The effect of different stent oversize on lumen remodeling of endovascular repair of type B aortic dissection / 中华普通外科杂志

Objective:To investigate the effect of different stent oversize in thoracic endovascular aortic repair (TEVAR) on lumen remodeling of type B aortic dissection (TBAD).Methods:The clinical and follow-up data of 89 TBAD patients receiving TEVAR from Nov 2010 to Jun 2020 at Yantai Yuhuangding Hospital were retrospectively analyzed. According to the difference of proximal stent oversize, 89 patients were divided into: low oversize group (<10%, 47 cases) and high oversize group (≥10%, 42 cases). The changes of the normal vessel diameter and area at the proximal end of the stent and the long diameter, short diameter and area of the true/false lumen at the distal end of the stent at 3, 6, and 12 months after surgery and postoperative complications were analyzed.Results:The change of proximal vessel diameter with time in the low oversize group is smaller than that in the high oversize group ( P<0.05),and the change of the distal false lumen area of the stent in the low oversize group was greater than that in the high oversize group ( P<0.05). The high oversize group was prone to retrograde type A aortic dissection (RTAD) ( P<0.05). Conclusion:Low oversize stents are more conducive to the remodeling of the aortic lumen in the early and mid-term after TEVAR in TBAD patients.

One patient with poor healing of sinus after implant of vascular prosthesis due to infected abdominal aortic aneurysms treated with negative pressure wound therapy combined with local flap / 中华烧伤杂志

In February 2018, a 67-year-old male patient with infected abdominal aortic aneurysm was admitted to the Department of Vascular Surgery of Yantai Yuhuangding Hospital Affiliated to Qingdao University Medical College. After admission, abdominal aortic endovascular exclusion surgery, right iliac artery-double femoral artery vascular bypass+ infected abdominal aortic aneurysmectomy+ stent removal surgery, and active anti-infective treatment were performed in the department of vascular surgery. Seven days after the vascular prosthesis bypass surgery, the surface skin of the vascular prosthesis of the patient was red and swollen, and there was a purulent discharge, which was diagnosed as poor healing of sinus of vascular prosthesis. Surgeons of our department and the department of vascular surgery performed incision and debridement of sinus of vascular prosthesis+ vacuum sealing drainage (VSD) in the early stage under local anesthesia. After the local infection was controlled and wound blood supply was improved, stage Ⅱ surgery of resection of sinus of vascular prosthesis+ vascular prosthesis partial diversion+ local flap propulsion under general anesthesia was performed. The incision healed well after surgery, and the patient was discharged smoothly. During the follow-up of 6 months, the patient′s flap was in good shape, and the wound was healed. This case prompts that after the diagnosis of infected abdominal aortic aneurysm vascular sinus poor healing, we can actively open the infected sinus, use VSD technology to treat granulation wounds, then divert the implanted vascular prosthesis to prepare fresh local flap which covers the vascular prosthesis, and use new silver ion dressing to cover the wounds, thus achieving satisfactory results.

Endovascular treatment for closed limb artery trauma: report of 12 cases / 中华普通外科杂志

ObjectiveTo explore the effect of endovascular treatment for closed limb artery trauma. MethodsFrom March 2006 to December 2011,the clinical data of 12 cases treated for closed limb artery trauma were analyzed retrospectively.Catheters sheath were placed by antegrade or retrograde puncture.Catheters was send to the proximal end of the lesion.Intraoperatively through angiography the location and extent of arterial lesions were determined.Catheter with the help of guidewire were sent through the lesion to establish treatment “ pathway,at the lesion site suitable stents were placed to repair damaged arteries. ResultsThe procedure was all successful in 12 patients,there was no mortality nor sever compalications.Postoperatively 2 cases suffered from acute renal failure,and were managed and cured by continuous veno-venous hemofiltration (CWH).Osteofascial compartment incision decompression was carried out in 3 cases due to osteofascial compartment syndrome.One case of them suffered from amputation due to sever muscle necrosis and lost of limb function.Eleven patients were followed-up for 1year.All the arteries were patent.There were no stent break,deformation or stenosis.ConclusionsEndovascular techniques for the treatment of closed limb arterial trauma is safe and effective.

The study of ischemia postconditioning intervention in a rabbit's acute mesenteric ischemia-reperfusion injury model / 中华普通外科杂志

ObjectiveTo study the effect of ischemia postconditioning intervention in a rabbit's acute mesenteric ischemia-reperfusion injury model.Methods 120 rabbits were divided randomly into Con( only expose SMA by operation),I/R( clamping SMA 30 min,reperfusing 120 min),IpostC1 ( clamping SMA 30 min,3 clamping 30 s/releasing 30 s round,reperfusing 117 min),and IpostC2 (clamping SMA 30 min,3 clamping 60 s/releasing 60 s round,reperfusing 114 min) group (n =30).Levels of MDA and MPO in serum and intestinal tissues were measured. Chiu-6 standard scoring was used to determine the pathology score of injured intestinal mucosae.ResultsCompared with the Con group,MDA and MPO levels in serum and intestinal tissues increased obviously in the three other groups,the same as in the pathology score of injured intestinal mucosae (P ＜ 0.01 ) ; Compared with the I/R group,the MDA and MPO levels in serum and intestinal tissues decreased obviously in the IpostC1 group ( P ＜ 0.01 ),but not in the IpostC2 group ( P ＞ 0.05 ).ConclusionsMDA and MPO levels in serum and intestinal tissues and intestinal mucosal injury decreased obviously in the rabbit's acute mesenteric ischemia-reperfusion injury model by ischemia postconditioning intervention.

Compared with the effect of thromboembolectomy assisted with intraoperative digital subtraction angiography (DSA) and traditional method / 中国医师杂志

Objective Compared with the effect of thromboembolectomy assisted with intraoperative digital subtraction angiography (DSA) and traditional method,evaluate the value of intraoperative DSA on surgical procedures for acute lower limb arterial embolism. Methods Sixeight cases of traditional thromboembolectomy to take on the operation (group A) and 72 cases under the DSA operation (group B)were analyzed during January 2005 to December 2009, Comparing two sets of operation (time, the amount of bleeding and the ankle brachial index changes before and after the surgery , amputations rate). Results The operation time of group B [(76 ±17) min] was less than that of group A [(95 ± 22) min, t =5. 736, P ＜ 0. 01] ; the amount of bleeding of group B [(83 ± 35 ) ml] was significantly less than group A [(102 ± 58 ) ml, t = 2. 362, P ＜ 0. 05]; The difference of ABI in group B after the operation than before (0. 32 ±0. 08) than that in group A(0. 25 ±0. 12) had remarkably improved ( t =2. 33, P ＜0. 05) ;there were 8 patient amputations in group A and 2 in group B ( u = 2. 06 , P＜ 0. 05 ); there were 2 patients died in group A and one in group B ( P ＞ 0.05 ). Conclusion Thromboembolectomy assisted with DSA can be accurate assessment of the arteries embolism position, elevate the success rate in the operation ,reduce the rate of amputation saws.