Mid-Term Results of Left Carotid-Subclavian Bypass in Patients Undergoing Zone 2 TEVAR

ABSTRACT Introduction: The aim of this study was to present the mid-term results of patients who had undergone a carotid-subclavian bypass surgery after a thoracic endovascular aortic repair (TEVAR) stent-graft implantation with proximal landing at zone 2 of the aorta. Methods: A total of 66 patients had undergone TEVAR and carotid-subclavian bypass between January 2015 and May 2020 at our clinic. Five of these patients were lost to follow-up, so 61 patients were included in this retrospective study. At follow-up visits, patency of the carotid-subclavian bypass grafts was evaluated with physical examination and radiological imaging. Results: The mean follow-up time was 15.11±12.29 months (ranging from 1 to 56 months). There were 3 (4.91%) in-hospital deaths of patients admitted with bilateral lower limb and visceral malperfusion. There were also 2 (3.27%) deaths unrelated to the procedure. Carotid-subclavian graft occlusion occurred in 3 (4.91%) patients. The occlusion was detected with radiological imaging within a period of 12 to 24 months. The graft patency rate was 100% in the first 12 months. The mean graft patency time (survival) was 52.56±2.10 months. Conclusion: Periprocedural carotid-subclavian bypass surgery with synthetic grafts is a recommended procedure with high patency and acceptably low mortality and morbidity rates in TEVAR.

Application of low-dose contrast agent in 3D dynamic contrast enhanced MR angiography of lower extremity arterial disease / 医疗卫生装备

Objective To explore a safe and effective imaging method by the application of 3D contrast-enhanced MR Angiography (3D CE-MRA) with low-or conventional-dose contrast agent to the examination of lower extremity arterial disease.Methods Totally 31 patients suspected with lower extremity arterial stenosis or occlusion underwent 3D CE-MRA examination including one patient had right leg cut due to the disease,of whom,18 ones had conventional-dose contrast agent (38 ml) injected in 1.5T MR machine and 13 ones had low-dose agent (15 ml) injected in 3.0T MR machine.Quality evaluation was carried out for the images by different doses of agents.Results All the patients had no agent allergy occurred,and one patient had left tibia-fibula motion artifact due to involuntary movement.3.0T MR machine with low-dose agent behaved better than 1.ST MR machine with conventional-dose agent in leg imaging,while there were no significant differences between the quality of the images except that of popliteal artery (P＞0.05).Conclusion 3D CE-MRA is an effective and safe method in detecting lower extremity artery disease,and 3.0T MR machine with low-dose agent lays a foundation for clinical diagnosis and treatment.

Clinical study of foam sclerotherapy for varicose veins of lower extremity with deep venous valve incompetence / 实用放射学杂志

Objective To investigate the clinical effectiveness of foam sclerotherapy for lower extremity varicose vein with deep venous valve incompetence.Methods A retrospective study was carried out in 124 patients (185 limbs) receiving foam sclerotherapy in our department.Sixty-one limbs diagnosed as deep venous valve incompetence were categorized as the observation group,while 124 limbs without that were the control group.The main outcome were success rate,remission rate of various symptoms and signs,the scores of CEAP and CIVIQ.Results The follow up rate was 69.3％,and the follow-up period ranged from one to nine months.There was no statistical difference in the success rate between the observation group (93.4％) and control group (94.4％)(P＞0.05).However,the symptom of heaviness and oedema and the CIVIQ scores in observation group be inferior to the control group,and the difference of them were statistically significant (P＜0.05).Conclusion Deep venous valve incompetence could not decrease the success rate of foam sclerotherapy,but may influence the remission of some symptoms.It should be supplemented with medical elastic stockings or ringing of femoral veins.

Clinical research of catheter-directed thrombolysis for acute lower limb deep venous thrombosis by the posterior tibial vein / 国际外科学杂志

Objective To investigate the clinical efficacy and clinical value of catheter-directed thrombolysis for acute lower limb deep venous thrombosis by the posterior tibial vein.Methods Atotal of 46 patints with acute deep venous thrombosis in the department of vecular surgery of People's hospital of the xinjiang uygur autonomous region,under the protection of the inferior vena cava fillters,we treated by catheter directed thrombosisthrough the posterior tibial vein with urokinase continuous infusion.Results In the total gourp of 46 patients,39 patients effectively relieve the swelling,7 of which was ineffective,and 4 cases of patients ease the swelling after the expansion by the iliac vein balloon,3 patients accepted the iliac vein balloon dilation and stent placement,6 patients who were bleeding were treated with pressure dressing,andthere was no other complications.After the treatment,the venous patency score was low,and the patency rate was high and which have a statistical difference (P ＜ 0.05) before and after thrombolysis.Before and after thrombolytic therapy for lower limb swelling rate,there was statistically significant difference (P ＜ 0.05).Conclusions It is a safe and effective method to treat the deep venous thrombosis of lower limbs with catheter-directed thrombolysis by the protection of inferior vena cava filter.It can enhance the patency of the vein and shorten the swelling time.

Effect of demographic and clinical factors on quality of life of LEAD patients / 现代临床护理

Objective To study the quality of life of patients with lower extremity artery disease (LEAD) and explore the effect of demographic and clinical factors on their quality of life. Method A self-designed demographic and clinical data questionnaire and the MOS 36 items short form health survey were used to investigate the life quality of 90 LEAD patients. Results The scores on the dimensions of life quality of the LEAD patients were significantly lower than those of common population (P<0.001). The marriage status and education affected patients′physical function, general health and social health;the longer the course of disease, the worse the general health;the complications, exercise and kind of disease affected patients'physical responsibility, physical function and emotion;the kind of disease affected patients'vitality; patients with exercise had higher general health (all P<0.05). Conclusions The life quality of LEAD patients is in general lower. The life quality of patients with different demographic and clinical data factors is varied. Therefore, doctors and nurses should correctly assess the life quality of LEAD patients and instruct those with problems so as to improve their quality of life.

Effects of Whole-Body Vibration Training on Low Extremity Muscle Strength and Mobility in the Elderly:A Me-ta-Analysis / 中国康复理论与实践

Objective To evaluate the effects of whole-body vibration (WBV) training on low extremity muscle strength and mobility in older adults by a meta-analysis. Methods Articles were searched from Cochrane Central Register of Controlled Trials, PubMed, EMbase, Elsevier, CBMdisc, Wanfang database and CNKI database, and the reference list of each eligible article were also included. Randomized controlled trials which investigated the effect of WBV on mobility and low extremity muscle strength were included in this article. The meth-odological quality of each selected article was rated by the Jadad Scale. The data on patients' characteristics, type of WBV intervention and outcomes were extracted. A meta-analysis was then performed. Results 15 randomized controlled trials involving 803 subjects were includ-ed finally. 8 were considered to have good or excellent methodological quality and the rest was rated as fair. Meta-analyses revealed that WBV had a significant treatment effect on leg extension isometric strength (MD=10.11, 95%CI 0.46-19.76), knee extension dynamic strength (MD=7.98, 95%CI 2.60-13.36), and functional measures of mobility such as performance in Timed-Up-and-Go test (MD=1.39, 95%CI 0.73-2.04), and performance in five times sit to stand test (MD=1.62, 95%CI 0.25-2.98) (P0.05), among older adults compared with the control group. Conclusion WBV may be effective on improving the low extremity muscle strength and mobility among older adults.

Clinical study on cilostazol combined with pancreatic kininogenase in treatment of LEADDP / 中华内分泌外科杂志

Objective To compare clinical effects between cilostazol(CLT)alone and cilostazol combined with pancreatic kininogenase(PK)on lower extremity arterial disease in diabetic patient(LEADDP).Methods Patients with LEADDP were randomly divided into 2 groups:single medication group or the control group(53 cases)and combination group or the treatment group(53 cases).Sugar-reducing medicines were given before and after treatment to keep a steady blood glucose level.The control group took CLT orally 100 mg each time,twice a day.Besides receiving the same dose of CLT,the treatment group took 120 tablet of PK on an empty stomach,three times a day,with the duration of 3 months.Clinical symptoms,ankle/brachial index(ABI),blood rheology,nailfold microcirculation,intimal medial thickness(IMT)and plaque thickness were compared between the 2 groups after treatment.Results Symptoms in both groups improved after treatment.ABI was elevated significantly compared to that before treatment(P<0.05)and the change was more obvious in combination group.The difference of ABI after treatment between the 2 groups had statistical significance(P<0.05).IMT of the right foot dorsal artery,and left and right posterior tibial artery increased significantly compared to that before treatment(P<0.05).Plaque thickness decreased compared to that before treatment(P<0.01)and the difference between before and after treatment in combination group was significantly greater than that in single medication group(P<0.05).Conclusion Cilostazol combined with pancreatic kininogenase has better clinical effects than cilostazol alone in treatment of patients with LEADDP.

Correlative Factors of Low Extremity Muscle Strength in Inpatients with Acute Stroke / 中国康复理论与实践

@#Objective To explore the factors correlated with low extremity muscle strength in inpatients with acute stroke. MethodsThe low extremity muscle strength determined with manual muscle test (MMT) in 100 inpatients were multiple linear regression analyzed with other 11 factors. ResultsThe low extremity muscle strength were positively correlative with low extremity paralysis (RR=0.613,P=0.000) and rehabilitation (RR=1.178,P=0.000). ConclusionRehabilitation might be a main factor for recover of low extremity muscle strength in patient with stroke.

The Effects of Modified Design of the Reverse Superficial Sural Artery Flap / 대한정형외과학회잡지

PURPOSE: To access the efficacy of a modified design of a reverse superficial sural artery flap (RSSAF) to decrease the level of venous congestion and flap necrosis. MATERIALS AND METHODS: Twenty four cases of RSSAF were performed. The mean age of the patients was 47 years and the mean follow up period was 21 months. The average size of the flap was 7.4x5.2 cm. There were 19 cases of the modified flap design and 5 cases of non-modified design. The venous congestion and complications were analyzed according to the modification of the flap design. RESULTS: The flap survived in 23 cases. Primary closure of the donor site was performed in 11 cases whose flap width was <5 cm, and 12 cases required a skin graft. Venous congestion was observed in 5 cases including 4 cases, who were not treated with the modified design and 1 case with arterosclerosis obliterans preoperatively. Partial flap necrosis occurred in 2 flaps that did not have the modified design. CONCLUSION: The modified RSSAF with a skin extension over the pedicle to decrease the tension of the tunnel is an effective procedure for reconstructing the lower extremity, which can prevent venous congestion and improve the survival rate of the flap.

Type I, II Acute Necrotizing Fasciitis of the Low Extremity / 대한정형외과학회잡지

PURPOSE: To retrospectively analyze the clinical presentations, radiographic findings, and surgical results of type I and II acute necrotizing fasciitis of the low extremity. MATERIALS AND METHODS: From April 1998 to March 2005, 13 patients who underwent surgery for the necrotizing fasciitis were reviewed. At the initial diagnosis, 6 patients were diagnosed with cellulitis and 3 patients were diagnosed correctly with necrotizing fasciitis. The underlying diseases, affected sites, official readings of MRI, the intervals between the onset of symptom and surgery, the duration of admission, and complications were investigated. RESULTS: The underlying diseases were 3 cases of diabetes, 3 cases of liver disease, 1 case of alcoholism and 1 case of cervical cancer with chemotherapy. Regarding the location of the disease, 5 cases were observed below the knees, and 8 cases were observed above the knees. Five out of 9 cases who underwent a preoperative MRI study, were diagnosed correctly as necrotizing fasciitis by the radiologist. The average period between onset of symptoms and surgery was 4.8 days. The complications were hip disarticulation in 1 case, below knee amputation in 1 case, toe amputation in 1 case, and a limited range of motion of the knee joint in 1 case. The 9 patients who healed without complications had no limitation in the range of joint motion and daily activity. CONCLUSION: Type I and II acute necrotizing fasciitis of the low extremity shows variable clinical presentations and radiological findings. Therefore, the possibility of the necrotizing fasciitis needs to be considered when dealing with patients with soft tissue infections in the low extremities.

Necrotizing Fasciitis of the Low Extremity / 대한정형외과학회잡지

PURPOSE: To describe the clinical presentation and course of necrotizing fasciitis of low extremity and to analyze the factors affecting the clinical result of necrotizing fasciitis. MATERIALS AND METHODS: The medical records and MRI of 26 patient who had suffered from necrotizing fasciitis were reviewed retrospectively. RESULTS: There were 18 men and 8 women with a mean age of 43.8 years. Twenty two of 26 patients had a medical disease and the most common comorbidity was diabetes mellitus. Exquisite pain, erythema, warm skin were the most consistent clinical feature at the time of admission. Only six patients had a diagnosis of necrotizing fasciitis initially. The interval between onset of symptom and operative treatment was average 5.4 days in 20 patients who didn't have a diagnosis of necrotizing fasciitis initially, and among them, 2 patients died. There were limited range motion of knee joint in 3 cases, sacral osteomyelitis in 1 case, and sciatic nerve palsy in 1 case as a complication. CONCLUSION: We think that the diagnosis of necrotizing fasciitis should be considered with a high index of suspicion in patients who present with unexplained limb pain, and delay in operative treatment and wide involvement of the necrosis is associated with poor results of necrotizing fasciits.

Intercalary Resection and Reconstruction for Malignant Bone and Soft Tissue Tumor of Lower Extremity / 대한정형외과학회잡지

PURPOSE: This study was undertaken to evaluate methods of reconstruction and their functional outcomes for segmental resections of the long bones of the lower extremity . MATERIALS AND METHODS: Eighteen cases were eligible for this study. There were 11 femoral lesions and there were 7 tibial. Lesions that had a good bone stock were reconstructed by means of a combination of rigid fixation and heat treated autogenous bone (Group1: in which there were 11 cases). Osteolytic lesions and those that necessitate a pathologic analysis underwent a temporary fixation procedure using intramedullary nail and bone cement (Group 2:7 cases). The average follow-up period was 49 (12-160) months. RESULTS: At the final follow-up examination, 15 patients were disease free, 2 had died of disease and remaining one was alive with disease. There were a total of 10 complications, 7 occurred in Group 1 and 3 in Group 2. Four cases of nonunion in Group 1 had a solid union after augumentation bone graft and a change of fixation device. Average union time for the recycled bone was 15 (9-35) months and their average functional score was 25.8. CONCLUSION: Although reconstruction by heat treated bone is a feasible, inexpensive method that has a low infection rate, the union process is not always successful. A rigid initial fixation is essential for a primary union. Temporal fixation using an IM nail and cement is a relatively sound method both functionally and technically and it might be useful in cases where the prognosis is unpredictable.

Clinical evaluation of ~(99m)Tc-MAA imaging in patients with lower extremital posttraumatosis and postoperation / 中国医师杂志

Objective To evaluate the clinical value of ~(99m)Tc-MAA imaging in patients with lower extremital posttraumatosis and postoperation(LEPP).Methods 21 LEPP patients with clinical highly suspected acute pulmonary embolism(APE) underwent ~(99m)Tc-MAA veins imaging and pulmonary perfusion imaging(PPI).Vena caval filters were inserted and thrombolysis were given in patients with big area APE and/or iliofemoral vein thrombosis indicated by ~(99m)Tc-MAA imaging.Thrombolysis was given in patients with small area APE and/or subpopliteal vein thrombosis.PPI was reexamined after 2～4weeks` treatment.The lung segments with 100% lack of perfusion were marked 3,those with 25%～75% were marked 2,those with less than 25% were marked 1 and normal was marked 0.The therapeutic results were assessed using this marking system.Results There were 13 patients with big area APE,8 with small area APE,14 with iliofemoral vein thrombosis,and 7 with subpopliteal vein thrombosis.2 cases(9.5%) died before thromobolytic therapy.The marks were significant different before(10.2?3.8) and after(2.8?1.4) treatment(t=7.75,P