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Objective:To evaluate the mid-term results of endovascular treatment for transplant renal artery stenosis (TRAS).Methods:The clinical and follow-up data of TRAS patients undergoing endovascular treatment at the First Affiliated Hospital of Zhengzhou University from Jan 2014 to Jan 2021 were retrospectively analyzed.Results:A total of 2 230 patients underwent kidney transplantation, 78 cases(3.6%) developed TRAS, among those 27 patients received endovascular treatment and followed-up from 12 to 80 months(mean 36 months). Thirteen patients (48.1%) underwent renal graft angiography and balloon dilatation, of which 2 patients underwent stent placement, 14 patients (51.9%) underwent renal graft angiography with balloon dilatation and stenting. The serum creatinine 2 weeks postoperatively and 12 months postoperatively were 127.6 μmol/L (47-220 μmol/L) and 103.4 μmol/L (63-166 μmol/L), respectively, significantly lower than the preoperative 217.1 μmol/L (98-541 μmol/L), ( P<0.05). Glomerular filtration rate (GFR) before surgery was 8.3-105.3 ml/min, 2 weeks and 12 months after surgery compared to 24.6-132.2 ml/min and 47.3-113.9 ml/min( P<0.05). The preoperative peak systolic velocity (PSV) of the transplanted renal artery during the systolic phase was 234 cm/s (75-457 cm/s), compared to 129 cm/s (52-290 cm/s) ( P<0.05) 2 weeks and 118 cm/s (57-300 cm/s) 12 months postoperatively ( P<0.05). During the follow-up period, 2 patients (7.4%) died of multiple organ failure. Conclusions:TRAS is the most common vascular complication after kidney transplantation. Endovascular treatment has a high success rate and low complication rate.
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Objective:To analyze the clinical characteristics and treatment of patients with renovascular hypertension (RVH) caused by renal arterial fibromuscular dysplasia (FMD).Methods:Clinical data and treatment result of 38 patients with renal arterial FMD and RVH admitted to our hospital from Jan 2014 to Dec 2020 were reviewed.Results:A total of 38 patients were enrolled in this study. Renal artery CTA showed that 40 renal arteries were involved, among these 6 branches had multifocal stenosis, and 34 branches had focal stenosis. Thity-three patients received surgical treatment, of which 32 patients underwent percutaneous transluminal renal angioplasty (PTRA), and 1 patient with renal aneurysm underwent renal artery stent implantation combined with aneurysm coil embolization. Postoperative blood pressure was significantly lower than that before the operation [(129.79±17.63) mmHg vs. (178.52±28.63) mmHg, t=-11.42, P<0.001]. The mean follow-up time was 35.5 months. Renal artery restenosis occurred in 4 patients and underwent reintervention. Conclusion:For patients with renal arterial FMD and RVH, PTRA is safe and effective, especially for patients with focal lesions, with fair short and mid-term prognosis.
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Objective To evaluate the clinical efficacy of portal venous thrombolysis by way of TIPS.Methods The clinical data of 40 patients with portal venous system thrombosis treated by TIPS at our department from May 2012 to May 2018 were retrospectively analyzed.There were 34 cases of via catheterdirected thrombolysis(7 cases by catheter-directed thrombolysis alone and 27 cases by way of TIPS before catheter-directed thrombolysis),and 6 cases via pharmaco mechanical thrombectomy (AngioJet);the postoperative complications of the two methods were followed up.Results The portal vein was opened in all 40 patients,and there were no major complications during the operation.One patient in the catheter-directed thrombolysis group developed acute liver failure after surgery.In the mechanical thrombolysis group,1 patient was discharged after small intestinal necrosis resection and intestinal fistula reconstruction.After 6-24 months of postoperative follow-up,6 patients in the group of thrombolysis suffered from shunt canal stricture.Conclusions It is a safe and minimally invasive method to treat portal venous system thrombosis through TIPS.Mechanical thrombolysis is more direct and rapid than catheter thrombolysis.
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Objective@#To analyze the clinical significance of contrast-enhanced ultrasound in the treatment of patients with carotid stenosis.@*Methods@#The clinical data of 89 patients with carotid stenosis was retrospectively analyzed.The morphology and stenosis of carotid plaques were observed by contrast-enhanced ultrasound, and analyzing the relationship between the patient′s clinical symptoms and treatment options.@*Results@#There were 66 males, 23 females, age ranging from 41 to 88 years.There were 147 plaques in 89 patients and 58 patients with bilateral lesions. The intensity of plaque ultrasound contrast was grade Ⅰ in 40 cases(27%), grade Ⅱ in 30(20%), grade Ⅲ in 31(21%), andgrade Ⅳ in 46(31%). The symptomatic group had higher CEUS strengths in grade Ⅲ(21.4%) and grade Ⅳ(37.9%). The difference was statistically significant between the two groups (P<0.05). Symptomatic group with high proportion of severe stenosis (44.7%) and occlusion (9.7%). It is narrower than that of asymptomatic group.The difference of stenosis was statistically significant between the two groups (P<0.05).@*Conclusion@#Contrast-enhanced ultrasound can dynamically and visually assess the distribution and density of carotid plaque morphology. It is useful for evaluating the treatment of patients with carotid stenosis.
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Objective To analyze the clinical significance of contrast-enhanced ultrasound in the treatment of patients with carotid stenosis.Methods The clinical data of 89 patients with carotid stenosis was retrospectively analyzed.The morphology and stenosis of carotid plaques were observed by contrastenhanced ultrasound,and analyzing the relationship between the patient's clinical symptoms and treatment options.Results There were 66 males,23 females,age ranging from 41 to 88 years.There were 147 plaques in 89 patients and 58 patients with bilateral lesions.The intensity of plaque ultrasound contrast was grade Ⅰ in 40 cases(27％),grade Ⅱ in 30(20％),grade Ⅲ in 31(21％),andgrade Ⅳ in 46 (31％).The symptomatic group had higher CEUS strengths in grade Ⅲ (21.4％) and grade Ⅳ (37.9％).The difference was statistically significant between the two groups (P ＜ 0.05).Symptomatic group with high proportion of severe stenosis (44.7％) and occlusion (9.7％).It is narrower than that of asymptomatic group.The difference of stenosis was statistically significant between the two groups (P ＜ 0.05).Conclusion Contrast-enhanced ultrasound can dynamically and visually assess the distribution and density of carotid plaque morphology.It is useful for evaluating the treatment of patients with carotid stenosis.
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Objective To evaluate the perioperative management of blood pressure in patients with bilateral carotid artery severe stenosis underwent staging carotid endarterectomy (CEA).Methods This retrospective study included 31 patients with bilateral carotid stenosis who underwent bilateral revascularizations in our department from April 2012 to November 2015.Patients were recorded with general information,and the changes of blood pressure in preoperative,intraoperative and postoperative were observed,respectively.Regulation and control of blood pressure were performed according to individual patient's condition.Results Thirty one patients underwent a total of 62 consecutive procedures successfully.Postoperative symptoms disappeared or significantly reduced.Twenty three cases (74.2％) had high perfusion symptoms in the ipsilateral CEA,and 5 cases (16.1％) with high perfusion syndrome in the contralateral surgery.Patients were improved after strict control of blood pressure and dehydration reduced intracranial pressure.The high peffusion symptoms in patients were significantly improved or disappeared after 1 week.Doppler ultrasound was used to evaluate the carotid artery before discharge.Conclusions For patients with bilateral carotid stenosis,staging purposes CEA is safe and effective.However,perioperative blood pressure management is very important.Individual control of blood pressure can significantly reduce the risk of postoperative high perfusion and cerebral infarction.Blood pressure control is recommended after 1 week in about 85％ of preoperative blood pressure.
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Objective To evaluate high resolution manometry in the diagnosis of hiatal hernia.Methods Clinical data were reviewed on 20 patients suffering from gastroesophageal reflux who had laparoscopic Toupet fundoplication for preoperative tentative diagnosis of hiatal hernia.Preoperative diagnosis of hiatal hernia was made collectively by endoscopy,X-ray examination,24 hour esophageal pH monitoring and high resolution manometry before surgery.Results Preoperative diagnosis of hiatal hernia was made in 3 patients by X-ray examination,in 9 patients by high resolution manometry.11 patients were finally diagnosed with hiatat hernia intraoperatively.X ray was consistent with intraoperative diagnosis in 27％ cases.Intraoperative and endoscopic diagnoses were 55％.High resolution manometry and intraoperative diagnoses were consistent in 82％.Lower esophageal sphincter length was (1.92 ± 0.38) cm in hiatal hernia group and (2.10 ± 0.92) cm in non-hiatal hernia group (t =0.60,P ＞ 0.05),lower esophageal sphincter pressure (respiratory min) was (0.64 ±0.55) kPa in hiatal hernia group and (1.31 ± 1.07) kPa in nonhiatal hernia group(t =1.80,P ＞ 0.05),and lower esophageal sphincter pressure (respiratory mean) was (1.43 ±0.92) kPa in hiatal hernia group and (2.57 ± 1.33) kPa in non-hiatal hernia group(t =2.26,P ＜0.05).The reflux parameters,including the percent total time pH ＜ 4,and DeMeester score,were significantly greater in hiatal hernia group than in non-hiatal hernia group (all P ＜ 0.05).Conclusions Hiatal hernia patients are with poor esophageal antireflux competency and severe reflux.High resolution manometry is more valuable in the diagnosis of hiatal hernia than endoscopy or X-ray examination.