Treatment of acute limb ischemia / 中国普通外科杂志

Objective To investigate the management of acute limb ischemia.Methods The clinical data of 28 patients with acute limb ischemia were retrospectively analyzed.Four patients with arterial embolism underwent embolectomy.one patient with pseudoaneurysm underwent false aneurysm resection and revascularization with PTFE,23 patieuts wiht arterial occlusive disease were treated by multiple means such as embolectomy,bypass,primary amputation,endovascular interventions,and pharmacologic therapy(n=23).Results The 5 patients with arterial embolism or pseudoaneurysm were all treated successfully.In the 23 patients with arterial occlusive disease,5(21.7%) were treated successfully,12(52.2%) were improved,and 6(26.1%) had ineffective treatment.No inpatient died,but 4 patients underwent amputation.During follow-up of 6-45 months,there were 4 deaths and other 5 amputations.Conclusions Proper intervention of patients with acute limb ischemia should be chosen according to clinical evaluation of the illness,and includes embolectomy and revascularization,to get limb or life salvage.

Ultrasound ablation combined with autologous transplantation of bone marrow mononuclear cells for treatment of arteriosclerosis obliterans / 中国普通外科杂志

Objective To investigate the efficacy of ultrasound ablation combined with autologous transplantation of bone marrow mononuclear cells in treatment of arteriosclerosis obliterans.Methods Clinical data of 39 patients with arteriosclerosis obliterans treated with ultrasound ablation and autologous transplantation of bone marrow mononuclear cells were analyzed.There were 21 male and 18 female patients,With average age of 63 years.At operation,260 mL of autologous bone marrow was withdrawn,mononuclear cells were separated,and 40 mL supension fluid of stem cells was prepared.Through percutaneous approach or surgical approach the ultrasound ablation catheter was inserted into occluded arterial segments.After ablation was performed,autologous bone marrow mononuclear cells were directly injected into the skeletal muscles of the ischemic leg.Results No complications were found in this group.Postoperatively,rest pain of all the patients was significiently improved and distance of claudication increased.The skin became warm in all legs.Conclusions Ultrasound ablation and autologous transplantation of bone marrow mononuclear cells is a simple,safe and effective method for treating patients with arteriosclerosis obliterans.

Treatment of acute abdominal aorta saddle embolism:a report of 21 cases / 中国普通外科杂志

Objective To summarize our experience in treating abdominal aorta saddle embolism(ASE).Methods The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other(methods) during January 2000 to July 2006 were retrospectively assessed.Results After the blood flow was restored by operation,4 died in the postoperative early stage because of sudden cardiac asystole due to(hyperkalemia);in the late stage,6 died of multiple organ dysfunction syndrome socondary from acute renal(failure)(ARF).Eleven patients were cured.Of them,bilateral lower extremites were salvaged in 5 patients;and 6 patients received amputation.Ten patients were followed up,and the blood supply of the salvaged legs was good.Conclusions Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE.The intra-operative and post-operative prevention and management of(hyperkalemia) and ARF are important for reduction of mortality.

Obervations on the clinical efficiency of autologous bone marrow stem cell transplantation on chronic ischemic disease of lower limb / 中国普通外科杂志

Objective To explore the application of autologous bone marrow stem celI transplantation in the treatment of chronic ischemic disease of lower extremity and evaluate the effect.Methods Forty patients with chronic ischemic limbs were treated from January 2008 to April 2009.The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(GCSF),300?g /d,for 2-3 days.Then,200 mL of bone marrow was withdrawn from the iliac spine and the stem cells were obtained.After the bone marrow separation and purification,they were transplanted into the more severely ischemic limb.After the transplantation,they were foIlowed up by phone once a month for six months.The skin temperature,transcutaneous oxygen pressure(TcPO2),digital subtraction angiography(DSA)and ankle/brachial index(ABI)were rechecked at 6 months later,and the symptoms of pain,cold,numbness,intermittent claudication and physical signs of ulcer and gangrene were also evaluated.Results All of the 40 patients were followed-up.At 6 months post-transplantation,the various indices were compared with before transplantation.(1)The skin temperature and TcPO2 had significante improvement (P0.05).(3)DSA and all of the clinical symptoms showed general improvement in more than 60% of cases.(4)There were no serious complications.Conclusions Transplantation of stimulated autologous bone marrow stem cells is effective in the treatment of ischemic disease of lower limb,which is a simple,safe and effective treatment for ischemic disease of lower limb.

Treatment of arterial occlusion of lower extremities / 中国普通外科杂志

ObjectiveTo study the treament of arterial occlusion of lower extrimities. MethodsSeventy-three cases(78 limbs) of chronic ischemia o f lower extremities were diagnosed as artroial occlusion by color u ltrasounography, DSA or MRA. Arterial bypass using grafting,endarterectomy and percuteneous transluminal angioplasty (PTA) were used for the artery segmental occlusion in 44 limbs. Venous arterialization and reconstruc tion of profunda femoris were performed for extensive occlusion in 29 limbs. ResultsAll the cases showed satisfactory r esults 6 months to 8 years after operation except 8 limbs (segmenta l occlusion in 3 limbs and extensive occlusion in 5 limbs) were amputated. ConclusionsThe key points of improvement of the therapeu tic effects of the arteral occlusion of lowe extremity lie on the cho ice of the therapeutic methods accoding to the results of DSA or MRA.