Application and value of intravascular ultrasound for excimer laser ablation combined with drug-coated balloon in the treatment of lower limb arteriosclerotic obliterans / 中华外科杂志

Objective: To examine the value of intravascular ultrasound (IVUS) for excimer laser ablation (ELA) combined with drug-coated balloon (DCB) in treating lower limb arteriosclerotic obliterans (ASO). Methods: As a prospective case series study, patients who underwent ELA combined with DCB for lower limb ASO with the guidance of IVUS from September 2021 to March 2022 at Department of Vascular Surgery, Zhongshan Hospital, Fudan University were enrolled prospectively. Lesion characteristics, procedure-related outcomes and complications were collected. The therapy outcomes were compared with baseline data by paired t test. Results: There were 8 males and 2 females, aged (72.0±5.9) years (range: 61 to 81 years). Of all the 11 lesions, there were 8 lesions in superficial femoral artery and 3 in popliteal artery. The lesion length was (7.0±2.4) cm (range: 3.2 to 9.8 cm). There were 4 chronic totally occlusion and 7 severe stenosis. All patients underwent the operation successfully. The technical success rate was 10/11. Bailout stenting was performed in one lesion because of flow-limiting dissection. Four lesions were grade 3 to 4 in peripheral artery calcium score system, and 9 lesions with calcification arc≥180°. Larger diameter drug-coated balloons were selected in 5 lesions after measurement of intravascular ultrasound. The follow-up time was (6.0±1.9) months (range: 3 to 9 months). The ankle-brachial index of the patient was significantly improved immediately after surgery (0.97±0.13 vs. 0.48±0.18, t=-7.60, P<0.01) and at 3 months after surgery (0.95±0.12 vs. 0.48±0.18, t=-7.17, P<0.01). The 3-month primary patency rate was 11/11, the target lesion reintervention was 0 and ulcer healing rate was 3/4. Conclusion: IVUS assisted ELA in the treatment of lower limb artery lesions is safe and effective in early stage.

Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency / 中华医学杂志(英文版)

BACKGROUND@#Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.@*METHODS@#Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis.@*RESULTS@#A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency.@*CONCLUSION@#Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.

Evaluation of acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.</p><p><b>METHODS</b>We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage (RIFLE) kidney disease criteria. The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.</p><p><b>RESULTS</b>Of the 71 patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU). Risk factors for AKI were ruptured AAA (odds ratio (OR) = 5.846, 95% confidence interval (CI): 1.346 - 25.390), intraoperative hypotension (OR = 6.008, 95%CI: 1.176 to 30.683), and perioperative blood transfusion (OR = 4.611, 95%CI: 1.307 - 16.276). Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in Surgical Intensive Care Unit.</p><p><b>CONCLUSIONS</b>Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.</p>

Management of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair / 中华医学杂志(英文版)

We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery.

The development of a type II endoleak domesticated pig model with continuous pressure monitor / 中华外科杂志

<p><b>OBJECTIVE</b>To develop a type II endoleak porcine model with continuous pressure monitor by the strain-gauge pressure transducer and the patch.</p><p><b>METHODS</b>Nine tamed porcine was randomized as the experiment group of 6 domesticated pigs and the control group of 3 domesticated pigs. When the abdominal aortic aneurysm (AAA) was created, the 2(nd) and 3(rd) pair of infrarenal lumber arteries were preserved in the experiment group, while ligated in the control group. The stent-graft was implanted in the endovascular repair. CT angiography was performed to seek endoleak, and the angiography was performed to excluded the type I and type III endoleak. The pressure in the excluded AAA monitored by the strain-gauge pressure transducer was recorded and compared in both groups to evaluated the effect of type II endoleak in the experiment group.</p><p><b>RESULTS</b>The AAA porcine model with pressure monitor were successfully developed in all 9 porcine. The endoleak and the retrograde flow of the lumber arteries were confirmed by CT angiography in the experiment group. The ratio of the average pressure after the procedure to before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). The ratio of the pulse pressure after the procedure to the average pressure before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020).</p><p><b>CONCLUSION</b>It is feasible to develop type II endoleak domesticated pig model by preserving the lumber arteries for the retrograde flow, and the AAA model with pressure monitor by the strain-gauge pressure transducer and the patch.</p>

Study on the professional assessment standards of clinical pharmacy / 中华医学教育探索杂志

Professional assessment in Chinese Higher Education has made great progress in three stages: the sporadic practice, trial and promotion. The authors present several comments on the characteristics and the professional assessment standards of clinical pharmacy in China, and focus on the scientific system of professional assessment.

Complications in endovascular repair of abdominal aortic aneurysms: treatment and prevention / 中华外科杂志

<p><b>OBJECTIVE</b>To review the prevention and treatment strategies in the complications after endovascular repair (EVAR) of abdominal aortic aneurysms, retrospectively in a single medical center.</p><p><b>METHODS</b>From January 2003 to December 2010, clinical data of 344 EVAR cases were analyzed retrospectively, including postoperative period and long-term results. There were 302 male and 42 female patients, with a mean age of (69 ± 8) years. Patients were followed up at 3 months, 6 months, and then every year with abdominal x-ray and spiral CT angiography.</p><p><b>RESULTS</b>The surgical success rate was 99.7% (343/344). The mortality with elective and emergency surgery was 0.30% (1/334) and 1/10 respectively. The average follow-up time was 3 to 84 months with a mean of 32.9 months. The follow-up rate was 81.8% (279/341). The mortality was 1.1% (3/279), the re-intervention rate was 10.4% (29/279) and the overall complication rate was 12.9% (36/279), including endoleak 5.7% (16/279), stent-graft migration 1.1% (3/279), aneurysm expansion or rupture 5.4% (15/279), limb occlusion 2.5% (7/279) and stent-graft infection 1.4% (4/279).</p><p><b>CONCLUSION</b>EVAR has allowed a minimally invasive approach to aortic pathology. A careful preoperative assessment is the key for EVAR. Endoleak continues to be the major long-term complication of the endoluminal grafting technique, and the major cause for re-intervention. Life-long follow-up is an integral part of EVAR.</p>

Surgical treatment of renal stenosis: a report of 80 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of surgical treatment for renal stenosis.</p><p><b>METHODS</b>Eighty cases from November 1997 to August 2008 were reviewed, including 53 males and 27 females, aged from 9 to 80 years old. There are 42 atherosclerosis, 23 Takayasu arteritis and 11 fibrodysplasia patients. Surgical procedures included aorto-renal bypass for 13 cases, autogenous renal transplantation for 5 cases, nephrectomy for 1 case, renal endarterectomy for 1 case, lesion resection and reconstruction for 1 case, balloon angioplasty for 14 cases, and stent implantation 48 cases.</p><p><b>RESULTS</b>There were 1 mortality peri-operation. During follow-up (1 to 129 months), 2 among 63 patients died. Significant decline of blood pressure [(135.7 +/- 15.8)/(80.1 +/- 8.5) mm Hg (1 mm Hg = 0.133 kPa) vs. (149.8 +/- 18.3)/(88 +/- 13.6) mm Hg, P < 0.01] and totally 65.6% effective rate were observed. Atherosclerosis, Takayasu arteritis and fibrodysplasia group all presented positive anti-hypertension results with 50%, 73.3% and 100% effective rate respectively (P < 0.05). The creatine level also underwent significant decrease [(112.7 +/- 53.6) micromol/L vs. (131.7 +/- 91.7) micromol/L, P < 0.05], mainly in atherosclerosis group [(127.2 +/- 56.6) micromol/L vs. (138.0 +/- 87.0) micromol/L, P < 0.05].</p><p><b>CONCLUSIONS</b>Surgical treatment of renal stenosis can achieve improvement in hypertension and renal function. Endovascular stent and angioplasty are the first choices for atherosclerotic and fibrodysplasia patients respectively, while open surgery is better for Takayasu arteritis ones.</p>

Prospective study of coverage of left subclavian artery during thoracic endovascular aortic repair in a single center / 中华外科杂志

<p><b>OBJECTIVE</b>To describe observation of security and availability of covering left subclavian artery during thoracic endovascular aortic repair (TEVAR) in follow-up.</p><p><b>METHODS</b>From December 2007 to December 2008, 111 consecutive patients received stent grafts to treat lesions involving thoracic aorta. According to the covering of left subclavian artery, four groups including total covering (TC), less-than 50% covering (LTC), more-than 50% covering (MTC) and non-covering (NC) were formed. Difference of blood pressure between two upper extremities was required before TEVAR and 1st, 3rd, 5th, 30th day after TEVAR. Patients were evaluated postoperatively and at follow-up for stroke as well as symptoms of paraplegia, hemiparalysis or left upper extremity claudication.</p><p><b>RESULTS</b>Fifty-five (49.6%), 18 (16.2%), 7 (6.3%) and 31 (27.9%) cases were divided into TC, LTC, MTC and NC groups, respectively. Difference of blood pressure between TC and the 3 latter groups were significantly different (P<0.01). Complications appeared as followed during one week after TEVAR: 13 patients in dizziness, among which 5 patients suffered from amaurosis and spotted vision, and 7 patients in left upper extremity claudication. No stroke, paraplegia or hemiparalysis in TC. Thoracic aortic lesions were successfully excluded in all patients.</p><p><b>CONCLUSIONS</b>Intentional coverage of left subclavian artery to obtain an adequate proximal landing zone during TEVAR is safe and well-tolerated. But it may be managed expectantly with some exceptions for further lasting efficacy.</p>

The indication and time of treatment of thoracic endovascular aortic repair in acute Stanford B dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection.</p><p><b>METHODS</b>From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups.</p><p><b>RESULTS</b>The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P<0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P<0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P<0.01). Four out of 24 cases of intramural hematoma had recurrent dissection.</p><p><b>CONCLUSIONS</b>Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.</p>

Short to midterm results of endovascular for 105 case of infrarenal abdominal aortic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To assess short to midterm outcome of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA) in 105 cases.</p><p><b>METHODS</b>Stent-grafts were placed into 105 patients with infrarenal AAA between January 2001 and February 2007. The clinical data of those cases were retrospectively analyzed.</p><p><b>RESULTS</b>Primary technical success rate was 100%. Eighty-two cases (78.09%) were followed-up for 1 to 73 months (mean, 8.9 +/- 5.8 months). Three cases (2.86%) died during peri-operative period, from acute cardiac infarction, multi-organ failure and significant upper gastrointestinal bleeding, respectively. Another one died from hepatic cancer 30 months after EVAR. Twenty-one cases experienced primary endoleak. Eighteen were type I, among which 10 underwent secondary intervention in the form of balloon dilatation (n = 9) and stent-graft placement (n = 1), 8 sealed spontaneously. Two cases were type II and sealed spontaneously. One type III was treated by placing a stent-graft. An emergent femorofemoral crossover was performed for one graft limb thrombosis 2 weeks after EVAR. Four late type I endoleaks occurred. One stent-graft migration without endoleak was cured conservatively. Two stent-graft infections occurred 1 month and 3 months after EVAR respectively, and were cured with debridement, drainage and antibiotics. Nine femorofemoral or iliofemoral bypass and three internal iliac bypasses were all patent during the follow-up period.</p><p><b>CONCLUSION</b>Endovascular repair is a safe and effective method for infrarenal AAA with perfect short to midterm outcomes.</p>

Endovascular repair of descending thoracic aortic aneurysm: preliminary experience / 中华外科杂志

<p><b>OBJECTIVE</b>To report an initial experience with the endovascular repair of descending thoracic aortic aneurysm (DTAA).</p><p><b>METHODS</b>Endoprostheses were placed into 41 patients with DTAA between January 2001 and July 2007 which were retrospectively analyzed. The preliminary right-left carotid and left carotid-subclavian bypass was performed in 4 cases in which the distances from the proximal aneurysm to the origin of the left common carotid artery were no longer than 15 mm. EVAR was conducted 1 week after the bypass or immediately.</p><p><b>RESULTS</b>All stent grafts were deployed in proper position. There were two deaths (4.9%) during perioperative period, resulting from multiorgan failure and acute cardiac infarction, respectively. Eighteen endoleaks occurred immediately after EVAR (43.9%), four disappeared after balloon dilatation. There were two acute renal insufficiencies (4.9%), one requiring hemodialysis for more than 30 days. Follow-up, which ranged from 1 to 60 months [median, (18.6 +/- 4.2) months] was carried out in 26 patients (63.4%). Type-I endoleak and type-III endoleak were detected in two patients in 4 years and 2 years after EVAR, might because of migration, and were corrected using another stent-graft each. Two patients died of other diseases during follow-up. Complete thrombosis of the thoracic aneurysm sac with no late migration or endoleaks was revealed on CT at 3 months postoperatively in the remaining patients. The decrease in maximal aneurysm diameter was 0-22 mm [median, (8.3 +/- 4.5) mm] and the prosthetic vascular grafts in four patients with preliminary carotid subclavian bypass surgery were patent during the follow-up period.</p><p><b>CONCLUSIONS</b>The treatment of descending thoracic aortic aneurysm with an endovascular approach is feasible with less trauma, quick recovery and less complications. It may offer the best means of therapy for high risk patients.</p>

Endovascular stent-grafts for the treatment of isolated iliac artery aneurysms: a report of 14 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endovascular repair (EVR) for isolated iliac artery aneurysms (II AA).</p><p><b>METHODS</b>Fourteen patients were treated with transluminally placed endovascular stent-grafts from October 2004 to May 2006. In eight patients, the aneurysms involved the right common iliac arteries. In five cases, left common iliac arteries were involved. The aneurysm involved the left internal iliac artery and ruptured in the other case. Criteria for repair were a diameter over 3.0 cm for true aneurysms.</p><p><b>RESULTS</b>Technical success was achieved in all cases. Eight cases with right common iliac artery aneurysms were treated with bifurcated aorto-iliac stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with right common iliac artery aneurysm involved the bottom of abdominal aorta was treated with AUI stent-graft and femorofemoral bypass. Five cases involved left common iliac arteries were treated with tubular stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with ruptured left internal iliac artery aneurysm was treated emergent with tubular stent-graft after ipsilateral internal iliac artery embolization with coils. Aortography carried out immediately after the procedure showed the II AA were completely excluded by stent-grafts and no serious endoleaks both on the proximal or distal connections. One case with acute left ventricular dysfunction and alveolar edema postoperatively recovered after emergent treatment No complications in thirteen cases. All patients were followed up for a mean of 10.2 months (3 to 19 months) by CTA, no aneurysms enlargement, no stent-grafts migration, no endoleak, femorofemoral bypass was patent.</p><p><b>CONCLUSIONS</b>Endovascular repair of isolated iliac artery aneurysms is a minimally invasive,safe and feasible technique and provides good short-term patency. Long-term patency is followed.</p>

Recent results of carotid stenting for treatment of extracranial carotid occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the recent results of CAS performed by vascular surgeons to treat extracranial carotid occlusive disease (ECOD) retrospectively in a single medical center.</p><p><b>METHODS</b>Forty-eight carotid arteries underwent CAS. Procedures were transfemoral. The postoperative follow-up was separated to 2 periods (<or=30 d and >30 d). The mortality and all kinds of complications were analyzed.</p><p><b>RESULTS</b>91.7% of them were men; 8.3% were women; mean age was (70.6 +/- 5.9) years. Preoperative asymptomatic cases were 37.5%; symptomatic cases were 62.5%. Mean internal carotid artery diameter stenosis was (71.2 +/- 14.8)%. 43.8% patients had single preoperative risk factors; two or more of these risk factors were present in 47.9%. In 33.3% cases the contralateral carotid artery had 50% or greater stenosis or was completely occluded. Technical success was achieved in 100%. There were no death, no major or minor stroke but 4.2% TIA. Carotid sinus compression syndrome occurred in 18.8% of patients. At follow-up > 30 days, there had been 4.2% instances of in-stent recurrent stenosis great than 50%, noted by color doppler ultrasound scanning. No stent deformity happened.</p><p><b>CONCLUSION</b>CAS can be preformed safely enough in patients with ECOD at high CEA risk, with lower perioperative morbidity and mortality.</p>

Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge.</p><p><b>METHODS</b>Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type III dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases.</p><p><b>RESULTS</b>Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA.</p><p><b>CONCLUSIONS</b>Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.</p>

Strategies for handling the insufficiency of the proximal landing zone during endovascular thoracic aortic repair / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss two strategies for handling the insufficiency of the proximal landing zone (PLZ) during endovascular thoracic aortic repair.</p><p><b>METHODS</b>Ten patients underwent endovascular repair (EVR) in the thoracic aorta in one year. Nine patients had DeBakey type III aortic dissection aneurysm (ADA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or the proximal aspect of DTAA, was measured less than 15 mm in all instances by contrast-enhanced CT scan and digital subtraction angiography. The preliminary carotid-carotid and left carotid-subclavian bypass combined with EVR was employed in the DTAA and 3 ADA cases, and the EVR with the intentional coverage of the LSA without the preliminary bypass in the rest 6 ADA patients.</p><p><b>RESULTS</b>The technical success was achieved in all instances. The case of DTAA died of the hemispheric cerebral infarction and subsequent multiple system organ failure, albeit the uneventful recovery from the prior cervical reconstruction. Dizziness occurred in 2 patients (ADA) after the EVR with the intentional bypass-absent coverage of the LSA, but noticeably resolved after the intravenous administration of mannitol for 4 to 5 days. No neurological deficits or limb ischemia developed perioperatively or during the follow-up range from 3 to 12 months. And complete thrombosis of the thoracic aortic false lumen and enlargement of the true lumen were revealed on CT at 3 months in all 9 patients with ADA.</p><p><b>CONCLUSIONS</b>Both the adjunctive surgical bypass and the intentional bypass-absent coverage of the left subclavian artery appear feasible in handling the insufficiency of the proximal landing zone during the endovascular thoracic aortic repair. It can expand the EVR applicability in management of DeBakey type III ADAs and DTAAs.</p>

The application of intravascular ultrasound imaging in the diagnosis of aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic dissection.</p><p><b>METHODS</b>Eighty-two patients with aortic dissection were admitted. The role of IVUS was evaluated and compared with CT, MRI, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), Duplex scanning and digital subtraction angiography (DSA).</p><p><b>RESULTS</b>The different laminar appearance of the outer wall of the true and false lumen, characteristic alterations in the true and false lumen junction and the thrombosis in the false lumen detected by IVUS were useful to differentiate the true from the false lumen. Static and dynamic narrowing, causing visceral ischemia could be detected by IVUS imaging. The detection rate of entry site by IVUS was 100%, higher than CT (28%), MRI (22%), TTE (2%) and TEE (61%), P < 0.01, having no statistic difference with DSA (88%). The detection rate of the distal end of the dissection by IVUS was 100%, higher than Duplex (21%), P < 0.01, but had no statistic difference as compared with CT (89%) and MRI (86%). The detection rate of visceral arteries by IVUS was 98%, higher than CT (56%), MRI (57%), Duplex (17%) and DSA (66%), P < 0.01. The aortic diameter measured by IVUS was correlated well with CT measurement (r = 0.94, P < 0.01).</p><p><b>CONCLUSIONS</b>A full picture of aortic dissection can be obtained using IVUS imaging. It has an advantage over routine examinations in detecting visceral artery origin and clarifying visceral ischemia causes.</p>

Surgical treatment of acute embolism of the upper extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity.</p><p><b>METHODS</b>Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity.</p><p><b>RESULTS</b>Both the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively.</p><p><b>CONCLUSIONS</b>Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.</p>