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With persistent progress in donor-recipient evaluation criteria, organ procurement and preservation regimens and surgical techniques, the incidence of vascular complication after kidney transplantation has been declined, whereas it is still one of the most severe surgical complications of kidney transplantation, which may lead to graft loss and recipient death, and seriously affect the efficacy of kidney transplantation. Therefore, the occurrence, clinical manifestations, diagnosis and treatment strategies of common vascular complications after kidney transplantation, including vascular stenosis, arterial dissection, pseudoaneurysm, vascular rupture and thrombosis were reviewed in this article. In combination with the incidence, diagnosis and treatment of vascular complications after kidney transplantation in the First Affiliated Hospital of Xi'an Jiaotong University, diagnosis and treatment strategies for common vascular complications after kidney transplantation were summarized, aiming to provide reference for clinical diagnosis and treatment of vascular complications after kidney transplantation, lower the incidence of vascular complications, and improve clinical efficacy of kidney transplantation and survival rate of recipients.
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Objective To investigate the clinical application value of contrast-enhanced ultrasound (CEUS) in hepatic artery thrombosis (HAT) after pediatric liver transplantation. Methods Clinical data of 126 pediatric recipients undergoing liver transplantation were retrospectively analyzed. The incidence of HAT after pediatric liver transplantation was summarized. Color Doppler ultrasound and CEUS manifestations of HAT were compared. Results According to color Doppler ultrasound, 17 cases were highly suspected with HAT. Nine cases were highly suspected with HAT by CEUS, who were subsequently confirmed by CT angiography (CTA) or surgery. CEUS manifestations of HAT showed that hepatic artery was not seen surrounding the portal vein during the arterial phase or even portal venous phase. Hepatocyte necrosis occurred in 4 patients with HAT, and no perfusion of intrahepatic contrast agent was observed on CEUS. Conclusions CEUS yields high clinical application value in the diagnosis of HAT after pediatric liver transplantation. It has significant advantages compared with traditional CTA, which could be widely applied in clinical practice.
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OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.
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Humans , Animals , Male , Cerebral Infarction/diagnostic imaging , Brain Ischemia/diagnostic imaging , Angiography, Digital Subtraction , China , Macaca mulatta , Models, Biological , Models, CardiovascularABSTRACT
Objective: To evaluate the clinical value of color coded quantitative-digital subtraction angiography(CCQ-DSA)in microvascular of liver carcinoma.Methods: 40 patients with hepatocellular carcinoma(HCC)who received treatment in hospital were selected in this research and they were divided into observation group(20 cases)and control group(20 cases).The CCQ-DSA was applied in observation group to observe microvascular of liver carcinoma and DSA imaging was applied in control group.And the applied effects of two groups in the display evaluation of new vessels of liver carcinoma were compared.Results: The differences of collateral circulation vessel and collateral circulation of small lesion of liver carcinoma between the two groups were significant(x2=5.584,x2=18.142,P＜0.05),respectively.And the difference of capillary type of liver carcinoma by diagnosis of angiography was significant(x2=10.039,P＜0.05).Conclusion: The diagnostic effect of CCQ-DSA for microvascular of liver carcinoma is better than that of DSA imaging,and it has significant advantage of display on image detail.
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Objective:To explore the configuration of air conditioner and ventilating system of large medical equipment in comprehensive hospital so as to meet the normal operation of various large medical equipment of hospital.Methods: Facing to the characteristics, that the requirements of large medical equipment on air conditioner and ventilating system were higher than that of common equipment and the configuration requirements of different large medical equipment on air conditioner and ventilating system were different, the allocation according to the demands was adopted.Results:Depended on the equipment parameter and requirement of actual operation of linear acceleration, magnetic resonance imaging (MRI), computed tomography (CT) and the machine room of digital subtraction angiography (DSA) in the items of new medical technique building of hospital to design the configuration plan of air conditioner and ventilating system of large medical equipment so as to ensure their normal operation. Conclusion: In the planning programming and construction management of air conditioner and ventilating system of large medical equipment, the different characteristics of them should be considered so as to establish better basis for installation, debugging and operation of equipment in later period. At the same time, these can provide better medical environment for patients and medical staff.
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Objective To compare the clinical value of three-dimensional dynamic contrast enhanced magnetic resonance angiography (3D DCE MRA) and digital subtraction angiography (DSA) in diagnosing inferior vena cava diseases in suspected case of Budd-Chiari syndrome (BCS).Methods Radiological findings of 91 suspected BCS cases obtained from 3D DCE MRA and DSA in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.DSA test was considered as golden standard,which assess the capacity of 3D DCE MRA in diagnosing inferior vena cava diseases,including sensitivity,specificity and accuracy.Kappa test was utilized to compare the coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases.Results Among 91 suspected BCS cases with 3D DCE MRA,a total of 17 cases without inferior vena cava diseases were misdiagnosed as inferior vena cava stenosis,two patients with inferior vena caval obstruction was misdiagnosed as falsely negative.Seventy-two patients with 3D DCE MRA were confirmed via DSA in diagnosing inferior vena cava diseases,sensitivity was up to 97.7％ (58/60),false positivity 54.8％ (17/31),specificity 45.2％ (14/31),respectively.Fair coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases (Kappa =0.474,P ＜ 0.05).Conclusions There could be clinical value of 3D DCE MRA for its high sensitivity and low specificity in diagnosing inferior vena cava diseases,and favorable coincidence ratio was discovered between 3D DCE MRA and DSA.Comprehensive consideration is needed for suspected cases of inferior vena cava stenosis detected by 3D DCE MRA,and further analysis may figure out potential causes of misdiagnosis and decline false positive events.
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Objective To carry out further analysis and assessment of the radiation risk from DSA examinations and related factors.Methods All the online radiation dose values and associated parameters of the 107 patients examined were collected for purpose of statistical analyses according to their classification.Results The analyses of DSA examinations indicated:for coronary angiography,DAP was (22 285.5±18 682.7)μGy·m2,ESD was (2 942.1 ±2 557.3) mGy;for head angiography,DAP (25 929.6±8 302.7) μGy·m2,ESD (1 288.8 ±682.3) mGy;for abdominal angiography,DAP (12 129.7 ± 10 646.1) μGy· m2,ESD (730.1 ± 584.7) mGy.Conclusions Among total accumulated radiation dose,the dose arising form coronary angiography is the highest,followed by the head angiography,and the dose from abdominal angiography is the lowest.
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Objective In order to meet the needs of more precise surgical navigation during interventional procedures and minimally invasive surgery, Aurora electromagnetic tracking technology-assisted surgical navigation with free combination of various surgical instruments was tested, trying to further solve problems encountered in surgery. Methods Aurora electromagnetic tracking system was used to match the medical surgical environment with metal-containing material. The built-in control software in this electromagnetic tracking system, which was equipped with the software development kit, was used to write a set of VC programming language suitable for real-time display of clinical surgical navigation system, and relative performance tests and comparative experiments were conducted for different medical surgical navigation application in the hospital to measure the precision degree of the tracking system, as well as the statistics of various surgical instruments corresponding to the application in different surgeries. Results 160 patients in interventional surgery with coronary angiography were randomly selected, 80 patients treated by digital subtraction angiography(DSA) with electromagnetic tracking systems as the experimental group, and 80 patients by DSA only as the control group. It was found out that with obviously less operating time, the amount of contrast agent was significantly reduced in the experimental group, and the degree of controllability for interventional surgical procedure was increased from 95% success rate to 99%. Conclusions The comparative experiments proved that Aurora electromagnetic tracking technology could significantly improve the accuracy in surgery, with the mean value of navigation less than 2 mm. In terms of interventional procedures and minimally invasive surgery, this electromagnetic tracking technology can greatly relieve patients' suffering and reduce medical risks to make medical care safer, and enhance the surgical technology level in hospital.
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@#Objective To evaluate the localization and the correlation with cardiovascular risk factors of cerebral arteries damage in patients with transient ischemic attack (TIA). Methods Digital subtraction angiography (DSA) was performed in the 97 patients with TIA. The localization, the degree of stenosis, the numbers of the arteries involved and their correlation with the cardiovascular risk factors were analyzed. Results DSA showed occlusive findings of cerebral arteries in 91.8% of the patients, and 68 cases (76.4%) among them were involved more than one artery. The proximal internal carotid arteries (35.5%) and the proximal vertebral arteries (28.2%) were the most frequently involved in this series. And the number of the arteries involved and the degree of stenosis were positively correlated with the level of risk factors. Conclusion There is a high incidence of cerebrovascular stenosis in patients with TIA. Most of them are involved more than one artery. The degree of the stenosis is positively related with the quantity of the risk factors.
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@#ObjectiveTo evaluate the value of transcranial Doppler (TCD) in pecutaneous transtuminl angioplasty and stenting (PTAS).MethodsThe index of hemodynamics, include mean peak flow velocity (Vm), systolic peak flow velocity (Vs), enddiastolic peak flow velocity (Vd), pulsatility index (Pi), resistance index (Ri) in 47 cases with the stenosis of the middle cerebral artery were investigated, while compared with that of intra arterial digital subtraction angiography (DSA). ResultsVs and Vm of 41 cases increased while the Pi reduced after operation, Ri had no change; Vs, Vm, Vd increased and Pi reduced with no reflow signal in 5 cases. Vs and Vm increased with Vd reduced in only 1 case. The accuracy rate with DSA in moderate or severe stenosis was 75% or 83% respectively. ConclusionTCD, as it's reliable, no-invasive, convenience and cheap, can play an important role in assessing the effect of PTAS in middle cerebral artery stenosis.
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@#ObjectiveTo evaluate the accuracy of the vascular ultrasound testing technique on detecting large arterial lesions in neck. MethodsVascular ultrasound testing and digital substraction angiography(DSA) were performed on 75 arteries in 53 consecutive patients with chronic cerebral ischemia, transient ischemic attack(TIA) or cerebral infarction.The sensitivity, specificity, and accuracy of vascular ultrasound testing on moderate stenosis(50%—69%), severe stenosis(70%—99%),or occlusion of arterial lesions in neck were analysed by means of cross tabulation, using DSA as the standard of reference. ResultsThe sensitivity, specificity and accuracy of vascular ultrasound testing on arterial lesions of moderate stenosis, severe stenosis and occlusion were 85.7%,78.9%,84.0%;90.2%,88.2%,89.3%;93.3%,95.0%,94.6%,respectively.The complete corresponding rate between the two type of tests was 73.3%. ConclusionThe vascular ultrasound testing technique shows high accuracy on detecting large arterial lesions, especially on severe stenosis or occlusion in neck. It can be applied extensively in prevention and treatment of cerebrovascular diseases.
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Objective To study the technique of modified multi-slice spiral CT aniography(MSCTA) for displaying the whole length of the carotid arteries and the origin of the vertebral arteries,and to evaluate its clinical value.Methods A total of 152 patients underwent modified MSCTA of extracranial carotid artery which scanned from skull base to aortic arch with contrast medium injected from the femoral vein, the image quality and the detection of lesions were assessed in comparison with that of DSA in a few of cases. Results (1) The jugular vein was displayed in 4 cases, only accounting for 2.63%. (2) The carotid segments including the proximal common carotid artery(CCA), the middle CCA, the carotid bifurcation, the internal carotid artery(ICA) bulb and the distal ICA could be visualized adequately by MSCTA,the showing rates were 97.69%,97.69%,97.69%,95.62% and 97.64%,respectively. Furthermore, moderate or severe stenosis detected by MSCTA in 17 cases was closely corresponding with the results of DSA. Conclusion Modified MSCTA of extracranial carotid artery can display the whole length of extracranial carotid artery and the origin of the vertebral arteries satisfactorily without the interference of the jugular, subclavian and innominate veins, and can improve its clinical application.
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Objective To study the pathogenesis of avascular necrosis of femoral head(ANFH) in young adults.Methods The data of DSA of femoral head(113 femoral heads) with ANFH proved by clinic or radiology and treated by interventional radiology and 45 normal peoples(46 femoral head) were comparatively analysed.Results The variation of artery of femoral head in interventional treating group was appeared in 28 cases(35.9%),51 arteries involved,including 17 internal iliac arteries variation(33.3%),29 medial femoral circumflex arteries variation(56.9%),4 lateral femoral circumflex arteries variation(7.8%),1 lateral and medial femoral circumflex arteries common bole variation(2.0%).The variation of artery of femoral head in control group was appeared in 5 cases,5 arteries involved.There was significant difference between the two groups(P
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Objective The application of CTHA/CTAP in examination of liver cancer relapse after interventional therapy were retrospectively analyzed.Methods The CTHA/CTAP and DSA were performed on 19 patients with primary hepatic cancer after receiving TACE procedure followed by obvious rising of AFP.Results CTHA/CTAP discovered 14 recurrent lesions in the peripheral region of the embolized tumors,and 15 new lesions.In comparison,DSA only discovered 6 recurrent lesions and 8 new lesions.Conclusion Comparing with DSA,CTHA/CTAP is a more sensitive and reliable method in detection of liver cancer relapse after interventional therapy.
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Time Interval Difference(TID)is a different type of subtraction method which can be used during Digital Subtraction Angiography(DSA)examination.The princi- ple,operation and results of TID were discussed,and about 300 examinations on different clinical cases were observed and the findings compared with that of DSA.It was found that the TID subtraction effect was more satisfactory than DSA,and it also reflected the hemo- dynamics and anatomical details more precisely.This paper included also analysis of TID manifestations of 12 different types of cardiac diseases.
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Objective To study the utilization of DSA for interventional examination and therapy in acute ischemic cerebrovascular disease. Methods The summarization of properly utilizing the DSA equipment and events happening in the process were analyzed after application on 550 cases with acute ischemic cerebrovascular attacks. Results Application of perfusion DSA is useful to obtain rapid diagnosis and evaluation of interventional therapeutic efficacy for acute ischemic cerebrovascular disease. The practical projection angle can display the features and extent of vasculopathy clearly, and offer the best operative position for promotion of rotation DSA and the diagnostic imaging and therapeutic efficacy, three-dimensional reconstruction are usful to the success of interventional management. Imaging measuring technique of DSA would provide precise data for doctors to choose the accurate intervention materials. Conclusion Reasonable utilization of DSA equipment plays an important role in interventional therapy of acute ischemic cerebrovascular disease, and also is the gold standard for displaying images for rapid diagnosis.