Transplantation of bone-marrow stem cell on chronic lower extremity ischemia / 国际外科学杂志

Atheroselerosis and thrombangiitis obliterans are the chief factors of chronic lower extremity ischemia. Usually we utilize intervcntional treatment which includs balloon dilatation and stent implantation or surgical revascularization for the patients who have good target vessels, but those methods are not suitable for the patients who have small target vessels. The transplantation of bone marrow stem cells is the new tech-nology for chronic lower extremity isehemia, which utilize the capacity of stem cells that have multiple differ-entiation activity and high self renewal potentiality. It can direetionally differentiated into endothelial cells. It has a good perspective in chronic lower extremity isehemia.

Primary implantation of self-expanding nitinol stents for atherosclerotic occlusive disease of the superficial femoral artery: Intermediateterm results / 中国微创外科杂志

0.15) was 81%(17/21) and the clinical improvement of symptoms was achieved in 95%(20/21) of cases.The 17 cases were followed up for a mean of 15.7 months(range,12～35 months).One patient died of cerebral infarction at 6 months postoperatively.One patient with stent occlusion at 3 months after operation was given an embolectomy(the artery has remained patent for 13 months).Stent occlusion also happened in 2 patients(at 3 and 4 months after operation,respectively),on whom a subsequent infragenicular femoropopliteal bypass was operated,and in 2 other patients(at 8 and 12 months after operation,respectively),on whom a below-knee amputation was operated.At one year postoperatively,the patency rate was 75%(15/20) after primary operation and 80%(16/20) after re-operation.The rate of clinical improvement of symptoms was 75%(15/20).The limb salvage rate in patients with critical limb ischemia was 88%(14/16).Conclusions Primary angioplasty with self-expending nitinol stent implantation is a safe, minimally invasive,and effective method,which can be used as the first choice for femoral arterial occlusive diseases,especially in senile patients who cannot tolerate bypass procedures.

Vascular Interventional Procedures Often Encountered by Primary Physicians

Among various vascular interventional procedures, there are some procedures of vascular recanalization often encountered by primary physicians in clinical practice. These are percutaneous transluminal angioplasty (PTA) and stent application in the lower extremity ishemia, catheter-directed thrombolysis with PTA, stenting for iliofemoral deep vein thrombosis, and interventional management of arteriovenous fistula and graft for hemodialysis access. PTA and stent are safe and effective treatment for iliac arterial stenosis and occlusion with a good long-term patency rate. Long-term effectiveness of femoropopliteal stent is yet to be determined. Catheter-directed thrombolysis is a new emerging vascular intervention for acute iliofemoral deep vein thrombosis. May-Thurner syndrome can be effectively treated with thrombolysis in the iliofemoral vein followed by PTA ad stenting for the left iliac vein stenosis or occlusion. For the failing arteriovenous fistula or grafts in patients with hemodialysis, interventional radiologists can play an important role for the maintenance of the patency by percutaneous thrombolysis and balloon dilatation. It will be very helpful for the primary physicians to understand the role of the interventional radiologists and the indications, techniques, and results of those vascular interventional procedures often encountered in daily practice.