Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo explore the value of potaried technique with Trivex system in treatment for venous skin ulcer with deep venous thrombosis sequelae (DVTS) of lower limbs. MethodsTotal 166 patients with venous skin ulcer with DVTS of lower limbs were included in this study. The patients of operation group (94 patients involving 94 legs) were treated by using potaried technique with Trivex system. The patients of nonoperation group (72 patients involving 72 legs) were treated by using nonoperative method. The clinical indexes of skin infection rate, skin necrosis rate, shrinkage rate of wound area, skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were used to assess the clinical curative effect between two groups on 5, 20, 120 and 360 d after operation or treatment, respectively. ResultsThere were no skin infection and skin necrosis in two groups on 5 d after operation or treatment. The rate of shrinkage of wound area and skin depigmentation of patients in operation group were significantly higher than those in nonoperation group on 20 d after operation or treatment 〔(95.8±2.138)% vs. (68.7±3.125)%，P=0.048; (87.6±1.263)% vs. (12.3±1.324)%， P=0.018〕. The rate of the ulcer healing of patients in operation group was significantly higher than that in nonoperation group on 120 d after operation or treatment (97.9%vs. 8.3%， P=0.014). The rate of the ulcer recurrence of patients in operation group was significantly lower than that in nonoperation group on 360 d after operation or treatment (5.3% vs. 97.2%， P=0.015). ConclusionThe potaried technique with Trivex system can be used as one of the surgical treatment methods for venous skin ulcer with DVTS of lower limbs.
目的 总结急性动脉栓塞致肌病肾病代谢综合征(myonephropathic-metabolic syndrome,MNMS)的诊治经验。方法 回顾性分析2005年1月至2006年3月由急性动脉栓塞导致的11例MNMS的临床资料。结果 5例存活(保肢4例）； 2例死于高钾血症引起的心搏骤停，4例死于以急性肾功能衰竭为首发的多器官功能不全综合征。结论 急性动脉栓塞一旦确诊，尽早手术。MNMS是急性动脉栓塞的常见、严重并发症，急性动脉栓塞时尽快重建血流、骨筋膜室综合征尽早行筋膜室切开术及坏疽肢体尽早截肢是预防和治疗MNMS的关键。
Objective To explore the effect and evaluation criterion of the transplantation of autologous peripheral blood stem cells(PBSC)for blood flow remodeling in the critical limb ischemia (CLI).MethodsThirty six patients with 39 limbs suffered from CLI at Yunnan Provincial Center of Vascular Surgery and Department of Vascular Surgery of The First Affiliated Hospital of China Medical University from March 2003 to January 2007 were included in this study.These patients were divided into two groups. One groupconsisted of 20 cases in all 22 limbs used the transplantation of autologous PBSC,and another group included 16 cases in all 17 limbs were not use this technique.Multifunction monitoring device,dopplor ultrasound monitoring device,per cutem oxygen partial pressure monitoring device and digital subtraction angiography were used to measure effect degree of limbs regional blood flow from cutaneous covering,blood vessel and blood on the preoperative and postoperative days and the follow-up time was six months.ResultsThe effect indexes of limbs regional blood flow of the case by transplantation of autologous PBSC was as follows:skin temperature index(STI)was(1.5±0.3) ℃， per cutem oxygen partial pressure monitoring device(TcPO2)was(36.6±9.3)mm Hg,ankle-brachium index(ABI)was0.7±0.1,photoplethysmograpy index(PPGI) was0.8±0.1,saturation of blood oxygen(SaO2)was(78.3±15.9)%,digital subtraction angiography score was1.5±0.3,the rate of limbs salvage was 82%,the distance of intermittent claudication was(150.3±41.1)meters,and the change of index was consistent with ameliorative tendency of symptom(0.415＜r＜0.592, P＜0.05).ConclusionThe transplantation of autologous PBSC can promote blood flowremodeling in limbs ischemia,and the effect indexes of limbs regional blood flow can objectively reflect the degree of blood flow remodeling.
Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups: group A (102 cases)： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B (97 cases)： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group (group C). Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini-invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.
目的 探讨下肢动脉硬化闭塞症继发血栓形成患者的有效治疗方法。方法 回顾性分析我院2005年6月至2009年5月期间收治的35例此类患者，11例重度者行急诊手术取栓和股动脉内膜剥脱术，其中截肢3例，二期行经皮球囊扩张血管成形术（PTA）和自体外周血干细胞移植术（APBSCT）4例。 轻中度者24例则先行解痉、扩血管、抗凝及溶栓治疗，二期在数字减影动脉造影术（DSA）下行PTA， 其中截趾4例，同期行APBSCT治疗 22例。结果 除死亡2例、急诊截肢3例以外，其余30例治疗后症状缓解，近、远期疗效满意，其中行APBSCT治疗的26例患者，其治疗后的间歇性跛行距离、皮温和踝/肱指数均较APBSCT治疗前明显改善，其差异均有统计学意义（均P=0.01）， CTA、MRA或DSA检查下肢动脉供血有所改善。结论 根据患者入院时下肢缺血的急、重程度而分别采用取栓及股动脉内膜剥脱术、药物以及后续的介入、APBSCT治疗后，近、远期疗效确切。早期及时和正确的处理是挽救患者肢体和生命的关键。