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Objective To explore the necessity of inferior vena cava(IVC) filter implantation during catheter directed thrombolysis (CDT) for acute deep vein thrombosis (DVT). Method Ninety-three patients with acute DVT were reviewed from Nov. 2006 to Dec. 2008. There were 35 men and 58 women, age averaging at (60 ±29) year old, treated with CDT followed by percutaneous transluminal angioplasty ( PTA). The course of DVT was from 5 h ～ 15 d (6. 28 ±7.08) d with 80 left lower limbs and 13 right lower limbs involved. Results There were 30 patients with prior IVC filter implanted compared with 63 patients without filters (67. 7% ,63/93). Among the patients without filter, there were 93. 6% (59/63) left lower limbs. DSA was redone after thrombolysis. Seventy-seven iliacfemoral thrombosis was resolved completely and stenosis or occlusion of the iliac vein were found in 90. 9% (70/77) cases. Endovascular treatment was performed in 57 patients. There was no patients suffering from symptomatic pulmonary embolism (PE). PE was found in 3 cases with a filter and 1 case without filter was suspected of PE on pulmonary CTA after treatment. Conclusion It is not necessary to routinely place an IVC filter during CDT for treating DVT on left lower limb when the thrombosis is not involing the IVC.
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Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.
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Objective To evaluate the clinical result of arterial reconstruction in critical limb isehemia. Methods Clinical data of 123 cases (137 lower extremities ) of critical limb ischemia ( Fontaine Ⅳ ), 79 males and 44 females, with a mean age of ( 74 ± 9 ) years, undergoing arterial reconstruction, were reviewed. Comorbidities included tobacco use (33. 33% ), coronary artery disease (43.09%), hypertension ( 50. 41% ), cerebral vascular disease ( 29. 27% ), and diabetes mellitus(52. 33% ). Result Perioperative mortality rate was 4. 88%, and 88. 89% cases were followed up with amean time of (18 ± 18) months and the mortality rate was 13.01%. The postoperative pateney rate of1 year, 2 years and 3 years was (81±4)% ,(68±6)% and (61±7)% respectively. Arterial occlusion occurred in 25 cases, 4 cases received reoperation and 9 cases received major amputation. Tissue healing rate was 78. 85% after half a year and 83. 65% after 1 year. The limb salvage rate was (81±4)% ,(71 ±5 )% and (65 ± 6)% after 1 year, 2 years and 3 years respectively. Conclusion Arterial reconstruction for the critical limb ischemia increases the limb salvage rate with satisfactory patency rate and improves the healing of ulcer.
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objective To evaluate the therapeutic efficacy of endovenous radiofrequency ablation in combination with TriVex for the treatment of chronic venous insufficiency (CVI)of the lower extremity.Methods One hundred and fifty CVI cases(150 limbs)were randomly assigned to Group A(75 limbs)and Group B(75 limbs).Patients in Group A were treated with greater saphenous vein radiofrequency ablation procedures in combination with TriVex.Patients in Grpup B were treated with greater saphenous vein traditional stripping operation in combination with TriVex.The short-term results in hospital and patient self-assessment for the operation at postoperative 4 week were compared with each other:The changes of CEAP classification and venous clinical severity score(VCSS)were compared. Results Operation time was(67±11)min in Group A versus(69-4-9)min in Group B(P＞0.05).Postoperative pain,average hospital stay in Group A were significantly less and shorter than in Group B(P ＜0.05).The scores of selfassessment for the operation were(11.21±2.00)in Group A versus(10.52±2.08)in Group B(P＜0.05).The change of CEAP classification and VCSS were statistically significant after operation in both groups(P＜0.01).The VCSS decreased 4.6 ±2.5 in Group A versus 4.3±2.7 in Grpup B(P＞0.05).Conclusions Endovenous radiofrequency ablation in combination with TriVex for treatment of CVI are effective,less traumatic,of fast recovery.CEAP classification and VCSS are useful tools for assessing outcomes after the operation.
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BACKGROUND: To evaluate the operative efficacy of chronic venous insufficiency (CVI), we used to emphasize on the improvement of clinical symptom and physical sign without quality of life (QOL).OBJECTIVE: To assess the QOL in CVI patients before and after operation.DESTGN: Comparative observation, scale evaluation and one-year follow-up.SETTING: Department of Vascular Surgery, Renji Hospital, Shanghai Second Medical University.PARTICIPANTS: 169 CVI patients (209 lower limbs) including 89 males and 80 females with an average age of (56±13) years and disease course of (11 ±3)years, who were treated at Department of Vascular Surgery, Renji Hospital,Shanghai Second Medical University from July 2001 to December 2003, were enrolled. All patients knew the therapeutic scheme and evaluation dimensions.METHODS: Three types of operation according to the reflux range and whether deep venous valve imcompetence were carried out. Forty-six subjects with 56 limbs in the superficial venous group received saphenous vein high ligation with stripping the saphenous and varicose vein. Seventy-three subjects with 87 limbs in the perforating venous group underwent both perforating vein ligation and saphenous vein high ligation with stripping the saphenous and varicose vein. Fifty subjects with 66 limbs in the deep venous group received the same operations of group 1 and group 2, in addition to external banding valvuloplasty of the superficial femoral vein. The chronic venous insufficiency questionnaire (CIVIQ) was applied to assess the patients' QOL one week before varicose vein surgery and one year later. The main impairment in QOL focused on 4 dimensions (20 questions), namely pain, physical dimension, social function and psychological dimension. There were five grades to each question (from 1 to 5 points accompany with the serious situation). Total CIVIQ score was sum score of 20 questions. 100 points indicated ideal QOL.MATN OUTCOME MEASURES: CIVIQ scores in CVI patients before and after operation.RESULTS: All 169 CVI patients were involved in the result analysis. ①Sex differences of CIVIQ: The total scores of patients were obviously elevated one year after operation (P ＜ 0.05). There was no significant difference in CIVIQ scores of both sexes (P ＞ 0.05). The total score was markedly elevated after operation (P ＜ 0.05). ②Relationship between CIVIQ scores and operation type: No significant difference was found in the superficial venous group, the perforating venous group and the deep venous group (P ＞ 0.05). The total CIVIQ scores in the deep venous group before operation were significantly lower than those in the superficial venous group and the perforating venous group (P ＜ 0.05).CONCLUSION: Reasonable operation type can improve the QOL in CVI patients. No significant difference is found in QOL improvement of patients of both sexes.
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<p><b>OBJECTIVE</b>To investigate the relationship between the endogenous vascular endothelial growth factor (VEGF) gene expression in diabetics' calf ischemic skeletal muscle and the pathogeny of diabetic foot.</p><p><b>METHODS</b>Twenty-four patients (33 limbs) were divided into 3 groups: diabetes mellitus (DM) without lower extremity ischemia (n = 5) (10 limbs); arteriosclerosis obliterans (ASO) without diabetes mellitus (n = 10) (13 limbs); diabetic lower limb arteriosclerosis obliterans (DLASO) (n = 9) (10 limbs). Control group consisted of normal volunteers (NOR) (n = 5) (10 limbs). The calf skeletal muscle tissue was obtained through muscle biopsy. RT-PCR was applied to determine the expression of hVEGF165mRNA.</p><p><b>RESULTS</b>There was no expression in the calf skeletal muscle tissue of normal volunteers and DM. The calf skeletal muscle tissue in DLASO had the expression of hVEGF165mRNA (0.021 +/- 0.013) micro g, but obviously lower than ASO (0.133 +/- 0.024) micro g, (t = 13.32, P < 0.01).</p><p><b>CONCLUSIONS</b>The endogenous VEGF gene expression in ischemic lower extremity of DLASO is obviously lower than that of ASO. It is the important endogenic cause of the genesis and development of diabetic foot ulcer.</p>
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Humans , Diabetic Foot , Gene Expression , Ischemia , Muscle, Skeletal , Vascular Endothelial Growth Factor AABSTRACT
ObjectiveTo evaluate a new cross-linking reagent—polyepoxy compound(PC)in vivo. MethodsTo reconstruct abdominal aota with jugular homografts of SD rats (diameter 0.8～1.1mm) pret4reated by glycero polyglycidyl ether(a kind of PC) or glutaraldehyde(GA). Grafts were explanted at different elapsed time, and their histological changes were studied. ResultsThere was no difference between the patencies of the PC and GA prepared homografts ( P >0.05), but the inci-dence of aneurysms in GA is higher than that in PC group ( P < 0.05). The healing procedures of endothelial cells in two experimental groups were basically same at the end of second month after transplantation. The endothelial cells cover the whole inner wall of the grafts. ConclusionCompaired PC graft with GA graft, it shows that PC are more unbreakable and compliant, lower rate of aneurysms and less calcification. PC might be a potential vessel-crosslink-reagent.
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Objective To evaluate postoperative life quality of patients with chronic venous insufficiency(CVI). Methods According to the chronic venous insufficiency questionnaire(CIVIQ) of four sorts and twenty items, the life qualities of 169 postoperative patients receiving respectively three different surgery: super venous, perforator venous, and deep venous. The average life score of 80 is regarded as good. ResultsThe average score is 84?16 in super venous group、88?14 in perforator venous group and 82?16 in deep venous group. ConclusionsThe life quality of postoperative patients treated by deep venous valvuloplasty is satisfactory. CIVIQ is reliable and practicable for the life quality evaluation.
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Objective To investigate the expression of CD35 on red blood cells (RBC) and CD11b on neutrophils in patients with chronic venous insufficiency (CVI). Methods Anticoagulated peripheral venous blood was assayed by flow cytometry for CD35 expression on RBC and CD116 on neutrophils from 42 CVI patients in different clinical picture,etiology,anatomic distribution, pathophysiology (CEAP) and clinical classes, results were compared with that of eight normal control subjects. Result Circulating neutrophils were more reactive to CDllb in CVI C5-C6 patients. Higher expression of CD35 on RBC were observed in C4 patients. Conclusion CD35 on RBC and CDllb on neutrophils may participate in the pathogenesis and to an extent reflect the severeness of CVI.
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Objective To review the experiences of re-operational effect for occluded arterial bypass in lower limbs. Method We analyzed the re-operational effect of 19 patients (20 limbs) with occluded arterial bypass in lower limbs from May 1996 to Fab 2004. A total of 31 operations were performed in these patients. Results The patent rate of simple thrombectomy in 18 cases was only 27.7% (5/18) with a rate of re-obstruction of 72. 3%(13/18). The period of patent outflow of another 13 re-operations with rebuilt of in-flow or out-flow varied at 4 days to 11 months. The patent rate in this group was 61.5% (8/13). The rate of re-obstruction was 38. 5% (5/13). The overall patent rate of re-operation was 41.9% (13/31). The average patent period was 9. 1 months (3-29 m). The operative mortality rate in 19 patients was 5. 3% (1/19). The limb salvage rate of 19 limbs in 18 patients was 73. 7%(14/19). The amputation rate was 25%(5/20). Conclusion The main cause of late re-obstruction of bypass procedure was endothelial proliferation and development of lesions. The effect of rebuilt of in-flow or out-flow was better than thrombectomy only. Duplex follow-up helps to find restenoses and manage the proliferated lesions before a bypass becomes occluded.