Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

Estudo comparativo experimental da distribuição do fluxo arterial, em isquemia e reperfusão por circulação retrógrada, através de mapeamento dúplex / Experimental, comparative, duplex mapping study of arterial flow distribution in ischemia and reperfusion by retrograde circulation

Resumo A isquemia crítica de membro inferior sem leito distal tem opções restritas para tratamento. Desviar o fluxo sanguíneo de maneira retrógrada através da circulação venosa é uma alternativa amparada em evidências de inúmeros trabalhos publicados. Comparou-se através de mapeamento dúplex a distribuição do fluxo sanguíneo arterial em membros posteriores de suínos mantidos em circulação fisiológica com o contralateral submetido à isquemia e reperfusão por circulação retrógrada. O fluxo nos membros em circulação fisiológica e retrógrada foi avaliado por mapeamento dúplex através da determinação da velocidade de pico sistólico (VPS), da velocidade diastólica final (VDF) e do índice de resistividade (IR) em artérias selecionadas. A análise comparativa das extremidades mantidas em circulação fisiológica em relação às mantidas em isquemia e reperfusão, por circulação retrógrada, mostrou nestas, ao mapeamento dúplex, que as alterações nos padrões de onda espectral e nas variáveis hemodinâmicas são indicadores satisfatórios e sugerem boa distribuição do fluxo sanguíneo vascular distal.

Abstract Treatment options for critical lower limb ischemia in the absence of the distal bed are limited. Diverting blood flow in a retrograde direction through the venous circulation is one alternative option that is supported by evidence from several published articles. Duplex scanning was used to compare the distribution of arterial flow in hind limbs of pigs maintained in physiological circulation to contralateral limbs subjected to ischemia and reperfusion by retrograde circulation. Flow in limbs with physiological and retrograde circulation was evaluated by duplex scanning with analysis of Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), and the Resistivity Index (RI) for selected arteries. This comparative analysis of extremities maintained in physiological circulation in relation to those subjected to ischemia and reperfusion by retrograde circulation showed, via duplex scanning, that changes in spectral wave patterns and hemodynamic variables are satisfactory indicators and suggest good distribution of distal blood flow.

Pressurizing and Stretching Experiment in Arterialized Veins of Rabbits / 医用生物力学

Objective To establish the model of rabbit vena arterialization, so as to investigate the difference of mechanical parameters between arteries and veins as well as before and after arterialization. Methods Twenty-four rabbits were randomly divided into experimental group (n=12) and control group (n=12). By establishing the rabbit vena arterialization model for experimental group, the arterial blood could flow into the veins. After model creation, the vein would be removed 4 weeks after surgery. In the meantime, the external jugular veins and cephalic arteries extracted from control group were acquired. Compressive pressurizing and stretching tests on all vessels were conducted at the same time(including arteries, veins and arterialized veins). Observation was supported by HE staining and immune tissue chemical techniques. Results There were no deaths among the 24 rabbits, with unobstructed blood flow in veins. With the increase of intravascular pressure, the outer diameter of veins changed at first and then stabilized at a fixed value. The elasticity of veins was worse than that of arteries. The external diameter of veins increased rapidly with internal pressure of veins increasing and reached its extreme elasticity. Comparatively, the elasticity of arteries increased slowly. HE staining results showed that thickness of the vascular wall was thinner, while it became thicker after vena arterialization. After vena arterialization, proliferating cell nuclear antigen（PCNA） and α-actin showed positive results. It further proved that proliferation existed among smooth muscle cells, and veins showed the tendency of restenosis again. The elasticity of veins after transplantation into the arterial system was improved compared with that before transplantation. Conclusions Accompanied by the increasing pressure, the vein could reach its elasticity extremity faster than the artery. Under such a long-term high pressure, vein intima was vulnerable. After vena arterialization, with the gradual thickening of vein intima, the tendency of vessel restenosis was obvious, and the elasticity of veins has been improved after transplantation.

Assessment Of Arterio–Venous Fistulae Result In Ckd Patients Undergoing Haemodialysis

We conducted a study on 50 Av fistula patients ,to assess artificial AVF result in CKD Patients undergoing haemodialysis .Our objectives were ,to evaluate the patency of AVF upto period of 6 months,to assess the complications of AVF to clinically assess the arterialization of vein and to evaluate the need for alternate site for fistula. We Included • Patients undergoing A–V Fistula surgery under IPD and OPD basis in Bharati Hospital and Research Centre. • Both sexes are included. • Age above 70 years and less than 18years. We Excluded • Patients who did not give consent. All patients undergoing AVF surgery prior to renal transplant

Application of three dimensional visualization combined with portal vein arterialization technologies in pancreaticoduodenectomy / 中华消化外科杂志

Objective To explore the application value of three-dimensional (3D) visualization combined with portal vein (PV) arterialization technologies in pancreaticoduodenectomy.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with duodenal cancer who was admitted to the Chenggong Hospital of Xiamen University in August 2015 were collected.The preoperative plain scan images in the upper abdomen and enhanced scan images in the arterial and PV phases using 320-slice spiral CT were converted to the 3D images by 3D visualization technology.The 3D data were used for detecting tumor invading pancreatic head and organizational structure surrounding hepatic hilus,and making a preliminary surgical plan.Open exploration found that tumor involved pancreatic head and didn't invade superior mesenteric artery and vein,and then pancreaticoduodenectomy was applied to the patient during operation.Intraoperative proper hepatic artery-PV end-to-side anastomosis was used for increasing R0 resection rate.Operation time,volume of intraoperative blood loss,result of postoperative pathological examination,liver function and complication and vascular patency at postoperative week 1 and vascular patency at postoperative month 1 were observed.The patient underwent color Doppler ultrasound and digital subtraction angiography (DSA) at postoperative month 1 in order to detect blood vessels,and was followed up by outpatient examination for observing tumor till November 2015.Results There was a clear and solid 3D reconstruction model between anatomical position of tumor and blood vessels,and preoperative assessment was consistent with intraoperative finding.Operation time and volume of intraoperative blood loss were 6.5 hours and about 1 500 mL.The patient was confirmed as intestinal diffuse large B-cell lymphoma by postoperative pathological examination.The patient had normal liver function at postoperative week 1 and discharged from hospital at postoperative week 2,without abdominal secondary hemorrhage,infection,pancreatic fistula,intestinal fistula and other severe complications.PV blood flowing was normal by color Doppler ultrasonography at postoperative week 1 and month 1.DSA examination showed that there was no proper hepatic artery images and visible compensatory liver artery at postoperative month 1.During follow-up,no tumor recurrence was detected.Conclusion 3D reconstruction model can provide an accurate preoperative assessment,and PV arterialization technology for unreserved hepatic artery has a certain degree of clinical value in pancreaticoduodenectomy.

Application of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma / 中华消化外科杂志

Objective To investigate the value of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma.Methods The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed.The two-dimensional computed tomography images were converted to three-dimensional images with the three-dimensional visualization system,and then the volume of liver and tumor size,volume of liver to be resected,remnant liver volume were measured.Surgical procedure was planned based on the three-dimensional images,and the difference between the actual and planned surgical procedures was analyzed.The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The mean liver volume,tumor size,predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496 ± 162) ml,(67 ± 18) ml,(335 ± 241)ml and (1140 ± 197)ml,respectively.The average error rate of predicted liver resection volume was 6.4％.Surgical plan was made in accordance with the principle of curative hepatectomy,including 4 cases of left semihepatectomy,2 cases of right semihepatectomy,3 cases of partial liver resection and 1 case of palliative liver resection.The coincidence rate between the planned and actual surgical procedures was 9/10.R0 resection was performed on 7 patients,R1 resection on 1 patient and palliative resection on 2 patients.One patient received restrictive portal vein arterialization.Preoperative evaluation of the anatomy of blood vessels,bile ducts and tumors based on three-dimensional images was confirmed with operative findings.The accuracy of tumor typing by the three-dimensional visualization system was 8/10.The actual liver resection volume was (325 ± 258) ml,which was positively correlated with the predicted liver resection volume (r =0.902,P ＜ 0.05).Conclusion The three-dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.

Management of grade Ⅳ portal vein thrombosis in liver transplantation (report of 6 cases) / 中华器官移植杂志

Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.

Current status and perspectives of application of portal vein arterialization in hepatobiliary surgery / 中华肝胆外科杂志

Since portal vein arterialization(PVA) was firstly introduced as a treatment in patients with portal hypertension due to liver cirrhosis, the concept of PVA has drawn much attention. In special situations, in hepatobiliary surgery, this procedure remains useful. However, PVA is unphysiological and there is much controversy on its use.This article reviews the current status of PVA in hepatic artery resection or injury, in acute liver failure and in liver transplantation, and suggests future directions in research in PVA.

Utilização da safena magna in situ para arterialização do arco venoso do pé / The great saphenous vein in situ for the arterialization of the venous arch of the foot

CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6 por cento) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9 por cento) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5 por cento). CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.

BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point onward. RESULTS: Limb salvage was achieved in 10 (55.6 percent) patients, 5 with AO and 5 with TO. Seven (38.9 percent) patients were amputated, 5 with AO, 1 with TO and 1 with Ta. One (5.5 percent) patient died. CONCLUSION: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.

Peoría paradójica en fístulas carótido-cavernosas durales: cuando el cuerpo se enferma más para curarse / Paradoxical worsening in carotid-cavemous ductal fistulas: when the body get more sick in order to cure

Las fístulas carótido-cavernosas son comunicaciones arteriovenosas patológicas entre la arteria carótida interna intravenosa y el seno venoso-cavernoso que la rodea. Un sistema de flujo y presión elevados irrumpe sobre otro de bajo flujo y velocidad. Ello origina los síntomas y signos. La gran mayoría, son resultantes de traumatismos craneales siendo de alto flujo y alta velocidad-fístulas traumáticas o directas; menos comunes son las llamadas fístulas espontáneas o durales localizadas en la duramadre y alimentadas por ramas menígeas provenientes de las arterías carótidas externa, interna o ambas y de las arterias vertebrales. Estas últimas raras veces tienen implicaciones graves para la vida, pero la pérdida visual constituye el mayor riesgo; no obstante, con elevada frecuencia, ocurre la oclusión espontánea, por lo que se impone la observación hasta que la sintomatología justifique el tratamiento. En el curso evolutivo puede ocurrir la trombosis aguda de la fístula y más propiamente de la totalidad de la vena oftálmica superior la que produce un distintivo cuadro de notable agravamiento de los síntomas que en forma contradictoria ocurre antes de la mejoría y reversión de los síntomas, el síndrome de empeoramiento o peoría paradójica. Para ilustrar el síndrome se presentan los casos clínicos de los pacientes

Caroid-cavernous fistulas are pathological arteriovenous communications between the intracavernous internal carotid artery and the cavernous sinus. A system of high flow and pressure bursts over another system of low flow and slow velocity. This causes the symptoms and signs. The vast majority are related with head trauma being high flow and high speed fistulas: traumatic or direct. Less common are the so-called spontaneous or dural fistulas located in the duramater and fed by meningeal branches from the external, internal, or both carotic arteries and the vertebral arteries. These latest rarely have serious implications for life, but visual loss is the greatest risk; however, with high frequency spontaneously occlusion occurs, and then observation imposes until symptoms justified the treatment. During its evolution acute thrombosis of the fistula itself can occur along the entire length of the ophthalmic vein which produces a distinctive and paradoxical worserning and reversal of symptoms, which is called the syndrome of paradoxical worserning. Clinical cases of two patients are presented to illustrate the syndrome

Arterialización venosa temporal del pie diabético / Temporal venous arterialization of the diabetic foot

La primera idea que tuvieron los cirujanos (1902) para evitar amputaciones por isquemia fue la de desviar el flujo arterial al sistema venoso por intermedio de una fístula arteriovenosa entre vasos adyacentes, pero con resultados inciertos. Desde entonces se han inventado las simpatecomias, las endarteriectomias y los injertos puentes o bypass y, últimamente, otros avances médicos, quirúrgicos y endovasculares. Sin embargo, en el mundo se siguen haciendo amputaciones, sobre todo en diabéticos. La arterialización de las venas del pie, basada en la vieja idea de la circulación invertida, constituye una esperanza más para estos pacientes ya condenados a la pérdida del miembro. Objetivo: Demostrar que la arterialización de las venas del pie en diabéticos con lesiones neuroisquémicas, generalmente infectadas (pie diabético), es un método eficaz y durable, aunque el puente solo funcione temporalmente. Pacientes y método: De enero de 2000 a febrero de 2009, 59 pacientes con pie diabético fueron tratados por arterialización de las venas del pie...

The first idea of surgeons (1902) to avoid amputations due to ischemia was to deviate the arterial flow to the venous system using an arteriovenous fistula between adjacent vessels; however, the results were unreliable. Since then, sympathectomies, endarterectomies and bypasses have been created, and more recently, other medical, surgical, and endovascular advances have been used. However, amputations continue to be performed worldwide mainly in diabetic patients. The arterialization of the foot veins, based on the old idea of inverted blood flow, is a new possibility for these patients who, otherwise, could lose their limbs. Objective: To demonstrate that arterialization of the foot veins in diabetic patients with neuroischemic lesions, usually infected (diabetic foot), is an effective and long-lasting method, even though the bypass only works temporally. Patients and method: From January 2000 to February 2009, 59 patients with diabetic foot were threated by means of arterialization of the foot veins. An early death was not included in the analysis. Of the 58 remaining patients, 44 were male and 14 were female. Their mean age was 71 years old: (53-91 years). Fifty-four of them were classified as being Fontaine IV and four were IIIB...

Case series of off-pump coronary artery bypass grafting involving 3703 patients / 中华胸心血管外科杂志

Objective To summarize our experience with off-pump coronary artery bypass grafting (OPCAB) during previous 13 years. Methods Data from 3703 patients who underwent OPCAB between October 1996 and December 2008 were collected and analyzed in this study. Following perioperative variables were reviewed and evaluated: changes in the number of patients, demographic characteristics of patients, coexisting conditions such as hypertension, and diabetes, grafting options,numbers of grafts per patient, and postoperative complications and clinical outcomes. Patients were divided into four age subgroups: those who were less than 45 years were assigned to group 1, those who were 45 to 60 years were assigned to group 2,those who were 60 to 75 years were assigned to group 3, and those older than 75 years of age were assigned to group 4. Perioperative data, including the use of internal mammary artery and the constituent of the grafts, were collected retrospectively and analyzed. Results Three thousand and twenty-five patients were male (81.7%) and 678 were female ( 18.3% ), mean age was (61.35 ±9.38) years old. The number of patients who underwent OPCAB increased steadily over time. The mean grafts per patient were 3.3 ± 0.8. The use of left internal mammary artery and "hybrid" bypass grafts composed of vein and artery played a predominant role in this cohort (P<0.05) . During this period of 13 years, intra-aortic balloon counterpulsation (IABP)was performed in 41 patients and continuous renal replacement therapy (CRRT)was required in 12 patients. Main complications included rethoracotomy for bleeding and tamponade in 1.49% of patients, deep sternal wound infection requiring re-exploration in 1.38%, perioperative myocardial infarction in 1.03%, neurological adverse events in 0.62%, tracheotomy in 0.59%, acute renal dysfunction in 0.77%, and other complications in 0.77%. The overall in-hospital mortality was 0.7% (26 of 3703 patients). A trend toward a reduction in morbidity and mortality was shown in this study. Diseases associated with hospital mortality were cardiac sudden death, multiple organ dysfunction syndrome, low cardiac output syndrome, severe infection, extensive myocardial infarction and neurological adverse events. Conclusion The indications for OPCAB, an innovative revascularization strategy, have been expanded and the curative rate for OPCAB has been improved in recent years. Appropriate and practical grafting strategies, as well as complete perioperative management, are considered as contributors to the improved outcomes.

Portal vein arterialization in liver surgery / 国际外科学杂志

Portal vein arterialization can prevent isehemia and damage of liver and fill portal vein with arterial blood. This article is a review about clinical applications and problems of portal vein arterialization which is used in liver transplantation and surgical therapy for portal hepatic tumor, portal hypertension and acute liver failure.

Arterialização do arco venoso do pé para tratamento da tromboangeíte obliterante / Arterialization of the venous arch of the foot for the treatment of thromboangiitis obliterans

Em isquemia crítica sem leito arterial distal, um dos modos de irrigar o membro isquêmico é derivar o fluxo de maneira retrógrada através do sistema venoso. As primeiras tentativas de fístulas arteriovenosas terapêuticas datam do início do século passado. Realizadas na parte proximal dos membros inferiores, não obtiveram resultados favoráveis. A partir da década de 70, com os trabalhos pioneiros de Lengua, as fístulas passaram a ser estendidas até o pé, e os bons resultados apareceram em várias publicações. Os autores relatam a evolução de um caso de tromboangeíte obliterante submetida ao procedimento. Essa é uma cirurgia de indicação precisa, que requer estudo pré-operatório arterial e venoso e observância a detalhes de técnica operatória.

In critical ischemia without arterial run-off, it is possible to irrigate the ischemic limb by turning the course of the flow reversely through the venous system. The first experiments with therapeutic arteriovenous fistulas date from the beginning of the last century. They were performed in the proximal area of the lower limbs, but showed unfavorable results. Since the 1970's, with the pioneer studies of Lengua, fistulas started being extended to the foot and several publications have reported good outcomes. The authors report the evolution of a case of thromboangiitis obliterans which was submitted to the procedure. This is an accurate surgical procedure which requires arterial and venous preoperative study and the observance of technical operative details.

Therapy of Thromboangitis Obliterans of Lower Extremities / 中国普外基础与临床杂志

Objective To explore the treatment of thromboangitis obliterans (TAO) of lower extremities.Methods From March 1994 to February 2009,24 cases (26 limbs) affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA,CTA or MRA.According to the different levels of the extensive and diffuse arterial occlusion,the revascularization was performed in the ways:19 cases (21 limbs) underwent venous arterialization,3 cases (3 limbs) underwent endovascular therapy,and 2 cases (2 limbs) underwent thrombectomy.ResultsAfter the venous arterialization,19 cases (21 limbs) were followed up for 1 to 14.5 years.Apart from the 5 limbs amputation (23.8%),the postoperative results of the most limbs were satisfactory (61.9%).The ABI before therapy (0.38?0.11) was significantly lower than that 6 months after therapy (0.79?0.08),P

The therapeutic effects of portal aterialization and complete shunt in portal hypertension dogs / 西安交通大学学报(医学版)

Objective In order to investigate the therapeutic effects of portal arterialization for portal hypertension,portal arterialization and complete shunt(PACS) was applied in canine model of portal hypertension,which was made by thread embolization within the portal vein.Methods A splenectomy,splenic artery and upper portal vein anastomosis,and a complete portal-caval shunt were performed on portal hypertension dogs.The blood pressure and flow of the portal vein including that towards the liver and towards the vena cava were observed.Results The postoperative hepatic inflow,PVF,increased to 180% of the former while PVP increased to 196%;the caval-inflow PVF increased to 130% of the former while PVP decreased to 45.5%.Significant difference existed(P

Splenic Portal Arterialization in Treatment of Portal Hypertension / 中国普外基础与临床杂志

Objective To study the effect on liver hemodynamics of portal arterialization and complete shunt(PACS),splenorenal shut(SRS) and peripheral cardia divided vessel(PCDV).Methods The preparation of canine model was made.Group PCDV accepted a splenectomy and peripheral cardia divided vessel,while the group SRS accepted a spleen-renal vein shunt.Group PACS accepted a splenectomy,splenic artery and upper portal vein anastomosis,and complete portal-caval shunt.The blood pressure and flow of the portal system were observed.The hepatic function was also measured before and 2 weeks after the three kinds of operation.Results In the PCDV group,the postoperative PVF decreased in 17% while PVP decreased in 5%.In the SRS group,the postoperative PVF decreased in 51% while PVP decreased in 51%.In the PACS group,the postoperative hepatic inflow PVF increased to 180% of the former while PVP increased to 196%;the caval-inflow PVF increased to 130% of the former while PVP decreased to 46%.The results of PACS group had a magnificent statistic difference comparing with those two traditional operations(P

Treatment of Peripheral Arterial Extensive Occlusive Disease by One Stage Arterialization of Posterior Tibial Vein / 中国普外基础与临床杂志

Objective To investigate the effect of one stage arterialization of posterior tibial vein in treatment of peripheral arterial extensive occlusive disease.Methods Forty-six cases(56 limbs) of patients with peripheral arterial extensive occlusive disease were treated with one stage arterialization of posterior tibial vein.Results The symptom of pain disappeared right after one stage arterialization of posterior tibial vein in all patients.Skin temperature went up.The long-term results were satisfactory during the period of 3 months to 7 years follow-up,except two limbs were amputated and two limbs were reoperated with pedicle omental transplantation.Conclusion The technique of one stage arterialization of posterior tibial vein has advantages of one-stage procedure,various indications,little influence to venous return and rapid relief of ischemic symptoms.

THE EFFECT OF PORTAL VEIN ARTERIALIZATION ON HEPATIC REGENERATION IN A RAT MODEL OF EXPERIMENTAL OBSTRUCTIVE JAUNDICE / 解放军医学杂志

0 05) between the experimental and control groups.The arterialization of portal vein did not have any negative effects on the hepatic regeneration. Hepatic cell could regenerate normally.

One Case of Sustemic Arterialization of Lung Without Sequestration / 결핵

Sustemic arterialization of the lung without sequestration is the rarest from of congenital anomalous systemic arterial supply to the lung, where an anomalous systemic artery arising from aorta supplies a normal unsequestrated segment of the lung. The non-sequestrated lung parenchyma which is supplied by an aberrant artery, has no parenchyma or bronchial abnormalities, and there is a normal connection with the bronchial trees. The symptoms of this disease varies. In most patients, it is often asymptomatic, but symptoms including dyspnea, hemoptysis, and central nervous system complications are possible. Here, we report a case of systemic arterialization of the lung without sequestration, which confirmed by angiography, with a review of the literature.