Application of preimplanted angiography catheter with digital subtraction angiography for surgical treatment of acute lower gastrointestinal bleeding / 中华全科医师杂志

To evaluate the application of preimplanted angiography catheter with digital subtraction angiograply(DSA) for surgical treatment of acute lower gastrointestinal bleeding.Clinical data of 17 patients with acute lower gastrointestinal bleeding admitted from June 2011 to December 2014 were retrospectively reviewed.The angiography catheter was implanted and methylene was injected to find the bleeding sites with DSA,then emergency laparotomy was performed.The results showed the bleeding sites in small intestine in 8 cases and in large intestine in 9 cases.Postoperative pathology revealed vascular malformation in 4 cases,2 in small intestine and 2 in colon;ulcerative colitis in 3 cases;colon cancer in 1 case;colonic diverticula in 3 cases and small intestinal stromal tumor in 6 cases.Results indicate that if the conservative therapy is not effective,surgical treatment assisted by preimplanted angiography catheter with DSA is safe and effective for patients with lower gastrointestinal bleeding.

Endovascular treatment of lower extremity arteriosclerosis obliterans of TASC-D type：its current clinical situation / 介入放射学杂志

In 2007, Transatlantic Cooperation Society Consensus Ⅱ(TASCⅡ) Conference Guideline has divided the aortoiliac artery and femoral popliteal artery diseases into 4 types , suggesting that endovascular treatment should be employed for TASC-A type lesions, individualized therapy should be adopted for TASC-B and TASC-C type lesions when a variety of factors are taken into consideration , and surgical treatment should be used for TASC-D type lesions. In recent years, along with the development of imaging technique and material science as well as the improvement of interventional operator ’s skill, the mini-invasive interventional therapy has been more and more performed for the relatively complex TASC-D type aortoiliac artery and femoral popliteal artery occlusive diseases , and satisfactory clinical curative effect has been achieved. This paper aims to make a comprehensive review about the current situation of endovascular treatment for lower extremity arteriosclerosis obliterans of TASC-D type in clinical practice.

The diagnosis and management of penetrating abdominal injury with large vessels damage in 18 cases / 中华普通外科杂志

Objective To investigate the experience of diagnosis and treatment of abdominal penetrating injury with large vessels damage.Methods The clinical data of 18 patients with abdominal large vessels injuries in our hospital from Jan 2003 to oct 2014 were analyzed retrospectively.Results 18 cases of large vessels injuries,accounting for 16.21％ during the same period of all penetrating wounds (18/111),emergency laparotomy was performed.There were 8 cases of arterial injury,4 cases of concurrent arteriovenous injury,6 cases of venous injury,Arterial and venous broken walls were repaired,splenic artery and venous ligation and splenectomy were performed.Vascular repair success rate was 100％,Intraoperative blood loss was 500-6 000 ml,average (3 750 ±670) ml.Operating time varied from 2.5 to 7 h,average (3.9 ±0.8) h.All patients were cured.12 cases were followed-up for 2-36 months,mean follow-up time was (15 ± 7) months,ultrasonography showed normal blood flow without complications.Conclusions Emergency surgical exploration and limited fluid resuscitation is the most effective therapy in abdominal penetrating injury involving large vessels.

An analysis of the causes of death for patients of peripheral arterial disease during the perioperative period / 中华普通外科杂志

Objective To investigate the causes of death and the influencing factors in patients with peripheral arterial disease(PAD) during the perioperative period and reduce the perioperative mortality.Methods A retrospective analysis of the causes of death was performed for PAD during the perioperative period in our hospital from July 2005 to July 2010. Results Nine patients died preoperatively.The causes of death were multible organ failure in 5,heart failure in 2,sudden cardiac death in 1,and respiratory failure in 1.Six patients died postoperatively.The causes of death were acute renal failure in 2,heart failure in 2,cerebral infarction in 1,and hemorrhagic shock in 1.The causes of death which were related to heart,kidney and lung were in 10,6 and 2,respectively.The causes of death which were directly due to heart failure,sudden cardiac death,renal failure,respiratory failure,cerebral infarction and hemorrhagic shock were in 4,1,2,1,1 and 1,respectively.The main causes of death were multible organ failure,heart failure and acute renal failure,which accounted for 73.33％ of all deaths.In this series the overall perioperative mortality was 3.11％ (15/483),Operative mortality was 1.47％ (6/407).Conclusions The influencing factors and the function of organs were closely correlated with the causes of death. To reduce the perioperative mortality of PAD,it is necessary both to intervene in the influencing factors and to monitor and treat the dysfunction of vital organs.

Endovascular procedure for TASC-D type iliac artery lesions / 中华普通外科杂志

Objective To evaluate recanalization for TASC-D type iliac artery lesions.Methods Between June 2006 and June 2010,26 patients with a total of 31 limbs of the TASC-D iliac artery lesions underwent endovascular procedure. Results Technical success rate was 90.3% (28/31).Clinical symptom improvement rate was 100%. Forty-four stents were placed in 28 limbs of the 24 patients.Eleven patients underwent an associated procedure; femoropopliteal endovascular procedures in 8 cases,femoro-popliteal bypass in 3 cases. Eight patients underwent an intravascular ultrasound thrombolysis.Postoperative ankle-brachial index ( ABI) was increased by more than 0. 15 in all patients. Twenty-two patients(26 limbs) were followed-up for 3 -44 mos, the primary patency rate at 12 months was 90% ,and cumulative patency rate was 95%. At 36 months primary patency rate was 70% , and secondary patency rate was 80%. Conclusions Because the technical success rate is high, endovascular techeniques are the choice of therapy in high risk patients with TASC-D type iliac artery lesions.

Transluminal angioplasty and stenting in treating iliac arterial occlusive disease / 中华普通外科杂志

Objective To evaluate therapeutic effect of transluminal angioplasty and stenting on arteriosclerosis related iliac arterial occlusive disease. Methods This retrospective study included a total of 61 cases (76 limbs) with iliac arterial atherosclerotic occlusive disease, grading as TASC A (n =29),B (n = 16), C (n = 11) and D (n = 5). Percutaneous interventional reconstruction and stent implantation were carried out in our hospital from December 2002 to December 2008. Results In 61 patients (76 lesions) 63 stents were implanted successfully with the success rate of 93% (71/76). The rate of clinical improvement was 100% among the patients who had primary technical success. The ankle-branchial index (ABI) improved from an average of 0. 33 ± 0. 17 before intervention to 0. 72 ± 0. 20 on the day following intervention (P < 0. 05). All cases were followed up between 6 month and 60 month. One year patency rate in all treated lesions was 90% (92% in the TASC A and B, 84% in the TASC C and D).Three year patency rate in all was 75% (80% in the TASC A and B, 63% in the TASC C and D). Five year patency rate was 72%. Conclusion There is a tendency towards utilizing transluminal angioplasty and stenting to treat iliac arterial occlusive disease as a therapy instead of traditional vascular surgery.

Clinical treatment of the intermittent claudication caused by lumbar spine disease combined lower extremity arteriosclerosis obliterans / 中国医师进修杂志

Objective To explore the principle of diagnosis and treatment of intermittent claudication caused by lumbar spine disease combined with lower extremity arteriosclerosis obliterans. Method Eighteen cases of patients with intermittent claudication caused by lumbar spine disease combined with lower extremity arteriosclerosis obliterans, using MRI and MRA, to determine the main reason due to of disease, to take the treatment for the cause. Results The patients were followed up for 7 to 24 months, average (16.0 ± 4.7) months. Assessed according to the modified MacNab criteria of clinical efficacy, excellent in 7 cases, good in 8 cases, general in 3 cases,satisfactory rate was 83.3%(15/18). Intermittent claudication were improved with all patients, walking distance of more than 1000 meters, relief rate was 100%. Postoperative ankle brachial score(0.90±0.54 ) was obviously increased compared with preoperative average(0.58±0.36), there was significant statistical difference(P<0.01). All cases were not amputee due to circulation disturbance. Conclusion The diagnosis and treatment of intermittent claudication caused by lumbar spine disease combined lower extremity arteriosclerosis obliterans,it is necessary to collect a history of serious and careful investigation,combined with imaging, can accurately determine the responsibility of lesions, target to give the appropriate treatment, can get a good effect