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Stenting for iliac vein stenosis or compression has become a common therapeutic approach in recent years. The antithrombotic therapy after the stent deployment, however, reaches no consensus. Medications strategies and patients' prognoses differ in non-thrombotic, acute thrombotic and chronic thrombotic these three circumstances. Non-thrombotic patients usually possess satisfactory stent patency whatever antithrombotic therapy is used. Anticoagulant is the basic medication for acute thrombotic patients, benefits from additional antiplatelet drug remains to be clarified. In terms of chronic thrombotic patients, their prognoses are unsatisfactory under all antithrombotic therapies. In this review, we outlined the recent progress of antithrombotic therapy after iliac vein stenting, aiming to provide feasible medication plans for each circumstance.
Subject(s)
Humans , Constriction, Pathologic , Drug Therapy , General Surgery , Fibrinolytic Agents , Therapeutic Uses , Iliac Vein , General Surgery , Stents , Treatment Outcome , Vascular PatencyABSTRACT
To access the efficacy of stents for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). The study is a prospective single-arm study which has been registered on Clinical Trials (NCT03916965). Clinical data and follow-up information of the SIDSMA patients who received stent implantation in the First Affiliated Hospital of Zhejiang University during April 1, 2019 and September 30, 2019 were collected. The patients were recommended to be followed up at 1, 3, 6 and 12 months. A total of 34 patients were enrolled. Their mean age was (54±8) years. Abdominal pain was the most common symptom. Patients received (2.1±0.6) stents on the average. Post-operation hospital stay was (2.7±1.6) days, and the patients were followed up for (2.3±1.9) months (CT angiography) and (5.5±1.7) months (clinical visit/phone call). There was no recurrence of abdominal pain. The CT angiography showed complete remodeling and incomplete remodeling took place in 23 and 9 patients (69.7% and 27.3%), respectively. Two patients (6.1%) had mild in-stent stenosis. No stent rupture or migration was reported. This study demonstrated a satisfactory short-term result of stents implantation for SIDSMA, which indicated the endovascular treatment could be the first-line therapy for SIDSMA.
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Humans , Middle Aged , Aortic Dissection , Endovascular Procedures , Mesenteric Artery, Superior , Prospective Studies , Retrospective Studies , Stents , Treatment OutcomeABSTRACT
OBJECTIVE： To establish the method for simultaneous determination of 4 kinds of flavones such as sutellarin， sutellarein， luteolin and apigenin in Scutellaria barbata decoction pieces， and to conduct principle component analysis. METHODS： HPLC method was adopted. The determination was performed on Agilent ZOXDB-C18 column with mobile phase consisted of methanol-acetonitrile （80 ∶ 20，V/V）-1％ acetic acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 335 nm， and column temperature was 30 ℃. The sample size was 10 μL. Principal component analysis was carried out by SPSS 20.0 and SIMCA-P 13.0 software. RESULTS： The linear ranges of sutellarin， sutellarein， luteolin and apigenin were 0.131-1.446 μg（r＝0.999 0）， 0.031-0.345 μg（r＝0.999 7）， 0.005-0.055 μg（r＝0.999 2）， 0.024-0.268 μg（r＝0.999 2）， respectively. The limits of quantitation were 1.178 8， 0.602 9， 0.744 1， 1.079 1 ng； the limits of detection were 0.353 6， 0.106 1， 0.223 2， 0.323 7 ng；RSDs of precision， stability and reproducibility tests were all lower than 2％. The recoveries were 99.38％-100.56％（RSD＝0.44％，n＝6）， 91.01％-96.81％（RSD＝2.43％， n＝6）， 91.44％-97.34％（RSD＝2.59％， n＝6）， 96.21％- 99.26％（RSD＝1.23％，n＝6）， respectively. By principal component analysis， principal component 1 and prinicipal component 2 were main influential factors of sample， quality accumulative variance contribution rate of them was 92.573％（＞80％）. The comprehensive score of sample S14-3 was the highest， and the overall quality was relatively good； samples S14-2， S14-3 were the second. These 3 batches of sample were processed and produced in S. barbata planting base with stable quality. CONCLUSIONS： Established method is simple and rapid， and can be used for simultaneous determination of 4 kinds of flavones in S. barbata decoction pieces. Principle component analysis can provide reference for the quality control of S. barbata decoction pieces.
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The aim of this study was to determine clinical efficacy of ulinastatin combined with octreotide in treatment of acute pancreatitis, and its effect on serum endothelin, endotoxin level and immune function. It was an analytical observational study carried out from September 2016 to March 2018. A total of 108 patients with acute pancreatitis were randomly divided into observation group and control group, 54 cases in each group. Control group was additionally treated with octreotide. Observation group was treated with ulinastatin. Therapeutic effects of two groups were compared. The total effective rate in observation group was higher than that in control group [p=0.046]. After seven days of treatment, serum endothelin and endotoxin levels in observation group were lower than those in control group [both p<0.001]; IgA, IgM and IgG levels in observation group were higher than those in control group [p=0.031, 0.007, and 0.001, respectively]. Ulinastatin combined with octreotide can reduce level of endothelin and endotoxin and improve immune function
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OBJECTIVE@#To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities.@*METHODS@#From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery.@*RESULTS@#The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found.@*CONCLUSIONS@#Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.
Subject(s)
Humans , Lower Extremity , General Surgery , May-Thurner Syndrome , General Surgery , Minimally Invasive Surgical Procedures , Reference Standards , Radiofrequency Ablation , Saphenous Vein , General Surgery , Treatment Outcome , Varicose Veins , General SurgeryABSTRACT
Endovascular aortic arch repair remains challenging due to the complicated anatomy and the involved vital branches. Off-label techniques emerged during the last decade, including endografts with parallel stents (known as Chimney, Periscope, Sandwich), surgeon-modified endografts, and various other reported techniques. fenestration of standard endografts represents another off-label endovascular means to maintain perfusion to aortic side branches located in the excluded area. Its principle is based on fenestration of an endograft following its deployment inside the vascular system. As data are emerging regarding fenestration, the aim of this article is to review recent progress of technical descriptions, and clinic results of fenestration from the available literature.
Subject(s)
Aorta, Thoracic , General Surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Prosthesis Design , Stents , Treatment OutcomeABSTRACT
Objective To evaluate percutaneous AngioJet thrombectomy in the treatment of iliofemoral deep venous thrombosis (DVT).Methods A total of 36 patients with 38 legs of lower extremity DVT treated by AngioJet mechanical thrombectomy from Feb 2016 to Dec 2016 were analyzed retrospectively.The effect of lower limb venous recanalization was evaluated by observing the intraoperativeangiography and the results of postoperative follow-up including complaints,signs,and lower extremity venous ultrasound or CT and Villalta scores.Results Thrombosis was completely dissolved by AngioJet thrombectomy device in 32 out of 38 legs (84.2％) at first stage.Slight bleeding occurred in 4 cases,1 patient could not tolerate the operation.23 patients were followed-up for 6 months,venous patency was present in 21 of 23 patients (91.3％).11 patients complete the one-year follow-up,9 patients (81.8％) were in the 0-4 Villalta group.Conclusions AngioJet can effectively and safely remove thrombus in the lower extremity deep venous system.It is especially advantageous for patients who have contraindications for thrombolysis with a satisfactory short term venous patency.
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Objective:To study the origin traceability of anemarrhenae rhizoma from Bozhou and Hebei based on multi-element fingerprints technology , and establish a discrimination model .Methods:The contents of 48 elements were determined by using induc-tively coupled plasma mass spectrometry ( ICP-MS) for 44 samples of anemarrhenae rhizome from Bozhou and Hebei province .Princi-pal component analysis ( PCA) and orthogonal partial least squares discrimination analysis ( OPLS-DA) were applied in the data analy-sis to screen out the significant elements .And then Fisher linear discrimination analysis was used to determine the origin of anemarrhe-nae rhizoma and the discrimination models were developed .Results:Two discrimination models were developed by the discrimination a-nalysis of the whole model method with nine significant elements identified by PCA and OPLS -DA, and 100％correct classification and 95.5％cross validation were achieved by the models .Conclusion: It is a promising approach to classify the geographical origin of anemarrhenae rhizome based on multi-element fingerprints analysis combined with multivariate statistical analysis .The discrimination models are good enough to be applied in the origin traceability of anemarrhenae rhizome.
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Coverage of the left subclavian artery is often necessary to establish an adequate landing zone in patients undergoing thoracic endovascular aortic repair,which can avoids endoleaks that contribute the important aspect of technical success of thoracic endovascular aortic repair.However,there have been controversial whether the routine revascularization of left subclavian artery benefits in preventing the complications in perioperative,like cerebrovascular accident,and which approach of revascularization should be taken for more advantages.In this review,the disputes have been discussed between the routine revascularization and selective revascularization of left subclavian artery based on clinic research published in recent years,and also introduce the progress in open surgery and endovascular technique of left subclavian artery revascularization.
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Objectives To evaluate the effect of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA).Methods There were 41 men and 7 women patients, aged at 32-78 years.46 patients presented with abdominal pain and 3 patients was asymptomatic.The SIDSMA was diagnosed by computed tomography angiography(CTA).Results In the 45 symptomatic patients, one was treated by laparotomy, SMA thrombectomy and necrotic bowel resection.44 patients underwent endovasular treatment, among them 2 patients failed endovasular procedure.The other 42 patients underwent successful intravascular remolding.3 asymptomatic patients underwwent conservative treatment.During the mean (17 ± 4)month follow-up period, computed tomography angiography showed patent true lumen in all the 42 patients.The 2 patients in which the endovascular intervention failed remain symptomatic of recurrent abdominal pain and digestive dysfunction.Conclusions The endovascular interventional therapy is safe and effective for SIDSMA.
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<p><b>OBJECTIVE</b>A retrospective study was undertaken to examine therapeutic strategies used in 6 patients with left renal venal nutcracker phenomenon.</p><p><b>METHODS</b>Three patients underwent surgical transposition of the superior mesenteric artery. Three patients underwent endograft stent implantations with intervention.</p><p><b>RESULTS</b>All 6 cases were completely relieved of left renal vein compression after the operations, leading to improved clinical symptoms and normal urine tests.</p><p><b>CONCLUSIONS</b>Transposition of the superior mesenteric artery is a feasible method, but leads to complications and great trauma. Treating left renal venal nutcracker phenomenon with endografting techniques is minimally invasive in certain cases, and seems to have a prospective future.</p>
Subject(s)
Adolescent , Adult , Humans , Male , Constriction, Pathologic , General Surgery , Mesenteric Artery, Superior , General Surgery , Renal Veins , Retrospective Studies , Stents , SyndromeABSTRACT
<p><b>OBJECTIVE</b>To explore the management of cerebral ischemia caused by Takayasu's arteritis.</p><p><b>METHODS</b>Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.</p><p><b>RESULTS</b>Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%.</p><p><b>CONCLUSION</b>Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Angioplasty, Balloon , Brain Ischemia , General Surgery , Therapeutics , Phytotherapy , Plant Preparations , Therapeutic Uses , Takayasu Arteritis , TripterygiumABSTRACT
0.05). Conclusion The value of muscular loop substitute valve of the popliteal vein in the treatment of DVI remains to be further evaluated.
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Objective To summarize our preliminary experience on diagnosis and treatment of aorta pseudoaneurysms due to deceleration injury. Methods Retrospective analysis was made on 8 cases of aorta pseudoaneurysms due to deceleration injury regarding its clinical findings, imagines and surgical operations or endografting treatment. Results Diagnosis was confirmed by imaging examinations. Among two cases who refused a surgery one died and the other lost follow-up after discharge. Surgery was successful in the remaining six cases including two cases treated by open surgery and four cases by intervensive endografting. Conclusions Aorta pseudoaneurysms due to deceleration injury can be correctly diagnosed by imaging examinations. Aorta pseudoaneurysms should be treated timely since spontaneous cure is almost impossible. Traditional surgical operations is effective, however, endografting is a relatively safe, less traumatic procedure.
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Objective To explore the treatment of left renal entrapment syndrome. Methods A retrospective analysis was made on the treatment of left renal entrapment syndrome. Diagnosis was established with ultrasonography, magnetic resonance angiography ( MRA) and left renal venography. The transposition of the superior mesenteric artery(SMA) was performed in three cases, the transposition of left renal vein( LRV) in two, and the stent implantation of the LRV in 15. Results Ultrasonography showed that the flow velocity of the proximal end of the LRV at horizontal position accelerates remarkably, and the acceleration is more obvious after standing for 15 minutes; The inner diameter ratio of the broadest place to the narrowest of the LRV at horizontal position is 4. 4?1. 6, while it is 8. 1?1.7 after standing for 15 minutes. MRA illustrated the angle between the abdominal aorta and the SMA was (30?5)?, the control was (64?16)?. The average pressure difference between the LRV and the inferior vena cava (IVC) was ( 14?5) mmHg and (2. 9?1. 4) mmHg before and after stent implantation. The surgical and interventional therapy was successful in all 20 cases. Follow-up from 6 months to 6 years revealed that macroscopic hematuria and symptom disappeared in all patients. Conclusion Ultrasonography, MRA and renal venography are decisive for the establishment of final diagnosis of left renal entrapment syndrome. The stent implantation is the choice of therapy because of less invasion.
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Objective To evaluate therapeutic results of radiofrequency endovenous obliteration (RFO) for the treatment of varicose veins of the lower limbs. Methods Fifty six cases (56 limbs) of primary greater saphenous vein tributary varicose veins were randomly assigned to RFO group (n=28) and conventional stripping operation group (n=28). In RFO group, the wall of the greater saphenous vein was treated at 85℃ with the catheter to occlude the whole length of the vein. The other 28 cases underwent stripping procedure. The scattered superficial varicose veins in calf in both groups were managed by phlebectomy. The number of surgical incision, postoperative pain, average hospital days and the short-term results were compared. Results Patients in RFO group have less surgical incisions and less postoperative pain, without subcutaneous hematoma. The average hospital stay was 2.5?1.00 days in RFO group compared to 4.14?0.85 days in stripping operation group. Conclusions RFO effectively obliterates the whole length of the great saphenous vein and is of less trauma,faster recovery, and less scars.