Carotid endarterectomy combined with stent angioplasty for the treatment of tandem stenosis of carotid artery / 介入放射学杂志

Objective To investigate the safety and feasibility of carotid endarterectomy (CEA) combined with carotid artery stent angioplasty (CASA) in treating tandem stenosis of carotid artery. Methods The clinical data of 9 patients with tandem stenosis of carotid artery, who were treated at authors' hospital during the period from January 2013 to October 2014, were retrospectively analyzed. The patients included 7 males and 2 females, with a mean age of (66.0 ±4.2) years. The disease course ranged from 2 months to 36 months, with a mean of 7 months. Clinically, all patients had cerebral ischemia symptoms. Transient ischemia attack was seen in 5 patients and history of cerebral infarction was present in 2 patients. Coronary artery disease was found in 2 patients, hypertension in 6 patients and lower limb ischemia in one patient. After receiving adequate antiplatelet therapy, CEA and CASA were carried out in all patients. Results The technical success rate was 100%, postoperative residual stenosis was less than 30%, no death occurred in perioperative period. After the treatment, the clinical symptoms were improved in all 9 patients;no new stroke or cerebral hemorrhage occurred. After the treatment, 2 patients developed cerebral hyperperfusion-related symptoms such as headache and dizziness, which were much relieved at the time of discharge. The patients were followed up for 4-19 months, with a mean of (10.5±6.2) months. No recurrence of symptoms was observed . In one patient , transcranial Doppler ultrasound performed at 6 months after treatment showed that the carotid artery became moderate restenosis (50%-70%). No death occurred. Conclusion For the treatment of tandem stenosis of carotid artery, CEA combined with CASA is safe and effective, although larger sample and long-term follow-up studies are still needed to further confirm the effect.

The application of multipoint puncturing technique in performing endovascular therapy for complex lower extremity arterial occlusive diseases Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China / 介入放射学杂志

Objective To discuss the methods, advantages and indications of multipoint puncturing in performing endovascular therapy for complex lower extremity arterial occlusive diseases. Methods During the period from Oct. 2011 to Oct. 2013, a total of 46 patients with complex lower extremity arterial occlusive diseases were treated with endovascular therapy by using multipoint puncturing technique. The puncturing type, the advantages of multipoint puncturing technique and the success rate of this technique were analyzed. Results The multipoint puncturing was divided into three types: type Ⅰ : puncturing from the opposite direction to deal with the same target vessel; type Ⅱ: direct puncturing of the target vessel; and type Ⅲ:using the same puncturing direction to deal with different target vessels. The success rate of endovascular treatment was 80.4%. Conclusion Multipoint puncturing technique helps improve endovascular treatment success rate for lower extremity arterial occlusive diseases. Full understanding of the advantages of multipoint puncturing technique, perfect preoperative planning, precise puncturing technique and proper interventional equipments are helpful to ensure a successful treatment.

Puncture complications of axillary artery approach in endovascular treatment / 中华普通外科杂志

Objective To explore the indications of axillary artery approach in endovascular treatment and to analyze complications associated with axillary artery puncture.Methods In 111 cases endovaccular treatment via axillary artery approach by Seldinger technique was performed.The indications of axillary artery approach and the complications associated with axillary artery punture were respectively analyzed.Results The success rate of angiography was 100％,and the success rate of angioplasty was 90.8％ by axillary artery approach.The total incidence of complications was 10.3％.The incidence of local hematomas was 4.8％,nerve injury was 3.2％,pseudoaneurysm was 0.8％,acute thrombosis of the axillary artery was 0.8％,acute thrombosis of the axillary vein was 0.8％.The main factors affecting complications include vascular conditions,perioperative medication,anatomy of the axillary artery,location of puncture point,the success rate of first attempt,and pressure of bandage.Conclusions The axillary artery approach increases the success rate of endovascular treatment.Reasonable choice of axillary artery appruch,meticulous perioperative management and fully understanding the anatomical characteristics of the axillary artery can decrease the complications of axillary artery puncture.