Investigation of endovascular aneurysm repair of complex abdominal aortic aneurysm in high-risk patients / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of a variety of alternative endovascular techniques applied to patients with complicated abdominal aortic aneurysm complex abdominal aortic aneurysm (cAAA) and unsuitable for open surgery.</p><p><b>METHODS</b>From January 2001 to December 2010, charts of all patients having an abdominal aortic aneurysm (AAA) were reviewed. Endovascular aneurysm repair (EVAR) was done in 138 patients, in which 9 patients were defined as cAAA such as juxta-renal AAA, short or angulated AAA neck, AAA with bilateral iliac artery aneurysms. There were 8 male and 1 female patients, aged from 26 to 87 years with a mean of 67 years. All these patients at high risk for open surgery were offered a modified EVAR technique including fenestrated technique, scallop technique, chimney technique, balloon assisted U-turn stenting and reverse-U stent-graft in 2, 5, 1 and 1 patients respectively.</p><p><b>RESULTS</b>All techniques were successful and without severe postoperative complications. An intraoperative endoleak was found in 4 patients and was corrected immediately. One patient with type I and III endoleaks underwent dilatation with a compliant balloon. Two patients with type I endoleak underwent coil embolization (1 patient) and bare stent (1 patient). During follow-up, one patient with a type II endoleak who demonstrated no increase in sac diameter during follow-up was observed. Mean follow-up was 25.9 months (ranging from 4 to 79 months). No rupture occurred and 8 aneurysms shrink significantly. In 7 patients, critical vessels (renal and mesenteric arteries) were protected during the initial procedure and remained patent except in one patient who was performed reverse "U" stent graft with thrombosis in hypogastric artery.</p><p><b>CONCLUSION</b>High-risk patients with cAAA inappropriate for traditional EVAR can be successfully treated by using simple ancillary endovascular techniques with acceptable short or mid-term results.</p>

Surgical treatment for popliteal artery occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate surgical procedures for popliteal artery occlusive disease.</p><p><b>METHODS</b>The clinical data of 25 patients with popliteal artery occlusive disease from June 2007 to June 2008 was analyzed retrospectively. There were 18 male and 7 female with an average age of (53 ± 21) years. Eleven patients (11 limbs, 42.3%) were acute limb ischemia and 14 patients (15 limbs, 57.7%) were chronic limb ischemia. All patients were treated with surgical revascularization. Four limbs underwent thrombectomy. Nineteen limbs underwent endarterectomy with patch below knee. Three limbs underwent femoral-popliteal bypass with reversed saphenous vein or graft. Six of all the limbs underwent resection of the aberrant muscle when revascularization.</p><p><b>RESULTS</b>Ischemic symptoms and claudication distance were improved in 24 patients (25 limbs). Postoperative ankle-branch index (ABI) was 0.75 ± 0.29, significantly higher than preoperative ABI 0.35 ± 0.20 (P < 0.01). Average follow up time was 10.2 months. I stage patency rate was 92.3%. Three patients were amputated postoperatively. The rate of limb salvage was 88.5% in this study.</p><p><b>CONCLUSIONS</b>The cause of popliteal artery occlusive disease are diverse. Treatment for popliteal artery occlusive disease should depend on its etiology to make the outcomes be satisfied.</p>

Endovascular revascularization for lower extremity atherosclerosis obliterans in elderly patients:a report of 86 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the outcome and risk factors of endovascular revascularization of lower limb artery for elder patients.</p><p><b>METHODS</b>From January 2006 to November 2008, 86 elder patients (98 ischemia limbs) underwent endovascular revascularization due to lower limb ischemia. Age of this group were 60 to 82 years old with a mean of (70 +/- 6) years old. Fifty-four limbs (55.0%) had severe intermittent claudication, 28 limbs (28.6%) had rest pain, 11 limbs (11.2%) had ulcer, and 5 limbs (5.1%) had gangrene. Sixty-six limbs were mono segment disease, including 25 aorta-iliac lesions, 33 femoral-popliteal lesions and 8 infra-popliteal lesions. Thirty-two limbs were multiple segment disease involving 2 or 3 segment lesions. Mortality, morbidity, primary patency, secondary patency and limb salvage were retrospectively analyzed. Risk factors on outcome were also evaluated.</p><p><b>RESULTS</b>Ten limbs underwent angioplasty, while the rest 88 limbs underwent angioplasty plus primary stent implantation. The total operation success rate was 95.9%. Perioperative mortality within the first 30 d was 0. Perioperative morbidity within the first 30 d was 5 cases (5.1%), including 2 myocardial infarction, 2 major amputations and 1 irreversible contrast-induced nephropathy. Follow-up duration were 1 to 35 months with a mean of (18 +/- 10) months. Eighty-three (96.5%) patients had effectively follow-up. Mortality was 2.3% (2 cases died due to myocardial infarction). Primary patency rate was 83.7%, secondary patency rate was 94.9% and limb salvage rate was 95.9%. Risk factor analysis showed that diabetes mellitus, critical ischemia and multiple segment lesions were associated with worse patency.</p><p><b>CONCLUSIONS</b>Endovascular treatment is effective, safe and repeatable revascularization for elder patients of Critical lower limb ischemia. Patients with diabetes mellitus, critical ischemia and multiple segment lesions should be paid more attention because their rather worse outcome.</p>

Revascularization for iliac-femoral artery pseudoaneurysm with greater saphenous vein / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.</p><p><b>METHODS</b>Twenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.</p><p><b>RESULTS</b>The surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.</p><p><b>CONCLUSIONS</b>The use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.</p>

Carotid endarterectomy versus carotid stenting: a prospective randomized trial / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm outcomes of carotid endarterectomy (CEA) compared with carotid stenting (CAS) in patients with carotid artery stenosis.</p><p><b>METHODS</b>A prospective randomized single-center clinical trail to compare with endarterectomy and stenting in patients with symptomatic carotid stenosis of at least 50% and asymptomatic stenosis of at least 70%. From May 2004 to December 2006, there were 40 patients who agreed with the treatment were randomly assigned to undergo either CEA or CAS. The primary end point was any stroke or death within 30 d after treatment and the secondary end point was any stroke, myocardial infarction and any complications of the treatment, or death or ipsilateral stroke and carotid restenosis between 1 month and 18 months, and the cost-effectiveness of both groups were analyzed retrospectively as well.</p><p><b>RESULTS</b>There were no significant differences of the characteristics in the two groups. Twenty cases in CEA group underwent 23 endarterectomies (3 cases had bilateral CEA, respectively), in which 9 carotid shunt (39.1%) and 12 patching (52.2%) were used. Twenty cases in CAS group underwent 23 stents (3 cases had bilateral CSA, respectively), in which 21 emboli-protection devices (91.3%) were used. There was no significant difference in 30 d neurological complications (4.3% vs. 8.7%), acute myocardial infarction (4.3% vs. 0), and wound hematoma (8.7% vs. 0) between CEA and CAS, respectively. There was no ipsilateral transient ischemic attack or carotid restenosis at 18 months in each group. The average cost of hospitalization was (16 450.95 +/- 6188.76) vs. (70 130.15 +/- 11 999.02) RMB in CEA and CAS, respectively, with significant difference (P < 0.01).</p><p><b>CONCLUSION</b>The early and midterm outcomes are no significant difference between CEA and CAS, but in China, the cost of hospitalization in CAS is much higher than that of CEA.</p>

Safety and efficiency of non-permanent inferior vena cava filters in preventing pulmonary embolism / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the effectiveness and safety of non-permanent filter in preventing pulmonary embolism (PE) caused by deep venous thromboembolism (DVT).</p><p><b>METHODS</b>The clinical data of 12 patients who were implanted with non-permanent filter for documented deep venous thromboembolism in Peking Union Medical College Hospital from September 2003 to June 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>Among these 12 patients, 10 were implanted with temporary filters, and 2 with retrievable filters. All the 12 operations were successful without major complications. In the 10 patients who received temporary filters, filters were smoothly removed after 4 weeks in 9 patients, while one patient was further treated with anticoagulation therapy for 12 weeks because large emboli were entrapped by filter. In the 2 patients who received retrievable filters, filter were smoothly removed 2 weeks later in one patient; however, in another patient, the filter was left inside because large emboli were entrapped by filter. In all the 12 patients, emboli were entrapped in 6 filters (50%), in which the emboli were larger than 2 cm in 2 patients, larger than 1 cm but less than 2 cm in 1 patient, and less than 1 cm in 3 patients. PE scanning was performed in 10 patients before primary implantation, and PE was found in 5 patients. PE scanning was performed in 8 patients 6 months after implantation, and minor PE was found in 4 patients, whose symptoms and affected pulmonary artery were obviously improved. All patients received regular follow-up (ranged from 3 months to 2 years), 1 patient died of malignant tumor 4 months after operation, 1 patient suffered inferior vena cava occlusion due to large emboli entrapped by the temporary filter, and 1 patient experienced the recurrence of symptomatic DVT. Symptoms were improved in all the 5 patients with PE.</p><p><b>CONCLUSIONS</b>Non-permanent filter can safely and effectively protect patients from PE. More standardized criteria for placement and protocols to ensure timely removal should be developed and implemented.</p>