Advances in the treatment and prevention of acute retinal arterial ischemia / 国际眼科杂志(Guoji Yanke Zazhi)

Acute transient or permanent retinal arterial ischemia is ocular and systemic emergency requiring immediate diagnosis and treatment. Transient monocular vision loss is transient retinal arterial ischemia which leaves no permanent deficits. Central retinal arterial occlusion and branch retinal arterial occlusion lead to permanent visual function deficits in the majority of patients. Current treatment include lowering intraocular pressure, dilating blood vessels, hyperbaric oxygen therapy, intravenous or intra-arterial thrombolysis and so on, but there is still no standard treatment procedure. High risk groups should receive primary prevention measures in order to reduce the incidence of the disease. Patients with acute retinal arterial ischemia are at high risk of subsequent stroke and adverse cardiovascular events. Relevant risk factors should be identified in time, the primary disease should be treated actively, and appropriate secondary prevention measures should be taken to improve the prognosis. This review summarizes the recent treatment and prevention procedures of acute retinal arterial ischemia, to provide references for the management of these diseases.

Distal embolic filter protection during debulking treatment of peripheral artery disease / 中华普通外科杂志

Objective:To discuss the strategies of distal embolic filter protection(DEFP) during excimer laser ablation (ELA) or percutaneous mechanical thrombectomy (PMT) in treatment of peripheral artery disease.Methods:Clinical data of 29 patients undergoing ELA or PMT under the DEFP from Oct 2019 to Aug 2021 were retrospectively collected to analyze the strategies of DEFP and high-risk factors of capturing clinically significant macrodebris.Results:There were 21 males and 8 females, aged (70.3±11.0) years with 32 lesions (29 limbs) including 5 in-stent restenosis (ISR), 10 thrombosis and 17 chronic total occlusion (CTO). The technical success rate of DEFP device release and recovery was 100%. The overall debris capture rate was 77.3% and the macrodebris capture rate was 36.4%. Even with DEFP the distal embolization (DE) incidence was 3.4%. When ELA for CTO with severe calcification or long-segment ISR lesions, the capture rate of macrodebris was as high as 60.0%, and the former was significantly higher than ELA for CTO without high calcification lesions ( P<0.05). Conclusion:ELA or PMT under the DEFP in treatment of peripheral artery disease appears to be of great significance in preventing DE.

Emergent Thrombectomy for a Patient with Coronavirus Disease 2019 (COVID-19) / 日本心臓血管外科学会雑誌

A 76-year-old man presented with right leg numbness and general fatigue. The patient had no respiratory symptoms and negative PCR of COVID-19, but the lungs on CT scan revealed highly suspected COVID-19. The CT scan also showed occlusion from the right external iliac artery through below-knee arteries. Our surgical staff had personal protective equipment with powered air-purifying respirators and performed emergent surgical thrombectomy with the Fogarty balloon catheter. A few days after the operation, we found that the patient's antibody for COVID-19 was positive. The patient received anticoagulation and the postoperative course was uneventful. It is desirable to have more novel and precise knowledge of thrombosis in patients with COVID-19.

Treatment strategy of peripheral arterial diseases with Rotarex / 中华普通外科杂志

Objective:To evaluate the effect of Rotarex in peripheral arterial disease (PAD).Methods:The clinical data of 90 PAD patients treated with Rotarex from Aug 2018 to Feb 2020 were retrospectively analyzed.Results:Among the 90 patients, 45 patients had atherosclerotic obliterans complicated with acute thrombosis (ASOCAT), 27 patients had graft restenosis or reocclusion, 16 patients had primary or embolism-induced thrombosis, 2 patients had traumatic or iatrogenic arterial occlusion. Except for 2 patients undergoing hybrid surgery, 88 patients underwent endovascular treatment. Two patients died perioperatively. Within 12 months follow-up, 2 patients died, 4 patients underwent major amputation, target arteries of 10 patients were re-stenosed or re-occluded and 5 patients were lost to follow-up. Compared with the preoperative ankle-branchial index (ABI), significant increase was observed in the 12-month ABI (0.80±0.22 vs. 0.43±0.16, P<0.01). The 12-month restenosis/re-occlusion-free rate was 82.7%, and the 12-month major amputation-free survival (MAFS) was 91.6%. Conclusion:For PAD patients, acceptable outcomes can be achieved with reasonable use of Rotarex for debulking, combined with balloon, stent and other techniques to correct the residual lesions.

Clinical follow?up study of paclitaxel?coated balloon in the treatment of symptomatic lower extremity arteriosclerosis obliterans / 中国综合临床

Objective To investigate the clinical effect of paclitaxel coated balloon in the treatment of symptomatic lower extremity arteriosclerosis obliterans.Methods From January 2016 to April 2017,64 patients with symptomatic lower limb arteriosclerosis obliterans ( ASO ) of femoral and popliteal artery stenosis admitted to Chongming Branch Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected as the research subjects.According to the principle of randomization, they were divided into two groups, 32 cases in each group.In the drug?coated group, ordinary balloon was pre?expanded,and then paclitaxel drug?coated balloon was used to expand.If there were still retraction and stenosis of diseased vessels, which affected the blood flow of lower limbs, remedial stents were implanted.Bare stent group used a slightly smaller balloon to pre?expand superficial femoral artery and then release the stent.After one year follow?up, the changes of ankle?brachial index ( ABI), restenosis rate of target lesion vessels, Rutherford grading changes, clinical drive target vessel revascularization rate, perioperative period,death rate of patients during follow?up period, amputation rate and complication rate were observed.Results There were no amputations or deaths in the whole group during the perioperative period and follow?up.The incidence of complications in the drug?coated group was 3.1%( 1／32 ), significantly lower than that in the bare stent group 18.8%( 6／32) ( χ2 ＝4.010, P＝ 0.045).Before treatment,the ABI of patients in drug?coated group and bare stent group at 6 months and 12 months after treatment were significantly different ( Finter?group ＝ 7.028, Pinter?group ＝ 0.024, Fintra?group ＝ 219.028, Pintra?group＝0.000,Finteraction＝350.028,Pinteraction＝0.000),and ABI of the two groups at 12 months after treatment were (0.73± 0.11) and ( 0.68 ± 0.09),respectively, the difference was statistically significant ( t＝1.990, P＝0.025).Six months after operation, the restenosis rates of target lesions in the two groups were 9.4%(3／32) and 15.6%(5／32), respectively, with no significant difference ( χ2 ＝0.571, P＝0.450); The restenosis rate of bare stent group was 37.5%(12／32) 12 months after operation,which was significantly higher than that of drug?coated group by 15.6%(5／32) (χ2＝3.925,P＝0.048).Clinical observation results showed that 12 months after operation,the target?lesion revascularization (TLR) of the drug?coated group was 3.1%(1／32) and that of the bare stent group was 9.4%(3／32),with no significant difference.Rutherford grading was improved in both groups(χ2＝1.067,P＞0.05). Conclusion Paclitaxel drug?coated balloon is safe and effective in the treatment of symptomatic lower limb arteriosclerosis obliterans,which is worthy of clinical application.

Central retinal arterial occlusion in a patient with pyoderma gangrenosum

A 74-year-old male presented to us with a history of vision loss for 36 hours in the right eye (RE). The RE had a visual acuity of hand movements. The fundus revealed a pale retina, cattle tracking in the retinal vessels, and a cherry-red spot at the macula. The patient was a known case of pyoderma gangrenosum (PG) and had received intravenous methylprednisolone and cyclophosphamide at the onset of visual symptoms. An emergency anterior chamber paracentesis was performed following unsuccessful attempts of ocular massage. The patient improved to 6/9 in the RE 4 months after paracentesis. The patient had an aggressive course of PG, for which he needed a combination of oral steroid, immunomodulator therapy and biologicals. An association between central retinal arterial occlusion and PG has not been reported before, according to the best of authors' knowledge.

Analysis of curative effect of catheter thrombolysis in the treatment of subacute lower limb arterial occlusion / 中国医师进修杂志

Objective To observe the curative effect of catheter thrombolysis in the treatment of subacute lower limb arterial occlusion.Methods Eighty-five patients with subacute lower limb arterial occlusion (98 limbs) and treated with catheter thrombolysis were enrolled and the removal of thrombus and patency of vessels were evaluated by angiography.Then,balloon dilatation or stent implantation was performed according to the angiographic findings after thrombolysis. Results After catheter thrombolysis, the degree and length of occlusion were significantly improved (P < 0.01). To judge the curative effect: significantly effective in 5 limbs (5.1%), effective in 85 limbs (86.7%), ineffective in 8 limbs(8.2%),total effective rate was 91.8%.Catheter thrombolysis combined with balloon dilatation and stent implantation were performed according the vascular occlusion status and all the occluded segments were open, the postoperative angiography showed no distal vascular occlusion. No bleeding occurred. Conclusions Catheter thrombolysis is effective and safe in the treatment of lower extremity arterial occlusion in subacute stage.Endovascular treatment combined with endovascular treatment can achieve good results.

Clinical observation on intravenous thrombolytic bridging and vascular intervention for treatment of patients with acute intracranial large arterial occlusion: a report of 7 cases / 中国中西医结合急救杂志

Objective To evaluate the efficacy and safety of using alteplase for intravenous thrombolysis combined with vascular intervention for treatment of patients with acute intracranial large arterial occlusion.Methods Clinical data of 7 patients with acute intracranial large arterial occlusion treated by using alteplase for intravenous thrombolysis combined with intravascular intervention admitted to Department of Neurosurgery in Affiliated Hospital of the Logistics University of Cinese People's Armed Police Force from July 2015 to August 2016 were retrospectively analyzed.All the 7 patients were treated by alteplase dry powder (50 mg or 20 mg each ampule),solvent dose was 0.9 mg/kg,the maximum dose being ＜ 90 mg,firstly 10％ dose was intravenously injected,and the remaining dose was continuously infused into a vein in 60 minutes,during or after intravenous thrombolysis,digital subtraction angiography (DSA) was performed immediately,and according to the results of the angiography,at least one of the 3 kinds of intravascular mechanical intervention therapy,thrombectomy,balloon dilatation or stent placement,were chosen,and 24 hours after surgery,the anti-platelet aggregation drug and calcium channel antagonists were given,The effect of interventional therapy was analyzed,and the clinical outcome of 90-day treatment was evaluated.Results The mean age of the patients was (60.0 ± 12.6) years.Seven patients all successfully completed the treatment,and satisfactory re-canalization was achieved [they all obtained grade 3 or 2b in accord with the gradation of Thrombolysis in Cerebral Ischemia Scale (TICI)] in all the 7 cases (100％),after treatment,the National Institutes of Health Stroke Scale (NIHSS) score was significantly lower than that before treatment (5.86 ±4.10 vs.19.71 ± 5.56,P ＜0.01).Clinical outcome of 90-day follow up was excellent [Modified Rankin Scale (mRS) score 0-2] in 3 cases (42.8％).Conclusion Using alteplase for intravenous thrombolysis combined with endovascular intervention for treatment of patients with acute intracranial large arterial occlusion can achieve good re-canalization rate.

Treatment of symptomatic cerebral artery stenosis and occlusion with Xenon CT guided cerebral revascularization / 中国脑血管病杂志

Objective To investigate the roles of Xenon-CT cerebral blood flow perfusion imaging in cerebral revascularization before surgery and efficacy evaluation.Methods The clinical data of 15 patients with symptomatic cerebral artery stenosis/occlusion of anterior circulation were analyzed retrospectively.Eight patients were treated with endovascular stenting,1 was treated with internal carotid endarterectomy,and 6 were treated with superficial temporal artery-middle cerebral artery bypass grafting.The regional cerebral blood flow (rCBF) detected by Xenon CT within 2 weeks before and after procedure and the modified Ranking scale (mRS) scores at 6 months after procedure were compared.Results (1) The mean rCBF value of 12 patients with abnormal blood perfusion of target vessels before procedure was 30±10 ml/(100 g·min) and that was 32±14 ml/(100 g·min) after procedure.Compared with before procedure,the difference was statistically significant (P0.05).(2) The postoperative mRS score was decreased in 8 cases and stable in 7 cases.Compared with before procedure,there were significant differences in mRS scores after procedure in 15 cases (P<0.05).During the follow-up period,none of the patients had new neurological impairment.Conclusion Revascularization can improve the presence of hemodynamic disorders in patients with symptomatic anterior circulation cerebral artery stenosis or occlusion of the target blood vessels in the distal local cerebral perfusion and neurological deficit symptoms.The patients with abnormal perfusion of preoperative Xenon-CT cerebral blood flow perfusion imaging may be more beneficial than those with normal perfusion.

Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases：a comparative study / 介入放射学杂志

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases：a comparative study / 介入放射学杂志

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Centeral Retinal Artery Occlusion after Viterctomy with Gas Tamponade for Retinal Detachment: A Case Report / 계명의대학술지

To introduce a case of Centeral Retinal Artery Occlusion in Gas Tamponade State after Viterctomy for the treatment of Retinal Detachment. A 47-year-old male patient with histories of LASEK surgery 15 years ago and cataract surgery 8 years ago visited our clinic with complaints of sudden visual disturbance in his right eye. He was diagnosed as regmatgenous retinal detachment and underwent pars plana vitrectomy, endolaser photocoagulation, 14% C3F8 gas tamponade, and subtenon triamcinolone injection. After the surgery, the retina was well attached and the visual acuity was improved from finger count 30cm at post-operative day 1 to 0.08 after the 2 weeks of surgery. Intraocular pressure was maintained 20~25 mmHg by Brimonidine/timolol eye drop treatment. The best corrected visual acuity was reduced to hand motion at post-operative day 15. Retinal arteriol attenuation and pale optic disc with 1/3 gas filled vitreous cavity was identified at post-operative day 30. Post-operative 2 years, visual acuity was non light perception with severe narrowing of arteriole and diffuse retinal pigment epithelial atrophy; no retinal vascular flow was observed on fluorescein angiography. Gas tamponade state after viterctomy for the treatment of retinal detachment at high myopia may be risk factors of central retinal artery occlusion.

The application of multipoint puncturing technique in performing endovascular therapy for complex lower extremity arterial occlusive diseases Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China / 介入放射学杂志

Objective To discuss the methods, advantages and indications of multipoint puncturing in performing endovascular therapy for complex lower extremity arterial occlusive diseases. Methods During the period from Oct. 2011 to Oct. 2013, a total of 46 patients with complex lower extremity arterial occlusive diseases were treated with endovascular therapy by using multipoint puncturing technique. The puncturing type, the advantages of multipoint puncturing technique and the success rate of this technique were analyzed. Results The multipoint puncturing was divided into three types: type Ⅰ : puncturing from the opposite direction to deal with the same target vessel; type Ⅱ: direct puncturing of the target vessel; and type Ⅲ:using the same puncturing direction to deal with different target vessels. The success rate of endovascular treatment was 80.4%. Conclusion Multipoint puncturing technique helps improve endovascular treatment success rate for lower extremity arterial occlusive diseases. Full understanding of the advantages of multipoint puncturing technique, perfect preoperative planning, precise puncturing technique and proper interventional equipments are helpful to ensure a successful treatment.

Diagnostic Value of Thrombus Size on T2*-weighted Gradient Echo Imaging in Acute Middle Cerebral Artery Occlusion

OBJECTIVE: The T2*-weighted gradient echo image susceptibility vessel sign (GRE SVS) is a well-known indicator of intraluminal thrombi in acute cerebral infarction. The purpose of this study was to evaluate the relationships between thrombus size on GRE SVS and recanalization after intravenous administration of tissue plasminogen activator (IV-tPA). MATERIALS AND METHODS: Fifty five patients with GRE SVSs on the M1 were enrolled. Examination of magnetic resonance image (MRI), including diffusion weighted imaging and MR angiography, was performed within 20 minutes of admission. Thrombus size on GRE was calculated using the Picture Archiving and Communication System upon initial MRI. Recanalization was assessed with follow-up MRI or transfemoral cerebral angiography within 24 hours of treatment. RESULTS: The patient group consisted of 37 males and 18 females with an average age of 63.74 +/- 10.28 years (range: 43 - 77 years). The median NIHSS score was 13. Fifteen of these patients achieved recanalization (27.3%). The average thrombus cross-sectional area in the recanalization group was 38.54 +/- 20.27 mm2, and the corresponding size of the non-recanalization group was 53.38 +/- 24.77 mm2 (p = 0.043). In the receiver operator characteristic curve for thrombus cross-sectional area in relation to recanalization, the cut-off point was 47.28 mm2. The sensitivity at this cut-off point was 73.3%, the specificity was 60%, and the area under the curve was 0.687. CONCLUSION: Thrombus size on GRE is a simple diagnostic tool that can be easily measured, and thrombus size on GRE SVS was found to be associated with recanalization after IV-tPA.

Susac's syndrome: First from India and youngest in the world.

A two and half year old female was admitted at the emergency room suffering from gradually worsening headache followed by nausea. The child presented with reduced level of consciousness and bilateral hypoacusis. The patient was lethargic. Ophthalmic examination showed branch retinal artery occlusion (BRAO). This finding was crucial to the diagnosis of Susac’s syndrome (SS), a rare autoimmune disease characterized by, endotheliopathy of retina, encephalic tissues and cochlea. Magnetic resonance imaging of the brain also showed typical features. Thorough blood investigations did not reveal any other abnormality. Patient was treated with immunosuppressive to prevent her from developing severe sequelae of this disease. The child showed dramatic improvement in her systemic condition within 48 h of starting the treatment. This is the youngest ever and first case report from India.

Effect of subarachnoid transplantation of bone marrow origin stem cell united with TCM on the gilial cell-line derived neurotrophic factor in brain of cerebal ischemai rats / 国际中医中药杂志

Objective Observe the influence on the Gilial cell-line derived neurotrophic factor (GDNF) after treatment stroke rats with Bone marrow mesenchymal stem cells (BMSCs) or Bone marrow mononuclear cells (BMNCs)combined with traditional Chinese medicine (TCM).Methods Separating and cultivating BMSCs and BMNCs were.140 Wistar rats were divided into 7 groups randomly,normal group,pretended surgery group,model group,BMNC group,BMNC+TCM group,BMSC group,BMSC+TCM group.The other five groups were performed for 2 hours middle cerebral arterial occlusion (MCAO) except normal group and pretended surgery group.Intervention methods in each group after 24 hours of MCAO:model group:Subarachnoid injection of 100 μl 0.01M PBS,BMNC group and BMNC + TCM group,Subarachnoid injection of 2 × 107 BMNCS,BMSC group and BMSC+TCM group,Subarachnoid injection of 2 × 107 BMSCS,BMNC +TCM group and BMSC+TCM group were treated united with TCM on the transplantation day (po.Qd.).GDNF level in all groups' rat brain were analyzed by Enzyme-linked immuno sorbent assay (ELISA) method at the 4th day and the 28th day after transplantation.Results The GDNF level of model group [(62.60±4.05) pg/ml] is higher than normal group's [(53.46 ± 3.91)pg/ml] at the 28th day (P＜ 0.05).The GDNF levels of BMNC group [(194.21 ±39.56)pg/ml,(67.70±4.73)pg/ml] and BMSC group [(169.83±28.84)pg/ml,(82.66±32.23)pg/ml] are higher than model group's at the 4th and 28th day(P＜0.05).The GDNF level of BMSC group is higher than BMNC group's at the 28th day(P＜0.05).The GDNF levels of group BMNC+TCM group[(560.61 ± 194.84) pg/ml,(265.83 ±93.58) pg/ml and BMSC+TCM group[(370.93 ±46.19) pg/ml,(247.34±98.02)pg/ml] are higher significantly than BMNC group's or BMSC group's at the 4th and 28th day(P＜0.05).At the 4th day the GDNF level of the BMNC+TCM group is higher than BMSC+TCM group's(P＜0.05).Conclusion Subarachnoid transplantation of BMNCs or BMSCs will increase the GDNF level in brain of MCAO rats.The transplantantion combined with TCM can inprove the capability of the enhance.That reflect the advantage of transplantantion bone marrow origin stem cell united with TCM.

A Case of Acute Arterial Occlusion of the Lower Extremity Caused by Huge Vegetation of Prosthetic Valve Endocarditis / 日本心臓血管外科学会雑誌

A 79-year-old woman with prosthetic valve endocarditis (PVE) on aortic position underwent re-aortic valve replacement. Although emergency operation was indicated due to huge vegetation over 20 mm in diameter attached to the prosthesis shown by preoperative transesophageal echocardiography, intraoperative transesophageal echocardiography showed disappearance of the vegetation. The prosthesis was carefully removed and replaced by a new bioprosthesis, though only small vegetation was observed on the removed prosthesis. Sudden blue toe 11 h after the operation and diminished pulse on right pedal artery suggested an acute arterial occlusion of a right lower extremity, requiring an emergency thrombectomy. Pathology diagnosed bacterial embolus with fresh thrombus that was considered apart from the prosthesis at the time of operation.

Thrombotic Occlusion of the External Iliac and Popliteal Arteries after Hip Hemiarthroplasty: A Case Report / 대한고관절학회지

Vascular complications related to hip arthroplasty are common, however, total occlusion of a critical artery that threatens survival of an extremity is extremely rare. We report on a patient who had thrombotic arterial occlusions at the iliac and popliteal arteries following hemiarthroplasty of the hip.

Endovascular treatment for right subclavian artery occlusion : techniques and results / 中华放射学杂志

Objective To evaluate the technique and result of endovascular treatment for right subclavian artery stenosis or occlusion.Methods Seventeen patients [13 males,4 females ; (56 ± 11)years old] with right subclavian artery stenosis or occlusion were treated with endovascular surgery which included recanalization,balloon angioplasty and stenting via femoral or brachial artery route.Cerebral protection devices were used in 6 cases to avoid cerebral embolism.Results Sixteen of the seventeen patients acquired successful recanalization in 8 cases with subclavian artery stenosis (100％ technical success rate) and in other 8 cases with subclavian artery occlusion (88.9％ technical success rate).Five cases were treated with balloon angioplasty,and 11 cases were treated with balloon angioplasty combined with stenting.Good patency was seen in the 16 cases immediately after the procedure.The cerebral protection devices prevented all the cases from cerebral embolism and were retrieved suceessfully.Sixteen cases were followed up from 1 to 66 months [mean (24 ± 18) months].Restenosis was found in one case 10 months later and was successfully treated with re-PTA.One case with aortoarteritis died of cerebral infarction 18 months later.No symptom recurrence was found in other cases and ultrasound or CTA of followup showed excellent patency.Conclusions Balloon angioplasty and stenting are safe and effective for the treatment of right subclavian artery occlusion.