three patients with primary endoleak and one patient with secondary endoleak underwent implantation of stent. Stents were deployed below renal artery in 1 case and cross bilateral renal arteries in 3 cases. Results In all 4 patients, the stents were successfully implanted and the endoleaks were completely occluded. No complications such as renal function damage, stent shift or endoleak reappearance were observed. Conclusion Stent placement appears to be a feasible, effective and safe treatment option for endoleak after endovascular exclusion for abdominal aortic aneurysms.

Affects upon renal function after conventional surgery or endovascular graft exclusion for infrarenal abdominal aortic aneurysms: A comparative investigation / 介入放射学杂志

Objective To assess and compare the affects upon renal function after endovascular exclusion (EVE) or conventional surgery (CS) for infrarenal abdominal aortic aneurysms(IAAA). Methods The records of 157 consecutive patients with IAAA from 1997 to 2002 were retrospectively reviewed. There were a group of 115 patients undergoing EVE and a group of 42 patients undergoing CS. The postoperative changes of plasma Cr and BUN with EVE and CS were analyzed respectively and compared. Results The plasma Cr and BUN were significantly increased in the group of CS postoperatively, but no significant difference were shown before and after endovascular repair was discovered in the group of EVE. Moreover, there was a case with acute renal failure in CS group. Conclusion The affects upon renal function with EVE are much less than CS for IAAA patients.