VENA stenting for symptomatic iliofemoral vein obstructive disease / 中华普通外科杂志

Objective To evaluate the clinical and technical effects of self-expanding VENA stent in the treatment of iliofemoral vein obstruction.Methods The clinical data of 58 patients(61 limbs) with symptomatic iliofemoral vein obstructive disease treated by VENA stent from February 2017 to June 2018 were collected and analyzed.The patency of the vein was assessed by the results of intraoperative angiography and postoperative symptoms relief changes in leg circumference.Follow up included relief of symptoms,Doppler ultrasound.Results A total of 63 VENA stents (43 in the left limb and 20 in the right limb) were implanted,sizes ranging from 12 mm to 16 mm,surgical technique success rate was 100％.The median follow-up time was 8.6 months.The primary patency rate of one month,three months,six months and 12 months was 96％,94％,92％ and 92％,respectively.Leg circumference fall down from(48 ±0.4) cm to (37 ± 0.3) cm (P ＜ 0.05).Conclusion Self-expanding nitinol stent implantation is a safe and effective treatment method for symptomatic iliofemoral vein obstruction disease.

Hybrid aortic endovascular repair with one stage supra-aortic branch or tliac artery revascularization / 中华普通外科杂志

Objective Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods We retrospectively reviewed the clinical data of 5 consecutive patients presenting with aortic aneurysm or dissection from 2007 to 2008 treated by the hybrid aorta repair. Complete surgical rerouting of the supra-aortic vessels was followed by endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type Ⅲ aortic dissection case. Procedures were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in these patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2-10 months, there was no incidence of endoleak. Documented perioperative neurelogic events did not occurred in all patients. Postoperatively one patient suffered from ARDS and cardiac failure and recovered. One patient died of myocardial infarction. Conclusions Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

Experience in the treatment of arterial embolism of the extremities, report of 536 cases / 中华普通外科杂志

Objective To evaluate the treatment for acute embolism in the extremities and define the primary factors affecting the prognosis. Methods From December 1984 to December 2006,536 patients with acute embolism of extremities were treated. Embolectomy with Forgarty catheters were performed in 507 cases, including salvage surgery in 34 cases and conservative therapy in 29 cases. Results The cure rate, mortality and amputation rate were 76.68%,9.51% and 10.26% respectively. Embolism recurred in 11.7% cases. Cardiopulmonary (27.5% ) and renal failure ( 25.5% ) were main causes of death during perioperative period. No bleeding nor other major complications occurred in 221 patients with atrial fibrillation who routinely received wafarine under proper monitoring. About 25.6% patients underwent heart valves surgery during hospitalization or within one year after discharge. Conclusions Patients suffering from acute embolism of the extremities should receive combination treatment. The main factors affecting the prognosis include time and degree of ischemia, and ischemia-reperfusion injury. Anticoagulant and etiologic treatment should be adopted in those with cardiogenic embolus and atrial fibrillation.

The treatment of acute infrarenal abdominal aorta occlusion / 中国普通外科杂志

Objective To sum up the experience in the management of acute infrarenal abdominal aorta occlusion. Methods We retrospectively analyzed 34 cases of acute infrarenal abdominal aorta occlusion treated during a period of 18 years. Cell saver was used intraoperatively in five cases.Results Twelve cases died postoperatively in this group (35 3%), with acute post operative renal failure, metabolic acidosis and hyperkalemia being the main causes of death. No acute renal failure and metabolic acidosis occurred in all cases treated by cell saver during operation. Limbs were salvaged in 36 out of 44 extremities of patients surviving the surgical procedure. ConclusionsPrompt diagnosis, proper surgery and correct management of post operative complications are necessary to decrease mortality. Perioperative application of cell saver is recommended to eliminate metabolic wastes from the body.

Axillofemoral bypass for the treatment of chronic severe lower limb ischemia / 中国普通外科杂志

ObjectiveTo evaluate axillofemoral bypass(AxFB) for the treatment of chronic severe lower limb ischemia. Method Consecutive AxFB performed in Anzhen Hospital from January 1995 to November 2002 was retrospectively analysed, with 31 patients of aortoiliac occlusive disease undergoing axillobifemoral bypass (AxBFB) and 32 axillounifemoral bypass(AxUFB) respectively. Result On discharge, rest pain disappeared in 44 cases and intermittent claudication in 19 cases, with average ankle/brachial index changing from preoperative 0.18(0～0.49) to postoperative 0.68(0.29～1.04). Rate of limbs salvage was 87.4%, amputation rate was 7.9%. Three cases died with a perioperative mortality of 4.8%. The patency rate of 1,3,5 years were 93.2%,79.8% and 64.1%, respectively. Conclusion AxFB for aortoiliac occlusive disease is considered to be acceptable procedure in high-risk patients with poor femoral run-off and chronic critical lower limb ischemia.

The in situ great saphenous vein bypass for the treatment of lower limb ischemia / 中国普通外科杂志

ObjectiveTo evaluate the result of in situ great saphenouse vein bypass for the treatment of lower limb ischemia.MethodsFrom 1995 to 2000, 34 patients with femoro popliteal artery occlusive disease underwent in situ great saphenouse vein bypass using self made valvulotome in our hospital.The distal anastomosis was made on above knee popliteal artery in 3 cases, below knee popliteal artery in 16 cases, posterior tibial artery in 11 cases and anterior tibial artery in 4 cases, respectively.ResultsOn discharge, the rest pain disappeared in 26 cases and intermittent claudication disappeared in 7 cases, with average ankle/brachial index changing from 0 34(0～0 52) preoperatively to 0 78(0 48～1 2) postoperatively.The cumulative patency rate at 6,12,24,36 and 48 monthes were 91 18%?88 14%?84 99%?80 52%?80 52%,respectively.ConclusionIn situ great saphenouse vein bypass is effective for the treatment of lower limb arterial ischemia. The vein valve was disrupted successfully with self made valvulotome.

An evaluation on complications following the placement of permanent inferior vena cava filters / 中国微创外科杂志

Objective To investigate the causes of and preventive measures for complications following the placement of permanent inferior vena cava filter (VCF). Methods A total of 71 patients, with proven diagnosis of lower limb deep vein thrombosis (DVT) by Doppler ultrasonography, underwent the placement of permanent VCF from December 1999 to June 2003. Forty of the patients were acute lower limb DVT. Cavography was performed routinely during operation to confirm no thrombosis in inferior vena cava and access veins. The insertion site of filters was below the renal veins. Four types of permanent VCF were used: Titan-Greenfield filters, Simon-Nitinol filters, LGM filters and TrapEase filters. Anticoagulation treatments were used in all the cases post-VCF insertion. Results The placement of VCFs was successfully accomplished in all the cases in the study. Follow- up observations for 1～41 months revealed vena cava thrombosis at the site of insertion in 2 cases and filter tilting less than 15? in 5 cases. There were no events of filter migration, filter fracture, vessel wall perforation, filter embolism or access vein thrombosis, as well as pulmonary embolism (PE). Conclusions Different types of VCFs have different kinds of complications and their incidence rates. Preoperative ultrasonography and intraoperative cavography should be performed to evaluate the vena cava and access vein. Careful surgical management and strict anticoagulation therapy are the key to the successful VCF placement and the prevention of PE or other complications.

Diagnosis and treatment of acute lower extremity arterial injury:experience of 125 cases / 中国普通外科杂志

Objective To sum up the experience in the diagnosis and management of acute lower extremity arterial injury.Methods Between Jan 1988 and Feb 2004,125 cases of lower limb arterial injuries were admitted and undergoing surgery, including gunshot in 3 cases, blunt trauma in 56 and stabbing in 66 cases. Associated injuries included bony injury in 36 cases, nerve injury in 11 cases, and vein injury in 23 cases. Arterial primary or patch repair was performed in 28 cases, end-to-end anastomosis in 37 cases, saphenous vein graft used in 32 cases, prosthetic graft bypass in 23 cases, thrombectomy in 2 cases and blood vessel ligation in 3 cases.Results Limb salvage rate was 85.6% and patient survival of 98.4%. Massive bleeding and multiple organ failure caused mortality in one each. The rate of amputation is 10.4%(13/125), with preoperative gangrene being present in 8 cases.Conclusion Lower extremity arterial injury carries a high amputation rate. The use of Doppler scanner is helpful for early diagnosis. An ankle/brachial index of less than 1 in the affected limb was considered as a positive sign of arterial injury. Prompt revascularization and early fasciectomy are important to reduce amputation rate and mortality.

Diagnosis and treatment of acute peripheral artery injury / 中国普通外科杂志

Objectives To study the diagnosis, treatment and prognosis of acute peripheral artery injury, and ways to improve the treatment. Methods Clinical data of 211 cases of acute peripheral arterial injuries admitted between January 1988 and June 2002 in Anzhen hospital were analyzed retrospectively. Of the 211 cases,73 cases were with blunt injuries, 99 penetrating injuries, 37 iatrogenic injuries, 2 gunshot injuries. Management procedures included arterial primary or patch repair in 28 cases, ligation alone in 17, end-to-end anastomosis in 41, interposition reverse saphenous vein graft in 37, interposition prosthetic graft in 29, thrombectomy in 14, excision of pseudoanurysm in 36, interventional thrombolytise in 2, ultrosonic-guided packing in 2, conservative management in 2. One hundred and ninety-two patients were cured,10 patients amputed, 4 patients died respectively.Results Ratio of cure,amputation,and mortality was 90.1%,4.74%,1.8% respectively.Amputation rate in blunt injuries was significantly higher than that in penetrarting injuries (P

Prosthetic graft occlusion and options of reoperative modality / 中国普通外科杂志

ObjectivesTo analyse the causes of occlusion of prosthetic grafts and to explore the appropriate modality of reoperation.MethodThe clinical data of 47 patients with occlusive prosthetic grafts were analyzed retrospectively. The procedure of treatment for patients with different causes of occlusive graft included thrombectomy alone in 9 cases, thrombectomy and anastomotic plasty in 16 cases, new bypass using prosthetic graft and saphenous autograft in 22 cases. ResultsThe reoccurrence of graft occlusion in patients undergoing thrombectomy alone or thrombectomy and anastomotic plasty was 67% and 56% respectively, which was siginificantly higher than that of 9% in patients treated by a new arterial bypass with prosthetic grafts and saphenous autografts. ConclusionsThe result of new bypass for occlusive prosthetic graft is superior to thrombectomy alone or thrombectomy and anatomotic plasty.

Permanent inferior vena cava filter placement for prevention of pulmonary embolism: an experience of 71 cases / 中国普通外科杂志

Objective To assess the efficiency,safety and indications of permanent inferior vena cava filters (VCF) placement for prevention of pulmonary embolism in cases of deep vein thrombosis (DVT). Method In this study 71 cases were treated with permanent inferior vena cava filters by way of the internal jugular vein and the common femoral vein. Cavography was performed routinely before inserting the VCF to confirm no thrombosis in IVC and access veins. The insertion site for filters is the subrenal vena cava. Results The procedure was successful in all cases. There was no case of symptomatic PE occurred during 1～41 months of follow-up. There were 2 cases of IVC thrombosis at the site of insertion and 5 cases of filter tilting less than 15?. There were no other complications. Conclusion Permanent IVC filter placement is an effective method for preventing fatal PE due to DVT. Imaging of the vena cava and access vein by venous ultrasound and cavography, strict anticoagulation therapy after VCF insertion are key to perform VCF placement, provide protection from recurrent life-threatening PE and reduce complications. The filter placement indications should be strict.

Surgical experience on 187 cases undergoing open repair of the abdominal aortic aneurysms / 中国普通外科杂志

Objective To summarize our surgical experience on 187 patients undergoing open repair of abdominal aortic aneurysms (AAAs). Methods Data of 187 patients with infrarenal AAA who were treated electively with open repair between January 1992 and February, 2004 were retrospectively reviewed. Results One patient (0.54%) died perioperatively due to ventricular premature beat, ventricular fibrillation 6 hours after. The mean duration of operative procedure was 3.8 hours. The mean blood loss was 445 ml. Perioperative complications included heart failure in 17 cases, respiratory failure in 8, acute myocardial infarction in 2, cerebral infarction in 1, and acute renal failure in 3. The 1? 3? 5-year survival rate was 97.0%? 84.6% and 78.3%, respectively. Conclusion The aneurysm diameter is not the absolute operative indication. Risk factors for open operation of AAA are old age, severe cardial, pulmonary diseases and renal desfunction. Open surgery is still the treatment of choice for AAA.