Mid-term outcomes between different typing uncomplicated acute type B aortic dissection treated with thoracic endovascular aortic repair in a single center / 中华普通外科杂志

Objective:To investigate the imaging characteristics of uncomplicated acute type B aortic dissection (uATBAD) and the short-term and mid-term outcomes treated with thoracic endovascular aortic repair (TEVAR).Methods:One hundred and forty uATBAD patients treated by TEVAR at Zhejiang Provincial People's Hospital from Jan 2015 to Aug 2021 were retrospectively analyzed. Patients were divided into non-high-risk characteristics group (uATBAD group, 22 cases) and high-risk characteristics group (high-risk uATBAD group, 118 cases) according to the presence or absence of high-risk characteristics. The clinical and follow-up data were analyzed, and the incidence of complications, re-intervention rate, and mortality in the perioperative period and 5-year follow-up were evaluated.Results:The aortic diameter, false lumen diameter and the proportion of laceration in lesser curvature in the high-risk group were higher than those in the non-high-risk group ( P<0.05). There was no significant difference in the incidence of perioperative complications and 30 day mortality between two groups ( P>0.05). The follow-up time ranged from 6 to 83 months (mean 38.3 months). The 5-year mid-term follow-up showed that there was no significant difference in the incidence of aorta-related complications, re-intervention rate, and mortality between two groups ( P>0.05). Conclusions:The imaging characteristics of different typing uATBAD were significantly different. The short- and mid-term clinical effects of TEVAR were similar between the two groups.

Long-term follow-up result for the foam sclerotherapy in the treatment of lower extremity incompetent perforating veins / 中华普通外科杂志

Objective To evaluate the long-term follow-up results of foam sclerosing agent in the treatment ofincompetent perforating vein.Methods 153 cases (316 incompetent perforating veins)received the treatment of foam sclerotherapy.The closure of perforating branches was followed up by ultrasound.Results 12 cases (27 incompetent perforating veins) were lost to follow up.289 incompetent perforating veins got follow up,The median follow-up time was 17 months (11-36 months).Closure rate was 100％ in vessels less than 3 mm in diameter,while that was 76％ invessels with the diameter between 3-5 mm.Closure rate was 16％ in vessels larger than 5 mm in diameter.Conclusion The long-term efficacy of the foam sclerosing agent in the treatment of incompetent perforating vein depends on the diameter of the vein.

Endovascular treatment of abdominal aortic aneurysm and aortic bifurcation stenosis by unibody bifurcation stent graft / 浙江大学学报·医学版

OBJECTIVE@#To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis.@*METHODS@#Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed.@*RESULTS@#Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed.@*CONCLUSIONS@#Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.

Thrombelastography in evaluating effect of antiplatelet drugs for patients undergoing peripheral endovascular treatment and relationship with ischemic-events-free duration / 中华普通外科杂志

Objective To evaluate the effect of antiplatelet drugs and ischemic-events-free duration by thromboelastography (TEG) in patients undergoing peripheral endovascular treatment.Methods From Mar 2015 to Oct 2016,38 patients undergoing initial successful peripheral stenting and then coming back for recurrent ischemic events.TEG was used to evaluate the platelet inhibition rate induced by arachidonic acid (AA％) approach,the platelet inhibition rate induced by adenosine diphosphate (ADP％) approach,and the ADP-induced platelet-fibrin clot strength (MAADP).Clinical feature differences between patients with MAADP ＞ 47 mm and MAADP ≤ 47 mm were compared.Results AA％ less than 50％ was found in 9 patients(23.9％),and ADP％ less than 30％ in 14 patients(36.8％).5 patients met the two conditions.Patients with MAADp ＞ 47 mm had a significantly lower ADP％ (x2 =10.755,P ＜ 0.001),compared to patients with MAADP ≤47 mm.Univariate survival analysis showed ADP％ ＜ 30％ and MAADP ＞47 mm were risk factors for getting shorter ischemic-events-free duration,compared to patients with ADP％ ≥ 30 (P ＜ 0.001),with MAADP ≤47 mm (x2 =4.408,P =0.036).Conclusions TEG may detect those patients who has a low response to antiplatelet drugs,and some TEG parameters may have a ischemic predictive value.

Ultrasound guided foam sclerosis for the treatment of lower extremity incompetent perforating veins / 中华普通外科杂志

Objective To discuss the curative effect and clinical significance of sclerosing foam agent in the treatment of chronic venous diseases (CVD) with incompetent perforating veins.Methods 65 cases of C4,C5,C6 CVD (a total of 84 limbs) underwent foam sclerotherapy closure for incompetent perforating vein.Patients were followed-up for 3 months,ultrasonography was used to observe the closure of perforating veins and the curative effect.Results 7 patients (9 limbs) were lost to follow-up,all with grade C4.In the 66 (C4,C5) limbs,pigmentation significantly subsided in 45,partial regression in 9,no change in 2.In the 9 limbs with grade C6,complete healing of ulcer in 5,partially healed in 3.Ultrasound observed satisfactory perforating vein closure.Conclusion Foam sclerotherapy closure for incompetent perforating vein has satisfactory effect,with good short-term curative result.