The application of bidirectional subintimal technique in endovascular treatment of subclavian arterial occlusion / 介入放射学杂志

Objective To evaluate the feasibility and safety of using bidirectional subintimal technique,i.e.subintimal arterial flossing with antegrade-retrograde intervention (SAFARI),in endovascular treatment of subclavian arterial occlusion when the guide wire cannot re-enter into the distal true cavity.Methods The clinical data of 11 patients with symptomatic subclavian artery occlusion,who were admitted to authors' hospital during the period from August 2013 to June 2016 to receive treatment,were retrospectively analyzed.The patients included 8 males and 3 females,with a mean age of 67 years old (61-74 years).Endovascular recanalization of subclavian artery with SAFARI technique and stent implantation were carried out in all patients after conventional reopening surgery of obstructed artery failed.Results Subclavian artery recanalization by using SAFARI technique together with implantation of stent (average length of 46.4 mm) was successfully accomplished in 10 patients,but in one patient the technical management failed,the technical success rate was 90.9％.No serious postoperative complications occurred.The patients were followed up for 6-36 months by telephone,and no in-stent restenosis was verified during the follow-up period.Conclusion In treating severely calcified and long-segmental subclavian artery occlusion,endovascular treatment using SAFARI technique is safe and effective,SAFARI technique can further improve the success rate of endovascular treatment.

Clinical application of intravascular ultrasound in the interventional treatment of internal carotid artery occlusion: initial experience of one case / 介入放射学杂志

Objective To discuss the clinical value of intravascular ultrasound (IVUS) in treatinginternal carotid arteries occlusion.Methods The patient was diagnosed with internal carotid artery occlusionthat was confirmed by CTA.Cerebral perfusion imaging showed that low perfusion area was consistent withischemic symptoms.Guided by IVUS,percutaneous transluminal angioplasty (PTA) was performed.By usingmicro-catheter coaxial technology,the micro guide wire was inserted in the carotid artery until it passedthrough the obstructed segment;After IVUS examination proved that the micro guide wire was in the truelumen of carotid artery,angiography through micro-catheter was carried out to confirm that the distal arterywas unobstructed;after adjusting the device position the embolism protector was placed.The plaque andlumen condition were assessed with IVUS,which was reevaluated after pre-expansion of balloon.After normaldirection blood flow was regained,the plaque stability was assessed with IVUS virtual organization sequence.Simple balloon dilatation therapy was adopted as the fibrous cap of plaque was in stable condition and thelumen stenosis rate was ＜40％.Results After balloon dilatation,the obstructed artery was reopened and theblood flow regained normal direction.IVUS examination showed that during the whole operation process thefibrous cap of plaque at the narrowed segment remained in stable condition,the lumen stenosis rate was ＜40％.Cerebral perfusion imaging revealed that after the treatment the low perfusion state was markedlyimproved.Conclusion IVUS plays an important guiding role in performing PTA for internal carotid arteryocclusion.This technique can increase the success rate of vascular recanalization and reduce the incidence ofcomplications.

Endovascular treatment for ruptured femoral artery pseudoaneurysm associated with bleeding caused by injection of addictive drug / 介入放射学杂志

Objective To investigate the feasibility,safety and effectiveness of endovascular angioplasty with covered stent and embolization with spring coil in treating ruptured femoral artery pseudoaneurysm (FAP) associated with bleeding caused by injection of addictive drug.Methods The clinical data of 32 patients with ruptured FAP complicated by bleeding caused by injection of addictive drug,who were admitted to authors' hospital during the period from July 2012 to December 2015,were retrospectively analyzed.The average age of the patients was 36.5 years old,among them 25 patients were male (78.1％).Results Successful hemostasis was achieved in all 32 patients.The technical success rate of endovascular therapy was 100％,and no death occurred during perioperative period.Endovascular repair with covered stent was carried out in 25 patients (78.1％),embolization of femoral profound artery with spring coil in 9 patients (9.4％),and covered stent implantation together with embolization of femoral profound artery in 4 patients (12.5％).The patients were followed up for a mean of (17.5±11.6) months,with a follow-up rate being 93.8％ (30/32).The 3-year cumulative stent patency rate was 90.9％,and the 3-year overall survival rate was 91.3％.Conclusion For the treatment of ruptured FAP complicated by bleeding caused by injection of addictive drug,endovascular treatment is safe and effective with satisfactory mid-term clinical effect.This technique helps win the valuable time for critically ill patients to receive two-stage surgical debridement and vascular repair,as two-stage thorough debridement is an important means to control infection.

Clinical significance of mediastinoscope on superior vena cava syndrome followed by stenting / 中国综合临床

Objective To summarize the clinical experiences of video-mediastinoscopy followed by stenting procedure in treating the superior vena cava syndrome (SVCS),and to investigate their application significant.Methods Nine patients with SVCS without clear histologic diagnosis before procedure were reviewed retrospectively,who were admitted into hospital from November 2007 to October 2013.All of 9 patients were received video-mediastinoscopy and they did not performed pathological check.They were placed the endovascular stent.Results Video-mediastinoscopy followed by stenting procedure 6 cases,parasternal TN mediastinoscopy 2 cases,joint neck and parasternal TV mediastinoscopy 1 case.Nine cases have received a clear pathological diagnosis.There was no death case in-hospital.The operative complication was hemorrhage of 1 case.The cubital venous pressures were (18.6±5.1) cmH2O at stending,(13.5±3.3) cmH2O,(11.3±2.5) cmH2O,(10.3± 2.0) cmH2O at 24,48,72 h after stending,and down to the normal at 72 h (F =67.245,P ＜0.01).The clinical symptoms were obviously relieved.All of them were remained free from SVCS during the follow-up.Conclusion The hybrid procedure of video-mediastinoscopy followed by stenting placement is a highly effective and safe treatment.It can accurately provide informations on diagnosis and treatment.

Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: la hipótesis de la insuficiencia venosa crónica cerebro medular: [revisión] / Endovascular procedures as multiple sclerosis treatment?: the hipothesis of the chronic cerebrospinal venous insufficiency: [review]

In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI), which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Ferrara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS), what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM)" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM), que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores.

Surgical Removal of Endovascular Stent after Migration to the Right Ventricle Following Right Subclavian Vein Deployment for Treatment of Central Venous Stenosis

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 40-year-old man on hemodialysis that underwent endovascular stenting to treat right subclavian vein stenosis and experienced stent migration to the right ventricle, requiring surgical removal.

Popliteal artery endovascular angioplasty for the treatment of diabetic foot (a report of 65 cases) / 中国综合临床

Objective To evaluate the effect of pepliteal artery endovascular angioplasty for the treatment of diabetic foot. Methods 65 cases (69 limbs) of diabetic foot were treated by long bloon endovascular angioplasty. Results No death occured. 60 cases (64 limbs) were successfully treated and 5 cases (5 limbs) failed. The imme-diately success rate was 92.75%. The pain relieved, the temperature was improved and the ankle brachial index (ABI) was up to 0.84±0.11. Anterior tibial artery or posterior tibial artery of 39 limbs could be touched. 21 limbs were cured by debride and change dressings. 10 limbs were cured after the gangrene was ablated. 6 limbs were cured after the gangrene was debrided. 22 limbs were cured after toe amputation. Half of the foot was amputated. No limb was amputated. Every month was further consulted by Doppler and the rate of follow upwas 100%. 6 limbs of 6 cases were reobliterated (1,1,2,2 cases occurred after 1,6,12,18 month respectively.) and treated by endovascular an-gioplasty again. Conclusion Endovascular angioplasty below the knees for the treatment of diabetic foot is an effec-tive method for the limbs saving, with minimal invasive, safety, less complication and retreatment. It can be used as a first choice for the artery obliteration of diabetic foots.

Percutaneous Transluminal Angioplasty and Stent Placement for the Treatment of Long Segmental Atherosclerotic Occlusive Disease of Lower Limb / 医学研究杂志

Objective To evaluate the clinical effects of endovascular angioplasty and stenting for the treatment of TASC B,C arteriosclerotic occlusion(ASO) of lower extremity.Methods After the identification of the occlusion by angiography via femoral artery access by Seldinger method,the occluded arteries (mean length 7.5cm; range 1~20 cm) in 40 patients(47limbs) were treated by percutaneous transluminal angioplasty and stent placement. Results The primary recanalization was successful in 45 of 47 limbs. The technical successful rate was 96%. Thirty one self-expanding stents were deployed. PTA without stent placememt was performed in 16 limbs(of them,11 were blow knee).The ankle brachial pressure index (ABI) increased from (0.36?0.14) preoperatively to (0.82?0.15) on the 7th postoperative day. All patients were follow-uped for 1 to 48 months. Stents were occluded in 4 patients. Restenosis was observed in 1 limbs. All of the rest remained patent in the follow-up period.Conclusion Endovascular angioplasty and stenting can be an effective method for the treatment of long segmental (including below-knee) arteriosclerotic occlusion of lower extremities.

Endovascular angioplasty and stenting for lower extremity arteriosclerotic occlusion: Report of 45 cases / 中国微创外科杂志

Objective To evaluate clinical effects of endovascular angioplasty and stenting for treating lower extremity arteriosclerotic occlusion(ASO).Methods After the identification of the stenosis or occlusion by angiography via femoral artery access by percutaneous puncture or incision puncture,recanalization of the occlusion was done by ultrasound ablation or guildewire clearance.Then the percutaneous transluminal angioplasty(PTA) was performed and an endovascular stent was introduced.Results A total of 45 cases(53 legs) had undergone endovascular angioplasty and stenting.The procedure was technically successful in all the patients.The ankle brachial index(ABI) increased from 0.36?0.14 preoperatively to 0.77?0.21 on the 7 postoperative day((t=2.397),P=0.021).Follow-up checkups in all the cases for 6~54 months(mean,23 months) revealed a primary patency rate of 90.6%(48/53).Conclusions Endovascular angioplasty and stenting is a safe and effective method for treating lower extremity arteriosclerotic occlusion.