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Objective By using computer tomography (CT) to evaluate the left common iliac vein (LCIV) minor diameter and stenosis in deep vein thrombosis (DVT) patients and normal population,and to explore the correlation between LCIV compression and left-sided DVT.Methods Measurement and calculation of LCIV minor diameter and stenosis were conducted in 19 right-sided DVT,60 left-sided DVT and 218 control subjects.Multiple factors regression analysis was used to study the correlation of LCIV minor diameter and stenosis with left-sided DVT.Results In control group,51.8％ had greater than 50％ compression of LCIV,and 24.3％ had greater than 70％ compression.LCIV diameter in women [(4.7 ± 2.7) mm] was significantly smaller than that of men [(6.6 ± 3.3) mm,P ＜ 0.05)].LCIV diameter in leftsided DVT [(2.4 ± 1.0) mm] was significantly smaller than that in control group [(5.4 ± 3.1) mm,P ＜0.001)] or right-sided DVT [(6.2 ± 1.8) mm,P ＜0.01].LCIV stenosis in left-sided DVT [(78 ±8) ％]was higher than that in control group [(49 ±25)％,P ＜0.01)] or right-sided DVT [(38 ±21)％,P ＜0.01)].The odds of left DVT increased by a factor of 2.69 for each millimeter decrease in LCIV diameter (P ＜ 0.001,95％ CI 1.91-3.77),and 2.78 for each ten percent increase in LCIV stenosis (P ＜ 0.001,95％ CI 1.95-3.96).With LCIV stenosis ＞75％,the risk of left DVT was associated with an 11.10-fold increase,and with LCIV diameter ＜ 2.5 mm,the risk was associated with a 13.57-fold increase.Conclusions LCIV compression was an independent risk factor for left-sided DVT.Patients with severe LCIV compression were at high risk for left-sided DVT.
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Objective To observe the effect of granulocyte colony-stimulating factor carried by fibrin gel on the total number of peripheral white blood cells and neovascularization of ischemic muscle in rat hindlimb ischemia model.Methods Thirty male SD rats were subjected to right hindlimb ischemia and randomly divided into three groups:Gel + G-CSF,G-CSF,and PBS,respectively injected with Gel+G-CSF,G-CSF and PBS.WBCs was detected before and 1,3,5,7 days; At first week and fourth week after surgery,5 rats in each group were sacrificed,and after histological detections was performed,blood vessels density counted.Results The peak value of WBCs counts in group Gel + G-CSF (14.69 ± 1.11 × 109/L)appeared at postoperative day 1 was significantly lower than that in group G-CSF (21.00 ±2.26 × 109/L) at postoperative day 3.The capillary density in group Gel + G-CSF (686 ± 108/mm2) was significantly higher than that in group G-CSF (491 ± 110/mm2) and group PBS (252 ± 78/mm2),P ＜ 0.05.The α-SMA-positive blood vessel density in group Gel + G-CSF (6.1 ± 0.8/mm2) was significantly higher than that in group PBS (2.6 ± 1.3/mm2),P ＜ 0.05.In group Gel + G-CSF,there were many VEGF-positive cells infiltrating in ischemic limb.Conclusions Gel + G-CSF promotes neovascularization in ischemic muscle,and induced more modest WBCs counts increase than the treatment with G-CSF.
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Objective To evaluate the feasibility,efficacy,and short to mid-term results of endovascular management of acute type B aortic dissection complicating visceral or lower limb malperfusion.Methods A retrospective study was conducted in 23 consecutive patients with acute type B dissection complicating visceral or lower limb malperfusion treated endovascularly at a single center between July 2001 to December 2012.Of the 23 patients identified [20 men,3 women; mean age (52 ±9) ranging 42-75]presented with clinical and imaging evidence of end-organ malperfusion:renal artary in 5 (21.7％),superior mesenteric artery in 9 (39.1％),celiac trunk in 3 (13％) and lower limb in 6 (20.1％),artary renal and lower limb in 2.Results All patients had stent-graft coverage of the proximal entry tear.11 (47.8％) patients needed additional branch vessel stenting.Successful correction of malperfusion was achieved in all the patients and the successful rate of operation and technology was 100％.In 1 patient,ischemia in the lower limb was resolved after a stent was implanted to the right iliac artery.In another patient,complicated with lower limb ischemic necrosis,amputation was performed after one stage stent-graft placement.The duration of follow-up was 6 months to 72 months,mean (21 ± 11)months.There was no migration of stent-graft and end-organ ischemia.No patients suffered from paraplegia in this group.Conclusions Endovascular coverage of the proximal entry tear in acute type B aortic dissections complicating end-organ malperfusion is a reasonable first line treatment.But some cases may need a combination branch vessel stenting.
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Objective To evaluate femoral artery ligation for femoral artery pseudoaneurysm secondary to drug injection. Methods Clinical data of 32 drug addicts of femoral artery pseudoaneursysm caused by drug injection undergoing femoral artery ligation and local debridement were reviewed retrospectively.The blood supply of affected limb was evaluated by oxygen saturation of distal limb and its function.All the cases were followed up at 3,6,9,and 12months after the operation. Results Surgery was successful in all cases. There were no significantly difference of the limb oxygen saturation between postoperative and preoperative period (95.1％ ± 2.8％ vs.96.9％ ± 1.9％ ; t =1.26,P =0.25 ).White blood cells and neutrophils percentage significantly decreased after surgery.All patients were followed up for 1 year.Lower extremity ischemia after 6 hours of operation in one case treated by autologous saphenous vein bypass recovered. On 3 months mild claudication was observed in 5 cases. On 6 months claudication remained in only 2 cases,which disappeared on 9 months.All patients were able to maintain normal life.Conclusions Femoral artery ligation is a safe, effective and simple treatment modality for femoral pseudoaneurysms secondary to drug injection.
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Objective To evaluate endovascular treatment of Budd-Chiari syndrome(BCS)with occlusion of hepatic veins.Methods Retrospective analysis on the clinical materials of 32 BCS cases with occlusion of hepatic veins was made.Four cases received inferior vena cava(IVC)angioplasty or stent implant and splenorenal shunt;Transfemoral vein or transjugular hepatic vein angioplasty was performed in 10 cases,and percutaneous transhepatic recanalization combined with transjugular and/or transfemoral vein angioplasty of hepatic veins was performed in 16 cases,respectively.Two cases failed therapy attempt.Results A failure to find the main hepatic vein in percutaneous transhepatic venography lead to the abandent of therapy in 2 cases.Hepatic vein angioplasty and IVC angioplasty was successful in the other 30 cases.The pressure of hepatic vein decreased from(43±8)cm H_2O to(16±4)cm H_2O(t=21.23,P<0.01).The symptoms were obviously relieved,ascites disappeared,abdominal distension palliated,chest and abdominal wall varicose veins collapsed one week after endovascular treatment.During perioperative procedure,2 cases with liver puncture bleeding were cured by laparotomy.The follow-up duration was 5 months to 65 months and mean(26.0±2.0)months.There was no stent migration and hepatic vein restenosis and occlusion.Chest and abdominal wall varicose veins disappeared and esophagus phlebeurysma were ameliorated as shown by esophageal barium series.There were no pulmonary embolism and death.Conclusions The procedure of endovascular treatment of BCS with occlusion of hepatic veins is simple,mini-traumatic and effective.
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Objective To explore the application of autologous bone marrow stem celI transplantation in the treatment of chronic ischemic disease of lower extremity and evaluate the effect.Methods Forty patients with chronic ischemic limbs were treated from January 2008 to April 2009.The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(GCSF),300?g /d,for 2-3 days.Then,200 mL of bone marrow was withdrawn from the iliac spine and the stem cells were obtained.After the bone marrow separation and purification,they were transplanted into the more severely ischemic limb.After the transplantation,they were foIlowed up by phone once a month for six months.The skin temperature,transcutaneous oxygen pressure(TcPO2),digital subtraction angiography(DSA)and ankle/brachial index(ABI)were rechecked at 6 months later,and the symptoms of pain,cold,numbness,intermittent claudication and physical signs of ulcer and gangrene were also evaluated.Results All of the 40 patients were followed-up.At 6 months post-transplantation,the various indices were compared with before transplantation.(1)The skin temperature and TcPO2 had significante improvement (P0.05).(3)DSA and all of the clinical symptoms showed general improvement in more than 60% of cases.(4)There were no serious complications.Conclusions Transplantation of stimulated autologous bone marrow stem cells is effective in the treatment of ischemic disease of lower limb,which is a simple,safe and effective treatment for ischemic disease of lower limb.
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Objective To evaluate the effect of left gastric venous caval shunt in the treatment of portal hypertension. Methods Eight patients suffering from portal hypertension underwent left gastric venouscaval shunt. The graft was of autogenous vein in 5 cases and artificial vein in 3 cases. Results There was no mortality and major complication nor early rebleeding. All patients were followed up from 10 mos to 10 years with an average of 5 years and 2 mos.Postoperatively,5 cases retrieved active living style. Two cases died, and one was lost during the follow-up. Conclusion Left gastric venous caval shunt decreasesthe venous pressure of the portal system within pericardiac and lower esophageal area. The shunt is a safe and effective surgical treatment presenting less alterations to splanchnic hemodynamics and with an additionaladvantage for pericardial devascularization.