Intervention combined surgery for the treatment of acute iliofemoral vein thrombosis / 中华普通外科杂志

ObjectiveTo compare two treatment methods for acute iliofemoral vein thrombosis:c atheter-directed pharmacomechanical thrombolysis (CDPT,47 cases) and intervention combined surgicaltherapy( IST,14 cases).MethodsThis study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST.All discharged cases were followed up by telephone for a period of 14 -37 months.ResultsAmong the 61 patients (64 extremities),47 (forty-seven extremities) treated by CDPT,and 14 cases (seventeen extremities) treated by IST.The IST group included three patients of bilateral iliofemoral vein thrombosis,five patients on postoperative status within one month,and three patients in which the iliofemoral vein was not accessible.When discharged from hospital,the effective rate of edema relief is 93.6％ in CDPT group while that is 94.1％ in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group.According to the results of 14 -37 months follow-up,the effective rate of edema relief is 85.0％ in CDPT group while that is 85.7％ in IST group ( x2 =0.004 and the P =0.948).Calf pigmentation occurred in only one patient of CDPT group.The patency rate of vein by BUS examination is 52.6％ in CDPT group while that is 84.6％ in IST group x2 =4.157,P =0.041 ).ConclusionsComparing with CDPT group,IST group has the similar effective rate of edema relief,but has higher patency rate of iliofemoral vein.In case of bilateral acute iliofemoral vein thrombosis,in patients in whom thrombolysis is contraindicated,or when the iliofemoral vein is not accessible,IST is the treatment of choice for acute iliofemoral vein thrombosis.

An in-vitro study of Lovastatin's biphasic effects on proliferation and adhesion of human umbilical vein endothelial cells / 中华普通外科杂志

Objective To investigate Lovastatin's effects on proliferation and adhesion of human umbilical vein endothelial cells (HUVECs). Methods Culture medium with different concentration of Lovastatin(0.001、0.01、0.1、1.0、10μmol/L) was prepared, HUVECs was cultured in 96 well-plate with the different medium. AT the point of 24,72 and 120 h, the cell's activity and quantity was assessed by MTT. HUVECs was cultured with Lovastatin in 6 well-plate for 24 hours, then collected the cells by trypsin digestion. The cells were seeded in 24 well-plate with 2×104/ml and adhering for 30 mins. Then counting the adhered cells in different wells. Results At 24 h, Lovastatin (0.01、 0.1 μmol/L ) promoted proliferation of HUVECs ( P ＜ 0.05 ); at 72 h, Lovastatin ( 1.0μmol/L) was positive accelerating cell growth(P＜ 0.05 ). While Lovastatin ( 10μmol/L) inhibited the proliferation significantly ( P ＜0.05 ) at 120 h. As HUVECs was cultured with Lovastatin for 24 hours, Lovastatin (0.1、1μmol/L) inhanced the adhesion capability of HUVECs significantly( P＜ 0.05 ). Conclusion Lovastatin had biphasic effects on proliferation and adhesion of HUVECs dependent on the concentration. Lovastatin (0.1、1.0 μmol/L) could promote the proliferation and adhesion, while at higher concentration ( 10.0μmol/L) it inhibits cell proliferation and adhesion.

Pre-occlusion and Stump Pressure of the Internal Carotid Artery in Carotid Endarterectomy / 中国微创外科杂志

Objective To investigate the value of the pre-occusion and stump pressure(SP)of the internal carotid artery in carotid endarterectomy(CEA).Methods During Januray 2007 to January 2009,12 patients with carotid arterial stenosis underwent CEA in our deparment.With cervical plexus block,we performed pre-occlusion test and measured the stump pressure(SP)by using vascular shunt selectively.The patients were monitored with clear consciousness during the whole procedure of CEA.The data of postoperative complications and results of pre-occlusion and SP as well as the follow-up were analyzed afterwards.Results During the operaion,three patients had transient increase of heart rate and blood pressure.The lowest SP was detected in two patients,who had moderate or severe stenosis of the contralateral carotid artery complicated with lesions in the vertebral basilar artery.Two patients showed positive results in pre-occusion test,and vascular shunt was used in four cases.After the operaion,one patients developed hyperperfusion syndrome.Nine patients showed improvement of symptoms of dizziness and decreased eyesight.This series were followed up for a mean of 11 months(ranged from 1 to 26 months).During the period,two of the patients showed re-stenosis of the carotid artery;none of them had cerebral infarction.Conclusions Cervical plexus block combined with pre-occusion test ensures the safty and effectiveness of minimally invasive carotid endarterectomy.We recommend selective vascular shunt according to the results of pre-occlusion test,SP,and the severity of the lesions in the contralateral carotid artery and vertebral basilar artery.

Safety and Feasibility of Femoral Vein Thrombectomy for Deep Vein Thrombosis in the Lower Limbs / 中国微创外科杂志

Objective To investigate the safety and feasibility of femoral vein thrombectomy for patients with acute deep vein thrombosis in the lower limbs.Methods During June 2003 to August 2006,a succession of 43 patients with acute deep vein thrombosis in the lower extremities received femoral vein thrombectomy in our hospital.An inferior vena cava filter was employed before the operation.Anticoagulation and regional thrombolysis were taken postoperatively.Analyse the data of operation procedure,curative effect and complications.Results The operation time ranged from 55 to 115 minutes with a mean of 92.6 minutes.Four of the patients received blood transfusion during the operation.The mean blood loss was 384.6 ml (100 to 1000 ml).Five patients showed transient fluctuation of blood pressure during the surgery.None of the patients had pulmonary embolism during and after the operation. Five patients developed lymph leakage from the incision at the inguinal area,and was cured in 1 week.One aged patient suffered from postoperative postatic pneumonia and was cured before being discharged;no other complications were found in this series.The thrombectomy achieved good outcomes in our patients.The edema and pain in the lower limbs were relieved quickly after the operation, the difference between the circumferences of the two legs decreaed from a median of 5.5 cm (thigh) and 4.0 cm (crus) to 1.5 cm and 1.0 cm (Z=-5.345,P=0.000 and Z=-5.461,P=0.000),respectively,32 of the patients received re-examination 6 months postoperation,none of them showed recurrent thrombosis.Conclusions Femoral vein thrombectomy is feasible and safe for serious acute deep vein thrombosis in the iliac and femoral veins.Patients can recover quickly after the operation.

A clinical study on varicose veins of the lower extremity and Cockett syndrome / 中国普通外科杂志

Objective This study was to investigate the incidence of Cockett syndrome in patients with varicose veins of the lower extremity and the relationship between Cockett syndrome and varicose veins and deep venous insufficiency of the left lower extremity. MethodsDuring 1999～2001,a total of 148 patients with varicose veins of the lower extremity were investigated by descending deep phlebography and iliography preoperatively. Results (1) There were 40(65.6%), 37(68.5%), 13(39.4%) cases respectively with abnormalities of the left common iliac vein(ALCIV) in patients with varicose veins of the bilateral, left and right leg, respectively. (2) There were 72 cases with left great saphenous vein reflux(LGSVR). Fifty cases(55.6%) with LGSVR were found in patients with ALCIV and 22 cases(37.9%) in patients without ALCIV(P