The application of reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with unfavourable proximal landing zone / 中国医师杂志

Objective To explore the preliminary results of application of reserving the left subclavian artery by fenestration of domestic stent graft in the thoracic endovascular aortic repair (TEVAR) of type B dissection with unfavourable proximal landing zone.Methods From October 2015 to January 2018,a total of 13 patients with type B aortic dissection without healthy proximal landing zones underwent TEVAR using fenestration of domestic stent graft in our hospital.Computed tomography angiography (CTA) data were measured before surgery.Digital subtraction angiography (DSA) was conducted after surgery.All patients underwent CTA or ultrasound examination during follow-up.Operation success rate,survive rate,patency of left subclavian artery and complications were analyzed.Results All the patients were deployed fenestrated endografts successfully.No proximal endoleak happened during perioperative period.Delirium occurred in 1 case during 7 postoperative days and fully recovered with the medical treatment.The mean follow-up period was (9.8 ± 9.5) months (range,1-29 months).11 patients underwent CTA and 2 patients underwent ultrasound examination during follow-up.During period of following up,no patients died,no proximal endoleak appeared,and all the left subclavian arteries reserving by fenestration.Conclusions Reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with hostile proximal sealing zone is economical,safe and feasible,which expand the indication of TEVAR for aortic dissection,and the long-term outcomes of this technique need to be assessed in the future.

Clinic analysis of treatment for injuries of supra-arch branches / 国际外科学杂志

Objective To analyse the initial resucts in different treatment methods for the treatment of aortic arch injury.Methods A total of 23 patients (18 males and 5 females) with injuries of superior arch arteries underwent our treatment in Shandong Provincial Hospital Affiliated to Shandong University from January 2008 to May 2017.Nine patients underwent surgical procedures(surgical group),13 patients underwent endovascular procedures (endovascular group),1 patient underwent conservative treatment.The conditions of all survived patients were followed up by telephone or outpatient from one to sixty months postoperative.Mortality and complications such as rehaemorrhagia,cerebralinfarction,stenosis or blockage during the follow-up period was assessed.Operation time,hospitalization time after treatment,mortality and complications within 30 days of surgical group and endovascular group were compared by statistical methods.The data were analyzed by SPSS 16.0 software.Measurement data were expressed as ((x) ± s).The count data were expressed as frequency and percentage (％),and comparison between groups were evaluated with t test,Chi-square.Results All patients had achieved technical success.In patients treated by surgical procedures,one case of death and 2 cases of cerebralinfarction were reported within 30 days.One patient died of rehaemorrhagia during the 2nd day of open operation.Meanwhile,another two patients suffered from cerebral infarction,they recovered within 30 days.All patients treated by endovascular procedures survived without cerebralinfarction.However,blockage occurred in one patient of these patients.The operation time [(2.4 ± 1.1) hours and (1.0 ± 0.4) hours] (P ＜ 0.01) and the time of postoperative hospitalization [(8.3 ± 3.0) days and(2.5 ± 1.0) days] (P ＜ 0.05) were statistically different of the two groups.The postoperative mortality rate of the two groups undergoing open surgery and endovascular treatment within 30 days was 11.1％ and 0.0％ (P =0.41),and complication rates with 33.3％ and 7.7％ respectively (P =0.26),there has no significant difference.Overall,66.7％ (6/9) patients treated by surgical procedures and 92.3％ (12/13) patients treated by endovascular procedures and one patient treated by consewative treatment survived without any complication during the follow up period.Conclusions Initial results suggest that endovascular procedures can significantly shorten the time of operation and the time of postoperative hospitalization,and the mortality and complication rate are also slightly lower than surgical procedures.Endovascular procedures is an important method for treatment for injuries that involve superior arch arteries.It plays a special role in rescuing injuries of superior arch arteries.

Clinical study on the prevention of post-thrombotic syndrome in lower extremity deep venous thrombosis patients / 中国普通外科杂志

Objective To assess the effect of anticoagulant drugs,elastic compression stockings(ECS)and(Daflon) on the prevetion of the post-thrombotic syndrome(PTS).Methods Fifty-eight deep venous(thrombosis)(DVT) patients were divided into control group and treatment group I and II.The control group (n=15) did not take anticoagulant drugs or the time of anticoagulant drug administration was less than 1 month,and the use of(ECS) was less than 3 months.The treatment group I(n=24) took warfarin for 6 months and the ECS were used in the follow-up time;the treatment group II(n=19),besides warfarin therapy and ECS,took Daflon for 12 months.All the patients were followed up,the general conditions were assessed with clinical score,and the therapeatic results of the 3 groups were assessed.Results The rate of PTS occurrence in control group was significantly higher than that in treatment group 1 and treatment group 2.At 6 months,the clinical score of treatment groups 1 and 2 was significantly lower than that of control group.At 1 and 1.5 years after discharge,the clinical score of treatment group 2 was significantly lower than that of treatment group 1.Conclusions The long-term comprehensive and systemic therapy(including warfarin,ECS and daflon) for DVT could prevent PTS.