ObjectiveTo investigate whether the recombinant human growth hormone (rhGH) can promote endothelialization, inhibit vascular intimal hyperplasia, and improve long-term patency rate by the treatment of rhGH after vascular prostheses bypass. MethodsBetween August 2007 and January 2009, 94 patients with lower extremity arteriosclerotic occlusive disease were treated. Among them, 32 patients (34 limbs) who met the selection criteria were enrolled in this study. All cases were randomly divided into study group (16 cases, 18 limbs) and control group (16 cases, 16 limbs). There was no significant difference (P>0.05) in gender, age, disease time, location of lesions, the Trans-Atlantic Inter-Society Consensus (TASC) grade, and basic diseases between 2 groups. The patients with superficial femoral artery disease received above-knee femoro-popliteal prostheses bypass. The patients who had combined abdominal-iliac artery disease received concurrent abdominal-femoral and femoro-popliteal prostheses bypass. Subcutaneous injection of 9 U rhGH was given every night for 7 days in study group, and saline was applied in control group. Ultrasonography was taken after 2 weeks and 3 months of operation to observe the patency and measure the wall thickness of vascular prostheses. ResultsAfter operation, 1 patient of control group died of renal failure caused by acute thrombosis. After 2 weeks, ultrasonography showed no obvious intimal hyperplasia in 2 groups; the wall thickness was (0.13±0.02) cm in study group and (0.15±0.03) cm in control group, showing no significant difference (t=-1.720, P=0.108). After 3 months, the wall thickness was (0.17±0.06) cm in study group and was (0.26±0.09) cm in control group, showing significant difference (t=-2.240, P=0.045). All cases were followed up 36-60 months (mean, 56.4 months). The 5-year primary patency rate was 52.5% in study group and 35.7% in control group, showing no significant difference (χ2=1.470, P=0.225). ConclusionThe rhGH can improve endothelialization in vascular prostheses and can inhibit postoperative vascular intimal hyperplasia in clinical application.
我国血管外科在布加综合征的研究和治疗、血管腔内技术、人工血管内皮化、干细胞移植治疗肢体缺血等方面均达到国际水平［1，2］。现就我国血管外科的进展和特点分述如下。......
Objective To summarize the current progress in the genetic modification of vascular prostheses and to look forward to the future of genetic modification in vascular prostheses. Methods PubMed onl ine search with the key words of “vascular prostheses, gene” was undertaken to identify articles about the genetic modification of vascular prostheses. Then these articles were reviewed and summarized. Results To improve long-term patency of vascular prostheses, various genes were transfected into seeded cells. The antithrombosis activity of local vessels increased. Conclusion Progresses in tissue engineering and molecular biology make possible endothel ial ization and genetic modification of vascular prostheses. However, because most relevant researches are still basic experiments, further study is needed before cl inical appl ication.
Objective To explore whether 125I-vascular endothel ial growth factor (VEGF)-coated artificial vascular patch accelerate the vessel endothel ial ization and inhibit thrombosis. Methods Ten adult male New Zealand rabbits (weighing 2.5-3.0 kg) were allocated into experimental group (n=5) and control group (n=5). In experimental group, the right common jugular vein was exposed for vascular clamping between proximal location and distal location, and then a 10 mm × 5 mm 125I-VEGF-coated artificial vascular patch was implanted into the right common jugular vein and sutured with 8-0 thread.In control group, the artificial vascular patch was implanted. After 2 weeks, the vein specimens were collected to measure the residues of 125I-VEGF by γ-ray counter. HE staining and immunohistochemical staining for smooth muscle actin (SMA) and CD34 were performed. The vascular endothel ial cells were counted and the intimal thickness was measured. Results The γ-ray counter showed the residues of 125I-VEGF in experimental group was (427.5 ± 194.9) CPM after 2 weeks, equivalent to 2.0% ± 0.8% of the preoperative value. Thrombosis formed in 2 rabbits of control group; no thrombosis formed in experimental group. There was significant difference in the intimal thickness [(41.1 ± 6.6) μm vs (49.0 ± 6.9) μm, P lt; 0.05]; but no significant difference in the vascular endothel ial cells count between experimental group and control group (60.0 ± 6.8 vs 58.0 ± 5.7, P gt; 0.05). Conclusion 125I-VEGF-coated artificial vascular patch can reduce thrombosis and inhibit intimal prol iferation at the acute phase. A consecutive l ine of endothel ial cells can form after implantation of patch in the rabbit jugular vein, however, the function of endothel ial cells may be premature.
Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
OBJECTIVE: To investigate the clinical effects of revascularization in lower extremity for severe ischemia. METHODS: Fifty-six lower limbs with severe ischemia in 49 patients were evaluated retrospectively, who underwent surgical intervention from January of 1995 to December of 2000. By arteriography, the actual anatomic distributions of occlusive disease included infrarenal aorta-bicommon iliac arteries, abdominal aorta-bicommon iliac arteries, iliac artery, and femoral artery or femoropopliteal artery. The indication for surgery was disabling claudication, rest pain and gangrene. Fourteen limbs in 12 cases received arterialization of femoral venous system by artificial venous-arterial fistula. Artificial vascular grafts were implanted in 33 limbs of 28 cases, endarterectomy and patch profundaplasty were performed in 5 limbs of 5 cases, and primary amputation was carried out in 4 cases. RESULTS: During 38 months follow-up in average, 4 limbs were amputated within 52 revascularizated limbs, and accumulated amputation rate was 14.3%. Patency rate was 68.4% in arterial revascularization limbs (26/38 limbs), and limb survival rate was 94.7%(36/38 limbs) by procedure of artificial vascular grafts, endarterectomy and patch profundaplasty. Limb survival rate in procedure of artificial venous-arterial fistula was 85.7%(12/14 limbs). CONCLUSION: In treatment of severe lower extremity ischemia, the effective revascularization can be achieved by artificial vascular bypass, endarterectomy and patch profundaplasty, or arterialization of femoral venous system. Options in the surgical management should depend on individual. Arteriography is essential for revascularization and properly planning a practicable surgical approach.
Objective To assess clinical results of three different conduit materials （Gore-Tex synthetic graft，bovinejugular vein and autologous pericardium）for palliative right ventricle-to-pulmonary artery （RV-PA） shunt，and explore the correlation between suitable conduit size and patients’ body weight and McGoon ratio. Methods We retrospectively analyzed clinical data of 24 patients with congenital heart diseases who underwent palliative RV-PA shunt in Department of Pediatric Cardiovascular Surgery of Fu Wai Cardiovascular Hospital from July 2010 to July 2012. There were 11 males and 13 females with their age ranging from 60 days to 6 years and body weight of 10.22±7.41 kg. There were 22 patients with pulmonary atresia and ventricular septal defect （PAVSD），1 patient with tetralogy of Fallot （TOF） and 1 patient with doubleoutlet right ventricle （DORV）. Among different conduit materials，autologous pericardium was used for 17 patients，Gore-Texsynthetic graft was used for 5 patients，and bovine jugular vein was used for 2 patients. Conduit size and children’s body weight were analyzed with linear regression，then the equation was corrected with McGoon ratio. Results There was no perioperative death. Postoperative percutaneous saturation （SpO2）of the 24 children was 20.37%±28.33% higher than preoperative SpO2 . Electrocardiogram showed sinus rhythm in all the patients. Twenty-three patients were NYHA classⅡ，and 1 patient was NYHA classⅢ. Postoperative mechanical ventilation time of patients with autologous pericardium were significantly shorter than those of patients with other 2 materials （P=0.017）. Sixteen patients were followed up from 10 months to 2 years after discharge，including 12 patients with autologous pericardium，3 patients with Gore-Tex synthetic graft and 1 patient with bovine jugular vein. During follow-up，McGoon ratio of patients with autologous pericardium，Gore-Tex synthetic graft and bovine jugular vein were 1.98±0.46，1.83±0.33 and 1.68 respectively，all of which weresignificantly higher than preoperative McGoon ratio （P＜0.05）. Six patients underwent radical corrective surgery，including5 patients with autologous pericardium and 1 patient with Gore-Tex synthetic graft. There was no complication directly related to surgery during follow-up. Linear regression was performed to form an equation between suitable conduit size and patients’ body weight：conduit diameter （mm）=0.327×body weight （kg）＋4.599. McGoon ratio，conduit size and equationresult were compared to find a practical choice of conduit size. If McGoon ratio＜0.8，the first integer greater than the equation result could be chosen. If McGoon ratio＞1.2，the first integer less than the equation result could be chosen. If 1.2＞McGoon ratio＞0.8，the first integer either less or greater than the equation result could be chosen. Group analysis showed that patients who recovered better postoperatively were those whose conduit sizes were closer to equation results as well as equation results corrected with McGoon ratio. Conclusion All the 3 materials can be conventionally chosen for RV-PA shunt. Appropriate conduit size can be decided upon patients’ body weight and McGoon ratio for RV-PA shunt.
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.