Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.</p><p><b>METHODS</b>Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.</p><p><b>RESULTS</b>We achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.</p><p><b>CONCLUSIONS</b>Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.</p>

Surgical treatment of 154 patients with non-traumatic acute lower limb ischemia / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical treatment and prognosis of non-traumatic acute lower limb ischemia, and compare the morbidity and prognosis of acute arterial embolism and acute arterial thrombosis.</p><p><b>METHODS</b>The clinical data of 154 acute lower limb ischemia patients surgically treated from July 1999 to December 2007 were retrospectively analyzed. Fogarty catheter embolectomy was used in all patients; in which, 128 cases underwent Fogarty catheter embolectomy only, 8 cases Fogarty catheter embolectomy combined with endarterectomy, 13 cases Fogarty catheter embolectomy combined with vascular reconstruction with prosthetic graft or great saphenous vein, 5 cases Fogarty catheter embolectomy combined with amputation. The patients were divided into two groups according to pathogenesis: acute arterial embolism group (99 cases) and acute arterial thrombosis group (55 cases). The morbidity, amputation, perioperative mortality rates and high risk factors of amputation in the two groups were compared.</p><p><b>RESULTS</b>Female experienced acute arterial embolism more often than man (60.6% vs 39.4%, P < 0.05), and more acute arterial thrombosis occurred in man (72.7% vs 27.3%, P < 0.05). The amputation rate of all cases was 9.7%, and perioperative mortality rate was 11.7%. The amputation rate in acute arterial embolism group was lower than acute arterial thrombosis group (5.1% vs 18.2%, P < 0.05). The perioperative mortality rates in the two groups were equal (11.1% vs 12.7%, P > 0.05). The statistically high risk factor of amputation for two groups was ischemic time, and smoking and diabetes were high risk factors for acute arterial thrombosis.</p><p><b>CONCLUSIONS</b>Men experiences acute arterial thrombosis more often, and women experiences acute arterial embolism more often. The amputation rate of acute arterial embolism is lower than acute arterial thrombosis, and acute arterial thrombosis has more high risk factors of amputation.</p>

Endovascular therapy and arterial bypass for subclavian artery occlusion / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of endovascular therapy and artery bypass for subclavian artery occlusion disease and to explore a suitable therapeutic procedure.</p><p><b>METHODS</b>Thirty-nine patients with subclavian artery occlusive disease received endovascular therapy or arterial bypass from June 1997 to May 2004. Twenty-seven endovascular stenting were performed on 26 patients through the femoral artery (n = 14) or combined brachial artery (n = 12). Retrograde endovascular balloon angioplasty and stent placement were performed on 12 patients. Eight subclavian arteries were punctured with ultrasound localization. On account of unsuccessful stenting, 13 cases received arterial bypass. In addition, endovascular stenting were performed on 9 cases with carotid or vertebrarterial stenoses.</p><p><b>RESULTS</b>The blood pressure difference was less than 10 mm Hg between the treated and the healthy arms in all 39 patients. The ratio of healthy/diseased side of the mean blood pressure index increased from 0.62 +/- 0.11 preoperatively to 0.98 +/- 0.04 postoperatively (P < 0.01). The mean patency time for endovascular therapy and arterial bypass was (57.6 +/- 3.7) and (60.2 +/- 7.2) months, respectively.</p><p><b>CONCLUSIONS</b>Both endovascular therapy and arterial bypass have good curative effect for subclavian artery occlusion. Endovascular therapy is the preferred treatment for subclavian artery occlusion with mini-trauma and safety.</p>

Clinical analysis on treatment for superficial varicosities of low limbs with minimally invasive rotary varicotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate therapeutic efficacy of minimally invasive rotary varicotomy (TriVex) for superficial varicosities of low limbs and summarize our therapeutic experiences.</p><p><b>METHODS</b>One hundred and eighty-two cases (totally 216 lower limbs) were applied minimally invasive rotary varicotomy (TriVex) and relative clinical data was analyzed.</p><p><b>RESULTS</b>The average operation time for each limb was 48 min. Discomfort and pain of lower limbs disappeared in all of patients after operation. There was no residual of superficial varicosities. There was no severe complication and recurrence of varicosities. The postoperative complication rate was 21.3%.</p><p><b>CONCLUSIONS</b>For treatment of superficial varicosities of low limbs, minimally invasive rotary varicotomy (TriVex) have many advantages including minimal invasion, quick recovery, safety and cosmetic effect. In addition, it has extensive indications and satisfactory therapeutic efficacy. It would be beneficial to master the operative techniques of key procedures. It could decrease complications and get better curative effects.</p>

Follow-up study in endovascular therapy for the renal artery stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of endovascular therapy for renal artery stenosis.</p><p><b>METHODS</b>Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed on 33 consecutive patients with severe renal artery stenosis who suffered from poorly controlled hypertension or renal dysfunction. They were subsequently underwent 7 to 49 months clinical follow up for the effect of the procedure on renal function, blood pressure control, mortality.</p><p><b>RESULTS</b>Angiographic success was obtained in 32 (97.0%) of the 33 patients. The mortality was 18.2%. After PTRAS, two (6.1%) died of myocardial infarction within 4 months. Four (12.1%) patients with preoperative serum creatinine (Scr) > or = 177 micromol/L died of uraemia within 17 approximately 28 months. Twelve and twenty-four months after the procedure, systolic and diastolic blood pressure of 26 (78.8%) cases with preoperative Scr < 177 micromol/L significantly decreased (P < 0.05), with less antihypertensive medications taken and satisfactory renal function.</p><p><b>CONCLUSION</b>For patients without serious cardiorenal disease, PTRAS has a beneficial effect on blood pressure and renal function. For patients with serious cardiorenal disease or preoperative Scr > or = 177 micromol/L, the mortality is higher. PTRAS should be performed prudently. The preservation of renal function may be enhance by using renal protection device.</p>

Stenting for carotid artery stenosis of 55 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the procedure of carotid stenting, and to summary experiences of 55 cases. To study the theory and clinical significance of carotid stenting for carotid artery stenosis.</p><p><b>METHODS</b>Fifty-five patients with severe carotid atheromatous stenoses were treated by stent implantation. Fifty-eight stents were implanted. Forty-one of these stents were Wallstent, 14 were Smart stents and 3 were OptiMed stents. Cerebral protection device was furnished for 18 patients.</p><p><b>RESULTS</b>During operation, there were 2 cases of small stroke and 2 cases of major stroke. One patient suffered from left eye area deficit, who had a little signs after 3 months. Another patient had consciousness loss and right-side paralysis and had a recovery in consciousness after salvage. The incidence of nervous system complications was 6.9%. Serious stroke rate was 3.5%. The incidence of circulatory system complications was 10.3%. Those patients who received cerebral protection device did not have nervous complication.</p><p><b>CONCLUSION</b>Carotid stenting is effective for the treatment of carotid artery stenosis. The experienced surgeon can make this procedure safe. The procedure's safety is enhanced by using cerebral protection device.</p>