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Objective:To explore the method and effect of endovascular treatment to innominate artery stenosis or occlusion.Methods:The data of 11 patients with stenosis or occlusion of innominate artery from January 2014 to November 2019 at Xuanwu Hospital of Capital Medical University were collected. All patients received endovascular treatment. We summarized the changes of clinical symptoms, surgical methods, perioperative complications, stent patency, and analyzed the changes in systolic blood pressure and peak blood flow velocity on the involving side.Results:All 11 patients underwent endovascular treatment. The surgical technique success rate was 100%. All patients were followed up. The follow-up time was 4-69 months, with an average of (30.1±23.4)months. 2 patients used cerebral umbrella during the operation. 1 patient was performed ipsilateral carotid endarterectomy, 1 patient underwent contralateral carotid stent implantation, 1 patient was diagnosed as severe stenosis of the innominate artery and left common carotid artery, and an innominate artery stent implantation was performed at one stage, left common carotid artery stent implantation was performed after half a year. We done operation from the femoral artery puncture approach (6 patients), brachial artery puncture approach (2 patients), axillary artery and femoral artery puncture approach (1 patients), and right common carotid artery and the femoral artery puncture approach (2 patients). 3 patients had in-stent restenosis at 6, 7and 12 months after stenting, respectively. 1 patient underwent balloon dilatation, and 2 patients underwent re-stent implantation. We have not do further intervention to 1 case of in-stent occlusion occurred 14 months after the stenting, for the clinical symptoms did not improve significantly. The clinical re-intervention rate in this group was 3/11, and the primary patency rate was 7/11. The secondary patency rate was 10/11. The symptoms of 10 patients were relieved and the weakness of right upper extremity was not significantly changed in 1 patient. No puncture point complications occurred in all patients, and no cerebral infarction occurred during the perioperative period. There were statistically significant differences in systolic blood pressure, blood pressure difference and peak blood flow velocity before and after the operation ( P<0.05). Conclusions:Endovascular treatment of innominate arterial stenosis or occlusion was safe and effective, and the appropriate surgical approach and plan should be selected according to the lesion characteristics and the whole body conditions.
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Objective To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum.Methods Retrospective analysis was done to assess the treatment effect of a case from vascular surgery,Xuanwu Hospital of Capital Medical University.This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum.Results One month after the treatment of cerebral infarction,we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum.There were no operative complications occurred.The stent had good shape and smooth blood flow was seen in the stent.Conclusions Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible,and the clinical outcome requires further long-term follow-up.
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Objective@#To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum.@*Methods@#Retrospective analysis was done to assess the treatment effect of a case from vascular surgery, Xuanwu Hospital of Capital Medical University. This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum.@*Results@#One month after the treatment of cerebral infarction, we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum. There were no operative complications occurred. The stent had good shape and smooth blood flow was seen in the stent.@*Conclusions@#Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible, and the clinical outcome requires further long-term follow-up.
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Objective The incidence of chronic lower limb ischemia caused by arteriosclerotic obliteration of lower extremities is increasing recent years and there is a high risk of amputation and mortality.This study was to find out the changes in a single center for 16 years.Methods A retrospective analysis of the data of patients in single-center vascular surgery in the past 16 years was carried out.The patients with chronic lower limb ischemia caused by lower limb arteriosclerosis obliterans were screened out,and the data of operation information,amputation,length of stay and hospitalization expenses during hospitalization were collected.Results A total of 4 602 patients were included,of whom 57.39％ were diabetic.It was found that the number of patients admitted,the number of endovascular treatment,the average cost of hospitalization increased year by year,and the average length of hospitalization decreased year by year.The amputation rate decreased from 8.12％ (from 2002 to 2007) to 0.92％ (from 2008 to 2017) (P ＜ 0.01).The average days of hospitalization decreased from 28.20 days (from 2002 to 2007) to 11.65 days (from 2008 to 2017) (P ＜ 0.01).The average hospitalization cost rose from 54 466.94 yuan (from 2002 to 2007) to 73 685.22 yuan (from 2008-2017) (P ＜ 0.01).There was no significant difference in amputation rate,hospitalization days and hospitalization costs between diabetic group and non-diabetic group.In diabetic subgroup,amputation rate decreased from 8.83％ (between 2002 and 2007) to 1.05％ (between 2008 and 2017) (P ＜ 0.01).The average hospitalization days decreased from 30.12 days (between 2002 and 2007) to 12.60 days (between 2008 and 2017) (P ＜ 0.01).The average cost of hospitalization rose from 58 530.94 yuan (between 2002 and 2007) to 74 433.75 yuan (between 2008 and 2017) (P ＜ 0.01).Conclusions From 2002 to 2017,the number of patients with chronic lower limb ischemia increased gradually,and so as the number of endovascular treatment.While the amputation rate and average hospitalization time decreased,and the average hospitalization cost increased.The same trend was observed in the diabetic subgroup.The significant decrease in amputation rate may be related to the development of endovascular therapy and angiogenesis therapy.
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Objective To explore the feasibility and safety of endovascular directional atherectomy angioplasty for the treatment of severe vertebral artery stenosis.Methods Directional atherectomy combined with use of drug-coating balloon (DCB) was employed to treat one patient with severe stenosis of vertebral artery in November 2017 at authors' hospital.Protective umbrella filter was placed at the distal site of V1 segment during the procedure course.Results The operation was successfully accomplished.No postoperative complications occurred.After the operation,the clinical symptom of dizziness disappeared and the patient was well recovered.Conclusion For the treatment of severe vertebral artery stenosis,directional atherectomy combined with use of DCB is safe and feasible.
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Objective To investigate the clinical outcome of drug-coated balloon ( DCB) treated atherosclerosis obliterans ( ASO) in lower extremity. Methods Data of 28 patients were retrospectively an-alyzed to determine the effectiveness and characteristics of DCB treatment. Results All the 28 patients were successfully treated with endovascular intervention therapy. Lesions mainly located in the superficial femoral arteries were divided into Groups A, B, C, and D according to TransAtlantic InterSociety Consensus (TASC) Ⅱ classification. Follow-up at 6, 9, and 12 months showed 100％, 84. 6％ and 76. 9％ patency rate in treated artery. After 9 months of endovascular intervention therapy, the combined artery patency rates in Groups A and B was 92. 8％, which was significantly better than 66. 7％ in Groups C and D ( P <0. 05 ) . DCB angioplasty had an artery patency rate of 86. 7％, while DCB angioplasty plus stenting had the patency rate of 85. 7％ (P>0. 05). Artery patency rate of Simple DCB angioplasty in ten patients (Exclu-ding patients with in-stent restenosis ) was 80％ and of Atherectomy plus DCB angioplasty in 5 patients was 100％ (P<0. 05). Conclusions DCB angioplasty has superiority over conventional intervention therapy. Combined debulky and DCB angioplasty appear to be the best choice in current treatment of ASO in lower extremity.
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Objective To evaluate efficacy, safety, and long-term patency and fracture rates of self-expanding nitinol stent after failed percutaneous transluminal angioplasty ( PTA) of popliteal artery in patients with chronic critical limb ischemia ( CLI ) or lifestyle-limiting claudication in Chinese patients. Methods A total of 64 patients (68 limbs) was retrospectively analyzed who underwent endovascular treat-ment for stenoocclusive lesions in the popliteal artery from January 2008 to July 2012. In a single-center study, self-expanding nitinol stents were implanted in 68 popliteal arteries for the treatment of stenosis grea-ter than 75％ or occlusions in the popliteal arteries. Follow-up patency was assessed by clinical examina-tion, ankle-brachial index, and color ultrasound or digital subtraction angiography, and stent fracture was assessed by plain X-rays at 6 and 12 months and annually thereafter. Results Stent implantation was suc-cessful in 63 patients (98. 5％). Mean follow-up was 22. 1 months (22. 1 ± 13. 8). 1-year, 2-year and 3-year primary patency rate ( PPR) was 76％, 60％ and 43％, respectively. The 1-year, 2-year, and 3-year secondary patency rate ( SPR) was 87％, 82％ and 73％, respectively. The 1-year , 2-year, and 3-year PPRs and SPRs for subgroups, trans-articular surface versus no trans-articular surface were not significant difference (P>0. 05). Two patients were lost to follow-up (3％). Two patients (3％) died during the fol-low-up period. Stent fractures were seen in 11 limbs (11 of 68, 16. 2％) and the fractures were identified in P1 and P2 segment. Three patients were performed above-knee amputation because of stent occlusion and gangrene of limb (3 of 68, 4. 4％). Conclusions Stent implantation is a safe and effective treatment of popliteal artery occlusion. One can improve the popliteal arterial stent patency rate by interventional tech-nique, such as transcatheter arterial thrombolysis, balloon angioplasty, silverhawk atherectomy, and rescue stent. One maybe try to avoid stent placement up to the popliteal arterial P1 and P2 segment owing to stent fracture.
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Objective To explore the clinical effectiveness and safety of selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropo-pliteal artery disease. Methods From Jan 2014 to December 2015, 45 femoropopliteal artery atherosclerot-ic patients were treated with SilverHawk atherectomy and selective embolic protection device (EPD). The indication for EPD was instent restenosis, highly calcified lesion, suspicious of thrombosis, ulcerated le-sion, and single below-the-knee runoff. All cases who met the indication were treated with atherectomy and EPD, and those who did not meet the indication were treated with or without EPD according to the patient's choice. The embolic related complications were analyzed. Results Twenty three out of 45 patients who met the EPD indication were all treated with SilverHawk atherectomy under EPD protection, filter captured deb-ris in 17 patients (73. 9％) of the patients. The other 22 patients who did not meet the indication were di-vided into 2 groups according to the patient's choice of EPD usage, 11 were treated by atherectomy with EPD and 11 without EPD. One case out of 11 unindicated patients without EPD suffered a tibioperoneal trunk embolization and restored with catheter aspiration. For 1/11 (9. 1％) unindicated cases with EPD protec-tion, the filter captured embolization. There was a significant difference of distal embolization rate between the indicated and unindicated patients (χ2 =19. 368,P =0. 000). All filters were retrieved successfully without any distal embolization and any complications except arterial spasm occurred in 2 patients and re-stored well with nitroglycerin. Conclusions It is safe and effective for selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropopliteal artery disease.
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Objective To investigate the safety and feasibility of carotid endarterectomy (CEA) combined with carotid artery stent angioplasty (CASA) in treating tandem stenosis of carotid artery. Methods The clinical data of 9 patients with tandem stenosis of carotid artery, who were treated at authors' hospital during the period from January 2013 to October 2014, were retrospectively analyzed. The patients included 7 males and 2 females, with a mean age of (66.0 ±4.2) years. The disease course ranged from 2 months to 36 months, with a mean of 7 months. Clinically, all patients had cerebral ischemia symptoms. Transient ischemia attack was seen in 5 patients and history of cerebral infarction was present in 2 patients. Coronary artery disease was found in 2 patients, hypertension in 6 patients and lower limb ischemia in one patient. After receiving adequate antiplatelet therapy, CEA and CASA were carried out in all patients. Results The technical success rate was 100%, postoperative residual stenosis was less than 30%, no death occurred in perioperative period. After the treatment, the clinical symptoms were improved in all 9 patients;no new stroke or cerebral hemorrhage occurred. After the treatment, 2 patients developed cerebral hyperperfusion-related symptoms such as headache and dizziness, which were much relieved at the time of discharge. The patients were followed up for 4-19 months, with a mean of (10.5±6.2) months. No recurrence of symptoms was observed . In one patient , transcranial Doppler ultrasound performed at 6 months after treatment showed that the carotid artery became moderate restenosis (50%-70%). No death occurred. Conclusion For the treatment of tandem stenosis of carotid artery, CEA combined with CASA is safe and effective, although larger sample and long-term follow-up studies are still needed to further confirm the effect.
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Objective To investigate the safety and medium-and long-term effects of endovascular stenting,axilloaxillary bypass (AAB),carotid-subclavian bypass (CSB) in patients of subclavian arterial occlusion.Method From 2001 to 2013,311 consecutive patients with subclavian arteriosclerosis obliterans were treated with endovascular stenting (n =191),axilloaxillary bypass (n =96) or carotidsubclavian bypass(n =32).We collected patients' medical data,calculated patency of the graft or stent with life-table method and compared patency between three approaches with Log-rank.Results The incidence of perioperative complications was 4.1％ in the stenting group vs.11.5％ in AAB group vs.18.7％ in CSB group.There was significant statistical differences between the stenting group and bypass group about the incidence of perioperative complications.The primary patency rates at 1,3 and 5 years were 90.3％,84％,81.6％ in stenting group vs.95.3％,92.6％,88.9％ for AAB group vs.100％,96.4％,96.4％ for CSB group.There was significant statistical differences between the stenting group and bypass group about the primary patency rates.Conclusions Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian arteriosclerosis obliterans.However,effect of extrathoracic surgical bypass is more durable in the medium-and long-term.
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<p><b>BACKGROUND</b>Totally laparoscopic aortoiliac surgery has been newly developed in China. It is known as the most complex laparoscopic technique to learn because of its high-risk procedures. Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique.</p><p><b>METHODS</b>Twelve male patients (56-70 years old) with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery (TLABS) in our institute. Clinical data and operation-related complications were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 12 patients, TLABS succeeded in nine and conversion to open surgery occurred in three. One of the converted patients finally died of pulmonary infection. Operation-related complications included bleeding from arterial injury, perforation from colonic injury, graft embolism, residual aortic stenosis, and hydronephrosis. Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery. Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications. Left hydronephrosis, which was thought to result from intraoperative injury and treated with ureteric intubation drainage, recovered 6 months after TLABS.</p><p><b>CONCLUSIONS</b>Good understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS. Immediate conversion to open surgery is necessary for saving the patient's life in case of life-threatening complications.</p>
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Aged , Humans , Male , Middle Aged , Arterial Occlusive Diseases , General Surgery , Iliac Artery , General Surgery , Laparoscopy , Methods , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To analyze the influence of diabetes mellitus (DM) on the outcomes of percutaneous transluminal angioplasty (PTA) with stenting of femoropopliteal artery,in patients with atherosclerotic occlusive disease (ASO).Method Clinical data of inpatients who successfully received PTA with stenting procedures of femoropopliteal artery in Xuanwu Hospital from January 2006 to December 2012 were analyzed retrospectively.Patients were stratified into DM and non-DM groups.Results were compared between the two groups including primary patency (PP),assisted patency (AP),limb salvage and survival using Kaplan-Meier life table and Cox regression analyses.Result Totally 291 patients underwent 332 procedures.There were 214 DM and 118 non-DM limbs.Mean follow-up was 34 months.The 5-year PP was 23.2％,AP was 35.3％,limb salvage was 89.2％,and survival was 69.6％.DM was associated with lower 5-year PP,limb salvage,and survival than non-DM.But there were no significant difference in AP between the two groups.Females were associated with decreased PP than males on Cox multivariate analysis.Hypertension and below tibial diseases were associated with lower limb salvage rate and age is the only predictor of survival rate.Conclusions DM is a risk factor for poor outcomes after PTA with stenting procedures.
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Objective To explore the safety and feasibility of calf arterial stent angioplasty to treat severe lower limb ischemia. Methods Clinical data of 13 patients in our hospital during recent 3 years were retrospectively analysed and all these patients were followed up after discharge.Of these patients there were 10 males and 3 females; mean age was (73 ±7) years; mean disease course was (8 ±4) months.Severe claudication was reported in 5 patients,rest pain in 4 patients,toe ulcer in 2 patients,gangrene in 2 patients.Stent was placed in the tibioperoneal trunk artery in 5 patients ; in the proximal part of peroneal artery in 3 patients; in the tibioperoneal trunk and proximal peroneal artery in 2 patients; in the anterior tibial artery in 2 patients; in the posterior tibial artery in one patient.Simultaneous endovascular treatment of femoral/popliteal arterial disease was done in 11 patients. Results All the procedures were successful and the treated arteries kept patent on discharge of patients.Claudication distance increased to be above 500 meter in 5 patients; rest pain relieved in 4 patients ; toes ulcer reduced in 2 patients,feet gangrene kept dry till discharge in 2 patients.Postoperative ABI increased in all patients.Patients were followed-up of mean (6.9 ± 2.2) months.One patient with previous toe gangrene underwent amputation due to recurrent pain while the stent in anterior tibial artery kept patent after 6 months discharge.In the other patient gangrene toe had fallen off and the wound healed.Two patients with toe ulcer had a total recovery and patients with previous rest pain had no recurrent symptoms. Conclusions Below knee arterial stent angioplasty is a safe and effective method in the treatment of severe lower limb ischemia.
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Objective To explore the indications of axillary artery approach in endovascular treatment and to analyze complications associated with axillary artery puncture.Methods In 111 cases endovaccular treatment via axillary artery approach by Seldinger technique was performed.The indications of axillary artery approach and the complications associated with axillary artery punture were respectively analyzed.Results The success rate of angiography was 100％,and the success rate of angioplasty was 90.8％ by axillary artery approach.The total incidence of complications was 10.3％.The incidence of local hematomas was 4.8％,nerve injury was 3.2％,pseudoaneurysm was 0.8％,acute thrombosis of the axillary artery was 0.8％,acute thrombosis of the axillary vein was 0.8％.The main factors affecting complications include vascular conditions,perioperative medication,anatomy of the axillary artery,location of puncture point,the success rate of first attempt,and pressure of bandage.Conclusions The axillary artery approach increases the success rate of endovascular treatment.Reasonable choice of axillary artery appruch,meticulous perioperative management and fully understanding the anatomical characteristics of the axillary artery can decrease the complications of axillary artery puncture.
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Objective To evaluate vascular surgery and interventional technique applied in Takayasu's arteritis. Methods Data of 26 patients of Takayasu's arteritis admitted between January 2006 and December 2009 were retrospectively analyzed. The sex ratio(M/F) was 1: 4. 2, age averaged at (27±15)y. There were 16 cases of type Ⅰ , 7 cases of type Ⅱ and 3 cases of type Ⅲ according to Lupi-Herrera classification. 25 patients received surgery including 16 patients undergoing pecutaneous transluminal angioplasty operations, 9 patients doing traditional bypass surgery, and one patient was treated conservatively. Results 23 case-times of percutaneous transluminal angioplasty (PTA) were performed in 16 patients, including 12 cases of balloon angioplasty and 4 cases of stent angioplasty. Four significantly stenotic and occluded carotid arteries were revascularized successfully in 5 patients. Thrombosis of the carotid artery was found in one patient after balloon angioplasty. There were 4 patients in which repeated PTA treatment up to a total of 11 times were needed to guarantee vessel patency. Open surgery succeeded in 9 patients, and clinical symptoms were relieved in all cases during peri-operative period. 22 patients were followed up for 12 -46 months,one patient died of cerebral hemorrhage 3 months post-operation, one patient was found pseudoaneurysm at anastomotic stoma, and 2 patients suffered from anastomotic restenosis.Conclusions Vascular surgery played important role in the therapy of Takayasu's arteritis. PTA can be used repeatedly. Surgical bypass operation is difficult in technology, and can be used in cases that fail to response to PTA or in patients with severe cerebral ischemia.
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Objective To evaluate the role of transcranial Doppler (TCD) in carotid endarterectomy and the effect of carotid endarterectomy on extracranial carotid artery stenosis.Methods From January 2002 to December 2008, fifty eight patients (40 males and 18 females)with mean age of 64.5 years were treated in our hospital. Of these patients, forty had symptoms of cerebral ischemia, eighteen were asymptomatic. All the patients had 70% and up carotid artery stenosis. Forty one patients underwent simple suture closure of the arterial incision while nine patients had angioplasty with arterial patch (polyester) and eight with autologous great saphenous vein. TCD monitoring was used in the surgery of 32 patients excluding two patients using arterial shunt. Results Surgery was successful in all 58 cases except for deflected tongue-protrusion in five patients after operation, of which three recovered conservatively and two recovered after administration of cortical steroids for two weeks. Cerebral ischemic symptoms improved to a certain degree in all the 40 preoperative symptomatic patients. Cerebral hyperperfusion occurred in five of no TCD-monitoring patients ( 19.2% ), no hyperperfusion was found in TCD-monitored patients. Fifty three patients were followed up for a mean time of 42.5 months. Five patients died and three patients had carotid artery restenosis, of which two underwent PTA and stenting, one is still under surveillance.Conclusions Carotid endarterectomy is a safe and effective procedure for treating extracranial carotid artery stenosis. TCD monitoring is valuable for determining the use of arterial shunt and preventing postoperative cerebral hyperperfusion.
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Objective To evaluate surgical treatment of lower limb ischemia due to combination of thromboangiitis obliterans (TAO) and arteriosclerosis obliterans (ASO). Methods Clinical data of six patients suffering from lower limb ischemia due to TAO and ASO were retrospectively analyzed. All patients had a history of smoking, and complained of rest pain. Three patients had foot ulcer and one had toe gangrene. Two patients reeeived aortie artery endartereetomy combined with FIFE graft bypass to deep femoral artery and below knee popliteal artery plus saphenous vein graft bypass to tibial artery. One patient received aortic thrombectomy and endarterectomy plus aortofemoral and femoropopliteal PTFE graft bypass. One patient with a history of left graft thrombosis after aorto-bifemoral arterial bypass using PTFE graft before admission underwent left PTFE graft thrombectomy via left groin and left deep femoral artery endarterectomy followed by femoropopliteal arterial bypass. One patient received left common iliac artery endarterectomy plus left profound femoral PTFE graft-left anterior tibial arterial bypass using in situ great saphenous vein graft. One patient received right to left femorofemoral arterial bypass using PTFE graft to left posterior tibial artety bypass using reversed great saphenous vein graft. Results One patient receiving aortoiliac thrombectomy and endarterectomy with aortofemoropopliteotibial arterial bypass suffered from graft thrombosis several hours after operation and emergency thrombectomy with distal posterior tibial arteriovenous fistulization was performed. The rest pain disappeared in 5 patients and partially relieved in one. All the grafts were patent on discharge. The foot ulcer reduced in 3 patients. All the 6 patients were followed up with a mean of 6. 5 months. 3 foot ulcers healed. One patient eventually received below knee amputation due to foot gangrene three months later. Conclusion Although it is difficult to treat combined limb ischemia of TAO and ASO, satisfactory results could be achieved when proper surgical procedure is adopted.
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Objective To compare the long term outcome between traditional arterial bypass and interventional therapy for chronic lower limb ischemia according to the TASC classification. Method A retrospective study was undertaken on 201 cases receiving graft bypass or interventional therapy for CLI (chronic limb ischemia) from December 2005 to December 2008. Result The patency rate at 6 month. 12 month and 24 month after operation by femoral artery stent angioplasty in therapy group (100%, 89.8%, 75%) is higher than that of angioplasty group(82.4%, 62.5%, 35.7%), P <0.05. The 2nd term patency rate(88%) of operation group (24 months after operation) is higher than that of interventional group (70.7%), P<0.05. Conclusion Arterial bypass has higher long term patency rate and is applicable for femoral artery long segment obliterate classified as TASC C, D, while for the short segment femoral artery obliterate classified as TASC A, B interventional therapy especially stenting is an alternative despite of low patency rate.
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Objective To explore effects of arterial self-expanding stents implanted in different position for treating lower limb ischemia.Methods Follow-up records of 65 patients of lower limb ischemia(71 limbs) teated by stent implantation from January 2002 to March 2006 were retrospectively reviewed.Out of the 71 patients,there were 38 patients(52.3%) of diabetic lower limb ischemia and 33 patients(47.7%) of non-diabetic ischemia.Stent implantation included 2 abdominal aortic stents in 2 patients,1 abdominal aortic and 2 iliac stents in 1 patient with the Leriche syndrome,38 iliac stents in 33 patients(35 limbs),12 stents for iliacofemoral lesions in 6 patients(6 limbs),23 femoral stents in 16 patients(19 limbs),10 stents for femoral and prioxiaml popliteal arterial lesions in 5 patients(6 limbs),and 2 stents for distal popliteal arterial lesions in 2 patients(2 limbs).Results The patients were followed for 2~50 months(mean,16.1 months).The patency rate was 100% in 3 patients with abdominal aortic stent implantation or abdominal and aortoiliac stent implantation.Iliac artery occlusion occurred in 4 patients(4 limbs),with the patency rate of iliac arterial stents being 88.6%(31/35).The patency rate of femoral arterial stents was 78.9%(15/19),and that of femoral and prioxiaml popliteal arterial stents was 83.3%(5/6).Stents in distal popliteal artery were occluded in all the 2 patients.Stents remained patent after a mean of 5.6 months postoperatively in 3 patients with 2 femoral stents in 2 limbs and 1 femoropopliteal stent in 1 limb while distal outflow arteries were blocked.Conclusions Stent implantation can be the first choice for aortoiliac stenosis or occlusive arterial diseases.It is also recommendable for stenotic or occlusive femoral and proximal popliteal arterial diseases.It is a proper option for the senile patients or those who can not stand bypass procedures.However,for tibial arterial stenosis or occlusion,it is not a favorable consideration.
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ObjectiveTo explore the effectiveness o f distal arterial bypass for the treatment of severe lower limb ischemia with p oor outflow artery. Method From July 2000 to Dec 2004, we treated 21 cases (21 limbs) of severe lower limb ischemia with poor outflow artery by distal bypass with additional arteriov enous anastomosis at or distal to the distal graft anastomosis. Results Among the 21 cases, one case recei ved reoperation for “void arterial perfusion” distal to the arteriovenous anas tomosis. The operative success rate was 95.2%.The patency rate of graft was 100 % and the healing rate of foot ulcer was 33.3% on discharge. Conclusion Additional areriovenous anastomos is at or distal to the distal graft anastomosis can dramatically increase the pa tency rate of the graft when outflow artery is too poor to guarantee a patent gr afting in the case of severe lower limb ischemia, although long-term effectiven ess needs to be varified.