Diagnosis and surgical treatment of abdominal aortic vascular endograft infections: an analysis of 13 cases / 中华普通外科杂志

Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.

Outcomes of standard endovascular aneurysm repair for abdominal aortic aneurysm with complex neck anatomical features / 中华普通外科杂志

Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.

Mid-to long-term results of chimney-endovascular aortic repair for abdominal aortic aneurysm:single center result / 中华普通外科杂志

Objective To evaluate the mid-and long-term results of chimney-endovascular aneurysm repair (Ch-EVAR) on efficacy and durability.Methods Data of abdominal aortic aneurysm (AAA) patients receiving Ch-EVAR were retrospectively collected and analyzed.Results From Jan 2011 to Dec 2016,21 patients received Ch-EVAR in our institution including 18 males and 3 females with the average age 74.0 ±6.31 years.One patient died and 20 patients were followed up for an mean period of 53.2 months.During EVAR procedures 14 patients received left renal artery chimney stents,6 patients had right renal artery chimney stents and one did bilateral renal artery chimney stents.Technical success was achieved in all patients (100％).Differences between preoperative and one-week postoperative value of serum creatinine (P =0.639) and estimated glomerular filtration rate (eGFR) (P =0.804) showed no statistical difference.The differences of maximum sac diameter between preoperiation (60.1 ± 13.1 mm) and follow-up (59.2 ± 13.5 mm) was not significant (P =0.826).Six patients died during follow-up and none was aortic events related.All chimney stents were patent.One patient developed late type Ⅱ endoleak and refused reintervention regardless of aneurysm expansion.Conclusion For short hostile neck AAA patients with considerable surgical risk Ch-EVAR may be an effective and durable alternative.

Effect of left subclavian artery coverage on ischemic stroke during thoracic endovascular aortic repair / 中华普通外科杂志

Objective To investigate the effect of left subclavian artery (LSA) coverage on ischemic stroke complications in thoracic aortic cavity repair (TEVAR).Methods The clinical data of 69 patients undergoing TEVAR with LSA coverage from Jun 2013 to Jan 2018 were retrospectively analyzed.Results There were 56 males and 13 females,average age of S1.1(32-76).Perioperative mortality was 4.3％ (3/69) and stroke related mortality was 1.4％ (1/69).There were 2 cases (2/66,3.0％) of symptomatic stroke in perioperative period and 5 cases (5/66,7.6％) of cryptogenic stroke,inclucling 2 cases of anterior circulation ischemia (2/66,3.0％),3 cases of posterior circulation ischemia (3/66,4.5％),and 2 cases of multiple ischemia (2/66,3.0％).48 cases (72.7％) of vertebral blood steal were grade Ⅰ,15 cases (22.7％) were Ⅱ and 3 cases (4.5％) were Ⅲ.No new stroke related deaths happened in 6 months,there were 3 cases of symptomatic stroke (3/66,4.5％) and 13 cases of cryptogenic stroke (13/66,19.7％).There were 3 cases of anterior circulation ischemia (3/66,4.4％),8 cases of posterior circulation ischemia (8/66,12.1％) and 5 cases of multiple ischemia (5/66,7.6％)respectively.Conclusion The compensation mechanism of LSA itself reduces the serious ischemic stroke risk caused by LSA coverage.

Clinical characteristics and prognostic value of focal enhancement on computed tomography angiography in patients with acute type B aortic intramural hematoma / 中华普通外科杂志

Objective To summarize the clinical experience on acute type B aortic intramural hematoma,and to investigate the relation between focal enhancement characteristics on CT angiography (CTA) and the outcome of acute type B aortic intramural hematoma.Methods From Sep 2009 to Mar 2017,a total of 29 patients with acute type B aortic intramural hematoma treated in our department were retrospectively reviewed.After type B aortic intramural hematoma diagnosis by CTA,patients were prescribed anti-hypertension medicine with targeted systolic blood pressure of less than 120 mmHg.Then patients underwent a schemed CT angiography review within 2 weeks if no complications occurred.Surgical indications included recurrent pain,enlarged extent of hematoma and appearance of penetrated ulcer/dissection/aneurysm,and hematoma around the aorta or rupture.Results In the initial CT imagines,lesions of intimal defect were found in 22 patients,intramural blood pool in 16 patients,and ulcer-like projection in 16 patients.15 patients underwent thoracic endovascular aortic repair,with success rate of 100％,no mortality.The median duration of follow-up was 28 months.There was no aortic related complications nor death.Among the 14 patients treated by medicine 1 patient had formation of dissection and 1 patient with new-onset penetrating ulcer lesion and formation of thoracic aortic aneurysm.These two received thoracic endovascular aortic repair successfully.The proportion of deterioration of intramural hematoma in patients with ulcer-like projection lesions in initial CT imagines was higher than that in patients without ulcer-like projection lesions (7％ vs.33％,P =0.047).The proportion of deterioration of intramural hematoma in patients with intimal defect and intramural blood pool lesions in initial CT imagines was 68％ and 69％,respectively.Conclusions Strict anti-hypertension medical treatment with timely surgical repair was effective for acute type B intramural hematoma of the aorta.Intramural hematoma with ulcer-like projection lesions are prone to deterioration.

Long term outcomes of Budd-Chiari syndrome patients undergoing radical resection with full exposure of the inferior vena cava of the hepatic segmen / 中华普通外科杂志

Objective To analyze the long-term curative effect of radical surgery for Budd-Chiari syndrome and the postoperative recurrence risk factors.Method Clinical data of 83 patients treated with radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment at Peking University People's Hospital between Jul 2001 and Dec 2010 was studied.Survival rate,patency rate of the inferior vena cava and hepatic vein,and risk factors were analyzed.Results There were 5 perioperative deaths with a mortality rate of 6％.Child-Pugh C liver function (P =0.001) was independently related to the perioperative death.The mean follow-up time was 84 ± 35 (60-173)months.There were 8 patients (10.3％) lost to follow-up.10 patients (12.8％) died during follow-up.Child-Pugh C liver function (P =0.003) was independently related to the follow-up death.24 cases (40％) suffered from recurrence with inferior vena cava restenosis in 12 cases (20％),that of hepatic vein in 2 cases (3.3％),and 10 cases (16.7％)with both inferior vena cava and hepatic vein restenosis.Membranous lesion of inferior vena cava (P =0.004) and inadequate anticoagulation time (P =0.004) were independently related to the recrudescence.Conclusions Long term recurrence of Budd-Chiari syndrome after radical surgery through exposure of the entire inferior vena cava of the hepatic segment is related to membranous lesion of inferior vena cava and inadequate anticoagulation time.

Control study of total percutaneous access with preclose technique versus open femoral artery exposure for endovascular aneurysm repair / 北京大学学报(医学版)

Objective:To compare total percutaneous access using preclose technique with femoral ar-tery cut-down in endovascular aneurysm repair (EVAR)and assess the safety and feasibility of preclose technique.Methods:In the study,81 cases undergoing EVAR from Dec.2011 to Nov.2014 in Peking University People’s Hospital were retrospectively reviewed.Preoperative CT angiography (CTA)showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases.The maximum diameter of aneurysm >4.5 cm met the indications for surgical treatment.The conditions of bi-lateral femoral artery and iliac artery CTA showed were good,and there was no moderate or severe steno-sis,nor was there any severe calcification in anterior wall of femoral artery.Not only were the cases fit for percutaneous endovascular aortic aneurysm repair (PEVAR),but also feasible with open endovascular aneurysm repair (OEVAR).According to the intention of the patients about the surgical incision,the ca-ses were divided into group PEVAR and group OEVAR.The data of the general situation,operation time,blood loss,technical success rate,length of hospital stay after procedure and wound complications were analyzed statistically.Results:In the study,44 cases (78 incisions)were enrolled in group PEVAR and 37 cases (65 incisions)in group OEVAR.There was no significant difference between the two groups in age,gender,body mass index (BMI),accompanying diseases,average number of stents and outer diameter of stent delivery system.Average operation time of group PEVAR was less than that of group OEVAR [(119.1 ±102.0)min vs.(163.6 ±61.9)min,P =0.025].The blood loss in group PEVAR was less than that in group OEVAR [(64.7 ±97.0)mL vs.(98.6 ±88.3)mL],but there was no significant difference (P =0.106).There was no difference in the technical success rate (94.9% vs. 95.4%,P =1.000).The average length of hospital stay after procedure was significantly shorter in group PEVAR [(7.8 ±2.8)d vs.(12.3 ±7.2)d,P <0.001].There were 2 cases with subcutaneous hematoma of wound in group PEVAR and 7 cases of wound complications that occurred in group OEVAR including 3 cases with lymphatic leakage,3 cases with lower limb ischemia and 1 case with subcutaneous hematoma.The analysis showed that PEVAR could reduce the wound complications (2.6%vs.10.8%), but there was no significant difference between the two groups (P =0.079).Conclusion:Using preclose technique in EVAR is safe and effective.It can shorten the operation time and length of hospital stay after procedure.

Effect analysis of the technique of retrograde puncture of popliteal artery applied in the interventional therapy of lower extremity arteriosclerosis obliterans patients / 中华全科医师杂志

To investigate the effectiveness of retrograde puncture of popliteal artery in lower extremity arteriosclerosis obliterans ( ASO ) patients classified as TASC ( Tans-Atlantic Inter-Society Consensus) C/D.Retrospective analysis of 35 lower extremity ASO patients, 28 male and 7 female , the mean age was 72 ±8, 23 cases of Rutherford 3, 8 cases of Rutherford 4 and 4 cases of Rutherford 5. Preoperative ABI was 0.35 ±0.14, Lesion length in CT angiography ( CTA ) was ( 18 ±5 ) cm.The technique success rate of 35 cases was 100%.The puncture time was (6 ±4) min.6 cases used 4 F sheath and 29 cases used no sheath technology at the puncture site.In 27 cases guide wires passed retrograde through the occluded superficial femoral artery lesion and returned to the true lumen.8 cases of SAFARI technology to established the guild wire track.The complication rate of retrograde puncture was 14.2%( 5/35), 2 cases of postoperative hematoma appeared at the puncture site the next day, 2 cases of pseudoaneurysms emerged and 1 case of postoperative arteriovenous fistula at the puncture site of popliteal area were found by Doppler ultrasonography before discharged.All 5 patients were recovered by conservative treatment.The retrograde puncture of popliteal artery is a safe and reliable method.

Endovascular treatment of abdominal aortic aneurysm with common iliac artery aneurysm using bellbottom technique in 17 patients / 中华普通外科杂志

Objective To summarize our experiences of endovascular treatment for abdominal aortic aneurysm (AAA) with common iliac artery aneurysm (CIAA) by using bell-bottom technique (BBT).Methods From February 2009 to June 2014,endovascular aortic repair (EVAR) was performed on 17patients with AAA with CIAA using BBT,including 16 patients with bilateral and 1 patient with unilateral CIAA.Among them,patients with common iliac artery (CIA) of less than 25 mm in diameter without involvement of the internal iliac artery and external iliac artery aneurvsm were treated with BBT.Results All procedures were successfully completed.There were 3 bilateral and 14 unilateral BBT.Type Ⅰa endoleak was noticed intraoperatively in 3 cases and balloon dilation were applied,the endoleak disappeared after dilation in 2 cases and in 1 case the diminished endoleak disappeared during the follow-up period.The median follow-up of the 17 cases was 28 months (ranging,4-68 months).During follow-up no AAA or CIAA rupture and no endoleak occurred,and no dilation of the CIAA was observed.None of them had BBT graft occlusion or buttock claudication.Conclusion AAA with CIAA can be successfully treated with EVAR and BBT,which can preserve internal iliac artery patency.

Retrospective analysis of management for primary leiomyosarcoma of inferior vena cava / 中华外科杂志

<p><b>OBJECTIVE</b>To study the treatment strategy and survival of patients with primary leiomyosarcoma of inferior vena cava (PIVCLMS).</p><p><b>METHODS</b>Clinical data of 12 cases with PIVCLMS admitted in Peking University People's Hospital from January 2006 to September 2014 were reviewed retrospectively. All cases were confirmed by pathology examination. Among them, there were 4 male and 8 female patients with a mean age of (54 ± 9) years old. Tumors arose from the inferior vena cava (IVC) upper segment in 5 patients, from the middle in other 7 patients. Cardiac extension was observed in 4 cases. Tumor resection was undertaken in 8 patients, the other 4 patients were inoperable. The series was analyzed to identify clinical outcome of surgical strategy and protective factors for patient survival.</p><p><b>RESULTS</b>In tumor resection group, 6 patients had radical resection and 2 underwent palliative resection. As for IVC reconstruction, caval wall resection with a direct suture was carried out in 6 patients or with prosthetic patch in 1 patient. The other 1 patient underwent a segment caval resection and prosthetic graft replacement in situ. In 4 cases of suprahepatic PIVCLMS cardiopulmonary bypass or perfusion by right atrial intubation was performed to assist bleeding control and maintain circulation stabilization, among them 1 patient survived for more than 101 months with no tumor recurrence or metastasis. Among the patients submitted to tumor resection 2 early postoperative deaths occurred, and another 2 patients had complications. All 4 patients submitted to non-resective operation (only neoplasm biopsy) died of PIVCLMS within 8 months. Except for 2 cases of early death, mean survival after tumor resection was (54 ± 40) months. Two patients presented local recurrence and hepatic metastasis at follow-up of 16 months and 68 months.</p><p><b>CONCLUSIONS</b>Tumor resection is the only therapy for PIVCLMS with an expectation for long-term survival. The applicant of cardiopulmonary bypass makes some inoperable indicated to tumor resection.</p>

The use of self-expandable bare stent in treating spontaneous isolated superior mesenteric artery dissection / 介入放射学杂志

Objective To investigate the clinical features of spontaneous isolated superior mesenteric artery dissection (SISMAD), and to discuss its interventional therapy. Methods The clinical data of 10 patients with SISMAD, who were admitted to authors' hospital to receive interventional treatment during the period from January 2006 to June 2014, were retrospectively analyzed. All the 10 patients were males, aged 44-66 years with a mean of (53±8) years. Clinically, all patients presented with acute-onset abdominal pain or pain around umbilicus, as the effect of conservative treatment was poor, implantation of self-expandable bare stent was carried out. Results Successful implantation of self-expandable bare stent was accomplished in all 10 patients;only one stent was used in 7 patients and 2 stents were used in 3 patients. The blood in the true lumen of superior mesenteric artery (SMA) restored and the residual stenosis extent was less than 15%. The technical success rate was 100%. The abdominal pain was relieved in 8 patients on the operative day after treatment, and in 2 patients the abdominal pain was relieved in 2 days after treatment. All the patients were followed up for 7-71 months (mean of 36 months) and the follow-up rate was 100%. After the treatment patients had no symptoms of abdominal discomfort. Contrast-enhanced CT scan performed at 6, 12 and 24 months after the treatment showed that SMA and stent was patent and no aneurysmal dilatation was observed. Conclusion For the treatment of SISMAD endovascular implantation of self-expandable bare stent is clinically safe and feasible, and its long-term effect is satisfactory.

The use of coils in endovascular repair of aortic diseases / 中华普通外科杂志

Objective To summarize the experience and efficiency of coils in endovascular aortic repair.Methods From September 2008 to December 2013,48 patients received endovascular aortic repair in combination of coil embolization including abdominal aortic aneurysm in 32 patients, and aortic dissection in 16.Results Coils were successfully implanted in all cases.One patient with ruptured abdominal aortic aneurism (AAA) underwent emergency endovascular aortic repair and died of multiple organ failure the day after surgery.One patient died of pulmonary artery embolization 3 hours after TEVAR.44 patients were followed up ranging from 7 to 60 months.In AAA group, 25 patients received endovascular exclusion in combination with internal iliac artery embolization, four of them had claudication due to gluteal ischemia but without other severe complications.Post-operative CTA found endovascular thrombosis in aneurysm.In the aortic dissection group, one patient died of pulmonary infection.During the follow up, there was no AAA dissection, and AAA rupture.Post-operative CT confirmed thrombus in cavity.There were no scaffold and coil translocation and surrounding tissue injury.Conclusions Endovascular aortic repair in combination with coil embolization is a complementary treatment to aortic diseases.

Treatment of iliac artery rupture during endovascular treatment of aorto-iliac disease / 中华普通外科杂志

Objective To evaluate iliac artery rupture during endovascular treatment of aorto-iliac disease and treatment with covered stent.Methods From November 2008 to August 2014,iliac artery rupture happened in 8 patients of 225 patients of aorto-iliac artery disease admitted to our hospital.Clinical data of the 8 patients were analyzed retrospectively.Four were of intraoperative rupture and four were of delayed rupture.The aorto-iliac diease of all the 8 patients were TSAC D.Direct placement of a covered stent was performed in all the cases,except for one patient who refused further treatment.Results All of the procedures finally achieved technical success and all patients become hemodynamically stable.One patient was complicated with heart failure who died of multiple organ dysfunction syndrome.Another one died of aspiration.5 patients were followed up from 9-52 moths,average 9-52 moths without recurrence.Conclusions Iliac artery rupture is a serious and life-threatening complication in the endovascular treatment of aorto-iliac disease.Covered stent provided a safe and effective treatment for iliac perforations.

The causes and management of recurrence of Budd-Chiari syndrome after radical correction / 中华普通外科杂志

Objective To analyse the recurrence rate of patients with Budd-Chiari syndrome (BCS) after radical correction.Method We retrospectively analyzed the clinical characters and follow-up of patients who underwent radical correction and suffered recurrence.Patency rate of inferior vena cava (IVC) and hepatic veins (HVs) were examined.We present the causes of recurrence and clarify risk factors for recurrence by survival analysis.Result Among the 102 patients undergoing radical correction,34 patients suffered from postoperative recurrence,including 32 cases of IVC lesions,21 cases of HVs lesions (19 patients suffered concurrently from IVC and HVs lesions).One patient received reoperation,16 patients received balloon angioplasty of IVC or HVs,3 patients received stent implantation,and 14 patients received conservative treatment.Conclusions The recurrence rate is high after radical correction for BCS.Once the abnormal syndrome recurs,the patients can be managed by radical correction,balloon or stent angioplasty.The main causes of recurrence are thrombosis of IVC,compression of caudate lobe,scar contracture,and the risk factors for recurrence are concurrent hypercoagulation status,too short period of postoperative anticoagulation (less than 6 months).

Popliteal artery entrapment syndrome: report of 8 cases / 中华普通外科杂志

Objective To summarize our experience on the diagnosis and management of 8 patients with popliteal artery entrapment syndrome (PAES). Methods Clinical data of 8 PAES cases admitted from Jul 2002 to Jul 2010 were retrospectively analyzed. There were 7 males and 1 female with the mean age of (29 ± 14)years (ranging 16 -56 years). In 6 cases posterior "S" shaped incisions in the popliteal fossa were applied and anomalous anatomic structures were verified. Segmental stenosis and post-stenotic popliteal arterial aneurysm was identified in 2 cases, and partial resection of the aneurismal wall and arterioplasty including one with saphenous vein patch were applied; For 4 cases with short segmental occlusion of the popliteal artery, surgical treatment included thromboendarterectomy in 2 cases (with saphenous vein patch plasty in one case), saphenous vein interposition in 1 case, and saphenous vein bypass grafting in 1 case.Medial longitudinal incisions and saphenous vein bypass grafting were applied in 2 cases with long segmental occlusion in popliteal artery without exploration for anatomic anomalies. Results All patients recovered uneventfully without any notable complication. During the follow-up period ranging from 4 to 99 months [average (50± 37) months], no ischemic symptom reoccurred in 7 cases with patent arteries or grafts, and recurrent claudication occurred in 1 case with distal anastomostic stenosis. The stenosis was subsequently treated with balloon angioplasty and vein graft thrombsis occurred one month later. Medicine and exercise were recommended for the patient and now mild claudication still remains without affecting his normal life.Conclusions PAES is a disease of relatively low incidence resulting in lower extremity ischemia, which can be successfully cured with proper management.

Management of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection by stented graft / 中华普通外科杂志

Objective To evaluate the management of wrong coverage of the left common carotid artery ( CCA ) during interventional treatment of type Ⅲ aortic dissection by stented graft. Methods Coverage of the left CCA occurred in four cases during endovascular repair of type Ⅲ aortic dissection using stented graft. All four cases were male. The ages ranged from 37 to 45 years old with the average of 41. The first case was due to moving proximally of the first stented graft during delivery of one more cuff because of endoleak. Recanalization of the left CCA and subclavian artery ( SA) was acquired through sliding distally of the stented graft with the help of an aortic balloon. Coverage of the left CCA and SA in the second case was due to jumping-forward of stented graft during deploying, we dragged the stented graft distally through the pigtail catheter introduced from the left brachial artery with the help of a trap device. Then, the covered left CCA and SA were recanalized. The 2/3 left CCA was covered because of mislocation of the left CCA for the 3rd case. We recanalized the covered left CCA using chimney technique with the exposure of the left CCA. For the 4th case, half the innominate artery, the left CCA and SA were covered because the performer mistake the stented graft without naked stent as one with proximal naked stent. A bypass of assending aorta to bi-carotid arteries and the left axillary artery was performed using vascular graft one month after the endovascular repair. Result The proximal intimal entry was sealed successfully in all four cases. No endoleak, cerebral infarction and ischemia of the left upper limb occurred. Conclusion In cases of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection, the CCA must be recanalized as soon as possible through surgical or interventional treatment in order to avoiding cerebral ischemia.

Surgical treatment of carotid body tumors / 中华普通外科杂志

Objective To investigate surgical treatment of carotid body tumors (CBT). Methods Fifty-four cases of carotid body tumor were treated by surgery from 1994. There were 39 males and 15 females with a gender ratio of 2.6: 1. The ages ranged from 22 to 53 years averaging at 31 years. All lesions were benign and unilateral. Simple resection of CBT was performed in 12 cases. Resection of CBT with external carotid artery in 5 cases. Resection of CBT with carotid reconstruction in 6 cases ( using great saphenous vein in 4 cases, using vascular graft in 2 cases). Resection of CBT under carotid artery shunt was performed in 32 cases ( including carotid reconstruction in 3 cases). Resection of CBT with breaking mandible was necessary in 2 cases because of too high tumor position. Results Complete resection of CBT without recurrence and metastasis was achieved in all 54 cases. No complication of cerebral ischemia was encountered in all cases. Nerve injury was found in 7 cases ( including injury of sympathetic nerve and superior laryngeal nerve in 2 cases respectively, injury of recurrent laryngeal nerve in 3 cases). Conclusion Carotid shunt is helpful in resection of complicated CBT, carotid reconstruction is required for cases with resection of internal carotid artery. Breaking mandible is helpful in exposing high located tumors.

Expression of chemokine-like factor 1 in balloon injured rat aorta / 中华普通外科杂志

Objective To investigate the expression of chemokine-like factor 1(CKLF1) in the balloon injured aorta of Sprague-Dawley rats.Methods Balloon expansion induced aorta injury model was established in 80 male Sprague-Dawley rats.Model rats were randomly divided into 8 groups.Rats were sacrificed at the postoperative periods of 12 hours,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks,and 8 weeks respectively.Sham injury operation was applied to 5 rats as control.The ratio of intimal area (IA) and medial area (MA) was calculated to determine the extent of neointimal hyperplasia.Expression of CKLF1 was examined at protein level with immunohistochemistry and at mRNA level with RT-PCR.Software IPP6.0 was used to examine the mean optical density of positive staining.With β-actin expression as an internal control,semi-quantity of CKLF1 expression was calculated by CKLF1/β-actin.Results Visible neointima was noticed at 1 week postoperation.Extend of intimal hyperplasia(IA/MA)was most remarkable at 4 weeks and receded afterwards. Immnohistochemistry study showed that expression of CKLF1 was stronger in the neointima than in the media(P=0.016).The expression was most obvious in the neotima at 1 week postoperation.RT-PCR showed peak expression at 3 days postoperation and declined gradually but still at a higher level than control(P<0.05).The extent of intimal hyperplasia(IA/MA)was positively correlated to the expression of CKLF1(R=0.70,P=0.188).Conclusion The expression of CKLF1 was up regulated in balloon injured rat aorta.The expression was more obvious in the neointima than in the media.CKLF1 may play a role in the development of intimal hyperplasia.

Stent-graft migration during endovascular repair of aortic dissection / 中华普通外科杂志

Objective To evaluate the cause and management of intraoperative stent-graft migration during endovascular repaire of aortic dissection (AD). Method During the period between May 2001 and Dec 2007 intraoperative stent-graft migration occurred in 17 cases ( 14 males and 3 females) including 15 acute AD cases and 2 chronic AD cases. Backward migration was noticed in 11 cases including the 2 cases found during balloon extention, in 1 case the migration found during the removal of the releasing sheath which scratched the stent-graft, in 2 cases the migration occurred when the grafts were half released. Forward migration occurred in 6 cases resulting in left subclavian artery (LSA) occlusion in 3 cases and left common carotid artery (LCCA) occlusion in the other 3 cases. For the 3 cases of LCCA occlusion, the backward migrated stent-graft was pushed forward by the cuff releasing system and consequently occluded the LCCA in 1 case, and the cuff jumped forward during release and occluded the LCCA in 1 case. Result Backward migration of stent-grafts can be treated by pushing forward the graft with the sheath or additional placement of a cuff. Intraoperative complication may be less life threatening and no perioperative death occurred in this group. Occlusion of LSA in 3 cases by forward migration of stent-grafts were left untreated and 1 case died of leter cerebellar infarction. For the LCCA occlusion in 3 cases, 2 were treated by drawing back the graft with a balloon, and in the remaining 1 case the migrated graft was pushed back with the catheter in the LSA captured by a snare. Conclusion Stent-graft migration during endovascular repair may be related with poor experience of the operator, specific anatomical condition of the patient and the design drawback of the stent-graft. Forward migration of stent-graft is less common but may be more harmful for the patient. Beside back drawing with a balloon, the captured catheter with a snare may be helpful in the management of forward migration of the released stent graft.

Experiences in carotid-artery stenting with the use of filter in 35 cases / 中华普通外科杂志

Objective To establish technique skills and evaluate complications of carotid artery stenting with the use of Filter. Methods In this study, 38 carotid lesions in 35 patients (with an asymptomatic stenosis exceeding 70% or a symptomatic stenosis exceeding 50% ) received stenting with the use of protective filter. The skills, complication and outcomes were evaluated. Follow-up surveillance included ultrasound examination, CTA, or MRA. Results The technique was successful in all 38 lesions. Angiography after stenting showed that the treated vessels were all patent (remained stenosis was less than 20% ). Sclerotic debris was found in 21 (55.3%) filters, 3 of which were full filled with debris. Complications included 1 (2.6%) stroke and hemiplegia, and I (2.6%) cerebral bleeding, 2 (5.3%) TIA after stenting and recovered after withdrawing the filter, 10 (26.3% ) suffered from perioperative transient decrease of heart rate and blood pressure. In a follow-up of 6 to 54 months (mean 32 months), all treated vessels were patent except 1 with stent-graft for carotid ulcer, no new TIA and stroke was found. Conclusion Meticulous technique and the use of carotid fiter permits carotid stenting in a safe and effective manner and prevents complications.