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Objective To evaluate clinical outcome of patients treated with endovascular dilation and stent placement for ilio-femoral venous postthrombotic syndrome (PTS).Methods 42 PTS cases were enrolled in our group from June 2003 to December 2011.Dilation and stent placement in stenosis/ occlusion of ilio-femoral veins were performed in all cases,temporary femoral arteriovenous fistula was established in 24 cases.Results These were not severe perioperative complications.All patients were followed up for 8-75 months.Preoperative limb ulcers in 5 cases were healed.Early thrombosis in stents found in 3 cases was cleared by catheter directed thrombolysis (CDT).Severe in-stent restenosis (＞ 50％)was found in 10 cases,treated with dialation or re-stenting.Primary patency,assisted primary patency and secondary patency rates were 75％,78％,80.1％;64.1％,67.1％,69.6％;63.8％,65.3％,66％;61.7％,65％,65.2％,respectively,at 6 months,12 months,24 months and 36 months.Postoperative Venous Clinical Severrity Score (VCSS) decreased (P =0.000).There was statistical significant improvement in every dimension evaluated by the MOS item short from health survey(SF-36) after operation (P =0.000).Conclusion Ilio-femoral venous stenting is a safe and effective treatment for PTS and with good clinical midterm results.
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Objective To evaluate ascending venography in the diagnosis of iliac vein compression syndrome.Methods From April 2011 to April 2013,we have had 556 patients with varicose veins suspected of Cockett syndrome.The degree of varicose veins by the International Union of Venous Clinical Classification (CEAP classification) was as following[1]:shallow varicose veins of lower limb (C2) in 190;varicose veins with limb swelling (C3) in 149 cases ; with body skin changes,such as pigmentation,eczema or lipid hard skin disease (C4) in 130; with healed ulcers (C5) in 17; with active ulcer(C6) in 70.Deep vein anterograde contrast and femoral venous cannula angiography were performed on 760 times.Results Iliac vein compression syndrome (Cockett) was detected by ascending venography in 154 patients,the diagnosis was established by following femoral venous cannula angiography.In the other 48 patients in whom Cockett syndrome was suspected by ascending venography,final diagnosis was reached by femoral venous cannula angiography.Altogether there were 202 iliac vein compression syndrome cases,with a positive rate 38.19％ (202/529).The narrowness was larger than 50％ in 173 cases.In 145 cases there were visible collateral vessels.Conclusions Deep vein ascending angiography is a useful screening method in the diagnosis and treatment of Cockett syndrome.
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Objective To evaluate the surgical and interventional therapy in patients with acute superior mesenteric vein thrombosis.Methods In this series,31 acute superior mesenteric vein thrombosis(SMVT) cases were reviewed from Oct 2006 to Feb 2012.According to varied clinical presence,patients received superior mesenteric vein thrombectomy with necrotic bowel resection or indirected catheter thrombolysis through superior mesenteric artery.Results 6 of 9 cases undergoing surgery were cured and other 3 still complained abdominal distension when discharged for not being able to bear anticoagulation and thrombolysis after operation due to alimentary tract hemorrhage,and residual thrombus was shown in superior veins by venography.17 of 22 treated by interventional therapy gained obvious relief within 72 hours after intervention,others gained symptomatic relief in 5-7 days.Indirected catheter thrombolysis were interrupted in 2 due to alimentary tract hemorrhage.One patient was shifted to surgery 48 hours after catheter thrombolysis due to deterioration.Mean duration of follow-up after hospital discharge was (19 ± 5) months in 25 cases,20 had no abdominal distension and pain,3 with postcibal abdominal distension.Conclusions Indirected thrombolytic therapy by way of the superior mesenteric artery is a technically simple,safe and effective therapy for patients with acute SMVT.
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Objective To study the short-and long-term results for Cockett syndrome caused acute deep vein thrombosis (DVT) of the lower extremity by surgical thrombectomy or catheter-directed thrombolysis.Methods One hundred and two Cockett syndrome caused acute DVT cases were treated by surgical thrombectomy or catheter-directed thrombolysis (CDT) from Jan 2006 to Dec 2011.There were 52 patients treated by CDT (group A),and 50 cases by surgical thrombectomy (group B).All patients received warfarin treatment after operation.Results There were no significant differences in general clinical characteristics between the two groups.The limb edema reduction rates between the two groups were of no significant difference(83％ ± 6％ vs.82％ ± 8％ P ＞ 0.05).The venous patency were basically the same (64.6％ ± 6.7％ vs.65.3％ ± 7.2％,P ＞ 0.05).The mean time required was shorter in group A than in group B[(30.5 ±6.7) min vs.(97.5 ±23.6) min,P ＜0.01].The average hospital stay was shorter [(9.8±5.4) d vs.(17.7 ±8.2) d,P＜0.01],and morbidity was less[13.4％ vs.42％,P＜0.01].Eighty six patients were followed up.The circunference difference of thigh,the score of vein patency between the two groups were of no significant difference (P ＞ 0.05).Conclusions Compared with surgical group,patients in CDT group have shorter hospital stay,less complication and similar long and shortterm results.
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Objective To evaluate a combination of interventional treatment and surgical exploration for acute lower limb ischemic disease.Methods We reviewed 42 cases admitted from July 2007 to January 2010,all patients complained pain,paralysis,pulselessness,pallor and paresthesia.After Fogarty thrombectomy angiography was taken in DSA room.Patients with angiostenosis greater than 50％ were then managed by interventional treatment(CDT,PTA,Stenting).Results Lives were saved in all patients,40 lower limbs were saved,and 2 patients received below knee amputation.The amputation rate was 4.76％.Dorsal or(and)posterior tibial artery of foot was felt in 33 patients,symptoms significantly improved.The other 7 patients still had painful and paralysis on the diseased limb.Conclusions The interventional treatment and surgical operation in acute lower limb ischemic disease is safe and result is satisfactory,which can improve the long-term patency and salvage rate of the lower limb.
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Objective To evaluate the safety and efficacy of SilverHawk directional atherectomy device in the treatment of arterial stenoses/occlusions of the femoropopliteal regions.Methods From April 2011 to May 2012,36 patients (28 men,8 women,age range 60 - 84y) with 40 arteriosclerotic lesions of femoro-popliteal arteries (de novo lesions in 25 arteries,in-stent restenosis in 15 arteries; Rutherford score of 3 - 5 ) were included in the treatment by SilverHawk directional atherectomy device.All the patients were diagnosed via low-extremity artery CTA and arteriography.The mean ankle brachial index (ABI) of treated limbs was 0.53 ±0.12.Results The overall technical success rate was 100％ (40/40).The procedural success rate was 87.5％ (35/40).There was no perioperative mortality with three cases developing complications,vascular injury occurred in two cases.One was treated by stent-graft while the other was managed conservatively; Procedure-related arterial embolization occurred in one case and was treated by suction through catheter.Symptoms were relieved in all patients,ABI increased to 0.72 ± 0.18.All the patients were followed up for an average of (6.4 ± 1.2) months.Postoperative restenosis developed in one case and treated with balloon angioplasty and stent placement after six month.Conclusions SilverHawk directional atherectomy device is effective and safe in treament of arterial stenoses/occlusions of the femoropopliteal lesions,with satisfactory early results.
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Objective To summarize the experience on treatment for 15 cases of acute pulmonary embolism(PE).Methods Fifteen acute PE patients admitted from June 2009 to May 2011 were analyzed retrospectively.All patients were diagnosed as PE and deep vein thrombosis,and treated with placement of inferior vena caval filters(IVC).Five patients with main pulmonary artery embolism accepted intrapulmonary arterial interventional therapy of thrombus fragmenlation and suction and catheter-directed thrombolysis (CDT).Ten patients with embolization on pulmonary artery branch and acute iliofemoral vein thrombus accepted therapy of peripheral thrombolysis.During postoperative course improvement was observed on the clinical symptoms,occurrence of complications,Miller index,change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen(PO2),as well as the patency of pulmonary artery.Result Five main pulmonary artery embolization patients gained complete patency of pulmonsnary artery,and the clinical symptoms immediately improved.Miller index reduced from (0.51 ± 0.04) to (0.27 ± 0.38),mPAP decreased from (55.3 ± 3.1 ) mm Hg to ( 32.7 ± 2.2 ) mm Hg,and PO2 elevated from ( 40 ±3 ) mm Hg to ( 63 ± 4) mm Hg,showing a significant difference ( P ＜ 0.01 ).Ten patients with pulmonary artery branch embolization gained patency of pulmonary artery branch,iliofemoral venous thrombosis cleared,and clinical symptoms significantly improved.All patients recovered after two weeks of intravenous thrombolytic,anticoagulation and antiplatelet therapy.During three to twelve months' follow up,the therapeutic effects persisted and there was no recurrence.Conclusions Emergency intrapulmonary arterial interventional therapy of acute PE has remarkable effectiveness,safety and feasibility,improving pulmonary obstruction and clinical symptoms.
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ObjectiveTo evaluate interventional therapy for Buddi-Chiari syndrome with occlusive hepatic veins.MethodsIn this study,37 Budd-Chiari syndrome cases with occlusive hepatic vein undergoing abdominal ultrasonography, CT scan, and liver vascular reconstruction before operation.Interventional procedures included recanalization of occlusive hepatic veins through transjugular,transfemoral vein or both. ResultsProcedures were successful in 34 patients (success rate 34/37,92％ ),with 38 hepatic veins opened. After hepatic vein was opened,nine patients were treated with PTA alone.27 stents were placed in 25 patients,with 2 cases receiving stent placement in both the right hepatic vein and accessory hepatic vein.7 home-made Z-stent were placed after the opening of occluded inferior vena cara.After the procedures hepatic vein pressure dropped from ( 36.0 ± 3.4) cm to ( 21.0 ± 2.3 ) cm H20.Recurrence of stenosis or oclusion was found in 4 out of 9 receiving PTA only after a follow-up of (23.0 ± 2.0) months.In the other 23 patients with stent implantation there were 6 eases of restenosis or occlusion (6/23,26％ ). ConclusionsAccording to the hepatic vein and intrahepatic collateral venous occlusion conditions,correct selection of interventional methods can significantly decrease the hepatic and portal vein pressure,improve clinical symptoms.
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Objective To evaluate the methods and efficacy of interventional treatment for subclavian arterial stenosis or occlusion retrospectively. Methods From Oct 2003 to Sop 2009,25 patients with subclavian arterial lesions , including stenosis in 13 cases and occlusion in 12 cases, underwent interventional treatment. Four patients received percutaneous transluminal angioplasty (PTA) alone, and concurrent 22 stents placement were performed in 20 cases. Results The technical success rate in stenotic lesions was 100% and in occluded lesions was 91.6% with a interventional failure in 1 case. Blood pressure increased significantly after interventional treatment. The diseased side/healthy side blood pressure index increased from 0.60 ±0.11 mm Hg preoperatively to (0.95 ±0.12) mm Hg postoperatively( t = 10.53 ,P ＜0.01 ). Clinical symptoms improved, and there were no complications with strokes and embolism. 20 cases were followed up for 30 months ( from 2 months to 69 months ). Restenosis was found in 2 cases and the restenosis rate was 8.3%. The cumulative primary patency rate was 92.5% and 81.3% at 1 and 3 years,respectively. Conclusions Intervention was a less invasive and safe, effective treatment for subclavian arterial lesions.
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Objective To evaluate the prevention and management for the complications in interventional therapy for the lower extremity arteriosclerosis obliterans (ASO). Methods In this study 207 ASO cases received interventional therapy. The relationship between complication rates and different TASC type and the influence of diabetes mellitus (DM) with coronary heart disease (CHD) on critical organs complication rates was analyzed. Results The intervention succeeded in 190 cases. There was 17 failures, including 13 procedure failures and 4 deaths due to postoperative critical organ complications. Among the complications there were puncture site hemorrhage in 12, pseudoaneurysm in 4, alimentary tract hemorrhage in 2, arteriorrhexis in 6, cerebral infarction in 8, acute heart failure in 9, respiratory failure in 13, renal failure in 6, thrombosis in 5 and blue-toe syndrome in 1. The intraoperative complication rate of femoral-political type (39.84%, 51/128) was high than that of aorta-iliac type (18.99%, 15/79) (P< 0.05). Those critical organ complication rates of patients with DM and patients with DM&CHD were 27.66% (13/47)and 24.49% (12/49)respectively, they were higher than that of patients without (5%, 2/40) (P<0.05). Conclusions The high complication rates during interventional therapy of ASO were because of misoperation and complicated pathological type and together with DM and CHD. These rates could be decreased when we treated DM and CHD before operation and chosen a reasonable method and shorten the duration of operation.
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Objective To discuss a new method of interventional and surgical therapy for the lower extremity postthrombotic syndrome (PTS). Methods 35 PTS cases were enrolled in our group. Dilation and stent placement in stenosis of iliac veins were performed in all cases, then temporary femoral arteriovenous fistula was established. After two weeks, 15 cases with varicosity underwent high ligation of the great saphenous vein and stripping, 5 cases with leg ulcers (ulcers diameter>3 cm) underwent skingrafting. After operation, patients took warfarin orally for 6 months and wear elastic compression stockings. Results Procedures were successful in all cases. Thrombectomy extracted only a few old thrombus. Before discharge, limb swelling subsided in 26 cases while 4 remain light swelling and 5 had no obviously relief. Twenty-six cases were followed-up for 3～24 monthes. Limb swelling subsided in 22 cases but still exist in 4. Limb ulcers were healed in 11 cases and the area of pigmentation were diminished. Limb ulcer recurred 12 months after skingrafting and healed finaly after perforator veins clipping with second skingrafting. Color Doppler was used in follow-up to check the potency of affected deep veins, good outcome was found in 20 cases and rough intima with stenosis of iliac veins was found in 2, no flow signal in 4. Conclusions Stenosis of iliac veins in PTS are common, the pathological changes could be treated by interveional method combined with temporary arteriovenous fistula. The degree of recanalization of femoral-popliteal veins determined the results.
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Objective To evaluate interventional therapy for left iliac vein stenosis or occlusion (left iliac vein compressed syndrome or Cokkett syndrome).Method In this study 316 cases received interventional therapy for left iliac common vein lesions,189 cases underwent staged saphenous vein high ligation and stripping,and 82 cases received external prosthetic sleeve valvuloplasty.Two hundred and thirty-one cases were followed up from 6 to 120 months(average 52 months),with all cases being evaluated by colour ultrasound,and among those 116 cases received venography.Results The stenosis or occlusive segments of left iliac vein were successfully dilated in 305 cases,of which 272 cases received stents implanting therapy.There was no inhospital mortality nor pulmonary embolism.According to following up results.the symptom of varicose vein disappeared in about 95.8%patients.and the symptom of leg swelling disappeared or dramatically relieved in about 95.7%cases.among which 74%leg ulcers were completely healed.Stents were occluded by thrombus during venography in about 5.4%. Conclusions The long term result of interventional therapy is satisfactory for left iliac vein stenosis or occlusion caused by Cockett syndrome.
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Objective To evaluate the efficacy of endovascular interventional treatment for infrapopliteal arterial ischemic diseases. Methods Sixty patients(65 limbs)of infrapopliteal arterial isehernia of the lower extremities received pereutancotm transluminal angioplasty(PTA)and/or stents implantation from November 2004 to July 2007.The symptoms,changes of ankle/brachial index(ABI),limb salvage rate and immediate patent rate were observed. Results PTA/stenting procedure was successful in 51 out of 60 patients(65 limbs)with the technical success rate of 83.3%.Symptoms were improved in 53 cases(88.3%)including complete symptom remission in 40 cases(66.7%),partial remission in 13 patients(21.7%).The procedure failed in 7 cases(11.6%).In successful cases,AB1 increased from preoperative 0.40±0.18 to postoperative 0.91±0.22(P＜0.01).The amputation below knee was performed in two cases and toe apodizers in four cases.The limb salvage rate was 91% during the same hospitalization.Discharged 54 cases were followed up with 14.5±1.2 months,during this period amputation above knee was performed in 2 cases,amputation below knee in 2 cases,and toe apodizers in 2 cases,with a limb salvage rate of 88.9%(48/54).Symptoms were recurrent in five cases,with recurrence rate of 9.2%.Vascular reocclusion or restenosis were found in 10 cases.the patent rate was 81.5% and the cumulative patent rate was 57.3% in one year. Conclusions Endovascular interventional treatment for infrapopliteal arterial ischemic disease is safe and effective.
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Objective To discuss the methods and the efficacy of interventional treatment of vascular injuries. Methods From January 2006 to March 2008, interventional therapy was performed in 13 cases of vascular injuries including injuries of internal jugular vein, subclavical artery, axillary artery,inferior vena cave, abdominal aorta, superior mesenteric artery, arteria iliaca, vena iliaca and femoral artery.Types of these injuries included arteriovenous fistula in 3, vascular rupture complicating haematoma in 4,pseudoaneurysm in 3 and arterial stenosis ensuing from injury repair in 3. Covered stent-grafts were used in 9 cases (10 stent-graft), mesh stem in 1, sealed with balloon in 2 and introcoil embolism in 1.Result Interventional procedure was successful in all these 13 cases, there was no mortality nor severe complications. Small amount of endoleak developed in thoracic aorta pseudoaneurysm and contrast leaked from internal jugular vein in left subclavical arteriovenous fistula after stent-graft insertion, these were healedconservatively. Twelve cases were followed up from 1 to 26 months. Hemoptysis occurred in patient with thoracic aorta pseudoaneurysm 12 months after intervention but without abnormality in CTA. There were no stem break, shift, deformation or stennsis and there were no recurrence of primary disease.Conclusion Interventional therapy is of less invasion, short performation duration, simple manipulation and quick postoperative recovery for vascular injuries.
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Objective To discuss the surgical and interventional treatment of vascular injuries. Methods Clinical data of 85 patients with vascular injuries were retrospectively studied by grouping. Location of injury included jugular vein, vertebral artery, main extremity vessels and superior mesenteric artery. There were 25 patients with traffic injury and 60 with stah injury, of whom 62 patients underwent surgical operation (vascular grafting were performed in 37 and vascular repair in 25) and 23 received in-tervention therapy. Results There were one death and one amputation. Fifty-eight patients were fol-lowed up, which showed that all patients had good vascular patency. Conclusions Prompt and correct diagnosis is very important for treatment of vascular injury. Interventional treatment had merits of minor trauma, short operation duration, simple manipulation and quick postoperative recovery. Surgical opera-tion and endovascular intervention can be used together in treating vascular injury.