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Objective:To explore the clinical application of the posterior tibial artery perforator flap with the great saphenous vein (GSV) in the treatment of severe degloving injury of the forearm.Methods:From June 2015 to October 2020, 5 patinets (4 males and 1 female, aged 20-46 years old, mean age 37 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital in Yantai. Aposterior tibial artery perforator flap with GSV was used to repair the partial wound of the injured forearm, together with the establishment of venous circulation of dorsal hand for all 5 patients. All the patients suffered from severe forearm degloving injury. Of which, 3 accompanied with ulna radius fracture, 2 with ulnar and radial artery injury and 2 with blood supply insufficiency in the injured fingers. The sizes of soft-tissue defect were 26 cm×18 cm-32 cm×25 cm. The sizes of the posterior tibial artery perforator flap with GSV ranged from 12 cm×5 cm to 33 cm×6 cm. The anastomoses were performed on the perforating artery and the radial artery. The GSV was anastomosed with cephalic vein with bridging anastomosis to re-establish the venous circulation of dorsal hand. Combined anterolateral thigh flaps (ALTF) were used to repair the rest wound of injured limbs in 4 patients, and the combined pedicled abdominal flap was used in 1 patient. The donor site of calf flap was sutured directly, and the skin of upper limb was thinned into medium thick to cover the thigh flap donor site, which was packed with pressure dressing. Regular follow-up reviews were carried out by outpatient clinic, telephone, WeChat APP or home-visit after the operation to observe the survival of flaps, the swelling of the distal end of injured limb, functional recovery and healing at the donor site. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the grafted flaps in 5 patients survived. Necrosis at epidermal edge occurred in 1 calf flap, and achieved secondary healing after dress changing for 4 weeks. There was neither arterial nor venous crisis in all flaps. The oedema of the hand disappeared within 4-8 weeks, with clear dermatoglyph. There was no obvious enlarged circumference of thumb and fingers. The follow-up was carried out for 8-20 months, with 11 months in average. The flaps were elastic in good colour, and full texture without pigmentation. The donor site of the calf flap showed a linear scar. No swollen was seen in the hands of the injured forearm and the feet of donor lower legs. The range of motion of phalangeal joints was good. Recovery of finger sensation achieved at S 4. The recovery of the sensation of posterior tibial artery perforator flap reached S 3 in 2 patients and S 2 in 3 patients. Assessment of the Upper Limb Function using the Standard Issued by the Hand Surgery Society of Chinese Medical Association rated excellent in 3 patients and good in 2 patients. Conclusion:The posterior tibial artery perforator flap with GSV has a reliable blood supply with a small damage to the donor site. This flap is ideal for repair of severe degloving injury of forearm and meanwhile to achieve the re-establishment of venous circulation in dorsal hand.
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Objective:To study the safety and short-term clinical effect of no-touch technique for harvesting great saphenous vein in off-pump coronary artery bypass grafting(OPCABG).Methods:The clinical data of 117 patients in the single medical group who underwent OPCABG from December 2018 to April 2020 were analyzed retrospectively, including 55 patients in the no touch group (NTSV group) and 62 patients in the traditional open access group (traditional SV group). To evaluate the feasibility, safety and short-term clinical effect of using no-touch technique to harvest great saphenous vein for OPCABG. The no-touch technique was mainly based on the invention of Dr. Souza’s team in Sweden. For the treatment of isolated great saphenous veins, some improvements were made according to the clinical experience of the application of sequential bridging and radial artery in our center.Results:There were no significant differences between the two groups in hypertension, diabetes, hyperlipidemia, history of myocardial infarction, ventricular aneurysm formation, left ventricular systolic function reduction, history of cerebral infarction, chronic obstructive pulmonary disease and other complications ( P>0.05). The NTSV group had higher male proportion (96.4% vs. 61.3%) and lower mean age (53.49 years old vs. 63.76 years old), and the difference were statistically significant ( P<0.01). The patients in the two groups successfully completed the operation without cardiopulmonary bypass, and the proximal anastomosis was the first. There were no statistical significances in the average number of bypass, time to acquire great saphenous vein, operation time, 24 h postoperative thoracic drainage, blood bank transfusion, secondary thoracotomy and hemostasis, perioperative myocardial infarction, hospital death, ICU stay time, postoperative hospital stay time, and poor healing of lower limb incision of the two groups. One year after the operation, 36 patients were followed up, including 15 patients in NTSV group, and 21 patients in traditional SV group. There was no recurrence of angina pectoris, no out of hospital death and other major adverse cardiovascular events. Among them, 26 patients completed CTA reexamination of coronary artery, including 12 patients in NTSV group and 14 patients in traditional SV group, the patency rate of vein bridge was 96.4% vs. 87.2%. There was no reduction of left ventricular ejection fraction and no revascularization. Conclusion:The method of using no-touch technique to harvest great saphenous vein is safe and feasible. It does not increase the operation time and the incidence of poor healing of lower limb incision. The short-term effect of applying no-touch technique for harvesting great saphenous vein to OPCABG is better than the traditional open way.
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Compression bandaging is a key aspect following stripping for varicose vein surgery. With adequate compression, formation of subcutaneous hematoma can be prevented and thereby prevent revascularisation of the hematoma leading to recurrence of varicose vein. Various techniques exist to provide compression. Our modification provides an easy alternative to achieve immediate compression following stripping and is especially useful in a setting where staff is very limited. Materials required include a 10 cm width gauze bandage, 1% lidocaine with epinephrine, and number 1 silk suture in addition to the conventional tools for open varicose vein surgery. The gauze bandage is introduced along with the stripper which is passed from groin to below knee. The bandage is kept in the subcutaneous tunnel till perforator ligation, groin wound closure and application of compression bandage. The gauze bandage is removed through a small window within the compression stocking below the knee and the wound closed in a single layer. From 2005 to 2020, 410 patients underwent varicose vein surgery with the modified technique. Of these, 1 patient developed complication secondary to hematoma formation which was managed conservatively. Our modification of the varicose vein stripping technique is shown to be a cost effective and simple technique which provides immediate compression and effortlessly facilitates haemostasis till wounds are closed and compression stockings applied. in various literatures.
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Background: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standard pre-interventional assessment is required to decide the treatment modalities. GSV diameter measured at sapheno-femoral junction, proximal thigh, distal thigh, knee, proximal leg, distal leg. Analysis done to find at which diameter size the reflux expected to occur.Methods: The study involved 100 limbs from outpatient vascular clinic. GSV diameter measurement was done at the sapheno-femoral junction, at the proximal thigh, at the distal thigh, below the knee, mid leg in correlation to the reflux.Results: SFJ reflux (group I) was observed at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.6±1.24 mm, and mid leg (group V) at 3.59±1.16 mm.Conclusions: Measurement at six sites revealed higher sensitivity and specificity to predict reflux, GSV diameter correlates with reflux, sites to predict reflux not only at SFJ and proximal thigh but GSV measurement at knee joint can predict reflux. Measurement of GSV at knee joint can predict reflux if more than 5.5 mm.
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@#【Objective】 To investigate the efficacy and safety of ultrasound- guided above- knee and below- knee radiofrequency ablation for the treatment of saphenous varicose veins.【Methods】Patients who underwent ultrasound-guided radiofrequency ablation closure in our department from July 2019 to November 2019 were compared in operation time ， recovery time，volume of sclerosant foam，pain score，venous clinical severity score（VCSS），Aberdeen Varicose Veins Questionnaire （AVVQ）， and complications. 【Results】 Fifty- nine patients underwent above- knee radiofrequency ablation and 19 patients underwent below-knee radiofrequency ablation. The average operation time（69.75 vs. 78.95）min， time return to normal activity（2.93 vs. 3.58）min or the volume of foam（28.3 vs. 24.2）mL were similar in both groups. The pain score，VCSS，and AVVQ scores 24 h，1 week，or 4 w postoperative decreased significantly in the two groups. No deep vein thrombosis，pulmonary embolism，or infection occurred in the two groups after surgery. Other complications including phlebitis，pigmentation，bleeding，rash，or paresthesia，showed no difference in rates. And overall incidence of complications were similar between the two groups. 【Conclusions】 Both above-knee and below-knee radiofrequency ablation are safe and effective treatments for great saphenous varicose veins.
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External support stent is a potential means for restricting the deformation and reducing wall stress of the vein graft, thereby improving the long-term patency of the graft in coronary artery bypass surgery. However, there still lacks a theoretical reference for choosing the size of stent based on the diameter of graft. Taking the VEST (venous external support) stent currently used in the clinical practice as the object of study, we constructed three models of VEST stents with different diameters and coupled them respectively to a model of the great saphenous vein graft, and numerically simulated the expansion-contraction process of the vein graft under the constraint of the stents to quantitatively evaluate the influence of stent size on the radial deformation and wall stress of the vein graft. The results showed that while the stent with a small diameter had a high restrictive effect in comparison with larger stents, it led to more severe concentration of wall stress and sharper changes in radial deformation along the axis of the graft, which may have adverse influence on the graft. In order to solve the aforementioned problems, we ameliorated the design of the stent by means of changing the cross-sectional shape of the thick and thin alloy wires from circle into rectangle and square, respectively, while keeping the cross-sectional areas of alloy wires and stent topology unchanged. Further numerical simulations demonstrated that the ameliorated stent evidently reduced the degrees of wall stress concentration and abrupt changes in radial deformation, which may help improve the biomechanical environment of the graft while maintaining the restrictive role of the stent.
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Alloys , Coronary Artery Bypass , Saphenous Vein/surgery , StentsABSTRACT
Objective@#To observe the effects of general anesthesia and intravertebral anesthesia on the patients' temperature, perfusion index(PI) and coagulation function.@*Methods@#From January 2016 to December 2017, 60 patients in the First Hospital of Jiaxing undergoing elective line of great saphenous varicose veins surgery were selected.According to the random number table, the patients were divided into the general anesthesia group(group G, n=30) and intraspinal anesthesia group(group I, n=30). The general condition, operation time, the core temperature(tympanic membrane temperature) before anesthesia(T0), 10 min after anesthesia(T1), 20 min later(T2), 30 min later(T3), and the PI with no-infusion upper limb were recorded.The changes of coagulation function before anesthesia(T0) and after surgery(T4) were observed by extraction of the thrombus(TEG).@*Results@#The core body temperature of T1, T2 and T3 was significantly decreased in both two groups(FG=58.789, P=0.000, FI=2.965, P=0.035), and the hypothermia of group G was greater than that of group I(t1=-2.998, t2=-5.985, t3=-7.705; P<0.05). The PI of T1, T2 and T3 was significantly higher than T0 in both two groups(FG=5.439, P=0.002, FI=3.404 P=0.020), and the increase of group G was greater than that of group I(t1=2.065, t2=2.041, t3=2.649; P<0.05). In group G, TEG examination was significantly prolonged(F=5.482, P=0.023), and no significant changes were observed in group I.@*Conclusion@#The hypothermia of the patients and the increase of PI increased significantly, and the R time index of TEG is prolonged, and the anesthesia in the spinal canal has no obvious effect on the coagulation function.
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The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. The average distance of origin of saphenous nerve from inguinal crease was 7.89±1.42 cm, the distance from upper end of medial border of patella to saphenous nerve at that level was 8.11±0.85 cm, distance from tibial tuberosity was 7.53±0.98 cm and from midpoint of anterior border of medial malleolus was 0.45±0.14 cm. Saphenous nerve provided two infrapatellar branches at the level of mid to lower limit of patellar ligament in 90% cases. It was in close contact or adhered to great saphenous vein across the lower 2/3rd of leg lying either anterior, posterior or deep to the vein. The saphenous nerve terminated by bifurcating proximal to medial malleolus in majority of cases though no obvious bifurcation was observed in 9.52% cases. The detailed morphology, relations and the distances from palpable bony landmarks may be helpful for clinicians to achieve successful saphenous nerve block and to avoid saphenous nerve damage and related complications during orthopedic procedures.
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Anesthesia and Analgesia , Ankle , Cadaver , Deception , Formaldehyde , Knee , Leg , Lower Extremity , Nerve Block , Nerve Compression Syndromes , Orthopedic Procedures , Patella , Patellar Ligament , Saphenous Vein , VeinsABSTRACT
Variations of great Saphenous Vein are clinically important because of its role in varicose veins recurrence andas application as an autograft for coronary angioplasty. The incidence of Great Saphenous Vein duplicationcited in medical literature ranges from 0.97% to 49%. The present case discusses a rare duplicated and meshappearance of Great Saphenous vein and its clinical applications. Great Saphenous Vein and its duplication,both started separately from dorsal venous arch of left foot in a 60 years old male cadaver during routinedissection. They were connected by three venous communications during their course and drained as a singlevein at saphenofemoral junction after uniting at the level of apex of femoral triangle. Thorough understanding ofanatomical variations of great saphenous vein and its tributaries are important ensuring the effective diagnosisand treatment of varicose veins.
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The objectiue was to explore how to improve stem cell derivation from human great saphenous vein. After the saphenous vein was cut into small pieces, the cells of the vessel wall were obtained by tissue adherent method and digestion with type Ⅱ collagenase. The morphological changes of blood vessel wall were observed under inverted microscope. The survival of vascular wall cells was assessed by trypan blue staining. Stem cells doubly positive for CD34 and CD117 were sorted out by immunofluorescent staining and flow cytometry. The cells obtained by tissue adherence method exhibited signs of fibrotic changes and aging at the third passage (P3), while the cells extracted by enzymatic digestion still showed colony-like growth. Survival rates of these two groups of cells were (91.7±1.2)% and (97.2±0.7)%, (P=0.005). The results of flow cytometry showed that the positive rates of CD34 and CD117 double positive cells in these two groups were (0.16± 0.05)% and (0.44±0.07)%, respectively, with statistical significance (P=0.005). Immunofluorescent staining showed that the positive rates of double positive stem cells in the two groups were (89.41±2.06)% and (94.03±1.83)%, P<0.05 one week after the sorted stem cells were cultured. The positive rates of CD31, VEGF2 and SMA in the stem cells determined by flow cytometry were (0.12±0.01)%, (0.19±0.02)% and (0.45±0.01)%, respectively, which were not statistically different from those of the control groups. This could rule out substantial inclusion of mature endothelial cells and smooth muscle cells. Tube forming experiment confirmed that these vascular stem cells had developmental plasticity. More viable and morphologically healthy vascular stem cells can be derived by enzymatic digestion. These cells can be widely used in clinical and basic research.
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Objective To compare vein graft quality and patency between the segmental incision and the open saphenous vein harvesting in coronary artery bypass grafting. Methods The data of patients underwent CABG in the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2015 were retrospectively analyzed. The patients were devided into 2 groups,which is 99 open and 114 sagmental incision,by the way of harvesting. The operative risk factors,harvesting time and length of venous grafts,as well as the inci-sion complications were compared between the above two groups. One year after operation,the vein graft patency was detected by the coronary artery CTA. Results No significant differences in the risk factors of incision compli-cations were observed between the two groups,but the incidence of various incision complications was significantly reduced in the segmental incision group(P < 0.05). No significant difference in patency rate of venous grafts was observed between two groups at 1 years post?operation. Conclusion Segmental incision saphenous vein harvesting was safe and feasible,which can decrease the incision complications without obvious effect on postoperative patency.
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Objective To investigate the efficacy of transilluminated powered phlebectomy (TIPP) and endovanous laser treatment(EVLT) combined with high ligation on treating varicose great saphenous vein.Methods A total of 238 cases with varicose great saphenous vein were divided into TIPP group (119 cases)and EVLT group (119 cases).The incidence of postoperative recovery and complications of the two groups were compared.Results There was no significant difference between the two groups on the surgery duration and postoperative recovery incident(P ＞ 0.05);the saphenous nerve injury incidence and skin impairment incidence of the TIPP group were significantly less than that of EVLT group (P ＜ 0.05);the amount of bleeding,subcutaneous hematoma incidence,and amount of surgical incision of TIPP group were significantly more than that of the EVLT group(P ＜ 0.05).Conclusions TIPP and EVLT combined with high ligation are two effective minimally invasive surgical approaches on treating varicose great saphenous vein.EVLT is with less surgical incision and less bleeding,and is more applicable for mild case;TIPP is with less operative trauma,and is more applicable for severe case.
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Objective To investigate the clinical value of color Doppler ultrasound in the diagnosis of lower extremity varicosis of great saphenous vein in patients with deep vein structure and hemodynamic status.Methods 79 patients with 96 deep lower extremity varicosis were detected deep venous wall and valve echo,lumen morphology,reflux time,reflux velocity and spectrum Doppler imaging by using color Doppler ultrasound,and the results were compared with intravenous X-line angiography,while the patients with normal deep vein were selected as the control group.Results Color Doppler ultrasonography compared with angiography,the completely normal diagnostic accuracy of deep vein was 98.3％,the diagnosis accuracy of simple deep venous valve insufficiency was 91.7％,the diagnostic accuracy of sequela of deep vein thrombosis was 100.0％,the diagnosis accuracy of arteriovenous fistula was 100.0％.The sonographic appearance of 60 deep veins was similar to those of the control group.In the stripping surgery of 60 great saphenous vein,there was no postoperative lower limb swelling,review of ultrasound had no deep venous reflux phenomenon.96 suffered limbs were measured in different parts,different levels of venous reflux.The reflux time of superficial femoral vein valve was the longest,which was (5.92 ± 1.83) s,the reflux rate was (50.28 ± 19.48) cm/s,and the lower leg traffic vein reflux time was the shortest,which was (2.37 ± 1.92) s,the reflux rate was (27.92 ± 17.28) cm/s.Conclusion Color Doppler ultrasound has important clinical value for the evaluation of lower extremity varicosis of great saphenous vein in patients with deep vein structure and blood flow.
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Objective To compare vein graft quality and patency between the segmental incision and the open saphenous vein harvesting in coronary artery bypass grafting. Methods The data of patients underwent CABG in the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2015 were retrospectively analyzed. The patients were devided into 2 groups,which is 99 open and 114 sagmental incision,by the way of harvesting. The operative risk factors,harvesting time and length of venous grafts,as well as the inci-sion complications were compared between the above two groups. One year after operation,the vein graft patency was detected by the coronary artery CTA. Results No significant differences in the risk factors of incision compli-cations were observed between the two groups,but the incidence of various incision complications was significantly reduced in the segmental incision group(P < 0.05). No significant difference in patency rate of venous grafts was observed between two groups at 1 years post?operation. Conclusion Segmental incision saphenous vein harvesting was safe and feasible,which can decrease the incision complications without obvious effect on postoperative patency.
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OBJECTIVES: This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control. METHOD: This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911. RESULTS: Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery. CONCLUSIONS: If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Catheter Ablation/methods , Laser Therapy/methods , Leg/blood supply , Saphenous Vein/surgery , Venous Insufficiency/surgery , Venous Thrombosis/surgery , Catheter Ablation/adverse effects , Femoral Vein/surgery , Postoperative Complications , Saphenous Vein/diagnostic imaging , Treatment Outcome , Ultrasonography, Doppler, Duplex , Varicose Veins/surgeryABSTRACT
Objective To explore the effect of great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap. Methods Fifty-two patients with skin and soft tissue lost on ankle received neoplasty using distally crural saphenous neurocutaneous pedicled skin flap. The patients were divided into two groups: the patients in interruption group (25 patients) were treated with great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap, the patients in conventional group (27 cases) were treated without saphenous vein interruption. Results Primary healing: 15 patients (55.56%, 15/27) in conventional group, 21 patients (84.00%,21/25) in interruption group. With effusion: 17 patients (62.96%,17/27) in conventional group, 7 patients(28.00%,7/25) in interruption group. With venous crisis: 10 patients (37.04%,10/27) in conventional group, 2 patients (8.00%,2/25) in interruption group. There was statistical significance between two groups on the above 3 indexes (P 0.05). Conclusions Great saphenous vein interruption could relieve swelling, reduce effusion and have higher primary healing rate in neoplasty using distally crural saphenous neurocutaneous pedicled skin flap compared with the conventional method, which greatly reduce the pain and medical expenses of the patients.
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Background: Great saphenous vein and short saphenous veins are the superficial veins of the lower limb. Variations in the superficial veins of the lowerlimb are uncommon. Our case report discusses anomalous course and its abnormal termination of short/small saphenous vein/Vena saphena parva. Materials and Methods: 80 Cadavers, Blade scalpel, Scissors, Forceps, Cotton, Other stationeries. Results: The short saphenous vein deviates the anatomical course without draining into popliteal vein, instead drains into deep femoral vein, femoral vein and Great saphenous vein. Discussion: During a routine dissection with 80 cadavers, an abnormal short saphenous vein was observed in the left lower limb of an aged male cadaver. The origin of small saphneous vein from the dorsum of the foot at the lateral end of the dorsal venous arch and continues behind the lateral malleolus and courses upward along the posterior side of the leg and has to end in popliteal vein but in our continuity of dissection the short saphenous vein has bifurcated into proper short saphenous vein and accessory saphenous vein at the junction of back of leg which drains into great saphenous vein. Conclusion: The knowledge of superficial veins of the lower limb is useful for clinicians during coronary bypass procedures, as these vessels are commonly used in such surgeries. It is therefore, essential for surgeons before harvesting the great saphenous vein to look for the abnormal drainage pattern of the short saphenous vein into the great saphenous vein either directly or through communication veins or with the presence of the Giacomini vein, Accessory saphenous vein.
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Objective To observe the feasibility and efficacy of small-incision high-ligation of great saphenous vein combined with endovascular microwave coagulation plus local injection of lauromacrogol for varicose veins of lower limbs . Methods From October 2012 to October 2013, there were 60 patients (70 legs) treated by high-ligation of the great saphenous vein , during which endovascular microwave coagulation was performed by using radiator and an additional injection of sclerotherapy at local tortuous vessels was carried out ( observation group ) .The control group ( between August 2011 and September 2012 ) underwent the traditional saphenous vein ligation plus superficial vein stripping surgery .The operation time , blood loss during operation , number of incisions , length of groin incision , and postoperative complications were compared between the two groups . Results As compared with the control group , the observation group had singnificantly shorter operative time , fewer blood loss , fewer surgical incisions , and shorter groin incision, respectively [(50.8 ±2.6) min vs.(103.5 ±16.0) min, t=-25.183, P=0.000;(43.2 ±4.6) ml vs.(107.5 ± 35.2) ml, t=-14.030, P=0.000;2.2 ±0.7 vs.6.3 ±2.5, t=-12.233, P=0.000;(2.3 ±0.3) cm vs.(4.8 ±0.3) cm, t=-17.697, P=0.000].There was no significant difference in complications rates between the two groups : local skin numbness occurred in 40 cases in the observation group and in 38 cases in the control group (χ2 =0.147, P =0.702 ) and subcutaneous congestion was noted in 4 cases in the observation group and in 9 cases in the control group (χ2 =2.157, P=0.142). Conclusion Small-incision high-ligation of the great saphenous vein combined with endovascular microwave coagulation plus local injection of lauromacrogol for varicose veins of lower limbs has advantages of minimal invasion , good cosmetic outcomes , quick recovery , high efficacy, fewer complications , and easy performance .
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Objective To evaluate the early and mid-term efficacy of endoscopic vein harvesting(EVH) undergoing coronary artery bypass grafting(CABG) in patients over 70 years old.Methods Patients' data of CABG were analyzed retrospectively in General Hospital of Shenyang Military Region from June 2011 to January 2013.400 patients were enrolled in the study according to the inclusion criteria.All patients were divided into two groups by the method of harvesting great saphenous vein (GSV):EVH group (n =200) and open vein harvesting(OVH) group(n =200).Each group was divided into two subgroups:group A(age≥70 years old) and group B (age ＜ 70 years old).The number of the group A was 85 in the EVH group and 79 in the OVH group.The number of the group B was 115 in the EVH group and 121 in the OVH group.The intraoperative findings,the quality of GSV and postoperative pain were evaluated,patients were followed up regularly after discharge.Results The postoperative complications occurred in the EVH group such as numbness and edema of lower limb in group A reduced greatly compared with group B(P ＜ 0.05).However,in the OVH group,there were no great difference in group A and group B(P ＞ 0.05) besides the postoperative pain (P ＜ 0.05).Conclusion The early and mid-term efficacy of EVH undergoing CABG is satisfied,especially in the patients over 70 years old.
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Objective To summarize the clinical result of patients undergoing endoscopic vein harvest (EVH) technology to collect greater saphenous vein (GSV) in coronary artery bypass graft (CABG) operation, and to assess the operation outcome of EVH. Methods A total of 862 patients underwent primary CABG, among whom saphenous vein of 482 patients were taken using EVH, and the others by open vein harvesting (OVH) based on patients' willingness. The operation risk factors and complication were compared between the two groups. The 64 multi-slice computed tomography (64-MSCTA) was used to evaluate the vein grafts patency after surgery for 1 year. The vein patency between the two groups was compared. Results There was no significant difference in risk factors of incision complication between two groups ( P>0.05). But the incidence of various incision complication was significantly lower in EVH group (10.2%,49/482) compared with that in OVH group (35.0%,133/380) ( P0.05). After 1 year's follow-up, the vein graft patency were 86.0%(404/470) and 87.1%(324/372) in EVH group and OVH group, and there was no significant difference ( P>0.05). Conclusions The decrease in incision complication of EVH is unquestionably superior to those of OVH, especially for those patients with risk factors of incision complication. The EVH vein graft has good patency in short time.