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@#Objective To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P<0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P<0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes. Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.
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@#Objective To investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery. Methods A retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years. Results The operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention. Conclusion Modified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.
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@#Objective To investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention. Methods A retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed. Results All patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened. Conclusion SCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.
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Intravenous leiomyomatosis (IVL) is a rare benign neoplasm which originates from the smooth muscle cells and is usually confined to the pelvic venous system. Rarely, intracaval and intracardiac extension has been described. Death can occur as a result of intracardiac involvement. We reported 4 cases of IVL with right heart involvement (intracardiac leiomyomatosis, ICL). Three of them suffered recurrent sudden syncope, and the other one was totally asymptomatic. All of them were successfully treated through one-stage operation under extracorporeal circulation.
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The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.
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To find out which biomaterial had the best biocompatibility, we compared the acute phase reaction of common biomaterials preparing for vascular grafts with the material of polyurethane modified by silk fibroin (SF-PU(1:1)). After transplanted the materials of dacron, polyterafluoroethylene (e-PTFE), polyurethane (PU), SF-PU(1:1) in rat muscle for one week, we studied the influence of different biomaterials on the histocompatibility by using rat acute toxicity test, test of local reaction in muscle, tissue section staining, WBC and PLT count. As a result, dacron had the worst histocompatibility. The other biomaterials had slight local inflammatory reaction. The WBC and PLT was nearly the same with the blank except dacron. e-PTFE, pure PU and SF-PU(1:1) had the better histocompatibility than traditional dacron. Especially SF-PU(1:1) had the best histocompatibility. Because of the better physical properties and histocompatibility of SF-PU( 1:1), the prospect of preparing small-diameter vascular grafts with SF-PU was cheerful.
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Animals , Female , Male , Rats , Acute-Phase Reaction , Biocompatible Materials , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation , Fibroins , Chemistry , Implants, Experimental , Macromolecular Substances , Chemistry , Materials Testing , Methods , Muscle, Skeletal , Physiology , Polyurethanes , Chemistry , Prosthesis Design , Random Allocation , Rats, Sprague-DawleyABSTRACT
In this study, a novel polyurethane membrane, modified by superfine silk-fibroin powder, was prepared for small-diameter vascular grafting. Scanning electron microscopy, transmission electron microscopy, and histological examination were applied to evaluate histocompatibility of this polyurethane membrane. The polyurethane membrane was compared with polytetrafluoroethylene material. A pseudomembrane and gap formed between polytetrafluoroethylene and the surrounding tissues, and no cells infiltrated or grew into the polytetrafluoroethylene material. On the contrary, superfine silk-fibroin powder/polyurethane blend membrane merged tightly with the surrounding tissues without gaps, and cells infiltrated and grew into the material. Moreover, the negative effects of superfine silk-fibroin powder/polyurethane blend membrane on cells were less than those of its polytetrafluoroethylene counterpart. Our findings indicated that the superfine silk-fibroin powder/polyurethane blend membrane has better histocompatibility than polytetrafluoroethylene membrane. It is concluded that the superfine silk-fibroin powder/polyurethane blend membrane is a promising biomaterial for small-diameter prosthesis.
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OBJECTIVE@#By reviewing the clinical material in 23 cases (25 tumors) of carotid body tumors, we concluded our experience in selecting the appropriate diagnostic modality and surgical therapy to facilitate surgical maneuvers and decrease the incidence of postoperative complications.@*METHOD@#From 2003 to 2008, 23 cases of carotid body tumors were admitted and treated in Wuhan Union Hospital. All the 23 cases were operated after determining diagnosis that was deterred by angiography and noninvasive examinations including color Doppler scan, computed tomography angiography and magnetic resonance angiography.@*RESULT@#There was no patient died, no cerebral infarctions, no recurrence after operation. Nervous complications occurred in 5 cases post operatively.@*CONCLUSION@#Preoperative angiography is a appropriate diagnostic modality for carotid body tumor, which can shows the supply arteries of the tumor and estimate the structure of the Willis Circle, so that we can judge the possibility to temporarily clamp the carotid artery during the operation to control the hemorrhage and eliminate the postoperative nervous complications.
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Adult , Aged , Female , Humans , Male , Middle Aged , Angiography, Digital Subtraction , Carotid Body Tumor , Diagnosis , Diagnostic Imaging , General Surgery , Treatment OutcomeABSTRACT
Objective To investigate the diagnosis and surgical treatment of intracaval venous tumors. Methods Clinical data of 6 cases were retrospectively analyzed, including signs and symptoms diagnostic means such as type-B ultrasound, CTA, MRA, surgical procedures and prognosis. Results All six cases received type-B ultrasonic examination, final definite diagnosis was achieved by CTA exam in 2 cases and through MRA in 4 cases. Heart involvement was found in 3 cases. All patients underwent a surgery. According to the extent of the tumor,3 cases had thoraco-abdominal incision,3 cases with extracorporeal circulation and right atrium opening. All of the tumors were completely resected. Pathological exam revealed that 4 cases were of leiomyomatosis and 2 cases were of leiomyosarcoma. One case with leiomyosarcoma died of liver disfunction postoperatively.The other 5 cases recovered without major complications. An average 51 months of follow-up found no recurrence. Conclusions CT and MRI are the mainstay for the diagnosis,and MRI can provide clear anatomy image to the surgeons, help choose the surgical procedures. The one-stage operation is effective. During the operation, the main branches of the vena cava system should be detected, and the attachment of the tumor should be found and removed thoroughly to prevent the recurrence of the tumor. When the attachment point is lower than the iliac vein level, ligation of the involved iliac vein should be mandatory.
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BACKGROUND:Conventional prosthetic vessel replacement has been gradually replaced by endovascular covered stent graft exclusion in the treatment of abdominal aortic aneurysm (AAA).However,whether it has advantages over conventional prosthetic vessel replacement in clinical curative effects and biocempatibility produced in the implantation of new type of biomaterials remains unclear.OBJECTIVE:To compare the curative effects and complications of endovascular covered stent graft exclusion and prosthetic vessel replacement in the treatment of AAA.DESIGN: A controlled observation analysis.SETTING: Department of Vascular Surgery,Wuhan nion Hospital.PARTICIPANTS: Forty-two patients with AAA (renal artery not involved) who received the treatment in the Department of Vascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between September 2001 and July 2006,were recruited in this study.They were all confirmed by CT angiography (CTA) and other examinations.According to the selected operative way,patients were allocated into interventional therapy group (n =17) and conventional therapy group (n =25).In the interventional therapy group,the patients,including 16 males and 1 female,were averaged (68±10)years old,and their mean tumor diameter was (6.4±1.3) cm.In the conventional therapy group,the patients,including 23 males and 2 females,were averaged (64±9) years,and their mean tumor diameter was (6.2±1.1) cm.Significant difference did not exist in the baseline material between two groups (P ＞ 0.05).This study was approved by the Hospital Ethics Committee.Written informed consents were obtained from all the patients.METHODS:In the interventional therapy group,patients underwent ndovascular covered stent graft exclusion by an interventional means.After being generally anesthetized,patients were dissected at unilateral femoral artery.Under the perspective condition,a covered stent graft was placed at a proper position with a forwarder,and then it was released and expanded.Following the position and xpansion of a covered stent being examined by CTA,femoral artery was anastomosed and incision was closed.If arteria iliaca was involved,then another covered stent was implanted from contralateral femoral artery and connected to stem.In the conventional therapy group,patients underwent prosthetic vessel replacement by a conventional means.Postoperatively,patients in the two groups all received anti-inflammation,anti-coagulation and other symptomatic and supportive treatments necessarily.MAIN OUTCOME MEASURES:① Postoperative complications of patients in two groups.② Recovery was observed by B-ultrasonography and CTA examination 1,3,6 and 12 months after operation.③ Follow-up of biocompatibility of biomaterials and host during 1 year postoperatively.RESULTS:Forty-two patients participated in the finial analysis.①Patients who exhibited pulmonary infection and renal function deterioration in the interventional therapy group were fewer than those in the conventional therapy group (P ＜0.05).② In the interventional therapy group,patients with covered-stent graft displacement,aortic injury and hematoma formed at the puncture point of femoral artery were not found.In the conventional therapy group,one patient died of acute large-area myocardial infarction at the 6th week postoperatively,and patients,who suffered from stomal leakage,prosthetic vessel thrombogenesis and infection,etc.,were not found.③ Neither obvious inflammatory reactions in the peripheral tissue of prosthetic vessel nor thrombogenesis in the prosthetic vessel was found in patients of two groups.It was demonstrated that both covered stent graft and prosthetic vessel had good biocompatibility.CONCLUSION:Endovascular covered stent graft exclusion can treat AAA due to its less surgical trauma,rapid postoperative recovery,good biocompatibility and other advantages.
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0.05).This study was approved by the Hospital Ethics Committee.Written informed consents were obtained from all the patients.METHODS:In the interventional therapy group,patients underwent endovascular covered stent graft exclusion by an interventional means.After being generally anesthetized,patients were dissected at unilateral femoral artery.Under the perspective condition,a covered stent graft was placed at a proper position with a forwarder,and then it was released and expanded.Following the position and expansion of a covered stent being examined by CTA,femoral artery was anastomosed and incision was closed.If arteria iliaca was involved,then another covered stent was implanted from contralateral femoral artery and connected to stem.In the conventional therapy group,patients underwent prosthetic vessel replacement by a conventional means.Postoperatively,patients in the two groups all received anti-inflammation,anti-coagulation and other symptomatic and supportive treatments necessarily.MAIN OUTCOME MEASURES:① Postoperative complications of patients in two groups.② Recovery was observed by B-ultrasonography and CTA examination 1,3,6 and 12 months after operation.③ Follow-up of biocompatibility of biomaterials and host during 1 year postoperatively.RESULTS:Forty-two patients participated in the finial analysis.①Patients who exhibited pulmonary infection and renal function deterioration in the interventional therapy group were fewer than those in the conventional therapy group(P