Mid- and long-term result of celiac artery coverage in TEVAR treatment for aortic dissection / 中南大学学报(医学版)

To observe the mid- and long-term result of intentional coverage of celiac artery in thoracic endovascular aortic repair (TEVAR) surgery for aortic dissection.
 Methods: We retrospectively analyzed 21 cases who received TEVAR with celiac artery coverage during the operation. The existence of collaterals between celiac artery (CA) and superior mesenteric artery (SMA) was confirmed by preoperative CT angiography (CTA) or digital substract angiography (DSA) for each patient. We used the stent-graft precisely above the orifice of SMA. Follow-ups were carried out at 2 weeks, 1 month, 3 months, 6 months, 1 year after the operation, and once per year thereafter.
 Results: No signs of visceral artery ischemic syptoms such as liver dysfunction, abdominal pain or distention were observed after the operation. There was no signs of spinal cord ischemia (SCI). Seven cases showed type II endoleak upon completion DSA but stopped automatically within 3 months. CTA in follow-ups showed thrombosis formation in false lumen.
 Conclusion: The intentional coverage of CA during the TEVAR for aortic dissection is safe and effective. The incidence of post-operative SCI or visceral artery ischemia is low. Type II endoleak is a major complication but it can be ceased automatically after medication.

Operation experience of atypical ruptured abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate and report surgical management and experience of atypical ruptured abdominal aortic aneurysm (RAAA).</p><p><b>METHODS</b>Clinical data of 52 RAAA patients from May 2002 to February 2015 were retrospectively collected and analyzed. Thirty-three cases were included into this study based on atypical clinical presentation and etiology, including 6 infected RAAA, 5 inflammatory RAAA, 1 traumatic aortic rupture, 6 tuberculotic RAAA, 2 aoritc-vena cava fistula, 3 intestinal fistula and 5 spine erosion cases. Two of them refused operation during preparation, 19 of them received emergency open repair and 13 of them received endovascular aortic repair (EVAR) with 1 case converted to open surgery.</p><p><b>RESULTS</b>The systolic blood pressure of atypical RAAA before operation was (88±16) mmHg (1 mmHg=0.133 kPa), duration time from admission to diagnosis making was (17±10) hours. Perioperative death occurred in 1 patient because of hemorrhagic shock induced acidosis. During follow-up for 3 to 72 months, no operation related complications occured, such as artificial graft infection.</p><p><b>CONCLUSIONS</b>Emergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and comprehensive perioperative management are measures conducive to reduce the mortality rate of RAAA.</p>

Surgical management of splanchnic artery aneurysms / 中华普通外科杂志

Objective To analyse the management of splanchnic artery aneurysms by open surgery and endoluminal therapy. Methods The clinical data of 10 splanchnic artery aneurysm patients (four male, six female) hospitalised from January 2002 were analysed retrospectively. The average age was (56 ± 13) years (28 - 74). Surgical or endoluminal treatment for six cases of splenic artery aneurysms or pseudoaneurysms were applied, among which multiple splenic artery aneurysms was found in one, and aberrant aneurysms at the proximal section of the splenic artery originating from a spleno-mesenteric trunk was found in three, splenic artery pseudoaneurysm in one and single aneurysm with normal splenic artery in anatomy in one. Besides, there were two superior mesenteric artery aneurysm, one of tuberculous celiac artery pseudoaneurysm and one renal artery aneurysm. Results The tuberculous celiac artery pseudoaneurysm was successfully managed by deploying a stent-graft endoluminally. One case was converted to open surgery after the splenic artery aneurysm was only paitially covered by a stent-graft. The other 8 cases were successfully treated by open surgery. All of the operations are successful. All patients were followed up from three months to six years, during which no death or other severe complications occurs. Conclusions The splanchnic artery varies from one to another anatomically. Preoperative CT scan or digital substraction angiology are helpful for the diagnosis of the splanchnic arterial aneurysms and choosing an appropriate management. Conventional open surgery is effective and reliable, while endoluminal therapy is a minimally invasive alternative.

Clinical analysis of venous thromboembolic disease during puerperium / 中华全科医师杂志

Thirty seven patients with venous thromboembolic disease in puerperium were admitted to hospital from January 2005 to December 2008; the clinical data of patients were retrospectively analyzed.The average age of patients was (33 ± 6)years (21 -42 years); the average onset time was ( 10 ± 6) d( 1 -50 d) after delivery.Seven patients had vaginal birth and 30 by cesarean section.The risk factors included pregnancy,cesarean section,age,infection,thrombophilia.All were diagnosed by ultrasonography and treated by anticoagulant,antiplatelet and thrombolytic therapy in the acute phase,followed by wearing elastic compressive stockings for more than 2 years.Pulmonary embolism was diagnosed in 8 patients by CT angiography,in 7 of whom inferior vena cava filter was administrated emergently.The patients were followed up for (29 ± 10)months ( 12 -60 months); during the follow-up 3 developed deep vein post-thrombosis syndrome,while others kept in good condition.The results indicate that initial anticoagulant,antiplatelet and thrombolytic therapy followed by elastic compressive stockings administration is effective for venous thromboembolic disease during puerperium.

Endovascular repair combined with assistant techniques for the treatment of Stanford Type B aortic dissection involving aortic arch / 中华普通外科杂志

Objective To evaluate endovascular repair combined with assistant techniques for the treatment of Stanford type B aortic dissection involving aortic arch.Method From July 2002 to June 2010,46 patients of aortic arch dissection with the primary entry tear next to the orifice of left subclavian artery,were treated with endovascular repair.Left subclavian arteries were covered with TEVAR in 43 cases.PDA occludes were used in 6 patients.Nine patients received extrathoracic supra-aortic branches bypass.Double-barrel technique was performed in 8 patients.Fenestrated stent graft was used in 1 patient.Result All patients survived and were followed up for 2 to 76 months.No severe neurological complications happened.All synthetic grafts and carotid artery stents were patent.Type Ⅱ endoleak occurred in 10 patients,among them 6 received PDA occlude implantation in the left subclavian artery,and 2 patients recovered by conservative treatment.Nine patients suffered from ischemia of the left upper extremity,and 8 of them were treated with conservative method,one received bilateral subclavian artery bypass because of severe ischemia after endovascular treatment.In follow-up,all of the stent-grafts and grafts were patent.In the descending aorta,the diameter of true lumen increased significantly and the diameter of false lumen shrank gradually.Conclusions Endovascular aortic repair combined with extrathoracic supra-aortic branches bypass,PDA occlude,double-barrel technique and fenestrated technique is a safe and effective method for Stanford Type B aortic dissection involving aortic arch.

Endovascular repair of acute standford type B aortic dissection complicated with massive hydrothorax / 中华普通外科杂志

Objective To evaluate endoluminal repair and preoperative management for acute Standford type B aortic dissection complicating massive hydrothorax. Methods The clinical data of 27 patients (23 males, 4 females) hospitalized from January 2003 to December 2008 were analysed retrospectively. The average age was 47 ±9 years (35 ～70). Eleven patients had bilateral huge hydrothorax (40. 7% ) , while 13 had left hydrothorax (48. 1% ) and 3 had right hydrothorax (11. 1% ) only, and in 2 of them with additional pericardial effusion (7.4% ). SaO2 was below 90% in all cases. All patients underwent emergency endovascular repair. For control of massive hydrothorax found by CT or chest fluoroscopy, puncture drainage or tube drainage were administrated postoperatively. Results All the 27 operations were successful, and there was no perioperative mortality. Three type Ⅰ and one type Ⅳ endoleaks occurred but disappeared in one month. Hydrothorax disappeared 28 days to 3 months postoperatively in all patients, of which 5 cases had puncture drainage (18.5%) and 1 case had tube drainage ( 3. 7% ). Mean follow-up was 30 ± 20 m ( 6 ～ 78 m ) after endovascular management. Complications included pleural thickening (6 of 27, 22. 2% ) , pulmonary atelectasis (2 of 27, 7. 4% ) , and lung consolidation combined with chest dent (2 of 27, 7. 4% ). Conclusions Emergency endovascular therapy is safe and effective for acute Stanford type B aortic dissection with massive hydrothorax. Drainage of hydrothorax after stent-graft deployment is a must for the patient suffering from severe respiratory failure.

Surgical treatment for complex pediatric retroperitoneal tumors / 中南大学学报(医学版)

OBJECTIVE@#To explore and summarize the experience of surgical treatment for primary retroperitoneal tumor (PRT)in children.@*METHODS@#Clinical data of 17 patients with PRT treated from January 2001 to January 2008 were retrospectively analyzed, including image examination, pathologic examination and surgical procedure.@*RESULTS@#Seventeen patients underwent complete resection; 8 benign PRT, and 9 malignant PRT were diagnosed by operation and postoperative pathologic examination. Vascular surgery was done on 11 patients, 6 cases of multi-visceral resection, 1 vascular transplant, and 1 multi-visceral resection. Two patients had recurrent malignant PRT.@*CONCLUSION@#For pediatric complex retroperitoneal tumors, complete resection can reduce the recurrence and improve the long-term survival.

Surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection / 中南大学学报(医学版)

OBJECTIVE@#To investigate the surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection.@*METHODS@#The clinical data of 63 cases of infected pseudoaneurysms of femoral artery caused by narcotics injection were reviewed retrospectively.@*RESULTS@#The tumors in 52 cases ruptured. Rupture hemorrhoea first occurred in 45 patients before admission and in 7 during hospitalization. Twenty-six patients suffered from recurrent or multiple hemorrhoea while in hospital. Forty-nine patients received external iliac artery-superficial femoral artery extra-anatomic bypass reconstruction with banded vascular grafts and the other 14 received ligation operations of the external iliac artery or the femoral artery. No one died in the perioperative period. One patient with vascular graft reconstruction developed graft infection during hospitalization and 5 developed graft infection during the follow-up. No ischemic necrosis occurred in the affected limbs after the infected vascular grafts were removed. One patient developed necrosis in the affected limb after the femoral artery was ligated and then above-knee amputation was performed. The others recovered well. Unobstructed blood circulation in the vascular graft was exhibited by color Doppler ultrasonography in 36 cases during the follow-up.@*CONCLUSION@#Operation as early as possible is the only way to rescue patients' lives threatened by infected pseudoaneurysms of femoral artery caused by narcotics injection. Thorough debridement and drainage, revascularization between external iliac artery and superficial femoral artery using band artificial blood vessel, and controlling infection are therapeutic modus operandi. Ligation of external iliac artery or femoral artery is also a feasible measure to rescue patients' lives when pseudoaneurysms are infected severely.

Arthroscopic surgery for patellar subluxation:surgical outcome of 17 cases / 第三军医大学学报

Objective To introduce arthroscopic technique in managing patellar subluxation and its clinical results. Methods Between Jan. 2004 and Jun. 2007, 17 patients suffered from patellar subluxation underwent arthroscopic surgery in Xijing Hospital. The key points of our technique are lateral retinaculum release and medial retinaculum shrinking suture. Tibial tuberosity was translated medially and elevated in 2 patients by osteotomy. The average age of all patients was (21.5?4.9) years (range 10 to 28). The patients suffering from patellar subluxation averaged (23.1?13.0) months (range 7 to 50) before operation. They were followed up for average (18.0?6.2) months (range 6 to 24). The Lysholm score before and after operation was compared in all patients. Results Fifteen of total 17 patients were followed up, and no recurrence was found. Lysholm score of 17 patients was significantly higher after operation than that before operation (t=5.63, P

Surgical management of arterial diseases / 中国普通外科杂志

Objective To explore the surgical management for arterial diseases. Methods The clinical data of 86 cases of arterial diseases were analysed retrospectively. These cases included:3 cases of thoracic aortic aneurysm,2 cases of descending aortic dissection with rupture and aneurysm formation,2 cases of abdominal aortic dissection with false aneurysm,1 case of abdominal aortic aneurysm(AAA)with duodenojejunal fistula and GI bleeding,5 cases of ruptured AAA with shock, 3 cases of traumatic rupture of abdominal aorta,21 cases of AAA combined with unilateral or bilateral iliac aneurysms,6 cases of iliac aneurysms,9 cases of popliteal aneurysms,21 cases of false aneurysm of iliac or popliteal artery,1 case of rupture of junction of subclavian and vertebral artery with false aneurysm,3 cases of rupture of subclavian artery with false aneurysm,2 cases of aneurysm of carotid artery and 7 cases of false aneurysm of carotid artery. Prosthetic vascular graft was performed in 71(cases),autologous vein graft in 3 cases and suture(repair) of arterial rupture in 12 cases.Results Operative (mortalty) was 3.5%(3/86)in this series.Seventy-one cases were followed-up for 1 month to 5 years, the results showed that all the patients were alive and well.Conclusions In the(management) of(appropriate) aortic diseases, the use of endoluminal technique is simple, microtraumtic, safe and has few complications. It also can shorten the hospital stay of the patient. Endovascular technique should be the first choice for patients with aortic diseases.

Endovascular therapy for complicated aortic dissection / 中国普通外科杂志

Objective To explore the method of endovascular therapy for complicated aortic dissections.(Methods) The clinical data of 25 patients with complicated aortic dissections were analysed retrospectively.Results The patients′ ages ranged from 31-72 years with a mean of 50.2 years.Among the 25 cases,6 cases had severe ischemia of mesenteric artery,5 cases had renal artery ischemia,4 cases had severe(ischemia) of both legs,3 cases had renal arteries ischemia combined with superior mesenteric artery ischemia,2 had complicated aortic dissection combined with AAA,and in 5 cases the true aortic lumen was totally(compressed) by the false aneurysmal lumen.All patients underwent endovascular therapy,and the instant(technique) was successfully performed in all patients.Endoleak occurred in 3 cases after the stent-graft(deployment),it stopped spontaneously in 2 of them 7 days later,and 1 case with endoleak waiting for(treatment).In the other 22 patients,angiography after the operation showed that all the diseased area were sealed completely,and the viscera arterial blood supply was restored mainly via the true lumen.All the(patients) were cured and discharged.Conclusions In the management of complicated aortic dissections,(endoluminal) technique is simple,less traumatic,safe and has less complications as compared to the traditional operation.Improvement of the endoluminal technique is essential for successful treatment of these complicated cases.

Surgical management of acute thoracoabdominal aortic diseases / 中国普通外科杂志

Objective To explore the surgical management for acute cases of aortic diseases. Methods The clinical data of 18 acute cases of thoracoabdominal aortic diseases were analysed retrospectively. Results This study included ruptured thoracoabdominal aortic dissection of 15 cases and open wound of the abdominal aorta of 3 cases. There were 15 males and 3 females, with mean age of 42.7 years. Eight patients were received open emergent operation, and the other 10 cases underwent endovascular procedure. The mortality was 11.1% (2/18). Follow-up from 2 months to 3 years revealed all patients in a good condition. Conclusions In cases of emergent aortic diseases, endoluminal technique is simple, mini-invasive and safe. However, open surgery is still mandatory and effective especially when endovascular procedure is not indicated or failed.