ObjectiveTo determine the influence of proximal aneurysm neck anatomy on typeⅠA endoleak follo-wing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm. MethodsFrom September 2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR. The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of typeⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. ResultsThe recurrence of typeⅠA endo-leak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren't related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. ConclusionsThe complicated proximal aneurysm neck anatomy is a major cause for the typeⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The applica-tion of EVAR depends largely on the shape of the proximal aneurysm neck.
Objective To evaluate the cl inical effect of percutaneous transluminal angioplasty (PTA) and PTA and stenting (PTAS) in treating multilevel arteriosclerosis obl iterans (ASO) of lower extremities. Methods Between January 2007 and October 2009, 29 cases of multilevel ASO of lower extremities were treated with PTA or PTAS. There were 17 males and 12females with an average age of 71 years (range, 56-83 years). The cl inical manifestations were l imbs numb with cold sensation, intermittent claudication (lt; 100 m), and 19 patients had rest pain. According to Fontaine stages classification, there were 7 cases of stage II, 14 cases of stage III, and 8 cases of stage IV. Concomitant diseases included hyperl ipidemia in 13 cases, diabetes in 6 cases, hypertension in 12 cases, chronic heart failure in 5 cases, chronic obstructive pulmonary disease in 3 cases, cerebral infarction in 5 cases, and toe ulcer in 15 cases. The preoperative ankle/brachial index (ABI) was 0.28 ± 0.13. Results In 3 cases of below knee lesions for the guide wire puncturing through the artery wall, 1 case gave up, and 2 cases continued recanal ized other arteries without serious bleeding compl ications. After operation, cerebral infarction occurred in 1 case, pulmonary infection in 2 cases, and groin puncture site hematoma in 2 cases. All patients were followed up 3 to 36 months. Limb skin temperature was significantly improved, and intermittent claudication disappeared or claudication distance lengthened, rest pain disappeared or significantly reduced in 27 patients (30 l imbs). The wound of amputee achieved good heal ing in 2 cases (2 l imbs). In 27 patients undergoing endovascular treatment, the postoperative ABI was 0.72 ± 0.19, showing significant difference when compared with the preoperative one (P lt; 0.05). Conclusion The PTA and PTAS treatment for multilevel ASO of lower extremities is a safe and effective option, and the short-term effect is good. Different treatments should be chosen according to the location and length of vascular occlusion.
Objective To explore the clinical experience of endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities. Methods Endovascular treatment were performed on 22 patients (26 limbs) suffering from ASO which were diagnosed by magnetic resonance angiography (MRA). The clinical efficacy after operation was analyzed. Results Twentytwo lower extremities of 18 patients successfully accepted endovascular treatment with 12 stents planted without major complications. Four cases failed to endovascular treatment and 2 of them converted to bypass surgery. The clinical symptoms of limb ischemia vanished or significantly improved after treatment. The ankle brachial index (ABI) of affected extremities increased from 0.35±0.13 (before operation) to 0.70±0.15 (after operation), Plt;0.01. During the follow-up of 2-18 months, 3 cases suffered re-occlusion of artery of lower extremity, in them one case received drug treatment and 2 cases resolved by percutaneous transluminal angioplasty (PTA) and stenting again. Conclusion Endovascular treatment for ASO of lower extremities has such advantages as minimal invasiveness, reduced complications and repeatability. It may serve as a more promising choice of method to clinical treatment of ASO.
Objective To discuss the clinical effect and value of stent placement combined with mechanical aspiration thrombectomy for acute iliofemoral venous thrombosis with iliac vein occlusion. Methods From October 2004 to December 2011， interventional treatment were performed in 273 patients with acute iliofemoral venous thrombosis and iliac vein occlusion， including left side of 235 cases and right side of 38 cases. Antegrade femoral vein under local anesthesia， an 8-14F catheter was inserted into iliofemoral vein with the guidance of guide wire to aspirate thrombus directly， 53 patients used 18-24F large lumen sheath to aspirate thrombus. As for the femoralpopliteal vein thrombus， a “cross sheath” was inserted to affected iliac vein with the help of guide wire capture technique， a guide wire was introd-uced to popliteal vein， then a Fogarty balloon catheter was inserted and extracted thrombus to iliac vein， mechanical aspiration thrombectomy was performed again. After iliofemoral vein thrombus were removed completely， percutaneous transluminal angioplasty （PTA） and stenting were performed for stenosis or occlusion displayed by venography. Results Thrombus removal were completely cleared （degreeⅢ） in 219 cases （80.22%）， partly cleared （degreeⅡ） in 49 cases （17.95%）， and minimal cleared （degreeⅠ） in 5 cases （1.83%）. The effect of stent placement：were cured in 235 cases （86.08%）， excellent in 29 cases （10.62%）， mild in 2 cases （2.57%）， and invalid in 7 cases （0.73%）. Total effective rate was 99.27% （271/273）， the average days in hospital was 7.5 days. Tumescence and pain of affected limb disappeared or relieved after interventional therapy for 1-2 days. The followe up effect：3-6 months， 7-12 months， 13-24 months， and 25-36 months after treatment of iliac vein patency were 94.87%，93.73%，87.08%，and 84.13% respectively. Conclusion Mechanical aspiration thrombectomy combined with stent placement for acute lower extremity deep venous thrombosis and iliac vein obstruction is an effective and safe treatment for its notable therapeutic effect and the short hospitalization time.
ObjectiveTo summarize clinical experience and surgical indications of open stented elephant trunk (sET) procedure for the treatment of complex acute Stanford type B aortic dissection (AD). MethodsFrom February 2009 to April 2013, 25 patients with complex acute Stanford type B AD underwent open sET procedure in Beijing Anzhen Hospital. There were 22 male and 3 female patients with their age of 46.92±9.12 years (range, 30 to 66 years). There were 16 patients with hypertension and 3 patients with preoperative acute renal failure. All the patients received sET implantation via an aortic arch incision under deep hypothermic circulatory arrest. Concomitant procedures included extra-anatomic bypass grafting in 11 patients, Bentall procedure in 1 patient, aortic valve replacement in 3 patients, and ascending aorta plasty in 3 patients. Computed tomography angiography (CTA) was performed before discharge and during follow-up for all the patients. ResultsOperation time was 4-7 (5.5±0.7) hours, cardiopulmonary bypass time was 93-206 (137.64±30.02) minutes, aortic cross-clamping time was 28-109 (57.96±21.05) minutes, and selective cerebral perfusion time was 15-76 (26.76±11.88) minutes. There was no in-hospital death. Postoperatively, there were 2 patients with pulmonary complications, 2 patients with type I endoleak, 1 patient with acute renal failure, 1 patient with temporary neurological disorder, 1 patient with sudden ventricular fibrillation, and 1 patient with delayed wound healing. Mean follow-up time was 6-54 (25.76±16.15) months, and 2 patients were lost during follow-up. The follow-up rate was 92%.There was no late death during follow-up. ConclusionsOpen sET procedure is a reliable and efficacious therapeutic strategy for patients with complex acute Stanford type B AD. Surgical indications include complex Stanford type B AD without enough landing zone, type B AD with ascending aortic disease, aortic root disease, valvular heart disease, coronary artery disease and congenital heart defects, and type B AD caused by genetic connective tissue disorder.
ObjectiveTo summarize the effects of endovascular intervention and artificial graft bypass for the occlusive superficial femoral artery disease. MethodsThe clinical data of 122 patients (136 limbs) with superficial artery occlusive disease underwent endovascular intervention or artificial graft bypass from January 2008 to April 2011 in this hospital were collected retrospectively. Age, TASCⅡgrading, condition of outflow tract, complications before and after procedures, hospital stay, primary patency rate, rate of amputation, and death rate were recorded. Results①Seventy-four limbs of 64 patients were accepted percutaneous transluminal angioplasty and stent graft (PTA/S group), 62 limbs of 58 patients were accepted femoral popliteal artery artificial graft bypass (artificial graft bypass group). Compared with the artificial graft bypass group, the age was significantly older (P < 0.05), TASCⅡA or B lesions were more (P < 0.05), TASCⅡC or D lesions were less (P < 0.05), the limbs with one or three outflow tracts were more (P < 0.05) in the PTA/S group. The limbs with two outflow tracts, and the patients combined with diabetes or hypertension or diabetes and hypertension had no significant differences between these two groups (P > 0.05).②There was no perioperative mortality in two groups. Compared with the artificial graft bypass group, the average hospital stay was sifnificantly shorter (P < 0.05), the 3-year death rate after procedure was higher (P < 0.05), the rate of postoperative incision infection was lower (P < 0.05), the primary patency rate of 36-month after operation was lower (P < 0.05) in the PTA/S group. The rate of amputation, the primary patency rates of 6-, 12-, and 24-month after operation had no significant differences between these two groups (P > 0.05). ConclusionsManagement of occlusive superficial femoral artery disease with femoral popliteal artery artificial bypass grafting exhibits a higher long term patency as compared with percutaneous stent graft. However, the hospital stay is longer than that in PTA/S group, and postoperative infection also occurres individually in artificial graft bypass group. Percutaneous transluminal angioplasty and stent graft has little trauma, faster recovery, shorter hospital stay, which is an important significance for the patients with too old or weak to accept femoral popliteal artery artificial graft bypass. But its long term patency rate needs to be improved.
ObjectiveTo investigate the clinical efficacy of sarpogrelate hydrochloride in preventing restenosis after femoral artery stent implantation. MethodsTwo hundreds and fifty-one cases of ischemic disease of lower extremity (286 affected limbs in total) who got treatment in our hospital were collected, and were divided into prevention group(125 cases with 146 affected limbs) and control group(126 cases with 140 affected limbs) according kinds of medicine. At the basement of medicine in control group, cases of prevention group got treatment of sarpogrelate hydrochloride in addition. Comparison of related indexed was performed by SPSS 17.0 software. ResultsCompared with before treatment in prevention group, only foot skin ulcer and gangrene score decreased(P<0.05), and there were no significant difference on other indexes included visual anafogue scales(VAS), intermittent claudication distance score, ankle brachial index (ABI), and vascular stenosis score(P>0.05). But in control group, compared with before treatment, foot skin ulcer and gangrene score and ABI value decreased(P<0.05), the VAS score, intermittent claudication distance score, and vascular stenosis score increased(P<0.05). There were significant difference on the difference between after treatment and before treatment of all 5 indexes(P<0.05), that the changed value of foot skin ulcer and gangrene score was higher in prevention group, but lower on other 4 indexes. There were no untoward effect happened during treatment. ConclusionClinical effect of sarpogrelate hydrochloride in the prevention of restenosis of the femoral artery after stent implantation was significantly, and it can keep related indexes stable.
Objective To design a novel stentless porcine aortic bioprosthesis and test the feasibility and its function in vitro after the valve was implanted by a modified method. Methods Six stentless porcine aortic bioprosthesis were divided into two groups according to different implantation, single layer suture group: new improvement stentless porcine aortic bioprosthesis sutured with single layer was implanted; double layer suture group: stentless porcine aortic bioprosthesis developmented by our laboratory used double layer suture was implanted. Each group contained three scales: 23 mm ,25 mm and 27 mm. Analogue ex vivo aortic valve replacement was performed , the feasibility of the new implantation was detected. Effective orifice area, transvalvular pressure gradient and regurgitation ratio were recorded at the cardiac output of 2.0 L/min, 3.5 L/min, 5.0 L/min and 7.0 L/min under the guideline of International Organization for tandardization （ISO）5840. Results The average aortic valve implantation time used for single layer suture and tradition double layer suture were 50 min and 70 min respectively. The transvalvular pressure gradient in the single layer suture group were significantly lower than those in double layer suture group under the flow of 5.0 L/min in 23 mm valve and 27 mm valve （13.51±0.51 mm Hg vs. 14.44±0.99 mm Hg, 7.36±0.19 mm Hg vs. 7.53±0.28 mm Hg；P＜0.01）;and the effective orifice area in the single layer suture group were larger than those in double layer suture group in the same case(1.87±0.06 cm2 vs. 1.76±0.08 cm2, 2.26±0.07 cm2 vs. 2.16±0.05 cm2；P＜0.01). There was no statistically difference in other parameters between both groups. Conclusion The novel design of new improvement stentless porcine aortic bioprosthesis used single layer suture has good hemodynamic characteristics as the nature structure . The modified suture method decrease the implantation time.Nemerical data of the evaluation in vitro show that the difference between single layer suture group and double layer suture group in effective orifice area,transvalvular pressure gradient and regurgitation ratio haveno statistical significance. This experiment is the foundation of the animal and clinical experiment in the future.
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H2O (1 cm H2O=0.098 kPa) before the surgery to (25.62±2.13) cm H2O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.