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Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.
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Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.
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Objective To explore the method of limb salvage therapy for hand and foot destructive injury, and to clarify the role of free tissue transplantation in limb salvage therapy in patients with hand and foot destructive injury. Methods From January, 2015 to January, 2016, 17 hand and foot destructive injuried patients were treated with limb salvage. The anterolateral thigh free flap, free fibular flap and arterial vein flap were used to repair the skin, soft tissue and bone defects. All patients were followed-up for 12 months. The appearance and function of the patients were evalu-ated after the treatment. The hand scoring criterion was the finger replantation function evaluation standard on probation of the Chinese Medical Association of Hand Surgery. The foot scoring criterion was the Maryland score system. Re-sults All flaps survived in 17 patients. One flap had vascular crisis after operation, and survived after vascular ex-ploratory operation. One case had infection postoperation and healed after several debridements. After 12 months, the functional scores were excellent in 5 cases, good in 5 cases, moderate in 3 cases and poor in 4 cases. Conclusion The early repair with free tissue transplantation can preserve limb length, cover the exposed bone and tendon, and improve the anti-infective ability, so as to improve the function of limb salvage and patient 's satisfaction.
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Objective To evaluate risks of symptomatic pulmonary embolism (PE) in deep vein thrombosis (DVT) patients complicating iliac vein compression syndrome (IVCS).Methods Between January 2010 and January 2015,patients diagnosed with lower extremity DVT and IVCS at our institution were included.The odds of symptomatic PE versus lower extremity DVT complicated with IVCS were assessed using Logistic regression models.Its association with age,gender,thrombophilic risk factors,degree of stenosis,filter implantation and symptomatic PE were assessed.Results Of 759 patients,410 patients had inferior vena cava (IVC) filters implanted and 349 had not.In filter placement group,3 patients suffered from symptomatic PE among 32 with thrombi intercepted in IVC filters.In the group with no IVC filters placement,39 cases suffered from symptomatic PE.Symptomatic PE was in positive correlation to respiratory disease and right lower extremity DVT,and negative correlation to IVC filter implantation.Conclusions In lower extremity DVT patients complicated with IVCS,the right lower extrenity DVT and respiratory disease are risk factors of symptomatic PE.IVC filter implantation prevents symptomatic PE from happening in most patients.
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Objective To observe the protein expressions of PI3Kp110, pAkt, pGSK3β of phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt) signaling pathway in the whole blood of patients with Kashin-Beck disease and analyze the status of PI3K/Akt signaling pathway. Methods Patients with Kashin-Beck disease ( KBD group ) were from six counties ( Xunyi , Linyou , Yongshou , Qianyang , Changwu and Long County) of Shannxi Province in Kashin-Beck disease areas , and the healthy controls (control group) were matched by age and sex. Venous blood was collected from patients and healthy controls. Trizol method was applied to extract the whole blood protein; protein expression levels of PI3K/Akt signaling pathway in whole blood were detected by Western blotting; the gray values were observed and recorded by the sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE) and GDS-8000 gel imaging analysis system. Differences between the two groups were assessed by Student’s t-test. Results Compared age and sex between KBD group and control group, differences were not statistically significant(t=0.701, P>0.05;χ2=0.400, P>0.05). The protein expression levels of PI3Kp110, pAkt and p-GSK3β in KBD group were higher than that in control group(156.1 ± 92.1 vs. 79.5 ± 21.5, 113.7 ± 15.2 vs. 43.3 ± 10.7 and 105.9 ± 17.5 vs. 37.3 ± 12.0, respectively) and the differences were statistically significant (t=2.563, 6.567, 7.916; all P < 0.05 or < 0.01). Conclusion The PI3Kp110, pAkt and p-GSK3β expressions of signaling pathway proteins in the whole blood of patiens with Kashin-Beck disease are up-regulated significantly and the status of PI3K/Akt signaling pathway is activated.
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Objective To investigate the use of free transplantation of peroneal artery perforator-based propeller to the repair of the front feet skin defect.Methods Thirteen cases with front foot skin defect patients repaired through transplation of propeller flap of the peroneal artery from January 2009 to September 2012.The wound range was 5 cm ×4 cm-11 cm × 14 cm.The propeller flap of the peroneal artery designed according to the position of the propeller of the peroneal artery in a leg.The wound of the leg were repaired through suture directly or transplantation of skin.Results All 13 cases of free propeller flap were survived,the wound healing goodly.One case with the postoperatie blood vessels were removed by the surgical exploration.The time of follow-up between 3 and 17 months(mean 9.4 months).The quality of free flap was good.The function of walk of the foot repaired were not significantly affect.The patients were satisfactory to the results.The wound of the leg healed well ; The leg had no obvious muscle cicatricial adhesion.According to the foot disease treatment effect evaluation standard (JOA) evaluation,the result for 77-100 points,an average of 85.5 points.Conclusion Using propeller flap of the peroneal artery to repair the skin defect of front feet with a little injury,the skin texture more close to the repaired area,it is a reasonable approach.