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To design a treatment plan for patients with epididymal obstruction, we explored the potential impact of factors such as body mass index (BMI) and age on the surgical outcomes of vasoepididymostomy (VE). In this retrospective study, 181 patients diagnosed with obstructive azoospermia (OA) due to epididymal obstruction between September 2014 and September 2017 were reviewed. All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon (KH) in a single hospital (Peking University Third Hospital, Beijing, China). Six factors that could possibly influence the patency rates were analyzed, including BMI, age, mode of anastomosis, site of anastomosis, and sperm motility and quantity in the intraoperative epididymal fluid. Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression. A total of 159 (87.8%, 159/181) patients were followed up. The follow-up time (mean ± standard deviation [s.d.]) was 27.7 ± 9.3 months, ranging from 12 months to 48 months. The overall patency rate was 73.0% (116/159). The multivariable analysis revealed that BMI and age significantly influenced the patency rate (P = 0.008 and 0.028, respectively). Younger age (≤28 years; odds ratio [OR] = 3.531, 95% confidence interval [95% CI]: 1.397-8.924) and lower BMI score (<26.0 kg m-2; OR = 2.352, 95% CI: 1.095-5.054) appeared to be associated with a higher patency rate. BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.
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Humans , Male , Adult , Retrospective Studies , Body Mass Index , Epididymis/surgery , Vas Deferens/surgery , Treatment Outcome , Sperm Motility , Microsurgery , Surgeons , VasovasostomyABSTRACT
Objective:To investigate the patency rates and risk factors of arteriovenous graft (AVG), and provide a clinical guidance for further optimization of vascular access selection and improvement of dialysis quality.Methods:This was a retrospective study. The clinical and follow-up data of patients who received AVG in the Blood Purification Center, First Affiliated Hospital of Zhengzhou University from January 1, 2017 to December 31, 2021 were selected. Kaplan-Meier curve and Cox regression model were used to analyze the patency rates and risk factors of AVG.Results:A total of 381 cases with AVG were included, with 154 cases (40.4%) of males, age of (55.5±11.8) years old, and 140 cases (36.7%) of diabetes. The median time of primary patency was 377.00(95% CI 314.26-439.74) days, and the primary patency rates at 1, 2, and 3 years were 51.0%, 30.7%, and 15.4%, respectively. The median time of primary assisted patency was 839.00(95% CI 668.89-1 009.11) days, and the primary assisted patency rates at 1, 2, and 3 years were 78.3%, 56.4%, and 39.1%, respectively. The secondary patency rates at 1, 2, and 3 years were 96.7%, 90.1%, and 78.5%, respectively. Multivariate Cox regression analysis results showed that anastomotic vein types of basilic vein and cephalic vein (median cubital vein as a reference, HR=1.869, 95% CI 1.124-3.107, P=0.016; HR=2.110, 95% CI 1.176-3.786, P=0.012) and the diameter of anastomotic vein<3.5 mm ( HR=1.411, 95% CI 1.020-1.952, P=0.037) were the independent influencing factors for abnormal primary patency of AVG. Males ( HR=1.680, 95% CI 1.127-2.503, P=0.011), mean arterial pressure<70 mmHg ( HR=3.228, 95% CI 1.109-9.394, P=0.032), Acuseal graft type (Intering as a reference, HR=1.884, 95% CI 1.185-2.994, P=0.007), anastomotic vein type of cephalic vein (median cubital vein as a reference, HR=2.817, 95% CI 1.328-5.977, P=0.007), the diameter of anastomotic vein<3.5 mm ( HR=1.555, 95% CI 1.048-2.306, P=0.028), serum phosphorus ≤1.78 mmol/L (1.13-1.78 mmol/L />1.78 mmol/L, HR=1.737, 95% CI 1.111-2.716, P=0.015;<1.13 mmol/L />1.78 mmol/L, HR=2.162, 95% CI 1.072- 4.362, P=0.031), and ferritin<200 μg/L ( HR=1.850, 95% CI 1.231-2.780, P=0.003) were the independent influencing factors for abnormal primary assisted patency of AVG. Serum albumin<40 g/L ( HR=2.165, 95% CI 1.096-4.275, P=0.026) was an independent influencing factor for abnormal secondary patency of AVG. Conclusions:The primary patency rates of AVG at 1, 2, and 3 years were 51.0%, 30.7%, and 15.4%, respectively. The secondary patency rates of AVG at 1, 2, and 3 years were 96.7%, 90.1%, and 78.5%, respectively. Anastomotic vein types of cephalic vein and basilic vein, and internal diameter<3.5 mm are the independent risk factors for abnormal primary patency of AVG. Anastomotic vein type of cephalic vein and internal diameter<3.5 mm are the independent risk factors for abnormal assisted primary patency of AVG. Serum albumin<40 g/L is an independent risk factor for abnormal secondary patency of AVG. It is suggested that systematic preoperative evaluation and good nutritional status of patients are important to maintain long-term patency of the AVG.
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Objective:To investigate the influencing factors and clinical effect analysis of the choice of treatment method for spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 35 patients with SISMAD admitted to Beijing Friendship Hospital, Capital Medical University from December 2015 to November 2021 were retrospectively analyzed. They were divided into conservative group ( n=24) and surgical group (endoluminal stent group + open surgery group, n=11). The conservative group was treated with conservative methods, the endoluminal stent group ( n=10) was treated with endoluminal stent placement, and the open surgery group ( n=1) was treated with superior mesenteric artery endarterectomy + angioplasty + ileal resection. The white blood cell (WBC) count on admission, the time of abdominal pain, YOO classification, aorta mesenteric angle(AMA), and the length of hospital stay between the two groups were analyzed. All patients were followed up for more than 24 months, at the end of which the vascular remodeling rate of superior mesenteric artery (SMA) between the two groups was studied. In addition, the primary patency rate and secondary patency rate of intracavitary stents were analyzed. Measurement data that conform to normal distribution were expressed as mean ± standard deviation ( ± s), and independent samples t-test was used for comparison between groups; measurement data that do not conform to normal distribution were expressed as median (interquartile range) [ M( Q1,Q3)], the nonparametric test was used for comparison between groups. Enumeration data were compared between groups using the Chi-square test. Results:Univariate analysis showed that compared with the conservative group, the IVS type in YOO classificationin of surgical group was significantly more than the conservative group. There was no significant difference in WBC, duration of abdominal pain, or AMA at admission ( P>0.05). In addition, the length of hospital stay in the conservative group was significantly shorter than that in the surgical group. No intestinal necrosis occurred in endoluminal stent group. After 24 months of follow-up, the remodeling rate of SMA in the surgical group was higher than that in the conservative group; the primary patency rate of the endoluminal stent group was 87.5%, and the secondary patency rate was 100%. One patient in the conservative group developed SMA dissection aneurysm during 12 months of follow-up and received endovascular treatment. Conclusions:For the treatment of SISMAD, most patients can be cured by conservative treatment. However, for patients with consistent abdominal pain and IVS type in YOO classification, if there is no severe manifestation of peritonitis, it is recommended to perform endovascular stent placement as soon as possible to open the blood supply. Meanwhile, the SMA stenting has an ideal long-term patency rate and vascular remodeling rate.
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Objective: To explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease. Methods: A retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity. Results: All patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis. Conclusion: Although the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.
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Objeetive As to the high incidence of arteriovenous fistula(AVF) stenosis,surgical operation will result in the exhaustion of vascular resources in patients,while percutaneous transluminal angioplasty(PTA) can maintain vascular resources for ostomy.However,there is still no clear definition between the choices of PTA and surgical resection.The aim of this study was to compare the efficacy of PTA and surgical resection followed by reconstruction for the treatment of arteriovenous fistula stenosis in order to find appropriate treatment.Methods Retrospective analysis had been done on 46 hemodialysis patients with arteriovenous fistula stenosis in Nanjing BenQ hospital from January 2015 to March 2017,which included 22 cases treated with PTA (PTA group) and 24 cases treated with surgical operation (operation group).Comparison was made in general clinical situation,patency rate at six months after surgery,over patency time and adverse reactions to surgery between the two groups.Results The number of stenoses in PTA group was bigger than that in operation group and the difference was of statistic significance (2.78±1.43 vs 1.67±0.71,P＜0.05).There was no significant difference in patency rate between the two groups (P =0.828).There were 57 venous stenoses in PTA group,among which 12 stenoses were anastomotic (21.05％) with 79.3％ average stenosis degree and 43 stenoses were at venous outflow tract of fistula (75.44％) with 84.26 average stenosis degree.In PTA group,3 patients had hematoma brachial puncture position and recovered by self-absorption without special treatment.In operation group,1 patient had mild blood oozing and recovered after treatment;4 patients recovered gradually from mild swelling on the back of the hand of the operation side.No difference was found in adverse reactions between two groups (P＞0.05).Conclusion PTA treatment is preferred for multiple stenoses(n ≥ 3),which ensures better preservation of vascular resources at a comparable patency rate.
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Objective To explore the treatment of multifocal lower extremity arteriosclerosis oblitera-tions. Methods From March 2014 to September 2014, combined procedures were performed on 30 lower limbs in 30 patients with multifocal lower extremity arteriosclerosis obliterations for revascularization. All the patients underwent endovascular , 20 of whom received endarterectomy , 10 received artery emboloctomy , and 8 received profundaplasty. The rates of technical success and clinical success were observed. The patients were followed up for 6-12 months to observe the total patency rate and rate of limb reservation. Results The technical success rate was 100%. The perioperative complication rate was 30% (9/30). 29 limbs gained improvement with differ-ent degree and the clinical success rate was 96.67% (29/30). The ankle-brachial index elevated 0.37 ± 0.19 on average (P < 0.001). Primary patency rate was 90% and 73% at 6 and 12 months, and 12-month limb reserva-tion rate was 97.67%. Conclusions The combined procedures for complex lower extremity arteriosclerosis oblit-erations have a higher short- to mid-term patency rate and limb reservation rate.
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Objective To retrospectively analyze the one-year outcomes of modified single-armed suture technique for microsurgical vasoepididymostomy in men with epididymal obstructive azoospermia (EOA).Methods From February,2012 to November,2013,microsurgical longitudinal intussusception vasoepididymostomies using a modified single-armed suture technique in 51 men with EOA was performed.The followed-up period was designed as 1 year.The correlations between the sperm motility in epididymal fluid,unilateral or bilateral procedure,anastomotic site,and the female partner age and the patency or pregnancy rate were analyzed.Results Followups were carried out for 39 (76.5％) men.The patency was noted in 24 (61.5％) men and pregnancy was reported in 15 (38.5％) female partners,including 1 received in vitro fertilization using fresh ejaculated sperm.Motile sperms in epididymal fluid were observed intraoperatively in 14 (58.3％) patent men and 3 (20.0％) nonpatent men,respectively (P ＜ 0.05).In patent cohort,the mean ages of the pregnant and non-pregnant female partners were 26.5 and 32.7 years(P ＜ 0.05),respectively.Conclusion The modified single-armed suture technique showed favourable patency and pregnancy rates in this study.It's a practical alternative in the areas without the specialized double armed suture.
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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.
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The treatment of ST elevation myocardial infarction (STEMI) has undergone significant advances over the past three decades. Current practice guidelines raise the importance of promptly restoring normal coronary blood flow and myocardial perfusion in the infarct zone after the onset of chest pain, through either pharmacologic or mechanical reperfusion strategies. Fibrinolytic therapy remains the most widely used reperfusion strategy worldwide. With the development of newer fibrinolytic agents and adjuvant potent anti-platelets therapies, this approach carries an increased risk of bleeding complications. The current research present up-date review of the use of reperfusion strategies for the treatment of STEMI, using data through the search of MEDLINE, PubMed, EMBASE, as well as related extracts from the annual report of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. We summarized data from the available studies conducted over the past last 30 years in relation to pharmacologic reperfusion therapy in regards to risks and benefits. Conclusion: Fibrinolytic therapy remains the main reperfusion strategy used for the treatment of STMI worldwide. In the current era, there is a lack of fibrinolytic therapy trials, mainly because of increased focus in mechanical reperfusion therapies’ studies in the developed world. Clinical trials on the use of the fibrinolytics with newer platelet agents are urgently needed.
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Objective To evaluate the patency rate of two types of metallic biliary stent in treating malignant biliary stenosis, and to discuss the patient’s survival rate. Methods A total of 126 patients with malignant biliary stenosis were treated with percutaneous implantation of biliary stent. The clinical data were retrospectively analyzed. A total of 167 metallic biliary stents were used in 126 patients. Ninety - two metal stents of mesh type were employed in 70 cases, while 75 metal stents of laser engraving type were adopted in 56 cases. After the treatment all patients were followed up, and the stent patency time as well as the median survival time was determined. The results were analyzed and compared between the two types of stents. Results Technical success rate was 100% (126/126). The median patency rate time of mesh type and laser type was 182 days and 196 days respectively, the patient’s median survival time of mesh type group and laser type group was 179 days and 186 days respectively. No statistically significant differences in the stent patency time and in the median survival time existed between the two groups (P > 0.05). Conclusion In treating malignant biliary obstruction with stenting, the mesh type stent and the laser type stent have quite same therapeutic effect. Therefore, in clinical practice the two types of stent can be replaced with each other to a certain degree.
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Recently, with the advent of medical devices and minimally invasive operations, endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting has been widely accepted. Although EVH has short-term advantages of less wound morbidity and better cosmetic results compared with open vein harvesting (OVH), several studies have demonstrated that the mid- and long-term patency rate of EVH veins is significantly lower than that of OVH veins, therefore the role of EVH is currently controversial. The purpose of this study was to investigate the early results of EVH compared with the OVH group. Between April 2011 and December 2012, 115 consecutive patients underwent coronary artery bypass grafting (CABG) in our institution. Of these, EVH was performed in 62 patients and OVH in 53. In EVH groups, all 50 patients were men, and mean age was 71.3±7.8 years. A total of 211 coronary anastomoses, 109 SVGs anastomoses were assessed for patency postoperatively by angiography or enhanced computed tomography before discharge. The mean vein harvesting time was 26.0±8.1 min, and the mean number of ostial branch tear was 0.34±0.59. The overall SVG patency rates at discharge were 95.4% in EVH and 92% in OVH, respectively (<i>p</i>=0.24). There was a significant reduction in the incidence of leg wound complications in the EVH group (EVH : 1.6% ; OVH : 13.2% ; <i>p</i>=0.038). In conclusion, the short-term result of EVH was satisfactory. EVH reduces leg wound complications compared with OVH.
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In this study, we report early and mid-term outcomes of endoscopic saphenous vein (SV) harvesting (EVH) for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178 (67.9%) patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7 (2.8%) patients. The early and mid-term patency was 95.8% (276/288) and 74.2% (187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization (82.5% vs. 73.6%, <i>p</i>=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.
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PURPOSE: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. METHODS: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients, whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. RESULTS: There were no statistically significant differences between the two groups, including age, gender, diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). CONCLUSION: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.
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Humans , Arteriovenous Fistula , Chimera , Constriction, Pathologic , Hypertension , Medical Records , Retrospective Studies , Thrombectomy , TransplantsABSTRACT
PURPOSE: The aim of this study is to analyze the patency rates according to the risk factors and comorbidities in patients treated with endovascular treatments or arterial bypass surgery due to chronic arterial occlusive disease in the lower extremity. METHODS: Two hundred fifty-seven patients were treated for chronic arterial occlusive disease in lower extremity from January 2000 to December 2010 at Chonbuk National University Hospital; of the 257 patients, we retrospectively reviewed medical records of 142 patients who could be followed-up. We analyzed the patency rates according to the Trans-Atlantic Inter-Society Consensus (TASC) II classification, risk factors and comorbidities. RESULTS: One year, three year, and five year patency rates according to TASC classification had no statistical significance (P=0.301), and those risk factors and comorbidities associated with each other also had no statistical significance. However, the patency rates according to the number of risk factors and comorbidities demonstrated statistical significance (P=0.004), respectively. In addition, when sum of the total number was above 6, the patency rates were the poorest with statistical significance (P<0.001). Also, these analyses had statistical significance in the groups regarding TASC C, D (P<0.001), aorto-iliac lesions (P<0.001) and femoro-popliteal lesions (P<0.001). CONCLUSION: Analysis of risk factors and comorbidities in patients with chronic arterial occlusive disease in the lower extremity can be useful in predicting the patency rates prior to endovascular treatments or arterial bypass surgeries.
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Humans , Arterial Occlusive Diseases , Comorbidity , Consensus , Lower Extremity , Medical Records , Retrospective Studies , Risk FactorsABSTRACT
ObjectiveTo evaluate endovascular stenting for TASC TASC Ⅱ C/D femoropopliteal arterial disease.MethodsBetween January 2008 and June 2011,Endovascular treatments of 51 limbs TASC Ⅱ C/D femoropopliteal artery occlusions in 46 patients(27 male and 19 female) were retrospectively reviewed.Mean age was (70 ± 8 ) years ( range,52 years to 88 years).Severe intermittent claudication,rest pain,minor tissue defect and foot ulceration or gangrene were in 29 limbs,12 limbs,6 limbs and 4 limbs,respectively. Technical success rate,ankle brachial index (ABI),complication rate, and cumulative primary patency rate were evaluated. ResultsTechnical success rate was 90.2％.93 stents were placed in 46 limbs of the 42 patients.Postoperative ABI was increased in all patients.42 patients(46 lower limbs) were followed up for a mean period of 14.6 months.Primary,assisted-primary,and cumulative patency rates at 6 months were 81.0％,88.1％ and 90.5％.Primary,assisted-primary,and cumulative patency rates at 12 months were 66.7％,71.8％ and 79.5％ respectively. ConclusionsEndovascular treatment of TASC Ⅱ C/D femoropopliteal arterial lesions is microinvasive,safe and effective.
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PURPOSE: Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic inflammatory vasoocclusive disease that affects the small- and medium-sized vessels of the extremities, and especially in young smokers. It is known that abstinence of smoking is the most effective treatment for Buerger's disease and surgical treatment is not frequently done because its result is not as good as that for atherosclerosis. We performed this study to determine the clinical implications and the effectiveness of arterial bypass surgery for limb salvage in patients with Buerger's disease. METHODS: We retrospectively reviewed the patients with Buerger's disease and who underwent arterial bypass surgery between September 2003 and August 2008. We followed the criteria of Shionoya that was reported in 1998 to diagnose Buerger's disease. The indications of surgery were patients with disabling claudication, severe resting pain, non-healing ulcer or gangrene, and non-diseased proximal and distal arteries were available for anastomosis. We evaluated the patency of the grafts with duplex ultrasonography or CT angiography after surgery. RESULTS: Arterial bypass surgery was performed in 16 lower extremities of 14 patients. An autologous venous graft was used in 12 limbs and a polytetrafluoroethylene graft was used in 4 limbs. Major amputation was performed in 2 limbs and reconstruction with a myocutaneous free flap after minor amputation was performed in 2 limbs. The patency rates of the arterial bypasses were 66.1%, 66.1% and 66.1% at 1, 3 and 5 years, respectively, and the limb salvage rates were 92.9%, 84.4% and 84.4% at 1, 3 and 5 years, respectively. CONCLUSION: Arterial bypass surgery could be considered as a favorable limb salvage treatment for the Buerger's disease patients with limited indications.
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Humans , Amputation, Surgical , Angiography , Arteries , Atherosclerosis , Extremities , Free Tissue Flaps , Gangrene , Limb Salvage , Lower Extremity , Polytetrafluoroethylene , Retrospective Studies , Smoke , Smoking , Thromboangiitis Obliterans , Transplants , UlcerABSTRACT
PURPOSE: This study was conducted to report our single center experience with performing directional atherectomy in patients with infra-inguinal arterial disease by using the Silverhawk plaque excision device. This procedure was performed at Washington University Hospital in St. Louis, USA (WASH). METHODS: Fifty-six patients with 102 lesions and who were classified into the Rutherford categories 2 to 6 underwent 66 procedures using the Silverhawk device from November 2004 to July 2007 in WASH. The patients' medical records were retrospectively reviewed. RESULTS: The initial technical success rate was 86.4%. The primary patency rate and limb salvage rate at 1 year was 48.5% and 80.3%, respectively. After 2 year' s follow-up, there was no occlusion or limb loss, and the overall primary patency rate and limb salvage was 45.5% and 75.8%, respectively. The mean preoperative ABI was 0.52+/-0.24 and the postoperative ABI was 0.73+/-0.22 (P=0.001). The one-year primary patency rate in the TASC II A and B group was 56.4% and that in the C and D group was 29.6% (P=0.003, P=0.007), respectively. There was a significantly different between both groups. However, the location, nature and length of the lesion, the Rutherford category and the adjunctive procedures did not statistically affect the primary patency rate. CONCLUSION: In this study, the Silverhawk plaque excision device was a feasible treatment modality for infra-inguinal peripheral arterial disease because of its high technical success rate, the primary patency rate and the limb salvage rate. However, it had an obstacle for being accepted for widespread use because secondary endovascular techniques are frequently required for restenosis after plaque excision. The practical use of the Silverhawk is controversial and further studies will be needed.
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Humans , Atherectomy , Endovascular Procedures , Extremities , Follow-Up Studies , Limb Salvage , Medical Records , Peripheral Arterial Disease , Retrospective Studies , WashingtonABSTRACT
PURPOSE: To review clinical features and operative results for patients, who underwent surgical treatment. METHOD: A retrospective review of 40 patients who underwent ilio-femoral artery bypasses surgery for ilio-femoral arterial occlusive disease. RESULT: Hypertension (60%) and diabetes (42%) were the most common underlying diseases among the patients according to the result of the patient's records; 35 (87.5%) men and 5 (12.5%) women, the mean age is 63. The operation was done for the patients who have the rest pain (57.5%), and this was followed by claudication (22.5%). The median follow-up period was 25.73 months. The most common occluded site was the superficial femoral artery (62.5%). The most common bypass operation was the femoropopliteal bypass (57.5%). In addition to that, the graft infection was the most common postoperative complication (12.5%). The 1st year and 2nd year primary graft patency rates were 60% and 42%. CONCLUSION: Among the various methods of treatment for the atherosclerotic arterial occlusive disease, bypass surgery is known as the most effective method. Although the early primary patency rates of this analysis were inferior to those of previous reports, a simple comparison was not adequate, because the data of this analysis was not sub-divided according to followings; the sites of occlusion, distal run off, operative indications, operative methods, and etc.
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Female , Humans , Male , Arterial Occlusive Diseases , Arteries , Atherosclerosis , Femoral Artery , Follow-Up Studies , Hypertension , Postoperative Complications , Retrospective Studies , TransplantsABSTRACT
PURPOSE: Patency of the arteriovenous fistula remains the most important support for patients with end stage renal disease. Prosthetic materials have been used only when autogenous arteriovenous fistula procedure is not feasible, because of the relatively low patency in prosthetic arteriovenous fistula. We designed this study to determine the appropriateness of primary prosthetic arteriovenous fistula. METHOD: Twenty-one consecutive patients who underwent prosthetic arteriovenous fistula formation on the arm in Chosun university hospital from Mar. 1998 to Feb. 2001 were retrospectively analysed. RESULT: The median patency in radio-antecubital fistula, brachio-antecubital fistula, and brachio-axillary fistula was 9.6, 11.4, and 16.6 months, respectively. The primary assisted patency rates in radio-antecubital fistula and brachio-antecubital fistula were 44.9% and 70.0% at the first year, respectively (P=0.03). The secondary patency rates in radio-antecubital fistula and brachio-antecubital fistula were 71.4% and 80.0% at the first year and 28.6% and 48.0% at the second year, respectively (0.02). CONCLUSION: The patency rates according to the site of prosthetic arteriovenous fistula were statistically significant in the radio-antecubital fistula and brachio-antecubital fistula groups. Nevertheless, the patency rates of the brachio-axillary fistula group were statistically insignificant. Primary brachio-antecubital fistula with PTFE creation showed favorable patency rates and many other benefits. Therefore, we suggest primary brachio-antecubital fistula with PTFE as the appropriate arteriovenous access in patients with poor vessel condition.
Subject(s)
Humans , Arm , Arteriovenous Fistula , Fistula , Kidney Failure, Chronic , Polytetrafluoroethylene , Retrospective StudiesABSTRACT
PURPOSE: A graft patency is influenced by various factors; the degree of preoperative ischemia, type of procedure, kinds of the conduit and the stati of inflow and outflow vessels. The aim of this study was to evaluate the patency rate according to the distal anastomosis level, kinds of conduit and the impact of runoff score. METHODS: Between August 1998 and August 2003, 141 lower extremity arterial bypass operations were performed. The runoff scores of the outflow arteries were graded according to the system proposed by the Ad Hoc Committee on Reporting Standards, SVS/ISCVS. The graft patency was determined by clinical examination, and ABI measurements, and with a Duplex scan if required, and assessed by a regular follow-up schedule. RESULTS: The primary patency rates according to the level of distal anastomosis at 1, 3 and 5 years were as follows; femoral artery (FA) 94.8, 87.1 and 87.1%, above-knee popliteal artery (AKPA) 83.7, 79.3 and 68.0%, below-knee popliteal artery (BKPA) 85.9, 64.4 and 42.9%, respectively, and the secondary patency rates; FA 95, 87.6 and 87.6%, AKPA 91.6, 68.3 and 38.6%, BKPA 83.8, 69.9 and 46.6%, respectively. The patency rates of below-knee popliteal bypass showed no statistical difference between each conduit, but showed a tendency to increase in the order: PTFE, vein patch and vein graft. No significant difference in the patency rate was shown except between a runoff score of 1 and above 1 at each level. CONCLUSION: The patency rates for the relatively proximal site of the distal anastomosis were superior to those of the distal site. The choice of conduit influenced the patency of infrapopliteal bypass grafts. The patent outflow vessels and the autogenous vein graft at infrapopliteal artery were more favorable for good graft patency. The recommended runoff score system seems to be revision in order to improve the predictability of a graft patency.