Hybrid surgery of vertebral artery transposition combined with scallop and fenestration technique for the repair of type B aortic dissection patient with isolated left vertebral artery: A case report.

RATIONALE: Acute type B aortic dissection (ABAD) is a fatal cardiovascular disease with high morbidity and mortality. Isolated left vertebral artery (ILVA) is a rare aortic arch mutation originating from the aortic arch. The simultaneous occurrence of both increases the complexity and difficulty of thoracic endovascular aortic repair. However, there have been few reports on the recommendation of thoracic endovascular aortic repair treatment strategies for aortic dissection patients concomitant ILVA with insufficient landing zone. Here, we report a case of ABAD combined with ILVA treated with hybrid surgery of left vertebral artery transposition alliance with Scallop and in vivo fenestration endograft. PATIENT CONCERNS: A 38-year-old middle-aged man was transferred to our vascular department with persistent pain in his lower abdomen for 8 hours. DIAGNOSES: Preoperative computed tomography angiogram of the thoracic and abdominal aorta diagnosed with ABAD accompanied with ILVA. INTERVENTIONS: Hybrid surgery of left vertebral artery transposition alliance with Scallop and in situ fenestration endograft for revascularization of ILVA, left subclavian artery, and left common carotid artery. OUTCOMES: The hybridization operation was successfully completed. There were no complications of cerebral and spinal cord ischemia after operation. Computed tomography angiogram examination indicated no internal leakage existed in the stent and patency of the arch vessels and the transposed left vertebral artery follow-up 3 months after surgery. LESSONS: This study gave us experience in the treatment of aortic dissection with left vertebral artery variation and suggested that left vertebral artery transposition combined with scallop and in vivo fenestration stent is safe and effective.

Effects of CDT on Hemodynamics and Quality of Life in a Subgroup of Patients with Lower Limb Deep Vein Thrombosis Carel: A Case-Control Study.

Objective: To explore the effects of combined catheter-directed thrombolysis (CDT) on hemodynamics and quality of life in a subgroup of patients with lower limb deep vein thrombosis carel by using a case-control study. Methods: Eighty-four patients with deep venous thrombosis (DVT: acute DVT and chronic DVT) of lower extremities treated in our hospital from April 2017 to June 2021 were randomly assigned into the control group (n = 42) and the research group (n = 42). The control group only received routine nursing combined with CDT; the research group was treated with cluster nursing l combined with CDT. The clinical efficacy, the difference in limb circumference, hemorheology, hemodynamics, coagulation index and life quality before and after treatment, and the nursing satisfaction scores were calculated. The effects of cluster nursing l combined with CDT on hemodynamics and life quality in patients with DVT of lower extremities were analyzed. Results: The clinical curative effect of the research group was better than that of the control group (P < 0.05). After intervention, the difference in the thigh and leg perimeter in the research group was reduced, and the difference in the thigh and leg perimeter in the research group was significantly lower than that in the control group (P < 0.05). After intervention, the whole blood low shear viscosity, plasma viscosity, platelet aggregation rate, and fibrinogen in the research group were lower than those in the control group (P < 0.05). After intervention, segmental venous volume (SVC), maximum venous blood flow (MVO), and SVC/MVO in the research group were significantly higher than those before intervention, VRT was significantly prolonged, and MVO and venous pressure recovery time (VRT) were significantly higher than those in the control group. After intervention, D-dimer and fibrinogen decreased, prothrombin time and activated partial thromboplastin time increased in the research group, and the improvement of blood coagulation index in the research group was significantly better than that in the control group (P < 0.05). After intervention, the scores of quality of life in the research group decreased, and the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower than those in the control group (P < 0.05). The satisfaction of patients in the research group was significantly higher than that in the control group (P < 0.05). Conclusion: The application of cluster nursing l combined with CDT can effectively prevent lower limb venous thrombosis after operation and can enhance patients' hemorheology, hemodynamics, and blood coagulation function and significantly promote their life quality, nursing satisfaction is high, and it is worth popularizing and applying in clinic.

Single-stage treatment with iliac vein stenting and stripping of the great saphenous vein for patients with left iliac vein compression syndrome.

BACKGROUND: We sought to evaluate the safety and feasibility of single-stage treatment with left iliac vein stenting and saphenous stripping in patients with left iliac vein compression (LIVC) and left great saphenous vein (GSV) incompetence. METHOD: s: We conducted a prospective cohort study of 72 patients diagnosed with LIVC and left GSV incompetence between June 2012 to Oct 2018. We evaluated the periprocedural, 30-day, and 1-year outcomes of venous clinical severity score (VCSS), Chronic Venous Insufficiency Questionnaire 2 (CIVIQ2), the success rate of stent placement, duration of intervention, length of hospital stay, duplex recurrence, and clinically visible recurrence. RESULTS: There were 43 patients in the two-staged group and 29 patients in the single-staged group. The clinical characteristics of the two groups were similar. There were no differences between the two groups in the technical success rate, perioperative mortality, and surgical morbidity. There was no significant difference in the duplex and clinically visible recurrence. The length of hospital stay was significantly lower in the single-staged group. The single-staged group was associated with a higher complication rate of ecchymosis. There was no death, pulmonary embolism, or contrast-induced nephropathy among the patients. The 1-year primary patency rate was similar. CONCLUSIONS: Both treatment approaches were equally effective and had a high technical success rate. The single-staged group had a higher complication rate of ecchymosis due to heparin applying during the procedure.

Acute Pancreatitis: A Rare Complication After Percutaneous Mechanical Thrombectomy of Portal Vein Thrombosis.

BACKGROUND: Acute pancreatitis caused by Percutaneous Mechanical Thrombectomy treatment is extremely rare, and so far, no clinical report involving portal veins has been reported. In the article, we summarize this unusual case and share our experience. METHODS: Percutaneous mechanical thrombectomy was performed for the patient who was diagnosed with portal vein thrombosis. Postoperatively, the patient was complicated by acute pancreatitis and received a series of medical treatments. RESULTS: During the first month of follow-up, the patient was free of any clinical symptoms or signs. CONCLUSIONS: When performing percutaneous mechanical thrombectomy therapy, it is crucial to grasp the time limit strictly, strengthen perioperative rehydration and urine alkalinization to prevent massive hemolysis and subsequent complications. Early detection and the early administration of therapy for this potentially severe complication are essential for obtaining a good prognosis.

Combined endovenous laser therapy and pinhole high ligation in the treatment of symptomatic great saphenous varicose veins.

BACKGROUND: The aim of this study was to determine the effectiveness and short-term outcomes of endovenous laser therapy (EVLT) combined with pinhole high ligation (PHL) in the treatment of great saphenous varicose veins. METHODS: From February 2011 to May 2012, 200 patients with great saphenous varicose veins were treated using combined EVLT and PHL. Sixty-eight of them had concurrent TriVex suction. There were 118 men and 82 women with a median age of 61 (range 28-82) years. All patients had more than one of the following presentations, including lower extremity heaviness, pain, edema, varicose vein, skin changes, or ulceration. Based on the CEAP clinical classification, 20 patients had C2, 85 had C3, 48 had C4, 23 had C5, and 24 had C6 chronic venous disease. Ninety patients had VV involving the left lower extremity, 56 involving the right lower extremity, and 54 involving the bilateral lower extremities. Duplex ultrasound (US) was performed for all the 200 patients, and showed great saphenous valve dysfunction and reflux in 148 patients. Fifty-two of the 200 patients had concurrent mild femoral vein reflux. Deep venous thrombosis (DVT) was ruled out in all the patients. RESULTS: Technical success rate of PHL and laser ablation was 100%. Median follow-up was 9 months, ranging from 3 to 20 months. Symptoms were resolved or significantly improved in all patients after surgery. The ulcers healed in 23 of the 24 patients (96%) within 3 months. Ten patients developed subcutaneous hematoma, and 8 had slightly worsening edema. Ten patients with complications of numbness due to saphenous nerve burning injury were treated with mecobalamin, and the numbness sensation improved within 1 month and disappeared within 3 months. Nine patients sustained saphenous vein thrombophlebitis postoperatively and were treated with ibuprofen and a heating pad. There was no recanalization of the great saphenous vein, deep venous thrombosis (DVT), or deaths in this group of patients. CONCLUSIONS: Combined EVLT and PHL are less invasive and are effective in the treatment of symptomatic great saphenous varicose veins. PHL prevents DVT, and significantly decreases recanalization of the great saphenous vein after endovenous laser ablation. Short-term outcomes have been satisfactory, but long-term follow-up is needed.