Intravascular Guidewire Residue After Endovascular Embolization for Intractable Epistaxis: A Case Report.

Endovascular embolization (EE) has become an effective method for the treatment of intractable epistaxis (IE). However, complications such as facial pain, headaches, aphasia, hemiplegia, and transient blindness can also occur during or after surgery. In this article, we report a rare case of IE with residual intravascular guidewire after EE. Open surgery was used to remove the guidewire. However, to avoid serious complications such as massive hemorrhage, only part of the guidewire was removed.

Experience with thoracic endovascular aortic repair applied in treating Stanford type B aortic dissection: An analysis of 98 cases.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has been frequently applied in Stanford type B aortic dissection since thoracic aortic diseases were first treated with artificial vessels. OBJECTIVES: The aim of this study was to analyze the clinical value of TEVAR applied in treating Stanford type B aortic dissection. MATERIAL AND METHODS: Between January 2007 and April 2014, 167 consecutive Stanford type B aortic dissection patients were treated with TEVAR and retrospectively analyzed. RESULTS: All patients had a successful operation. A total of 98 patients were followed-up and the duration of the follow-up ranged from 3 to 63 months with a mean of 25.6 ±8.4 months. Proximal type I endoleak occurred in 18 patients with an incidence rate of 18.37% and a cuff was deployed in 7 patients, in whom the endoleak disappeared after 3 months. Two patients died in the perioperative period: one died from aortic dissection rupture, while the other died from infectious shock. One patient died from acute myocardial infarction during the follow-up period. Tears occurred in the end piece of stent grafts in 12 patients, and additional TEVAR was performed. One patient had a proximal retrograde type A dissection; the patient was in an acceptable state of health apart from persistent chest and back pain, and is still in follow-up. Spinal cord ischemia, stent displacement and collapse did not occur. CONCLUSIONS: TEVAR is reliable and safe, and it can be widely applied in treating Stanford type B aortic dissection.

Tuberculous abdominal aortic pseudoaneurysm with renal and vertebral tuberculosis: a case and literature review.

Tuberculous pseudoaneurysm of the aorta is rare and exposes patients to a very high risk of unpredictable rupture. To our best knowledge, only 32 cases have been reported related to all arterial systems from 1993 to 2013 in the literature. We report a 44-year-old male who presented with an aortic pseudoaneurysm and tuberculosis of the kidney and vertebrae. He underwent endovascular repair and antibiotic therapy for tuberculosis, combined with a bare stent implanted to seal endoleaks after endograft stenting. The postoperative course was uneventful and the patient recovered and lived well afterwards. Epidemiology, pathogenesis, presentation, management, and mortality of this entity were reviewed and discussed.

[Outcome comparison of open versus endovascular techniques in the treatment of abdominal aortic aneurysms].

OBJECTIVE: To compare the efficacy, cost and safety of endovascular aortic repair (EVAR) versus open surgery in the treatment of infrarenal abdominal aortic aneurysms. METHODS: Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital. Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm. In EVAR group, there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm. RESULTS: Among 86 open cases, there were inverted "Y" type artificial graft (n = 83) and straight artificial graft (n = 3). The surgical success rate was 98.8%, perioperative period mortality rate was 2.3%, a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml. The mean operative duration was 230 min, a mean hospitalization time (30 ± 3) days and a mean hospitalization cost RMB yuan 58 000. In EVAR group, the surgical success rate was 100% and perioperative period mortality rate 0.8%. Separating stent graft (n = 121, 91.7%), straight stent graft (n = 4, 3%) and one-stent-graft (n = 7, 5.3%). The mean operative duration was 150 min, a mean volume of blood loss 140 ml, a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800. The operative duration, volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group (P < 0.05). But the cost of group EVAR was significantly higher than that of group open surgery (P < 0.05). In group open surgery, 80 cases (94.1%) received a mean follow-up period of 46 months. And 79 artificial grafts maintained patency (98.8%) and 8 cases died (10%). There were 125 cases in group EVAR (94.7%) with a mean time of 32.5 months; stent graft patency in 120 cases (96%), 10 death; 8 complication cases (5.6%) involved stent migration (n = 2) and iliac artery branch occlusion (n = 6). Long-term effects had no significant difference between two groups (P > 0.05). In terms of the incidence of complications, group EVAR was significantly more than group open surgery (P < 0.05). CONCLUSION: In terms of operative duration, volume of blood loss and length of hospital stay, EVAR and open surgery treatment for infrarenal abdominal aortic aneurysms group EVAR is significantly better than group open surgery. As far hospitalization cost, group EVAR is significantly higher than group open surgery. But, in terms of incidence of long-term complications, group EVAR is significantly higher than group open surgery while the latter often requires further interventions.

[Surgical treatment of subclavian artery occlusion].

OBJECTIVE: To explore the effective surgical approaches in treating subclavian artery occlusion. METHODS: Between December 2005 and February 2010, 53 patients with subclavian artery occlusion were treated, including left subclavian artery occlusion (35 cases) and stenosis (5 cases), right subclavian artery occlusion (5 cases) and stenosis (4 cases), and bilateral subclavian artery occlusion (4 cases). There were 40 males and 13 females with an average age of 64 years (range, 22-77 years), including 49 cases of arteriosclerosis obliterans and 4 cases of aortic arteritis. The disease duration was 15 days to 20 months (6.5 months on average). In 49 patients with unilateral subclavian artery occlusion, 39 cases complicated by carotid or/ and cerebral artery lesion underwent axillo-axillary bypass grafting, and 10 cases without carotid or/and cerebral artery lesion underwent carotid-subclavian bypass grafting. Ascending aorta to bi-subclavian bypass grafting were performed on 4 cases with bilateral subclavian artery occlusion. After operation, patients received routine treatment with anticoagulant and antiplatelet agents. RESULTS: The operations were successfully performed in 52 cases with a successful rate of 98.11%. Thrombogenesis at anastomotic site occurred in 1 case of aortic arteritis after 48 hours. Two cases had brachial plexus crush injury and 4 had hematoma around the bilateral anastomosis after axillo-axillary bypass grafting, and all recovered with nonoperative therapy. A total of 52 patients were followed up 1-52 months (24.5 months on average). All patients survived and the symptoms of basilar and upper limb artery ischemia disappeared. Doppler ultrasonography showed that the blood flow was patent through anastomosis and polytetrafluoroethylene graft, and the vertebral artery flow was normal. Pseudoaneurysm at anastomosis was found in 1 case after 18 months and treated by interventional embolization. The postoperative graft patency rate was 100% at 1 year and at 2 years. CONCLUSION: Both thoracic and extrathoracic surgical approaches are effective for treating subclavian artery occlusion. The reasonable surgical approach should be selected according to the arteriopathy and the patient's condition. Perioperative treatment and strict intraoperative manipulation are important to guarantee the success of surgery.

[Differentiating into endothelioid cells from murine embryonic stem cell].

OBJECTIVE: To induce embryonic stem cell (ESC) to differentiate into endothelioid cells using a simple adhesive culture method, and to provide a new cells seed source for vascular tissue engineering or cell therapy. METHODS: SV129-derived ESC were seeded at 2 x 10(4)/cm2 and maintained undifferentiated on ESC culture medium in the presence of 1000 U/mL leukaemia inhibitory factor (LIF). Embryoid body (EB) formatted when ESC cultured in suspension in the lack of LIF. At 4 days, EB was transferred to 0.1% gelatin coated dish and cultured with medium supplementary of VEGF to be induced differentiation. The characteristics of differentiated cells were determined by immunohistochemistry staining, flow cytometry (FCM), 1, 1-dioctadecyl-3, 3, 3, 3-tetramethylindocarbocyanine-labeled acetylated low density lipoprotein (DiI-Ac-LDL) take up test, and TEM detection. RESULTS: Differentiated cells were morphologically characterized as endothelial cells. They could take up DiI-Ac-LDL, be stained positive by Flk-1 and CD31. The CD31 positive cells reached above 90% when measured by FCM. Furthermore, Weibel-Palade bodies were detected and tight junctions were found when differentiated cells were examined by TEM. CONCLUSION: Using a simple adhesive culture method and by supplied with VEGF alone, ESCs can be induced to differentiate into endothelioid cells. The differentiation method is simple and economic, and can provide seed cells for vascular tissue engineering or cell-therapy.

[Treatment of severe acute deep venous thrombosis in lower extremity].

OBJECTIVE: To explore the method and effectiveness of treatment for severe acute deep venous thrombosis (DVT) in lower extremity. METHODS: Eighteen patients with severe acute DVT treated in our hospital from January 1, 2002 to December 31, 2008 were retrospectively analysed. All the patients had limb edema and pain, sixteen had limb cyanochroia(one had calf skin ulcer and foot gangrene), two had limb pallor, ten had weakened dorsalis pedis artery pulsation, eight had silent dorsalis pedis artery pulsation. Colour Doppler ultrasonography revealed DVT and superficial venous thrombosis in all diseased limbs. One patient underwent above knee amputation for limb gangrene. Seventeen underwent surgical thrombectomy, of which three were simple thrombectomy, five were supplemented with suprapubic saphenous vein bypass, six with suprapubic PTFE graft bypass, three with iliac vein lysis angioplasty. RESULTS: One patient died (5.6%) on the third day after surgery. Limb edema relieved in seven patients (41.2%), reduced in ten patients (58.8%). All diseased limbs regained normal artery pulsation and skin appearance except for one limb amputated. Sixteen patients (94.1%) were followed up by a mean of 34 months. Limb edema disappeared in five patients (31.3%), reduced in eight patients (50%), recurrent in three patients (18.7%). Among three recurrent patients, one died of malignant tumor 9 months after operation, two had their graft occluded resulting from intimal hyperplasia. CONCLUSIONS: Surgical thrombectomy is an effective method for treating severe acute DVT in lower extremity.