Comparison of carotid endarterectomy vs. carotid stent implantation in the treatment of carotid stenosis / 中华普通外科杂志

Objective:To compare carotid endarterectomy (CEA) and carotid artery stenting (CAS) in perioperative, medium and long term prognosis of patients with carotid artery stenosis.Methods:A retrospective analysis was performed on 1 329 cases of carotid artery stenosis treated at Department of Vascular Surgery, Beijing Anzhen Hospital from Jan 2011 to Aug 2020, as all cases being divided into CAS group and CEA group.Results:There were significant differences in age ( t=0.098, P=0.023) and drinking habits ( χ2=8.055, P=0.005) between the two groups. There were more unstable plaques in CEA group ( χ2=4.392, P=0.038), and more bilateral lesions in CAS group ( χ2=9.673, P=0.038). In perioperative period, there were more mannitol use in CEA group ( χ2=78.614, P<0.001), more incision/puncture site complications ( χ2=5.158, P=0.035), lung infection ( χ2=6.355, P=0.013), cerebral hyperperfusion syndrome (CHS) ( χ2=5.158, P=0.035) and extracranial nerve injury ( χ2=23.760, P<0.001) in CEA group than in CAS group, and more acute renal failure in CAS group ( χ2=10.393, P=0.001). There was no significant difference in survival rate and ischemic stroke, myocardial infarction, cerebral hemorrhage and renal insufficiency between the two groups (all P>0.05). The mean survival time of CAS group was 53.195 months (95% CI: 52.040-54.350), and 54.492 months (95% CI: 53.790-55.195) in CEA group ( P=0.051). Conclusions:Patients in CEA group had more unstable plaque and a lower perioperative stroke rate. CEA group had higher risk of CHS,while CAS was with lower postoperative lung infection rate and less wound local complications. There was no significant difference in long-term survival between the two groups.

Patch angioplasty versus primary closure after carotid endarterectomy / 中华普通外科杂志

Objective:To compare the perioperative complications of carotid endarterectomy with patch angioplasty or primary closure.Methods:The clinical data of 492 carotid endarterectomy patients at the Vascular Surgery Department of Anzhen Hospital from Mar 2003 to Dec 2016 was analyzed retrospectively.Results:There were 364 cases (74%) in the patch angioplasty group and 128 cases (26%) in the primary closure group. The incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than that in the primary closure group (0.8% vs. 3.9%, P=0.031), and there was no difference in the incidence of the remaining perioperative complications. By subgroup analysis, the incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than in the primary closure group when the diameter of the internal carotid artery was <5 mm (0.7% vs. 6.0%, P=0.001), whereas there was no difference between the two groups when the diameter of the internal carotid artery was ≥5 mm. Conclusions:Carotid endarterectomy with patch angioplasty can reduce the incidence of perioperative cerebral infarction, especially in cases with an internal carotid artery diameter <5 mm.

Progress in clinical trials of boron neutron capture therapy of head and neck cancers / 中华放射医学与防护杂志

Boron neutron capture therapy(BNCT)is an advanced radiotherapy combined with targeted therapy and heavy ion therapy. BNCT is based on the nuclear reaction 10B (n, α) 7Li that occurs when boron-10 isotopes is irradiated with neutrons of the appropriate energy to produce high-energy recoiling 7Li nuclei and α particles. The released high linear energy transfer (LET) particles have path lengths of approximately one cell diameter (5-9 μm) and deposit most of their energy within the boron-containing tumor cells. BNCT has the advantages of precise tumor targeting, less damage to normal tissue and fewer irradiation fractionations (1-3 fractionations) than conventional radiotherapy (30 fractionation). The neutrons used in BNCT are produced by reactors or accelerators. The boron drugs used in clinical trials include BPA and BSH. In this paper, we review the clinical trial status and the significant progress of BNCT for head and neck tumors. The clinical data have approved the effectiveness of BNCT in the treatment of head and neck cancer. With the technical improvement of accelerator neutron source and the development of new boron drugs, BNCT will play a more important role in the field of clinical radiotherapy in the future.

Clinical analysis of peri-operative gastrointestinal complications after endovascular and open repair of abdominal aortic aneurysm / 中华外科杂志

Objective@#To investigate the etiology, treatment method and prevention of gastrointestinal complications(GCs) after endovascular and open repair of abdominal aortic aneurysm (AAA).@*Methods@#The clinical data of 716 cases who were diagnosed as AAA and underwent endovascular(EVAR) or open repair (OR) from Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University April 2009 to March 2017 were collected and analyzed retrospectively. There were 608 males (84.9%)and 108 females(15.1%), aging of 69.4 years (range: 52-86 years). There were 539 cases(75.3%) underwent EVAR and 177 cases(24.7%) underwent OR. The morbidity of GCs and mortality of GCs, such as acute pancreatitis, cholecystitis, ischemic colitis, intestinal obstruction and peptic ulcer, between EVAR and OR group were compared. The treatment of the GCs and the prognosis of the patients were reported.@*Results@#The morbidity of GCs in EVAR and OR group were 4.6%(25/539)and 35.0%(62/177), respectively. There were 10 cases and 28 cases suffering from acute pancreatitis in EVAR and OR group, respectively; 4 cases and 6 cases suffering from cholecystitis in the two groups; 6 cases and 13 cases suffering from ischemic colitis in the two groups; 5 cases suffering from intestinal obstruction in OR group; 5 cases and 10 cases suffering from peptic ulcer in the two groups. Two patients died in EVAR group, and the peri-operative mortality was 0.37%, one died of ischemic colitis with acute myocardial infarction, the other died of ischemic colitis with septic shock. Six patients died in OR group, and the peri-operative mortality was 3.39%, two patients died of acute pancreatitis with intestinal necrosis, one patient died of cholangitis with peritonitis and septic shock, three patients died of ischemic colitis with acute renal failure or septicemia.@*Conclusions@#The etiology of peri-operative GCs after AAA repair may include inferior mesenteric artery occlusion or ligation, pancreas injury, organ hypoperfusion and so on.

Effects of liraglutide on bone metabolism and Wnt pathway in type 2 diabetic rats with osteoporosis / 中华内分泌外科杂志

Objective@#To study the effects of liraglutide on bone metabolism and Wnt pathway in type 2 diabetic osteoporosis rats.@*Methods@#SD rats were randomly divided into control group, model group and liraglutide group. The latter two groups were fed with high-fat and high-sugar diet and intraperitoneally injected with low-dose streptozotocin to establish type 2 diabetic model. Liraglutide group was subcutaneously injected with 0.6 mg/kg/d liraglutide for 8 weeks. Bone mineral density, calcium and phosphorus content, the expression of Wnt pathway molecule [Wnt3a, low density lipoprotein receptor-related protein 5 (LRP5) , β-catenin] and the contents of bone metabolism indicators [ALP, osteocalcin (OC) , osteoprotegerin (OPG) , receptor activator of nuclear factor-κ B ligand (RANKL) , tartrate-resistant acid phosphatase (TrACP) , cross-linked carboxy-terminal telopeptide of type I collagen (CTX-1) ] in serum were determined.@*Results@#The tibial bone mineral density[left (0.158±0.024) vs (0.232±0.041) g/cm2, right (0.152±0.027) vs (0.219±0.038) g/cm2, P<0.05) , the content of calcium and phosphorus [ (5.12±0.58) vs (5.93±0.74) mol/g, (2.93±0.41) vs (3.84±0.56) mol/g, P<0.05) , the expression of Wnt3a, LRP5, β-catenin in tibia [ (0.29±0.06) vs (0.78±0.13) , (0.30±0.05) vs (0.73±0.14) , (0.38±0.06) vs (1.01±0.18) , P<0.05], the content of ALP, OC and OPG in serum of model group were significantly lower than those of control group[ (40.27±7.52) vs (59.29±9.19) ng/ml, (252.45±42.95) vs (341.28±52.39) pg/ml, (0.40±0.06) vs (0.78±0.09) ng/ml, P<0.05) , and the contents of RANKL, TrACP and CTX-1 in serum were significantly higher than those of control group [ (17.79±2.84) vs (12.46±2.09) pg/ml, (56.45±7.79) vs (41.38±8.19) μmol/l, (19.26±3.14) vs (11.39±2.25) pg/ml, P<0.05]; the tibial bone mineral density, the content of calcium and phosphorus, the expression of Wnt3a, LRP5, β-catenin in tibia, the content of ALP, OC and OPG in serum of liraglutide group were significantly higher than those of control group, and the contents of RANKL, TrACP and CTX-1 in serum were significantly lower than those of control group.@*Conclusion@#Liraglutide can improve bone mineral density and bone metabolism in type 2 diabetic rats with osteoporosis, which may be related to activation of Wnt pathway.

Effects of liraglutide on bone metabolism and Wnt pathway in type 2 diabetic rats with osteoporosis / 中华内分泌外科杂志

Objective To study the effects of liraglutide on bone metabolism and Wnt pathway in type 2 diabetic osteoporosis rats. Methods SD rats were randomly divided into control group, model group and liraglu-tide group. The latter two groups were fed with high-fat and high-sugar diet and intraperitoneally injected with low-dose streptozotocin to establish type 2 diabetic model. Liraglutide group was subcutaneously injected with 0.6 mg/kg/d liraglutide for 8 weeks. Bone mineral density, calcium and phosphorus content, the expression of Wnt path-way molecule [Wnt3a, low density lipoprotein receptor-related protein 5 (LRP5), β-catenin] and the contents of bone metabolism indicators [ALP, osteocalcin(OC), osteoprotegerin(OPG), receptor activator of nuclear factor-κ B ligand(RANKL), tartrate-resistant acid phosphatase(TrACP), cross-linked carboxy-terminal telopeptide of type I collagen (CTX-1)] in serum were determined. Results The tibial bone mineral density [left (0.158±0.024) vs (0.232±0.041) g/cm2, right(0.152±0.027) vs(0.219±0.038) g/cm2, P<0.05), the content of calcium and phospho-rus [(5.12±0.58) vs (5.93±0.74) mol/g, (2.93±0.41) vs (3.84±0.56) mol/g, P<0.05), the expression of Wnt3a, LRP5, β-catenin in tibia [(0.29±0.06) vs (0.78±0.13), (0.30±0.05) vs (0.73±0.14), (0.38±0.06) vs (1.01± 0.18), P<0.05], the content of ALP, OC and OPG in serum of model group were significantly lower than those of control group [(40.27±7.52) vs (59.29±9.19) ng/ml, (252.45±42.95) vs (341.28±52.39) pg/ml, (0.40±0.06) vs (0.78±0.09) ng/ml, P<0.05), and the contents of RANKL, TrACP and CTX-1 in serum were significantly higher than those of control group [(17.79±2.84) vs(12.46±2.09) pg/ml, (56.45±7.79) vs (41.38±8.19)μmol/l, (19.26± 3.14) vs (11.39±2.25) pg/ml, P<0.05]; the tibial bone mineral density, the content of calcium and phosphorus, the expression of Wnt3a, LRP5, β-catenin in tibia, the content of ALP, OC and OPG in serum of liraglutide group were significantly higher than those of control group, and the contents of RANKL, TrACP and CTX-1 in serum were significantly lower than those of control group. Conclusion Liraglutide can improve bone mineral density and bone metabolism in type 2 diabetic rats with osteoporosis, which may be related to activation of Wnt pathway.

The diagnosis value of DWI in duodenal papillary adenocarcinoma / 实用放射学杂志

Objective To investigate the MRI findings of duodenal papillary adenocarcinoma(DPA),and to evaluate the importance of diffusion-weighted imaging(DWI)in diagnosis of DPA.Methods A complete data of 52 patients with DPA were prospectively collected.All patients underwent surgery within 72 hours after conventional MRI,DWI and MRCP scans.Before surgery,four different MRI findings were used to calculate the sensitivity,specificity and the probability of correctness.Two experienced radiologists who were blind to the pathologic diagnosis handled the MRI findings.Thirty eight patients were pathologically diagnosed for DPA.Based on the pathological diagnosis,the detection rate of DPA by the MR sequence was recorded and the chi square test was used to do the statistical analysis. Results The accuracy rate in diagnosis of DPA with MRI was 78.8% in our study.The findings of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.Corresponding sensitivities were 70.5%,66.7%,86.3% and 87.9%,and specificities were 75.0%,30.0%,50.0% and 63.1% respectively.The incidences of positive on T2WI and T1WI,MRCP,DWI scans were 60.5%,76.3% and 92.1% respectively.The detection rate of each sequence has significant difference(χ2=10.48,P<0.005).Conclusion The MRI manifestations of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.The detection rate of DWI sepuence on DPA lesions is significantly higher than that of other sequences.

Comparision of perioperative cerebrovascular events through different surgical approaches for severe bilateral carotid artery stenosis / 中华普通外科杂志

Objective To explore the feasibility and safety of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients with severe bilateral carotid stenosis.Methods From Jul 2003 to Sep 2017,unilateral CEA or CAS were performed in 1 046 patients,213 of which were with severe bilateral carotid stenosis.These 213 patients were divided into CEA group and CAS group according to procedures taken.The perioperative outcomes of 213 patients were analyzed retrospectively.Results The incidence of typical cerebral ischemia symptoms of CEA group was higher than that in CAS group (25.3％ vs.13.3％,P =0.029).The incidence of perioperative death or stroke in CEA group was 5.63％ (4/71),which had no significant difference with that in CAS group (2.82％,4/142) (P =0.524).Conclusion Based on adequate preoperative assessment and reasonable surgical selection,CEA and CAS are both safe and feasible for the unilateral lesion during one-stage operation for patients with severe bilateral carotid stenosis

Retrograde transpopliteal access for femoral-popliteal artery occlusion by blind puncture / 中华普通外科杂志

Objective To evaluate retrograde transpopliteal access for femoral-popliteal artery total occlusion with blind puncture.Methods Clinical data of 22 cases admitted from Sep 2014 to June 2016 undergoing endovascular treatment of the femoral-politeal artery occlusion with transpopliteal artery retrograde access by blind puncture were analyzed.Results A total of 22 patients underwent retrograde popliteal access with blind puncture after antegrade attempts failed.Puncture above the knee was performed in 18 cases and below the knee in 4 cases.The average increase of ABI was 0.57.Hematoma of puncture site was observed in 2 patients,other complications included pneumonia in 1 case and renal insufficiency in 2 cases.The mean follow-up time was (13 ± 5)months.Restenosis occurred in 8 patiens(36.4％)during the follow-up time.The primary patency was (86.4 ± 0.07) ％ at 6 months and (70.7-± 0.12) ％ at 12 months.There was no major amputation rate and mortality during the follow-up.Conclusions Retrograde transpopliteal access for femoral-popliteal artery occlusion with blind puncture is safe and effective.

Endovascular versus open repair for ruptured abdominal aortic aneurysm / 中华普通外科杂志

Objective To compare the effect after endovascular repair (EVAR) or open repair (OR) of ruptured abdominal aortic aneurysm (rAAA) in Department of Vascular Surgery,Beijing Anzhen Hospital.Methods Clinical data of 46 repaired rAAAs patients was retrospectively analyzed from 2005 to 2015.The difference between the EVAR group and the OR group in perioperative mortality,operation time,ICU stay,blood transfused,length of stay (LOS),complication rate were compared by x2 test and t test.Results 18 rAAA patients were repaired by EVAR,aged from 51 to 91 with a mean of (68 ±9).28 were repaired by OR,aged from 41 to 83 with a mean of (70 ± 11).Perioperative mortality was 21.0％ for EVAR and 28.6％ for OR (P ＞0.05).LOS was (15.3 ±9.5) days for EVAR,and (23.9 ± 10.5) days for OR (P ＜0.05).Blood transfused was (3 210 ± 3 780) ml for EVAR and (4 814 ± 3 392) ml for OR (P＜0.05).ICU stay time was (7.7 ±4.2) d for EVAR and (4.2 ±2.5) d for OR (P＜0.05).Conclusion EVAR is a reliable approach for the treatment of acute rAAA.

Study on dosimetric verification of VMAT treatment planning for chest esophageal carcinoma / 中华放射肿瘤学杂志

Objective To study the dosimetry characteristics of VMAT plan in the esophageal carcinoma radiotherapy.Methods Application of 0.6 cm3 ionization chamber and COMPASS threedimensional dose verification system,20 cases of upper and middle chest esophageal carcinoma on the VMAT plans for absolute dose and relative dose verification.Dose volume histogram (DVH) comparison treatment target,lungs,heart,and differences in the spinal cord irradiation dose and volume,and analyses γpass rate of GTV,CTV,PTV and organs at risks.Results The center dose of upper and middle chest esophageal carcinoma accurate rates were above 99％.Thoracic segment esophageal:GTV,PTV and organs at risks of γ pass rate above 97％.D95％ and Dmean of GTV,CTV and PTV were relatively undervalued within 3％.D1％ of spinal cord is 2.21％ overvalued.Left and right pulmonary V5 were slightly overvalued by about 0.5％,V10-D30,Dmean undervalued within 2％.In period of middle chest esophageal carcinoma:the gamma passed rate of GTV,CTV,PTV and organs at risks of above 97％,GTV,CTV,PTV D95％,Dmean were relatively undervalued within 2％.Spinal cord D1％ is 2.04％ overvalued.Left and right pulmonary V5-D30 to V10 as a trend of gradually to be underestimated,at 1.5％.Heart Dmean was undervalued by 2.68％.Conclusion VMAT technology is applicable in the chest esophageal carcinoma radiotherapy.

The effect of sarpogrelate on in-stent restenosis after percutaneous transluminal angioplasty in peripheral arterial disease / 中华普通外科杂志

Objective To evaluate the impact of sarpogrelate on the in-stent restenosis (ISR) after percutaneous transluminal angioplasty (PTA) in peripheral arterial diseases (PAD).Methods PAD patients who had PTA for the first time were divided into two groups receiving respectively clopidogrel and aspirin (clopidogrel group) or sarpogrelate and aspirin (sarpogrelate group).Vascular ultrasonography was performed at 6 months after PTA in all patients to evaluate the degree of ISR.Results 62 patients finished the follow-up visits as required.The in-stent restenosis in the sarpogrelate group and clopidogrel group was 7.0％ vs.18.1％ (P =0.036),the peak systolic velocity ratio was 1.34 vs.2.08 (P =0.010) and the cases of ISR was 1 vs.10 (P =0.005) respectively.No patients reported serious adverse events.Conclusions Sarpogrelate combined with aspirin is safe and effective.Compare with clopidogrel and aspirin,sarpogrelate and aspirin can significantly reduce the rate of ISR after PTA and the intimal proliferation in the stent.

Biological safety evaluation of Carbon-Carbon composites / 国际生物医学工程杂志

Objective Due to the superior performance,Carbon-Carbon composites,although still at their early stage of development,have gained more and more attention and showed great application potential.Methods According to the National Standard,the biological safety evaluation of carbon-carbon composites were done in the following aspects:cytotoxicity test,acute systemic toxicity test,haemolysis test,pyrogen test,intramuscular implantation test.Results test results showed the biological safety evaluation of carbon-carbon composites well meet the requirement of the national standard with fine biological compatibility.Conclusion The experiment results demonstrate that carbon-carbon composites can be put in clinical application

Color Doppler ultrasonography in the diagonosis of acute and chronic artery occlusion of the extremities / 中华普通外科杂志

ObjectiveTo investigate the clinical value of color Doppler ultrasound examination in the diagonosis of acute and chronic artery occlusion of the extremities.MethodsA review was made on 129 extremetiy artery occlusion patients at Anzhen Hospital during 2006 -2010. 85 cases were male, and 44 cases were female. Age was from 17 to 94 years (average: 62 ±9 years). We analyzed two-dimensional and color Doppler flow imagings of 39 acute occlusion arteries and 97 chronic occlusion arteries. We compared factors including the echoes of artery lumens, the vessel wall structures, hemodynamic parameters of inlet and outlet at the occlusion, and collaterals between groups.ResultsThe factors of depths of vessel wall,internal diameters of ccclusion arteries, proximal resistant index and collaterals were significantly different between groups ( P ＜ 0. 05 ). The internal diameters of acute occlusion arteries were wider than chronic occlusion arteries. The depths of vessel wall, proximal resistant index and collaterals were thinner, smaller,and less than chronic occlusion arteries. The total accurate rate of differential diagnosis for acute and chronic artery occlusion by color Doppler ultrasound was 95.6％.ConclusionsColor Doppler ultrasound is an effective method for the differential diagnosis of acute and chronic artery occlusion of the extremities.

Endovascular repair of abdominal aortic aneurysm: a single center experience / 中华普通外科杂志

Objective To evaluate the perioperative and long-term effects of endovascular aneurysm repair(EVAR) of infrarenal abdominal aortic aneurysm (AAA).Methods Clinical data of 131 AAA cases undergoing EVAR were retrospectively evaluated for the safety and long-term efficacy.Results The operative time was (137 ±29) min,blood loss was (142 ±20) ml,blood transfusion was (46 ± 26) ml,ICU staying time was (17 ± 4) h.Major perioperative complications were severe heart failure in 8 cases,myocardial infarction in 2 cases,pulmonary complications in 5 cases,internal leakage in 4 cases.During the period of up to 60 months there were15 cases of endoleak including 8 cases of type Ⅰ,5 cases of type Ⅱ,1 each case of type Ⅲ and Ⅳ and 2 deaths.By Kaplan-Meier survival analysis there were complications developing after 60 months and up to 40％ of them needing reintervention.Conclusions Endovascular repair is the safe treatment for AAA,but discharged patients need close long-term follow-up.Complications that ensued need intensive management.

Postoperative complications of open abdominal aortic aneurysm surgery / 中华普通外科杂志

Objective To investigate the treatment and prevention for postoperative complications of abdominal aortic aneurysm(AAA)in open surgery.Methods 329 AAA patients received open surgery from January 1991 to August 2009.The postoperative complications were analyzed retrospectively.Results 30 d mortality rate was 0.91%,the incidence of postoperative complications was 19.1%(63/329),including cardiac dysfunction in 21 cases,respiratory insufficiency in 15 cases,myocardial infarction in 6 cases,renal failure in 5 cases,arrhythmia in 6 cases,cerebral infarction in 2 cases,artery embolism of lower extremity in 2 cases,wound dehiscence in 2 cases,incisional hernia in 1 case,ecchymoma in 1 case and deep vein thrombosis in 2 cases.One patient died of acute myocardial infarction,one died of renal failure after 20 d dialysis,1 patient died of premature ventricualr contraction and fibrillation ventricular.Other patients recovered well. Conclusions Cardiac dysfunction and respiratory insufficiency are the main postoperative complications of AAA.Preoperative evaluation.careful intraoperative maneuvre and postoperative care ale the key to improve the treatment effectiveness.

Subclavian artery occlusion:a clinical study on 69 cases / 中华普通外科杂志

Objective To evaluate endovascular therapy and open surgery for subclavian artery occlusion disease. Methods In this study, 69 patients received endovascular therapy (44 patients)or open surgery(25 patients)from January 2002 to July 2007.Balloon dilatation was carried out in 3 cases and 43 stents was placed in 41 cases. Results All procedures were successful. In endovascular therapy group, the ratio of healthy/dieased side of mean blood pressure was improved from 0.66±0.14 to 0.96±0.13(t=9.532,P＜0.001＝;in surgery group, the ratio improved from 0.63±0.16 to 0.95±0.18(t=8.236,P＜0.001＝.Sixty-one discharged patients were followed up for 2～49 months(mean 16.7 months),in endovascular group, restenosis occurred in 1 patient 1 year after the therapy, in surgery group, all prothesis remained patent and there was no complication related to prothesis. Conclusions Both endovascular therapy and surgery were the effective methods for subclavian artery occlusion, and endovascular therapy is preferred for less invasiveness.

Diagnosis and treatment of acute lower extremity arterial injury:experience of 125 cases / 中国普通外科杂志

Objective To sum up the experience in the diagnosis and management of acute lower extremity arterial injury.Methods Between Jan 1988 and Feb 2004,125 cases of lower limb arterial injuries were admitted and undergoing surgery, including gunshot in 3 cases, blunt trauma in 56 and stabbing in 66 cases. Associated injuries included bony injury in 36 cases, nerve injury in 11 cases, and vein injury in 23 cases. Arterial primary or patch repair was performed in 28 cases, end-to-end anastomosis in 37 cases, saphenous vein graft used in 32 cases, prosthetic graft bypass in 23 cases, thrombectomy in 2 cases and blood vessel ligation in 3 cases.Results Limb salvage rate was 85.6% and patient survival of 98.4%. Massive bleeding and multiple organ failure caused mortality in one each. The rate of amputation is 10.4%(13/125), with preoperative gangrene being present in 8 cases.Conclusion Lower extremity arterial injury carries a high amputation rate. The use of Doppler scanner is helpful for early diagnosis. An ankle/brachial index of less than 1 in the affected limb was considered as a positive sign of arterial injury. Prompt revascularization and early fasciectomy are important to reduce amputation rate and mortality.

Surgical management for ruptured aortoiliac artery / 中国普通外科杂志

Objective To evaluate surgical therapy for ruptured aortoiliac artery. Method Between Apr 1984 and Dec 2003, 23 patients of ruptured aortoiliac artery were admitted with ruptured aortoiliac artery aneurysm in 18 cases and traumatic artery rupture in 5 patients. Two patients were treated with direct vascular repair and 21 patients underwent prosthetic grafts replacement. Result Four cases died perioperatively including 2 patients dying of acute renal failure, one of upper gastrointestinal heamorrhage caused by stress ulcer at 48 h after operation, and one of respiratory failure in 72 h. Conclusion Based on the etiology emergency operations should be performed on patients of ruptured aortoiliac artery by repairing or prosthetic grafts replacement.

Prosthetic graft occlusion and options of reoperative modality / 中国普通外科杂志

ObjectivesTo analyse the causes of occlusion of prosthetic grafts and to explore the appropriate modality of reoperation.MethodThe clinical data of 47 patients with occlusive prosthetic grafts were analyzed retrospectively. The procedure of treatment for patients with different causes of occlusive graft included thrombectomy alone in 9 cases, thrombectomy and anastomotic plasty in 16 cases, new bypass using prosthetic graft and saphenous autograft in 22 cases. ResultsThe reoccurrence of graft occlusion in patients undergoing thrombectomy alone or thrombectomy and anastomotic plasty was 67% and 56% respectively, which was siginificantly higher than that of 9% in patients treated by a new arterial bypass with prosthetic grafts and saphenous autografts. ConclusionsThe result of new bypass for occlusive prosthetic graft is superior to thrombectomy alone or thrombectomy and anatomotic plasty.