Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and management algorithm / Revascularização aberta na isquemia mesentérica crônica durante a era endovascular: experiência de um centro quaternário e um algoritmo de tratamento

Abstract Background Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR). Objectives To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition. Methods Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature. Results All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years. Conclusions Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.

Resumo Contexto A isquemia mesentérica crônica (IMC) é uma doença debilitante, com grave impacto na qualidade de vida. A literatura recomenda a angioplastia com stent da artéria mesentérica superior (AMS) como primeira opção de tratamento, mas há falta de consenso que defina indicações precisas para a revascularização aberta. Objetivos Descrever uma série de quatro pacientes com IMC, tratados com revascularização aberta, e apresentar um algoritmo para o manejo dessa condição. Métodos Três pacientes apresentaram angina intestinal típica e perda ponderal. Uma paciente foi submetida a reparo aberto de aneurisma da aorta abdominal e apresentava obstrução da AMS, que foi revascularizada profilaticamente. As técnicas cirúrgicas incluíram: 1) enxerto entre a aorta infrarrenal e a AMS; 2) enxerto entre o dácron utilizado em um enxerto aortobifemoral e a AMS; 3) enxerto entre a artéria ilíaca comum direita e a AMS; e 4) enxerto entre o ramo direito do dácron utilizado em um enxerto aorto-biilíaco e a artéria cólica média (ao nível da arcada de Riolan). Todos os enxertos foram feitos utilizando politetrafluoretileno em uma configuração retrógrada, tunelizados abaixo da veia renal esquerda, fazendo uma alça em C. Resultados Todos os pacientes demonstraram resolução dos sintomas e ganho ponderal. Todos os enxertos se mantiveram pérvios durante um seguimento médio de 2 anos. Conclusões A revascularização aberta para IMC utilizando-se a alça em C é uma técnica valiosa e pode ser considerada em pacientes selecionados. O algoritmo proposto pode auxiliar na decisão terapêutica em centros quaternários.

Assessment of the local blood supply when femoral neck fracture occurs:advances in the anatomy research and its clinical application / 中国骨伤

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

Research progress in targeting autophagy of traditional Chinese medicine and natural compounds to regulate atherosclerosis / 中国中药杂志

Atherosclerosis(AS) is the common pathological basis of many ischemic cardiovascular diseases, and its formation process involves various aspects such as vascular endothelial injury and platelet activation. Vascular endothelial injury is the initiating factor of AS plaque. Monocytes are recruited to differentiate into macrophages at the damaged endothelial cells, which absorb oxidized low-density lipoprotein(ox-LDL) and slowly transform into foam cells. Smooth muscle cells(SMCs) proliferate and migrate continuously. As the only cell producing interstitial collagen fibers in the fibrous cap, SMCs largely determine whether the plaque ruptured or not. The amplifying inflammatory response during the formation of AS recruits platelets to adhere to the damaged area of vascular endothelium and stimulates excessive platelet aggregation. Autophagy activity is associated with vascular lesions and abnormal platelet activation, and excessive autophagy is considered to be a negative factor for plaque stability. Therefore, precise regulation of different types of vascular autophagy and platelet autophagy to treat AS may provide a new therapeutic perspective for the prevention and treatment of atherosclerotic ischemic cardiovascular disease. Currently, treatment strategies for AS still focus on lowering lipid levels with high-intensity statins, which often cause significant side effects. Therefore, the development of safer and more effective drugs and treatment modes is the focus of current research. Traditional Chinese medicine and natural compounds have the potential to treat AS by targeted autophagy, and have been playing an increasingly important role in the prevention and treatment of cardiovascular diseases in China. This paper summarizes the experimental studies on different vascular cell types and platelet autophagy in AS, and sums up the published research results on targeted autophagy of traditional Chinese medicine and natural plant compounds to regulate AS, providing new ideas for further research.

Acute Paraplegia Result from Spinal Ischemia Nine Years After Hybrid Total Arch Repair with Frozen Elephant Trunk: A Case Report

ABSTRACT Spinal cord ischemia due to decreased cord perfusion is a devastating complication in patients with thoracoabdominal dissection following frozen elephant trunk (FET) repair surgery. However, rare occurrence of spinal cord ischemia leading to paraplegia after long-term follow-up of FET repair has been reported. Here, we describe a case of spinal cord ischemia resulting in paraplegia nine years after hybrid total arch repair with FET. Cerebrospinal fluid drainage and serial treatment were utilized to decrease intraspinal pressure and increase blood flow to the spinal cord. Three months after the onset of paraplegia and with treatment and rehabilitation, the patient recovered to walk.

Treatment of vascular paralysis syndrome with methylene blue during kidney transplantation: one case report / 中华器官移植杂志

The report described one case of vascular paralysis syndrome during kidney transplantation to provide references for clinical practice.After intraoperative opening of kidney artery and vein, the recipient developed vascular paralysis syndrome.However, the efficacy is not obvious after dosing of norepinephrine.After an intravenous infusion of methylene blue, the recipient has a successful removal of tracheal intubation and recovered well.

Tuberculous Aortic Aneurysm - A Review

ABSTRACT Introduction: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. Methods: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. Results: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. Conclusion: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

Study on the intrapulmonary vascular volume in normal preschool children based on computer aided measurement / 中华放射学杂志

Objective:To investigate the development of intrapulmonary vascular volume (IPVV) in normal preschool children based on quantitative measurement on chest CT.Methods:The CT data of 407 normal preschool children (236 males and 171 females, aged 1-72 months, with a median of 36 months) who underwent chest CT examination from January 2014 to May 2017 in the "Digital Lung" imaging database were retrospectively collected. The pulmonary vessels were segmented by the "Digital Lung" automatic detection tool, and the IPVV of the whole lung, the right lung, the left lung and each lobe were obtained, and the IPVV upper/lower and IPVV left/right were calculated. According to the age, the subjects were divided into infant period (0-12 months), early childhood period (13-36 months) and preschool period (37-72 months), with 30 cases (17 males and 13 females), 175 cases (95 males and 80 females) and 202 cases (124 males and 78 females) respectively. Spearman correlation analysis was used to evaluate the correlation between IPVV and month age. One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences of IPVV, IPVV upper/lower and IPVV left/right between different months of age. Independent sample t test or Mann-Whitney U test was used to compare the differences of IPVV between different genders, and the normal reference range of IPVV in normal preschool children of different months of age was established. Results:The IPVV of the whole lung, right lung, left lung and each lung lobe were positively correlated with age, the correlation coefficient was 0. 638-0.820 in males and 0. 683-0.791 in females (all P<0.001). There was no significant difference in IPVV of whole lung, right lung, left lung and each lobe between male and female from 0 to 12 months (all P>0.05), but there was significant difference in IPVV of whole lung, right lung, left lung and each lobe between male and female from 13 to 36 months (all P<0.05). There were significant differences in IPVV of the whole lung, right lung, left lung and upper lobe of both lungs between boys and girls from 37 to 72 months (all P<0.05). IPVV upper/lower in the right lung (χ 2=14.00, 12.87, P=0.001, 0.002) and IPVV upper/lower in the left lung (χ 2=6.65, 22.84, P=0.036,<0.001) were significantly different in both boys and girls among 3 months of age. And with the increase of age, it showed a decreasing trend. There was no significant difference in IPVV upper/lower between boys and girls at the same age (all P>0.05).There was no significant difference in IPVV left/right among different months and between different sexes (all P>0.05). Finally, the normal reference value range of IPVV of different genders in infancy, early childhood and preschool age was calculated. Conclusions:The increase of pulmonary vessels in normal preschool children is positively correlated with age. There is no significant difference in IPVV between boys and girls in infant period, but IPVV in boys is larger than that in girls in early childhood period and preschool period. IPVV in the lower lung increased faster than that in the upper lung, but there was no significant difference between the left and right lungs.

Application analysis of carotid-subclavian artery blood vessel prosthesis bypass grafting in the reconstruction of cerebral blood supply / 国际外科学杂志

Objective:To study the application effect of carotid-subclavian artery blood vessel prosthesis bypass grafting in the reconstruction of cerebral blood supply.Methods:The clinical data of 14 patients undergoing carotid-subclavian artery blood vessel prosthesis bypass grafting to reconstruct cerebral blood supply in the Department of Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University from March 2019 to March 2022 was retrospective collected. And the surgical indications, clinical effect and complications were analyzed.Results:There were 12 males and 2 females, aged from 47 to 74 years, with an average age of 60.5 years. Of 14 patients, 2 patients suffered from common carotid artery stenosis with posterior dilatation, 12 patients suffered from subclavian artery occlusion with vertebral artery steal. All the procedures were successfully performed without intraoperative cerebral infarction, cardiovascular accident, lymphatic leakage or artificial vascular infection. Phrenic nerve injury occurred in 1 patient after operation. During the follow-up of 3-27 months, average 14 months, there were no artificial vascular stenosis, anastomotic stenosis, vertebral artery steal, new cerebral infarction, upper limb ischemia or cerebral ischemia.Conclusion:Carotid-subclavian artery blood vessel prosthesis bypass grafting can be used in reconstructing the blood supply of both the anterior circulation, and the posterior circulation safely and effectively.

Clinical analysis of Rotarex percutaneous mechanical thrombectomy for treatment of lower extremity artificial bypass occlusion / 国际外科学杂志

Objective:To evaluate the clinical efficacy of Rotarex percutaneous mechanical thrombectomy(PMT) for treatment of lower extremity arterial graft occlusion.Methods:The clinical data of 19 patients with lower extremity arterial bypass occlusion admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients were treated with Rotarex-based endovascular therapy. After 12 months follow-up, the clinical features, surgical outcomes and follow-up data were analyzed to identify effectiveness and safety of the therapy. Independent sample t test was used to analyze the measurement data of continuous normal distribution which were expressed as mean±standard deviation( ± s), enumeration data were expressed as number and percentage, and the comparison between groups were analyzed by chi-square test. Results:A technical success rate of 100% was demonstrated. Rotarex combined with catheter directed thrombolysis was performed in 2 cases, Rotarex combined with percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Rotarex combined with stent implantation was performed in 8 patients. The Ankle brachial index significantly increased (0.82±0.14 vs 0.47±0.11, P<0.05). Critical limb ischemia (Rutherford class 4 or higher) improved significantly (0 case vs 9 cases, P<0.05). Distal embolism occurred in 1 patient and acute myocardial infarction occurred in 1 patient. There was no vascular rupture, haemorrhage, infection, pseudoaneurysm, death and amputation. Kaplan-Meier survival analysis revealed 12-month primary patency rate and freedom from clinically driven target lesion revascularization was 78.9% and 89.5% respectively. Conclusion:Rotarex-based endovascular therapy is a safe and effective treatment for graft occlusion after lower extremity arterial prosthesis bypass with high patency rate and few complications.

Decreased body-fat accumulation and increased vasorelaxation to glyceryl trinitrate in middle-aged male rats following six-weeks consumption of coconut milk protein

Abstract We investigated whether coconut milk protein (CMP) contributes to the beneficial effects of coconut milk consumption on cardiovascular health markers previously found in middle-aged rats. CMP was isolated and precipitated from dried fresh coconut milk, then gavaged (1 g/kg) to middle-aged male rats for six weeks; control rats received distilled water. Compared to controls, CMP caused decreased body fat and lipid accumulation in liver cells and the platelet count. CMP did not affect basal blood pressure or heart rate in anesthetized rats. Vascular responsiveness to phenylephrine, DL-propargylglycine (PAG), acetylcholine or sodium nitroprusside was unaffected, but vasorelaxation to glyceryl trinitrate (GTN) increased. Effects of ODQ on vasorelaxation to GTN were similar in both groups. Expression of blood vessel eNOS, CSE and sGC was normal. The cyclic guanosine monophosphate (cGMP) level of CMP-treated rats was normal but addition of GTN increased cGMP and NO concentration more in CMP-treated rats than in controls, an effect unaltered by addition of diadzin. Taken together, CMP appears partially responsible for the improvement in cardiovascular health markers caused by coconut milk in middle-aged male rats

Effects of different intensity aerobic exercises on macular retinal vascular density in patients with primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of different intensity aerobic exercises on macular retinal vascular density in patients with primary open angle glaucoma(POAG). <p>METHODS: Prospective case-control study, 88 eyes of 48 patients with POAG diagnosed in our hospital from January 2019 to April 2021 were included(POAG group), 43 cases(86 eyes)were included in the normal control group(control group). The fundus photographic examination without mydriasis was performed with a mydriatic fundus camera, and the operation and film reading were carried out by a special ophthalmologist. Macular vascular density was measured by macular vascular segmentation method. According to macular vascular density, 48 patients with POAG were divided into low vascular density group and high vascular density group, with 24 cases in each group. 48 patients with POAG were instructed to perform treadmill load exercise to compare the vascular density levels in macular area of patients with high intensity(76%-87% HRmax), moderate intensity(64%-75% HRmax)and low intensity(52%-63% HRmax).<p>RESULTS: The vascular density in macular area of control group was significantly higher than that of POAG group; Compared with the high vascular density group, the age and systolic blood pressure were significantly higher in the low vascular density group, and the body weight was significantly lower; In both low and high vascular density groups, the retinal vascular density of macular area under moderate intensity aerobic exercise was significantly higher than that of low intensity and high intensity aerobic exercise; Systolic blood pressure and aerobic exercise were the influencing factors of vascular density in macular area; the above results showed statistically significant differences(<i>P</i><0.05).<p>CONCLUSION: Systolic blood pressure and aerobic exercise are factors affecting macular vascular density, and moderate intensity aerobic exercise can significantly increase macular vascular density.

Analysis of influencing factors for arteriovenous graft dysfunction in hemodialysis patients / 中华肾脏病杂志

Objective:To explore the influencing factors of arteriovenous graft (AVG) dysfunction in hemodialysis (HD) patients, and provide a basis for predicting the risk of dysfunction and prolonging the service time.Methods:Retrospective analysis was performed on the clinical and follow-up data of patients who underwent AVG surgery in Department of Vascular and Interventional Surgery, Nanfang Hospital, Southern Medical University from January 2013 to September 2018. The factors of AVG dysfunction were determined by statistical methods.Results:A total of 139 patients were enrolled, including 58 males (41.7%); the median age was 57; in which 83 patients (59.7%) developed AVG dysfunction within 24 months. Kaplan-Meier survival analysis showed that the primary patency rates were 76.1%, 56.8%, and 38.5% at 6, 12, and 24 months after the establishment of AVG. The results of Kaplan-Meier survival analysis showed that at 24 months after surgery, the risk of AVG dysfunction in elderly patients (>65 years old) was significantly higher than that of patients≤65 years old (Log-rank χ2=7.632, P=0.006); the risk of AVG dysfunction in patients with mean platelet volume (MPV)>10.1 fl was significantly higher than that of patients with MPV≤10.1 fl (Log-rank χ2=19.910, P<0.001); the risk of AVG dysfunction in patients with platelet distribution width (PDW)>11.4 fl was significantly higher than that of patients with PDW≤11.4 fl (Log-rank χ2=35.410, P<0.001); the risk of AVG dysfunction in patients with platelet-larger cell ratio (P-LCR)>24.8% was significantly higher than that of patients with P-LCR≤24.8% (Log-rank χ2=7.181, P=0.007). Multivariate Cox proportional risk regression analysis showed that high MPV (MPV>10.1 fl, HR=6.501, 95% CI 1.916-22.054, P=0.003), high PDW (PDW>11.4 fl, HR=3.625, 95% CI 1.957-6.714, P<0.001) and low P-LCR (P-LCR>24.8%, HR=0.145, 95% CI 0.045-0.470, P=0.001) were independent influencing factors for AVG dysfunction. The establishment of a functional prediction equation based on the above factors had a certain value in predicting the risk of AVG dysfunction in HD patients (likelihood ratio test: χ2=49.360, P<0.001). Conclusions:There are multiple factors that affect AVG dysfunction in HD patients, among which MPV, PDW and P-LCR levels may be the influencing factors for AVG dysfunction. Preoperative examination or postoperative comprehensive review of these factors during the follow-up period has certain directive significance for the prevention of AVG dysfunction.

Pseudoaneurisma para-anastomótico gigante tras revascularización por baipás aorto-bifemoral: Informe de un caso / Giant para-anastomotic pseudoaneurysm after revascularization though aorto-bifemoral bypass grafting: Case report

RESUMEN El pseudoaneurisma es aquel hematoma pulsátil y encapsulado producido tras la rotura de todas las túnicas del vaso y contenido por tejidos vecinos circundantes. Es considerado una complicación tardía en la cirugía protésica aorto-ilíaca. Se presenta un paciente de 72 años al que se le realizó un baipás aorto-bifemoral 13 años atrás, y que posteriormente se le diagnosticó un pseudoaneurisma para-anastomótico que se dejó evolucionar por presentar varias comorbilidades asociadas. Transcurridos 2 años fue necesario realizarle una intervención quirúrgica por presentar crecimiento excesivo de la tumefacción y complicación isquémica con necrosis cutánea. La aparición de un pseudoaneurisma está relacionada con el sexo, el material protésico y con el tiempo que transcurre desde la cirugía. El seguimiento ultrasonográfico durante el postoperatorio es primordial para identificar tempranamente esta complicación.

ABSTRACT Pseudoaneurysm is that pulsatile and encapsulated hematoma produced after the rupture of all vessel layers and contained by surrounding neighboring tissues. It is considered a late complication in aorto-iliac prosthetic surgery. We present a 72-year-old patient who underwent an aorto-bifemoral bypass grafting 13 years ago, and who was subsequently diagnosed with a para-anastomotic pseudoaneurysm that was allowed to evolve due to presenting several associated comorbidities. After two years, it was necessary to perform a surgical intervention due to the excessive growth of the swelling, and ischemic complication with skin necrosis. The appearance of a pseudoaneurysm is related to sex, prosthetic material as well as the time that elapses since the surgery. Ultrasound follow-up during the postoperative period is essential for an early identification of this complication.

Direct and virtual measurements of abdominal aortic aneurysms: three-dimensional printed models / Medidas de aneurisma da aorta abdominal: modelos tridimensionais impressos e virtuais

Abstract Objective: To validate the use of a three-dimensional printing system for metric and volumetric analysis of the segments of an abdominal aortic aneurysm (AAA). Materials and Methods: In patients scheduled to undergo endovascular AAA repair, the computed tomography angiography (CTA) measurements obtained during the preoperative assessment of the patients were compared with those obtained by computed tomography of individualized three-dimensional biomodels. Results: The volumetric assessment showed a discrepancy of 3-12%, and the difference between the areas was 10-16%. Conclusion: Computed tomography measurements of 3D-printed biomodels of AAAs appear to be comparable to those of threedimensional CTA measurements of the same AAAs, in terms of the metric and volumetric dimensions.

Resumo Objetivo: Validar a aplicação do método de impressão tridimensional de biomodelos para aferição métrica e volumétrica de segmentos de aneurisma de aorta abdominal. Materiais e Métodos: Compararam-se as medidas obtidas por tomografia computadorizada dos biomodelos tridimensionais com as realizadas no planejamento pré-operatório de pacientes submetidos a correção endovascular de aneurisma de aorta abdominal. Resultados: A avaliação da volumetria demonstrou discrepância de 3% a 12% e a diferença entre as áreas foi de 10% a 16%. Conclusão: A tomografia computadorizada dos biomodelos impressos é compatível nas aferições métricas e volumétricas com as imagens tridimensionais da angiotomografia do paciente.

Isquemia crítica de miembros inferiores en paciente joven: presentación atípica del síndrome de atrapamiento poplíteo / Critical lower extremity ischemia in a young patient: atypical presentation of the popliteal artery entrapment syndrome

Introducción. El síndrome de atrapamiento poplíteo es una entidad infrecuente, cuya incidencia oscila entre 0,17 y 3,5 %, representando una de las principales causas de isquemia en miembros inferiores en adultos jóvenes. Suele manifestarse con claudicación intermitente (69 %) o isquemia aguda (26 %), siendo muy rara su presentación con isquemia crítica de miembros inferiores. Caso clínico. Paciente de 30 años quien presentó úlcera subungueal en primer dedo de pie derecho con dolor intenso. En la exploración física no se palpaban pulsos distales y se observó palidez cutánea intensa y frialdad. Se realizó arteriografía donde se observó defecto de repleción de bordes regulares y desplazamiento medial de la arteria poplítea. La resonancia magnética mostró una inserción anómala del gastrocnemio medial, con lo que se hizo diagnóstico de síndrome de atrapamiento poplíteo tipo I. Mediante abordaje posterior se realizó reconstrucción vascular con injerto venoso y sección tendinosa del gastrocnemio medial. En el postoperatorio inmediato el paciente recupera pulso pedio y en el seguimiento a un año el paciente no presenta clínica de isquemia de miembros inferiores, encontrándose el baipás permeable. Discusión. A pesar de su baja incidencia, es importante incluir el síndrome de atrapamiento poplíteo en el diagnóstico diferencial de isquemia en miembros inferiores en adultos jóvenes. Su presentación con isquemia crítica es excepcional, encontrando muy pocos casos publicados en la literatura. La reconstrucción arterial precoz mediante injerto o plastia con material autólogo constituye el tratamiento de elección

Introduction. The popliteal entrapment syndrome is an infrequent entity, whose incidence ranges between 0.17 and 3.5%, representing one of the main causes of lower limb ischemia in young adults. It usually manifests with intermittent claudication (69%) or acute ischemia (26%), being very rare its presentation with critical ischemia of the lower limbs.Clinical case. A 30-year-old patient with a history of smoking, with no other risk factors, who presented with a subungual ulcer on the first right toe. On physical examination, distal pulses are not palpated, intense skin paleness and coldness are observed. Magnetic resonance imaging showed an anomalous insertion of the medial gastrocnemius with extrinsic compression of the popliteal artery, confirming a diagnosis of popliteal entrapment syndrome type I. Vascular reconstruction with venous graft and tendon section of the medial gastrocnemius was performed through a posterior approach. In the immediate postoperative period, the patient recovers a pediatric pulse and in the one-year follow-up the patient does not present symptoms of lower limb ischemia, finding the bypass patent. Discussion. Despite its low incidence, it is important to include popliteal impingement syndrome in the differential diagnosis of lower limb ischemia in young adults. Its presentation with critical ischemia is exceptional, finding very few cases published in the literature. Early arterial reconstruction by graft or plasty with autologous material is the treatment of choice

Experimental comparative study of arterial implants made of silicone reinforced with polyester fabric and expanded polytetrafluoroethylene (PTFE) in rabbits aorta / Estudo experimental comparativo de implantes arteriais em silicone com reforço de poliéster e politetrafluoretileno expandido (PTFE) em aorta de coelhos

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.

RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.

Efficacy of thoracic endovascular aortic repair for treatment of Stanford type B traumatic aortic dissection / 中华创伤杂志

Objective:To investigate the clinical efficacy of thoracic endovascular aortic repair (TEVAR) in treating Stanford type B traumatic aortic dissection (TAD).Methods:A retrospective case series study was conducted to analyze the clinical date of 26 patients with Stanford type B TAD admitted to Nantong First People's Hospital from June 2011 to December 2019. There were 21 males and 5 females, aged 35-83 years [(56.2±12.9)years]. All patients mainly suffered from chest and back trauma and were treated with TEVAR. The operation time, intraoperative blood loss, intraoperative heparin dosage, duration of ICU stay and postoperative organ complications were collected. The changes of brain natriuretic peptide, urea nitrogen and creatinine were compared before operation and at one day after operation. The CT angiography (CTA) was performed to mainly detect the location of stent, reverse tearing, paraplegia and internal leakage at 6 months after TEVAR. The aortic CTA was used to measure the maximum diameter of aortic dissecting aneurysm and true lumen diameter of distal aorta before operation and at 6 months after operation, and the diameter changes were compared to determine the aortic remodeling after TEVAR.Results:All patients were followed up for 6-36 months [(25.9±6.3)months]. The operation time was 60-200 minutes [(96.7±30.7)minutes], the intraoperative blood loss was 20-45 ml [(31.1±6.8)ml], the dosage of heparin was 0-0.53 mg/kg [(0.4±0.1)mg/kg], the postoperative ICU stay was 1-7 days [(4.7±1.3)days]. Seven patients developed pulmonary infections after operation and showed significant improvement after closed thoracic drainage, airway management and anti-infection treatment. Two patients had abnormal renal function after operation and received medical therapy for improvement. There was no significant difference in brain natriuretic peptide, urea nitrogen and creatinine between before operation and one day after operation ( P>0.05). At 6 months after operation, the CTA showed that the stent position was satisfactory and there were no serious complications such as reverse tearing and paraplegia. Of one patient with type I endoleak, the tumor did not further expand and his condition was stable. At 6 months after operation, the diameter of dissecting aneurysm [(34.4±5.0)mm] was smaller than that before operation [(38.2±5.6)mm], the true lumen of distal stent [(26.8±4.6)mm] was larger than that before operation [(22.6±6.0)mm] ( P<0.05 or 0.01). Conclusion:For Stanford type B TAD, TEVAR has no significant effect on cardiac function and renal function, with no severe complications and good aortic remodeling.

Ross procedure to cure aortic valve disease in children with expended polytetrafluoraethylene(ePTFE) artificial valve for right ventricular outflow tract reconstruction / 中华胸心血管外科杂志

Objective:To review and analyze the clinical experience of children with aortic valve stenosis and/or insufficiency treated with autologous pulmonary valve for aortic valve replacement procedure(Ross operation) with ePTFE artificial valve for right ventricular outflow tract reconstruction.Methods:From 2015 to 2020, 8 cases of aortic stenosis and/or aortic insufficiency treated by Ross operation in our center were collected, with an age of 0.5-13.2 years old. 4 cases of aortic stenosis were diagnosed preoperatively, 3 cases of aortic stenosis with aortic insufficiency, and 1 case of infective endocarditis involving the aortic valve. The operation was carried out in three steps: Harvest autologous pulmonary valve; the diseased aortic valve was resected and autologous pulmonary valve was transplanted to the aorta by aortic root transplantation; the right ventricular outflow tract was reconstructed by a handmade ePTFE artificial flap blood vessel.Results:In 6 cases, the right ventricular outflow tract was reconstructed by hand-sewn ePTFE trileaflets, and artificial univalve in 2 cases, no death occurred during operation; all patients were cured and discharged. The patients were followed up for 1 to 36 months, with mean of(12.63±12.19) months. There was no long-term death or valvular complications. During follow-up echocardiography indicated 1 case of moderate aortic regurgitation, 1 case of mild-moderate regurgitation, and moderate regurgitation was found in 2 patients with artificial single pulmonary valve. For the remaining patients, they were mild aortic regurgitation, and a trivial or mild pulmonary artery regurgitation with hand-sewn three-leaflets ePTFE artificial vessel; All patients were followed up at the last time with a peak pressure of(6.63±3.46) mmHg(1 mmHg=0.133 kPa) across the aortic valve. The left ventricular outflow tract and aortic annulus shrank slightly after surgery(the diameter of one patient with Ross-Konno operation increased), but the annulus diameter increased with age. There was no need for further intervention.Conclusion:The Ross operation is safe for the treatment of aortic valve disease, it has good hemodynamic effect, and the autologous pulmonary artery has growth potential, especially suitable for children and young patients. Hand-sewn ePTFE with trileaflet vessels for reconstruction of right ventricular outflow tract performs well in anti-regurgitation function in the short term or may be used as a replacement material for the homograft/heterograft vessel, but longer follow-up and more cases are needed.

Relationship between blood vessel density in optic disc area and visual field index and visual field defect morphology in patients with normal tension glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the relationship between the changes of blood vessel density in optic disc area of normal tension glaucoma(NTG)and visual field index(VFI)of glaucoma and morphological staging of visual field defect. <p>METHODS: Totally 106 patients(106 eyes)with NTG and 79 patients(79 eyes)with primary open angle glaucoma(POAG)in the hospital between December 2018 and December 2020 were selected for cross-sectional study. Among them, 1 eye of binocular disease was selected as the sample by the random number table method, and another 92 healthy subjects with physical examination in the hospital were selected as control group. All three groups completed the optic disc blood vessel density, VFI detection and visual field defect morphological staging, and the relationship between optic disc blood vessel density and VFI and visual field defect morphological staging were analyzed.<p>RESULTS: The intraocular pressure in POAG group was significantly higher than that in NTG group and control group(<i>P</i><0.05). The whole optic disc area blood vessel density, large vessel density and capillary density of NTG group and POAG group were significantly lower than those of control group(<i>P</i><0.05)while the density of avascular area was significantly higher than that of control group(<i>P</i><0.05), and there were differences in various indicators between NTG group and POAG group(<i>P</i><0.05). The VFI of NTG group and POAG group was significantly lower than that of control group(<i>P</i><0.05)while the mean visual field defect(MD)was significantly higher than that of control group(<i>P</i><0.05), and there were no statistical differences in VFI and MD between NTG group and POAG group(<i>P</i>>0.05). With the increase in visual field defect morphology staging, the whole optic disc area blood vessel density and capillary density of patients with NTG showed a significant decrease(<i>P</i><0.05). The whole optic disc area blood vessel density and capillary density of patients with NTG were positively correlated with VFI and negatively correlated with visual field defect staging, and avascular area density was negatively correlated with VFI and positively correlated with visual field defect staging(all <i>P</i><0.05). <p>CONCLUSION:Optic disc blood vessel density of patients with NTG is significantly lower than that of patients with POAG and normal people, and it is significantly correlated with VFI and visual field defect morphological staging. Among them, capillary density has the highest correlation. It can be seen that OCTA has important clinical significance for NTG diagnosis, treatment and follow-up.

Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique / 器官移植

Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.