Short-Term Efficacy of Two Different Access Site Ultrasound-Guided Radiofrequency Ablation for Saphenous Varicose Veins at Two Different Access Sites / 中山大学学报(医学科学版)

@#【Objective】 To investigate the efficacy and safety of ultrasound- guided above- knee and below- knee radiofrequency ablation for the treatment of saphenous varicose veins.【Methods】Patients who underwent ultrasound-guided radiofrequency ablation closure in our department from July 2019 to November 2019 were compared in operation time ， recovery time，volume of sclerosant foam，pain score，venous clinical severity score（VCSS），Aberdeen Varicose Veins Questionnaire （AVVQ）， and complications. 【Results】 Fifty- nine patients underwent above- knee radiofrequency ablation and 19 patients underwent below-knee radiofrequency ablation. The average operation time（69.75 vs. 78.95）min， time return to normal activity（2.93 vs. 3.58）min or the volume of foam（28.3 vs. 24.2）mL were similar in both groups. The pain score，VCSS，and AVVQ scores 24 h，1 week，or 4 w postoperative decreased significantly in the two groups. No deep vein thrombosis，pulmonary embolism，or infection occurred in the two groups after surgery. Other complications including phlebitis，pigmentation，bleeding，rash，or paresthesia，showed no difference in rates. And overall incidence of complications were similar between the two groups. 【Conclusions】 Both above-knee and below-knee radiofrequency ablation are safe and effective treatments for great saphenous varicose veins.

Assessment of the mechanical properties and biocompatibility of a new electrospun polyurethane vascular prosthesis / 南方医科大学学报

<p><b>OBJECTIVE</b>To develop a small-caliber vascular grafts and study its morphologies, mechanical properties and biocompatibility.</p><p><b>METHODS</b>The effects of electrospinning conditions on the microstructure and porosity of the resulting scaffolds were investigated for preparation of a small-caliber (4 mm) polyurethane vascular grafts with optimum microstructures and mechanical properties. The mechanical properties and biocompatibility of the prepared grafts were evaluated.</p><p><b>RESULTS</b>The polyurethane vascular grafts showed a three-dimensional reticular structure consisting of nanofibers, with an average porosity of (51.48∓4.47)% and tensile strength of 5.85 ∓ 0.62 MPa. The grafts provided a better long-term support than e-PTFE graft for endothelial cell growth and endothelialization.</p><p><b>CONCLUSION</b>The polyurethane vascular prosthesis possessed favorable microstructures, excellent mechanical properties and good biocompatibility for potential clinical application.</p>

Potential causes and optimal treatment strategy of recurrent venous ulceration in lower limb / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation.</p><p><b>METHODS</b>Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52.6 years (ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months (ranging from 5 to 37 months). Average diameter of ulcers was 3.7 cm (ranging from 1.3 to 6.5 cm). Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70.4%), primary deep vein insufficiency in 38 limbs (46.9%), post-DVT syndrome in 16 limbs (19.8%), reflux of accessory saphenous veins in 11 limbs (13.6%) and residual/re-opened great saphenous vein in 8 limbs (9.9%). Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality.</p><p><b>RESULTS</b>All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation. Only 3 limbs (3.7%) suffered again from recurrence 1 year after re-operation.</p><p><b>CONCLUSIONS</b>Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.</p>

Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.</p><p><b>METHODS</b>The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.</p><p><b>RESULTS</b>All covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.</p><p><b>CONCLUSIONS</b>EVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.</p>

Stent-grafting for unfavorable abdominal aortic aneurysm: a practical challenge / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The endovascular treatment of abdominal aortic aneurysm (AAA) has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm (uAAA).</p><p><b>METHODS</b>During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months (mean 20.5 months).</p><p><b>RESULTS</b>Technical success rate was 97.6% (40/41) with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine (22.5%) type I endoleaks (5 proximal and 4 distal) were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 (5.0%) type I endoleaks at 30 days; one type I patient was treated by open conversion, another type I patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type II endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type I endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type II endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminal angioplasty. There was no additional aneurysm rupture or any endograft imgration.</p><p><b>CONCLUSION</b>The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.</p>

RANTES expression in venous ulceration of lower limbs / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expression of RANTES in venous ulceration.</p><p><b>METHODS</b>From patients with lower limb venous ulceration, patients with non-ulcerous venous insufficiency, and healthy individuals, peripheral blood was collected from the lower limb veins for measurement of RANTES mRNA using RT-PCR.</p><p><b>RESULTS</b>In the ulceration group, the expression of RANTES mRNA was significantly increased as compared with the other two groups (P<0.01). RANTES mRNA expression was also significant higher in the non-ulcerous group than the control group (P<0.01).</p><p><b>CONCLUSION</b>High expression of RANTES mRNA may be one of the important mechanisms of venous ulceration.</p>

Endovascular stent-graft treatment for DeBakey I aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To study endovascular treatment of DeBakey type I aortic dissecting aneurysm.</p><p><b>METHODS</b>Seven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach.</p><p><b>RESULTS</b>The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed.</p><p><b>CONCLUSIONS</b>Endovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.</p>

Single or staged endovascular stent-graft repair for aortic dissection with multi-tears / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the single or staged endovascular stent-graft repair for aortic dissection with multi-tears.</p><p><b>METHODS</b>The stent-grafts were inserted through the femoral artery to seal the tears of dissection.</p><p><b>RESULTS</b>Between January 2001 and June 2004, 8 patients with aortic dissection underwent stent-graft placement. There were 5 tears in one patient, 4 tears in two patients, 3 tears in two patients and 2 tears in three patients. There were 11 tears located at descending thoracic aorta, 11 at abdominal aorta and 4 at iliac artery. Six patients underwent operation in single stage, and 2 in staged maneuver. Total 23 stent-grafts were used, including 20 straight type grafts and 3 bifurcated grafts. Placement of the stent-graft was technically successful in all patients. Follow-up with CT or MRA examination after 3, 6, 12 and 24 months postoperatively showed the dissection disappeared with thrombosis in the false lumen, no endoleak occurred. All patients survived to present.</p><p><b>CONCLUSION</b>Single or staged endovascular stent-graft repair is a promising, safe and effective procedure for aortic dissection with multi-tears.</p>