Application and progress of resuscitative endovascular balloon occlusion of the aorta(REBOA) in early anti-shock therapy / 中华胸心血管外科杂志

Resuscitative endovascular balloon occlusion of the aorta(REBOA) is an important technical method for early anti-shock. It can quickly achieve effective hemostasis, maintain basic blood pressure, ensure blood supply to important organs such as the brain, and improve the success rate of anti-shock treatment. However, the use of REBOA is limited because it can cause complications such as severe distal ischemia. With the improvement of clinical awareness and the continuous improvement of anti-shock treatment concept, REBOA has made significant progress, including the use of pREBOA and iREBOA, and the use in cardiac arrest. In order to make better use of REBOA, further in-depth research is needed to establish a comprehensive medical treatment system and training system to maximize its role.

The beneficial enlightenment of thoracic endovascular aortic repair for traumatic type B aortic dissection with long-term follow-up of single center / 中华胸心血管外科杂志

Objective To evaluate the long-term clinical effect of Thoracic endovascular aortic repair (TEVAR) for traumatic Type B aortic dissection,and to provide a reference for the next stage treatment.Methods Twenty-one patients with traumatic Stanford type B aortic dissection treated in our center from December 1999 to June 2012 were retrospectively analyzed for the treatment effectiveness and follow-up results.The average age of 21 Traumatic Type B aortic dissection patients was 42.7 years (range:19 to 67 years).Men accounted for 85.7％ (18/21).80.9％ (17/21) of the dissection were caused by car accident,4 were due to falling accident from high places.There were 7 cases of hypertension,4 cases of diabetes,4 cases of hyperlipidemia,2 cases of chronic ischemic heart disease,14 cases of pneumothorax,8 cases of rib fracture,3 cases of craniocerebral trauma / neuropsychiatric symptoms,and 1 patient with shock.The median time from onset to treatment was 5 days (range:1-73 days).There were 16 cases (≤14 days) in the acute phase,2 cases (15-60 days) in the subacute phase,and 3 cases (＞ 60 days) in the chronic phase.There was no patient in super acute phase in the study group (0-24 hour).Results The perioperative mortality was 9.52％ (2/21) for the patients traumatic type B aortic dissection,4.76％ (1/21)for those with postoperative endoleaks;2-year and 5-year survival rates were 90.48％ and 85.71％.Conclusion Intracavitary treatment of traumatic Stanford B type aortic dissection is effective and has good long-term clinical benefit,which provides a guidance for future clinical treatment of traumatic type B aortic dissection.

Thoracic stent graft sizing for endovascular repair in Stanford type B aortic dissection / 中华外科杂志

Endovascular treatment for Stanford type B aortic dissection uses thoracic aortic stent-graft system, which consists of covered stent and delivery system. The system is different in the configuration of the stent, the delivery system and the mode of release. The principle of endovascular treatment for Stanford type B aortic dissection is different from aortic aneurysm, so there are differences in stent selection. On the basis of preoperative assessment and measurement, it is suggested that the proximal diameter oversize of the stent is 0 to 5%, at 160 to 200 millimeters in length. The distal end of the stent should pass through the bend of the descending aorta to accommodate the descending aorta blood flow, and the oversize is 0. The postoperative complications and mortality including reverse dissection of proximal part and intima rupture of distal part induced by the stent will be effectively reduced with familiarity with the characteristics of stent-graft, understanding of the possible side effects of stent-graft, combining with the actual conditions and mastering the above principles.

Endovascular repair strategy for Stanford type B aortic dissection involving visceral branches / 介入放射学杂志

At present, thoracic endovascular aortic repair (TEVAR) is the routine treatment for Stanford type B aortic dissection. Usually, during the interventional treatment only the primary entry tear, i.e. so-called proximal entry tear, is to be isolated with a stent-graft, while less intervention is adopted for the distal entry tear. With the deepening of research concerning aortic remodeling after TEVAR, the researchers have found that 25％-50％ of patients will develop aneurysmal dilation at the distal end of dissected aorta, which needs to be treated again. Among them, the treatment of entry tear at visceral branch area of the abdominal aorta has a certain degree of difficulty and technical particularity as the interventional management may affect the blood supply of vital organs. Referring to the research progress at home and abroad, this article aims to make a review about the common therapeutic methods for the entry tear at visceral branch area of the abdominal aorta.

Research progress in robot-assisted vascular interventional therapy / 介入放射学杂志

Traditional vascular intervention relies on C-arm rotation and use of contrast to obtain imaging,which results in the loss of 3D-image information and increased burden on kidney.Moreover,interventional operators bear higher occupational hazard risk under longtime X-ray exposure and the heavy burden of lead protection apron.Robot-assisted vascular intervention system carries certain advantages,it can significantly reduce the X-ray exposure to operators,obtain precise localization of lesions as well as accurate and stable manipulation.While reducing the contact of the instruments with the vascular wall and the operation tremor,it can improve operator's comfortable sensation.This paper aims to make a detailed summary about the development of robot-assisted vascular intervention system and its clinical application.The future development directions of robot-assisted vascular intervention system is also discussed.

Long-term efficacy of fibrin sealant treating proximal type Ⅰ endoleak after endovascular aneurysm repair in abdominal aortic aneurysm / 中华普通外科杂志

Objective To observe the long-term efficacy of human fibrin sealant (FS) in the treatment of proximal type Ⅰ endoleak after endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA).Methods The clinical data of 104 AAA patients with proximal type Ⅰ endoleak receiving EVAR + FS in Changhai Hospital from 2003 to 2012 was retrospectively analyzed,among those 77 cases were with less than 15 mm proximal neck,21 cases with greater than 60 degrees proximal neck angulation,37 cases with severe calcification or thrombosis in proximal neck.After failure of conventional endoleak therapy FS was injected through AAA catheter and long-term efficacy was evaluated by CTA during the follow-up.Results Intra-sac pressure decreased significantly after FS injection.Three patients (2.9％)died perioperatively.Postoperative 1'-,3' and 5 year survival rate was 91.8％,80.6％ and 60.2％respectively.Maximum diameter of AAA decreased from (58.78 ± 13.41) mm to (52.6-± 12.2) mm.There was no FS injection related complications.Conclusion Intra-sac injection of FS is an effective,economical and safe method for treating post-EVAR endoleak,especially for AAA with relatively short and twisted aneurysm neck.

Vascular involvements in Beh(c)et's disease: a retrospective clinical study of 41 cases / 中华风湿病学杂志

Objective This study aims to investigate the frequency and characteristics of vascular involvement in Beh(c)et's disease (BD).Methods We enrolled patients who were hospitalized at Changhai Hospital affiliated Naval Medical University and who had been diagnosed with BD at discharge from January 1999 to July 2017.Patientswere divided into two groups,Vascular Beh(c)et's disease (VBD) group and non-VBD group,according to vascular involvement or not.We recorded and compared the demographicinformation,disease activity scores Beh(c)et’s Disease Current Activity Form (BDCAF),other systemic involvement and laboratory test results between the two groups.The clinical features of vascular involvement were analyzed.The measureddata were statistically analyzed with Student's t/t’ test or Mann-Whitney U test.The numerical data were statistically analyzed with x2 test or continuity correction x2 test.Results The total numbers of BD patients were 224,including 120 males and 104 females.Vascular involvements were found in 41 (18.3％) cases,including 34 males and 7 females.VBD was more common in males (28.3％ vs 6.7％,x2=17.388,P＜0.01).Of 41 VBD patients,11 cases (26.8％) had single vascular lesions,and 30 cases (73.2％) had multiple vascular lesions.Moreover,24 cases (58.5％) had arterial lesions,and 25 cases (61.0％) had venous lesions.Eight (19.5％) patients had both arterial and venous lesions.Compared to the non-VBD group,the VBD group had a higher frequency of cardiac involvement (22.0％ vs 3.8％,x2=16.592,P＜0.01),a higher disease activity index score (BDCAF) [3.0(2.0,4.0) score vs 2.0(2.0,3.0) score,U=2 609.5,P=0.001],higher levels of C-reactiveprotein (CRP) (14.45(4.97,64.08) mg/L vs 9.02(3.16,26.53) mg/L,U=2 809,P=0.046) and plasma homocysteine (Hcy) [(17.6±7.7) μmol/L vs (7.1±2.1) μmol/L,t'=7.894,P＜0.01].Conclusion VBD mainly affectsmales.It mainly presentsas multiple lesions.Moreover,patients in the VBD group havehigher frequency of cardiac complications,higher disease activity index scores (BDCAF),higher levels of CRP and Hcy than the non-VBD group.These results may have great valueto predict and diagnoseof VBD.

Emergency treatment for aorto-esophageal fistula by endovascular aortic repair / 中华胸心血管外科杂志

Objective To investigate the clinical features,essentials of diagnosis,selection of endovascular treatment and prognosis of aorto-esophageal fistula(AEF).To improve the understanding of the disease.Methods 3 patients with AEF from October 2010 to July 2016 in Changhai Hospital,including clinical symptoms and signs,endovascular treatment process and follow-up results,and review the relevant literature.Results Two of the 3 patients are men,and another is a woman.Aged 64-70 years.The causes of AEF are chest trauma,thoracic aorta pseudoaneurysms and foreign body ingestion,respectively.All the 3 patients had chest pain,hematemesis,and fever.Two of them showed sentinel hemorrhage and another showed a sudden massive hematemesis.Upper gastrointestinal endoscopy or computed tomographic angiography (CTA) confirmed the diagnosis in all patients.They all underwent thoracic endovascular aortic repair(TEVAR).The effect was good in acute phase.It didn't have any significant short-term complications.Re-bleeding time was 35 days to 85 days.Two patients died of recurrent severe hemorrhage post operation,and one of them had received TEVAR again but not it was ineffective.Another died of multiple organ failure after open surgery.Conclusion Since it showed the short-term effect but not the long-term effect,TEVAR can only be applied as a temporary remedy to the patients in poor conditions and be substituted by the open surgery when the patients were in better conditions.

Diagnosis and treatment strategies on vascular disease in abdominal surgery / 中华消化外科杂志

Although the incidence of vascular disease in abdominal surgery is low,there are speedy development,critical condition and high lethal rate when it happens.Moreover,the onset is usually latent and difficult in early diagnosis due to atypical clinical performance or non-specific signs at the early stage,with a high misdiagnosis rate.The aforementioned issues impose an urgent need to enhance the understanding of this type of disease.

Introductions and proceedings of imaging in preoperative assessment of transcatheter aortic valve replacement / 中华胸心血管外科杂志

Objective If left untreated, aortic stenosis(AS)is associated with a dismal prognosis.Transcatheter aortic valve replacement(TAVR)is emerging as a viable treatment alternative for these patients,with multiple co-morbidities and an-ticipated increased surgical risk, excluded from surgical intervention.Transcatheter valvular heart procedures are characterized by lack of exposure and visualization of the operative field, therefore relying on image guidance, both for patient selection and preparation and the implantation procedure itself.Temporal imaging methods used for preoperative assessment of TAVR include transthoracic echocardiography(TTE), transesophageal echocardiography(TEE), multi-detector row computed tomography (MDCT).However,these methods are associated with some limitations.Recent advances explored the utility of 4-dimensional CT angiogram and 3D print for accurate assessment before TAVR,which can replicate both the anatomic and functional proper-ties of severe degenerative aortic valve stenosis.

AngioJet mechanical thrombectomy plus thrombolysis for the treatment of acute deep venous thrombosis of the lower extremity / 中华普通外科杂志

Objective To summary the experience of AngioJet mechanical thrombectomy for the treatment of acute deep venous thrombosis (DVT) of lower extremity.Methods Clinical data of 28 patients suffering from acute DVT of lower extremities treated by AngioJet mechanical thrombectomy were analyzed retrospectively from October 2013 to February 2015.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results Twelve patients were planted temporary vena cava filters.The average length of hospitalization was (3.9 ± 1.1) days.The average operation time was (1.2 ± 0.4) hours.The dosage of urokinase was (320 ± 120) × 104 U and heparin was (46 ± 10)mg during surgery.The average reduction of hemoglobin was (7.5 ± 2.6) g/L.Two patients (Grade Ⅰ thrombolysis) were converted to catheter-directed thrombolysis (CDT).There were 10 (35.7％) cases achieving grade Ⅱ and 16 (57.1％) cases achieving grade Ⅲ,respectively.Technique success rate were 92.9％.Minor bleeding events occurred in 2 patients.Nine (32.1％) patients had stents implanted.One year follow-up found patent deep venous in 26 (92.9％) patients and stent patency rate was 88.9％ (1/9).Two (7.1％) cases developed mild postthrombotic syndrome (PTS).Conclusion AngioJet is a safe and effective tool to treat acute DVT accelerating thrombolytic therapy,and reducing bleeding complications.

Access and effect of catheter-directed thrombolysis for treating acute deep venous thrombosis of the lower extremity / 中华普通外科杂志

Objective To evaluate the therapeutic effect of catheter-directed thrombolysis (CDT) for the treatment of acute deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 195 patients of acute DVT treated by CDT and adjunctive angioplasty and stenting from August 2010 to February 2014 were analyzed retrospectively.CDT by antegrade puncture of popliteal vein,CDT by great saphenous vein and CDT by retrograde puncture of contralateral femoral vein were used in these cases.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Results Technique success rate,clinical success rate,in popliteal vein group,great saphenous vein group and contralateral femoral vein group were 94.6％,72.2％ and 90.3％,97.3％,83.3％,and 90.0％.Patent rate of deep venous,patent rate of stenting and mild post-thrombotic syndrome (PTS) rate were 88.6％,66.7％ and 75.0％,83.3％,57.1％ and 88.9％,8.3％,26.7％ and 20.8％.Conclusion CDT by antegrade puncture of popliteal vein group combined with adjunctive angioplasty and stenting is safe and effective with higher clinical success rate and better long term results than other approaches for the treatment of DVT patients.

Diagnosis and treatment of vascular diseases in the acute abdomen / 中华消化外科杂志

Acute abdominal pain is a major clinical symptom of acute abdomen,and vasogenic acute abdomen caused by vascular diseases is rare and difficult to diagnose at its early stage with atypical clinical symptom and high mortality.Therefore,there is an urgent need to strengthen and improve the knowledge of surgeons about vasogenic acute abdomen.

History and progress of endovascular treatment for abdominal aortic aneurysm / 中华消化外科杂志

The traditional treatment of abdominal aortic aneurysm was open surgery.In the 1990s,endovascular abdominal aortic aneurysm repair (EVAR) began to emerge.In the early stage,this kind of minimally invasive method was applied in highly selected patient cohort due to the limitation of anatomic conditions of patients,age of patients and shortage of available endovascular devices.The indications for open surgery which were used in this new kind of therapeutic modality also influenced the outcomes.As the technique became mature and the properties of endogarft were developed,endovascular treatment can be used to treat more complex pathologies and the results were improved.However,several challenges were rising,including dealing with complex proximal aneurismal neck,intra-and post-operative endoleak,abdominal aortic aneurysm compromising branched arteries and ruptured abdominal aortic aneurysm.To solve these problems,chimney technique,fenestrated stent,branched stent and the sandwich technique had been invented and developed.It is believed that endovascular treatment for abdominal aortic aneurysm could be applied more widely under vascular surgeons' efforts.

Attach importance to the planning and implementation of endovascular repair for ascending aorta dissection / 中华外科杂志

Since 2000 Dorros et al. reported the first case of type A aortic dissection (TAAD) treated with an endovascular repair, surgeons explored a novel treatment option for TAAD gradually. The application of endovascular repair for TAAD highlights some points below which should pay attention to because of the special anatomic location and morphological characteristics of ascending aorta: (1) customized treatment strategy based on the characteristics of patients; (2) pre-operation evaluation; (3) selection of the stent and delivery system; (4) selection of the access sites; (5) preservation of the coronary artery flow, aortic valve function and perfusion of the branch vessels; (6) accurate location of stent-graft; (7) mid-term and long-term follow-up. In a word, it's helpful to avoid misunderstanding in treatment and improve the safety of operation by grasping the indication and the technical points and making the customized treatment strategy based on the characteristics of patients.

Femoral-deep femoral crossover bypass for unilateral iliofemoral arteriosclerosis obliterans / 中华普通外科杂志

Objective To evaluate the clinical results of femoral-deep femoral crossover bypass in the treatment of long-segment unilateral iliac artery occlusive disease.Methods From July 1995 to December 2010,40 patients (28 males,12 females,aged from 66 to 90,with mean age of 73) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were enrolled in this procedure.All patients suffered from unilateral common iliac,external iliac,common femoral,and superficial femoral arteriosclerosis obliterans.These patients were treated with femoral-deep femoral crossover bypass.Postoperative ankle-brachial index,blood flow velocity and patency rates in 5,7 and 10 years and limb salvage rates in 5,7 and 10 years were evaluated.Results There was no perioperative mortality nor extremity amputation.35 (87.5％ ) patients were followed-up from 1 to 13 years (mean 5.7 y).Anklebrachial index rose from preoperative 0.23 ± 0.10 to postoperative 0.55 ± 0.11 (t =15.91,P =0.000 ).Popliteal arterial velocity rose from preoperative ( 14 ±6) cm/s to postoperative (34 ± 10) cm/s (t =15.63,P =0.000) ; Tibial arterial velocity rose from ( 10 ±4) cm/s to (22 ±7) cm/s (t =15.71,P =0.000).The primary and secondary patency rates were 60.1％,44.3％,25.3％,and 93.5％,86.8％,57.9％ at 5,7 and 10 years,respectively.Limb salvage rates were 97.5％,95％,and 90％,at 5,7 and 10 years,respectively.Conclusions Femoral-deep femoral crossover bypass is safe and reliable in treating certain unilateral iliofemoral occlusive disease,especially for high-risk old patients or those who are not indicated for endovascular therapies or direct aortic approaches.

A study on treatment of visceral artery aneurysm / 中华普通外科杂志

Objective To evaluate open and endovascular procedures for the treatment of visceral arterial naeurysms.Methods Clinical data of 93 cases were reviewed from Jan 2001 to Jan 2011,including 47 males,and 46 females.Splenic artery aneurysm in 45 cases,superior mesenteric artery aneurysm in 15 cases,renal artery aneurysms in 10 cases,common hepatic artery aneurysm in 7,celiac artery aneurysms in 11 and gastroduodenal artery aneurysm in 5 cases.All cases had either open procedures or endovascular procedures after comprehensive evaluation.Results Surgical open procedures were performed on 34 cases,and endovascular procedures were performed on 59 cases.The perioperative complication rate were 52.9％ and 13.6％ for open and endovascular groups respectively.The mean follow-up time was 36.8 months ( 11 months to 10 years).1 -year survival rate and 5-year survival rate were 100％and 60.6％ in open surgery group,compared with 100％ and 84.5％ in endovascular group.Conclusions Endovascular repair is effective for visceral artery aneurysm with lower perioperative complication rate and better long-term survival rate.

A study on the expression of interleukin-1 beta in type Ⅰ thoracic aortic dissections and ascending thoracic aortic aneurysms / 中华普通外科杂志

Objective To study the expression of interleukin-1β in aortic dissections and aneurysms. Methods Aortic specimens were obtained from patients with type Ⅰ thoracic aortic dissection (11 cases),ascending thoracic aortic aneurysms (10 cases),and healthy organ donors (7 cases).Expression of interleukin-1β,matrix metalloproteinase-9,and signal transduction factors phospho-p38 and phospho-JNK were detected by real time RT-PCR,Western blot,and immunohistochemistry,respectively.TUNEL staining was performed to detect apoptosis of media cells. Results Apoptosis in the media of thoracic aortic dissection and ascending thoracic aortic aneurysms was dramatically higher than control group.Expression of interleukin-1β gradually increased in an order of control group,thoracic aortic dissection to ascending thoracic aortic aneurysms ( P ＜ 0.01,respectively).Expression of matrix metalloproteinase-9significantly increased in the media of thoracic aortic dissection and ascending thoracic aortic aneurysms compared with control group (P ＜ 0.01,respectively).There were positive correlations between interleukin1 β and matrix metalloproteinase-9,interleukin-1β and phospho-p38 in thoracic aortic dissection ( P ＜ 0.01,respectively),interleukin-1β and apoptosis in ascending thoracic aortic aneurysms (P ＜ 0.01 ).Conclusions Interleukin-1β and interferon-γ might effect the formation of thoracic aortic dissection and ascending thoracic aortic aneurysms possibly through the up-regulation of matrix metalloproteinase-9 and apoptosis of media cells in humans.

Expression of destrin in vessel wall tissue of traumatic arterial aneurysm and study of its clinical relativity / 中国矫形外科杂志

[Objective]To investigate the expression of protein destrin in cytoskeleton protein in traumatic arterial aneurysm(TAA) vessel wall tissue and its relationship with clinical representations and pathological characteristics.[Method]Western-blot analysis and RT-PCR were used to detect the quantitative expression of destrin protein in 13 patients with TAA and in the femoral arterial tissues of 8 normal subjects.The difference of protein expression was compared,and the results with clinical data were analyzed statistically.The correlation of unbalanced expression of destrin protein with the clinical presentations was studied.[Result] The expression of destrin in TAA tissue was lower than that in the femoral artery of normal subjects(P

Problems and improvement in field tents and medical boxes / 医疗卫生装备

There are some unsafe and inconvenient problems in moving Ⅴb-type field tents because the overall weight amounts to 310Kg,and the medical boxes are lack of sign cards and block slots.Improving methods and suggestions for these problems are put forword.