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Objective:To explore the feasibility and recent efficacy of iliac vein molding and stenting in daytime treatment mode in patients with iliac vein stenosis.Methods:Medical records of iliac vein molding and stenting performed in the ipsilateral great saphenous vein approach conducted from February 2017 to March 2022 were retrospective reviewed.There were 21 cases,6 males and 15 females.Age ranged from 37 to 79 years[(62.5±10.2)years].The stenosis in the 21 limbs simply involved the common iliac veins in 16 patients,2 patients had the simple and external iliac veins,and both the total and external iliac veins in 3 patients.Both iliac vein molding and iliac vein stenting were performed through the ipsilateral great saphenous vein approach.The patients with simple iliac vein stenosis with great saphenous vein valve insufficiency also underwent radiofrequency closure of great saphenous vein and flexural vein sclerosis therapy simultaneously.Regular postoperative direct oral anticoagulants therapy and stress therapy were followed.All the patients were hospitalized for less than 24 h.Results:All the 21 patients operations were successful(the success rate was 100％),without any intraoperative compli-cations.Immediate postoperative complications were puncture point bleeding in 1 case.The bandage gauze was completely wet.The bleeding was stopped after 5min of recompression.All the patients were hospitalized for less than 24 h.Follow-up results:The 3-month follow-up rate after operation was 100％.Absolute effective 18 cases(18/21,85.7％).Relatively effective(postmentation still after surgery,but with less extent)in 3 cases(3/21,14.3％).The iliac vein stents were unobstructed,and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treat-ment.The 6-month follow-up rate after operation was 71.4％(15/21).Of these,14 cases(14/15,93.3％)were absolutely effective.Relatively effective(postmentation still after surgery,but with less ex-tent)in 1 case(1/15,6.7％).The iliac vein stents were no restenosis or obstruction,and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treat-ment.Conclusion:The interventional treatment technique of iliac vein stenosis is feasible in the daytime treatment mode,with clear advantages and satisfactory recent efficacy.
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Objective:To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.Methods:In the study,42 cases of renal artery stenosis were treated with 52 renal artery stent implantation.Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney,ipsilateral kidney (renal) glomerular filtration rate (GFR),renal effective renal plasma flow effective renal plasma flow (ERPF),kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.Results:The 52 cases of renal artery stent implantation were all successful.Preoperative ipsilateral GFR was significantly lower than that of normal side (t =-3.989,P =0.000);preoperative ipsilateral ERPF was significantly lower than the contralateral side (t =-4.926,P =0.000).On both sides,the overall FF values were equal (t =1.273,P =O.207).Postoperative ipsilateral renal GFR was increased,but there was no statistical difference (t =-1.411,P =0.164).Postoperative ipsilateral renal ERPF was increased significantly (t =-4.954,P =0.000),and FF lower (closer to the normal value (t =3.274,P =0.002).Postoperative side GFR was significantly reduced (t =2.569,P =0.000),the contralateral ERPF was significantly reduced (t =3.889,P =0.001),and FF had no significant change (t =-0.758,P =0.454).Postoperative side GFR was lower than that of the contralateral (t =-3.283,P =0.002) and postoperative side ERPF was still lower than that of the contralateral (t =-3.351,P =0.001),but on both sides,the FF values were equal (t =-0.361,P =0.719).Preoperative FF was relatively normal in the patients with kidney,and the postoperative FF value change was small (t =O.799,P =O.430);preoperative FF was significantly higher in the patients with kidney,and the postoperative FF value was lower than the preoperative (normal value,t =5.299,P =0.000).Postoperative overall serum creatinine was significantly decreased (t =2.505,P =0.016);but for the patients with unilateral renal artery stenosis,the changes in serum creatinine had no statistical difference (t =1.228,P =0.299);and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative,the changes were decreased significantly (t =2.518,P =0.030);postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t =8.945,P =0.000);antihypertensive drugs taken were decreased significantly compared with the preoperative (t =5.280,P =0.000).Conclusion:For the patients with renal artery stenosis,FF is a useful index to understand the pathophysiological process of renal ischemia.Whether preoperative FF is significantly increased or FF is relatively normal,should be regarded as the indications of renal artery stent implantation.
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Objective:To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy .Methods:After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients , we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate , blood pressure , pulmonary arterial pressure , arterial partial pressure of oxygen and hemachrome before and after thrombolysis , as well as the thrombolysis effect time the two groups took.Results: The heart rate, blood pressure, pulmonary arterial pressure , arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation ( P0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation ( P0 .05 );the thrombolysis effect time by adop-ting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase ( P<0 .05 ) . Conclusion: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism .However , r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.
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Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.
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ObjectiveTo compare two treatment methods for acute iliofemoral vein thrombosis:c atheter-directed pharmacomechanical thrombolysis (CDPT,47 cases) and intervention combined surgicaltherapy( IST,14 cases).MethodsThis study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST.All discharged cases were followed up by telephone for a period of 14 -37 months.ResultsAmong the 61 patients (64 extremities),47 (forty-seven extremities) treated by CDPT,and 14 cases (seventeen extremities) treated by IST.The IST group included three patients of bilateral iliofemoral vein thrombosis,five patients on postoperative status within one month,and three patients in which the iliofemoral vein was not accessible.When discharged from hospital,the effective rate of edema relief is 93.6％ in CDPT group while that is 94.1％ in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group.According to the results of 14 -37 months follow-up,the effective rate of edema relief is 85.0％ in CDPT group while that is 85.7％ in IST group ( x2 =0.004 and the P =0.948).Calf pigmentation occurred in only one patient of CDPT group.The patency rate of vein by BUS examination is 52.6％ in CDPT group while that is 84.6％ in IST group x2 =4.157,P =0.041 ).ConclusionsComparing with CDPT group,IST group has the similar effective rate of edema relief,but has higher patency rate of iliofemoral vein.In case of bilateral acute iliofemoral vein thrombosis,in patients in whom thrombolysis is contraindicated,or when the iliofemoral vein is not accessible,IST is the treatment of choice for acute iliofemoral vein thrombosis.