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Objective:To investigate the efficacy of bare stent implantation alone and stent assisted coiling in the repair of isolated superior mesenteric artery dissection (ISMAD) false lumen.Methods:Clinical data of 50 patients with ISMAD who underwent endovascular treatment between December 2012 and March 2021 were analyzed retrospectively. Depending on the endoluminal treatment methods, they were divided into the bare stent implantation alone group (29 cases) and the stent assisted coiling group (21 cases), and the rates of complete postoperative dissection remodeling, stent restenosis, and symptom recurrence were compared between the two groups.Results:The rates of complete remodeling of the dissection in the immediate postoperative period, 3 months and 6 months in the bare stent placement alone group were 13.8% (4/29), 51.7% (15/29) and 75.9% (22/29), respectively, which were lower than that of the stent assisted coiling group 71.4% (15/21), 85.7% (18/21), and 100% (21/21), and the difference was statistically significant (χ 2=17.17, 6.27, 4.06 respectively, and P=0.001, 0.012, 0.044 respectively). While the rates of complete remodeling of the dissection were 82.8%(24/29), 100%(21/21) in the two groups at 12 months after surgery, respectively, and the difference was not statistically significant (χ 2=2.34, P=0.126). There was no significant difference in stent patency rate and symptom recurrence rate between the two groups ( P>0.05). Conclusions:The efficacy of bare stent implantation alone and stent assisted coiling in the treatment of ISMAD is definite. Although the rate of complete remodeling of the dissection with bare stent placement alone is low in the short term, the rate of complete remodeling of the dissection with bare stent implantation alone gradually increases with the extension of time, which is worthy of clinical application and promotion.
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Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.
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Transarterial chemoembolization (TACE) is a minimally invasive procedure involving intra-arterial catheter-based chemotherapy to selectively administer high doses of cytotoxic drugs to the tumor bed along with ischemic necrosis induced by arterial embolization. Chemoembolization forms the essential core of management in patients with hepatocellular carcinoma (HCC) who are not suitable for curative therapies such as transplantation, resection, or percutaneous ablation. TACE of hepatic cancer(s) has proven to be helpful in achieving local tumor control, and has supported the ability to prevent tumor progression, prolong patient life, and manage patient symptoms. Recent data have demonstrated that, in patients with single-nodule HCC ≤3 âcm without vascular invasion, the 5-year overall survival with TACE was found to be comparable with hepatic resection and radiofrequency ablation. Used for several years, Lipiodol continues to play a vital role as a tumor-seeking and radiopaque drug delivery vector in interventional oncology. Efforts have been made to enhance the administration of chemotherapeutic agents to tumors. Compared with conventional TACE, drug-eluting bead TACE is a fairly new drug delivery embolization technique that permits fixed dosing and has the ability to provide sustained release of anticancer agents over a period of time. The present review discusses the basic procedure of TACE and its properties, and the effectiveness of conventional and drug-eluting bead chemoembolization systems currently available or presently undergoing clinical evaluation.
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To assess the feasibility of creating swine model of filter-assisted caval thrombosis and to evaluate the efficacy in removing clot in this model using rheolytic thrombectomy. The model was created by implanting a filter into the inferior vena cava followed by injection of autologous thrombus. Rheolytic thrombectomy was performed for all models to remove the clot. The success rate of model creation and the efficacy of clot removal were analyzed. The success rate of model creation was 100% (15/15). Following rheolytic thrombectomy, 3 of 5 pigs attained complete clot removal in a 7-day-old model, while no pigs attained complete clot removal in 14- and 21-day-old models. Creating a filter-related caval thrombosis model in swine is technically feasible and can be used to mimic a clinical episode of caval thrombosis from acute phase to chronic occlusion. Rheolytic thrombectomy can be used to remove filter-related thrombosis that aged less than 14 days. Graphical Abstract Swine Model of Filter-Assisted Caval Thrombotic Occlusion.
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Endovascular Procedures/instrumentation , Thrombectomy/instrumentation , Vena Cava Filters , Vena Cava, Inferior , Venous Thrombosis/therapy , Animals , Disease Models, Animal , Feasibility Studies , Phlebography , Sus scrofa , Time Factors , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/pathology , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Venous Thrombosis/pathologyABSTRACT
Objective:To evaluate the safety and clinical efficacy of AngioJet pharmacomechanical thrombectomy (APMT) in rescue treatment for patients with acute massive pulmonary embolism (AMPE) after unsuccessful thrombolysis with urokinase (UK).Methods:From June 2016 to June 2018, the clinical data of 16 AMPE patients underwent APMT after unsuccessful thrombolysis with UK were collected. For these patients, the therapy was discontinued and replaced with APMT adjunctive low-dose thrombolysis with UK. Heart rate (HR), systolic blood pressure (SBP), arterial partial pressure of oxygen (PaO 2), pulmonary artery pressure (PAP), CT obstruction index (CTOI) and therapy replacement safety were evaluated. The pared-samples t-test was used to analyze quantitative data before and after treatment. Results:All 16 patients completed APMT procedure. PAP posterior was lower than prior treatment ( P<0.05). The average adjunctive thrombolysis duration of UK was (3.25±1.78) d, HR, SPB, PaO 2 after APMT were significantly improved ( P<0.01). CTOI before and after APMT were (26.81±14.86)% and (11.56±3.26)%, respectively, and the difference was statistically significant ( t=3.435, P<0.01). Symptoms and signs of pulmonary embolism were significantly improved after treatment. The complications associated with APMT occurred in 2 patients with bradyarrhythmia, 2 patients with chest discomfort and 2 patients with hemoglobinuria. There were no statistically significant difference between the biochemistry indexes before and after APMT treatment ( P>0.05). Moreover, no major bleeding occurred during thrombolysis procedure, and minor bleeding complications occurred only in two cases. Conclusions:APMT adjunctive low-dose UK thrombolysis for rescue treatment of AMPE patients after unsuccessful thrombolysis with UK is relatively safe and effective. It can remove pulmonary artery thrombus rapidly, and improve clinical symptoms and signs of PE.
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The arteriovenous fistula (AVF) is the first choice for vascular access for hemodialysis of renal failure patients. Venous remodeling after exposure to high fistula flow is important for AVF to mature but the mechanism underlying remodeling is still unknown. The objective of this study is to identify the molecular mechanisms that contribute to venous remodeling after AVF. To screen and identify the differentially expressed genes (DEGs) that may involve venous remodeling after AVF, we used bioinformatics to download the public microarray data (GSE39488) from the Gene Expression Omnibus (GEO) and screen for DEGs. We then performed gene ontology (GO) function analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and gene set enrichment analysis (GSEA) for the functional annotation of DEGs. The protein-protein interaction (PPI) network was constructed and the hub genes were carried out. Finally, we harvested 12 normal vein samples and 12 AVF vein samples which were used to confirm the expressions of the hub genes by immunohistochemistry. A total of 45 DEGs were detected, including 32 upregulated and 13 downregulated DEGs. The biological process (BP) of the GO analysis were enriched in the extrinsic apoptotic signaling pathway, cGMP-mediated pathway signaling, and molting cycle. The KEGG pathway analysis showed that the upregulated DEGs were enriched in glycosaminoglycan biosynthesis and purine metabolism, while the downregulated DEGs were mainly enriched in pathways of glycosaminoglycan biosynthesis, antifolate resistance, and ABC transporters. The GSEA analysis result showed that the top three involved pathways were oxidative phosphorylation, TNFA signaling via NF-K B, and the inflammatory response. The PPI was constructed and the hub genes found through the method of DMNC showed that INHBA and NR4A2 might play an important role in venous remodeling after AVF. The integrated optical density (DOI) examined by immunohistochemistry staining showed that the expression of both INHBA and NR4A2 increased in AVF compared to the control group. Our research contributes to the understanding of the molecular mechanism of venous remodeling after exposure to high fistula flow, which may be useful in treating AVF failure.
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Vena cava filter is a filter device designed to prevent pulmonary embolism caused by thrombus detached from lower limbs and pelvis. A new retrievable vena cava filter was designed in this study. To evaluate hemodynamic performance and thrombus capture efficiency after transplanting vena cava filter, numerical simulation of computational fluid dynamics was used to simulate hemodynamics and compare it with the commercialized Denali and Aegisy filters, and in vitro experimental test was performed to compare the thrombus capture effect. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, wall shear stress on the wall of the filter, the area ratio of the high and low wall shear stress area and thrombus capture efficiency when the thrombus diameter was 5 mm, 10 mm, 15 mm and thrombus content was 10%, 20%, 30%, respectively. Meanwhile, the thrombus capture effects of the above three filters were also compared and evaluated by in vitro experimental data. The results showed that the Denali filter has minimal interference to blood flow after implantation, but has the worst capture effect on 5 mm small diameter thrombus; the Aegisy filter has the best effect on the trapping of thrombus with different diameters and concentrations, but the low wall shear stress area ratio is the largest; the new filter designed in this study has a good filtering and capture efficiency on small-diameter thrombus, and the area ratio of low wall shear stress which is prone to thrombosis is small. The low wall shear stress area of the Denali and Aegisy filters is relatively large, and the risk of thrombosis is high. Based on the above results, it is expected that the new vena cava filter designed in this paper can provide a reference for the design and clinical selection of new filters.
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Humans , Blood Flow Velocity , Hemodynamics , Software , Thrombosis , Therapeutics , Vena Cava Filters , Vena Cava, InferiorABSTRACT
Objective@#To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.@*Methods@#Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation(IVCF). Of them, 57 patients initially underwent thrombectomy and subsequently received the adjunctive catheter-directed thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B). Clinical efficacy and safety of treatments in the two groups were examined.@*Results@#Among the 94 patients, 88 cases had retrievable IVCF, and the retrieval rate was 94.3%(83/88). There were significant differences in total infusion time(73.92±31.68 h vs.156.2±30.2 h)and total doses of infused thrombolytic agents(180.71±44.83 million unit vs.355.0±96.0 million unit)between Groups A and B(P<0.05). There was a significant difference in average hospitalized time between Groups A and B(9.4±2.4 d vs.12.8±4.3 d, t=-4.99, P<0.01). There was no significant difference in clinical efficacy between Groups A and B(χ2=1.263, P>0.05). Fifty-six patients were treated with angioplasty(PTA), 34 of them were combined with stent implantation, and there was no difference between the two groups(χ2=1.128, P>0.05). Neither of the two groups saw serious complications.The incidence of minor hemorrhage was 9.6%(9/94), including 2 cases and 7 cases in Group A and Group B respectively, and the difference was statistically significant(χ2=4.503, P=0.034). The average follow-up time was 16.7±8.3 months in the 94 patients, and the stent patency rate was 91.2%(31/34). Doppler ultrasonography results at the last follow-up showed that the reverse flow rate of the valve was 20.2%(19/94), the occurrence rates of post-thrombotic syndrome(PTS)were 24.6%(14/57)and 29.7%(11/37)in Group A and Group B respectively, and the difference was not statistically significant(χ2=0.307, P=0.580). Patients in the mild, moderate and severe stages assessed by Villata scoring were 9 vs.6, 4 vs.5, 0 vs.1 in Group A and Group B respectively, and the differences were not statistically significant(χ2=0.007 and 0.205, P>0.05).@*Conclusions@#It is safe and effective for elderly patients with DVT when timely and appropriate the treatment strategies are chosen and comprehensive approaches including IVCF, anticoagulation, endovascular CDT, thrombectomy, PTA and stent implantation are used.
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Objective To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.Methods Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation (IVCF).Of them,57 patients initially underwent thrombectomy and subsequently received the adjunctive catheterdirected thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B).Clinical efficacy and safety of treatments in the two groups were examined.Results Among the 94 patients,88 cases had retrievable IVCF,and the retrieval rate was 94.3％ (83/88).There were significant differences in total infusion time(73.92 ± 31.68 h vs.156.2 ± 30.2 h) and total doses of infused thrombolytic agents (180.71± 44.83 million unit vs.355.0±96.0 million unit)between Groups A and B(P ＜0.05).There was a significant difference in average hospitalized time between Groups A and B(9.4±2.4 d vs.12.8 ± 4.3 d,t =-4.99,P ＜0.01).There was no significant difference in clinical efficacy between Groups A and B(x2 =1.263,P ＞ 0.05).Fifty-six patients were treated with angioplasty(PTA),34 of them were combined with stent implantation,and there was no difference between the two groups(x2=1.128,P ＞0.05).Neither of the two groups saw serious complications.The incidence of minor hemorrhage was 9.6％ (9/94),including 2 cases and 7 cases in Group A and Group B respectively,and the difference was statistically significant (x2 =4.503,P =0.034).The average follow-up time was 16.7± 8.3 months in the 94 patients,and the stent patency rate was 91.2％ (31/34).Doppler ultrasonography results at the last follow-up showed that the reverse flow rate of the valve was 20.2％ (19/94),the occurrence rates of post-thrombotic syndrome(PTS)were 24.6％ (14/57)and 29.7％(11/37) in Group A and Group B respectively,and the difference was not statistically significant(x2=0.307,P =0.580).Patients in the mild,moderate and severe stages assessed by Villata scoring were 9 vs.6,4 vs.5,0 vs.1 in Group A and Group B respectively,and the differences were not statistically significant(x2 =0.007 and 0.205,P＞0.05).Conclusions It is safe and effective for elderly patients with DVT when timely and appropriate the treatment strategies are chosen and comprehensive approaches including IVCF,anticoagulation,endovascular CDT,thrombectomy,PTA and stent implantation are used.
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Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.
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Objective@#To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT).@*Methods@#CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale.@*Results@#All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt>15 degrees in 8 (11.1%) and tilt ≤15 degrees in 34 (47.2%). Caval penetration with 0 grade was observed in 47 (65.3%) and beyond grade 1 was observed in 25 (34.7%), including grade Ⅰ in 12 (16.7%), grade Ⅱ in eight (11.1%), grade Ⅲ in four (5.6%) and grade Ⅳ in one (1.4%). No patient presented with symptoms associated with caval penetration. Filter retrieval was attempted in 54(75.0%) patients,the indwell time was 5.0 to 111.0 days, mean(32.0±23.9) days. There were 52 (96.3%) filters successfully removed, including four filters tilted lead retrieval hook embedded the caval wall, which used the adjunctive retrieval techniques. Filter retrieval failure in two (3.7%) cases, including one case retrieval hook embedded the caval wall and the other with retrieval hook penetration.@*Conclusions@#Celect inferior vena cava filter can effectively prevent PE, but had a tendency to tilt and to penetrate caval wall, which affected the filter retrieval, and had the potential risk of serious complications such as abdominal aortic pseudoaneurysm. The filter should be removed as soon as the risk of PE is manageable. We advocate CT follow-up for patients with long-term inferior vena cava filter placement.
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Objective To assess the clinical value of ultrasound-guided para-aneurysmal saline injection (PASI) in the treatment of iatrogenic femoral pseudoaneurysm, i.e. postcatheterization femoral artery pseudoaneurysm (FAP). Methods A total of 18 patients developed FAP after receiving interventional therapy through femoral artery puncturing, the diagnosis was confirmed by clinical and color ultrasonography examinations in all patients. Under real-time color Doppler ultrasound guidance and ECG monitoring, PASI was carried out. Local anesthesia was performed by injection of 5-10 ml of 1％ lidocaine, which was followed by percutaneous puncturing with a 21-gauge needle, that was connected to a plastic syringe filled with 0.9％ sodium chloride solution, into the site about 2-5mm away from the fistula between the pseudoaneurysm and the formal artery, then, the saline was continuously and slowly injected into this area until the abnormal blood flow signal within the fistula disappeared. Manual compression was applied on the local area for about 5 minutes. The dose of injected saline and the total time of the procedure were recorded. Clinical and color Doppler ultrasound reexaminations were conducted at 24 hours, one week and one month after the treatment, and the local pulsation, murmur, intra-pseudoaneurysmal blood flow and thrombosis were tested. Results Successful treatment with single procedure was achieved in 17 patients (17/18, 94.4％). In one patient continuous blood flow signal within the pseudoaneurysm was still observed at 24 hours after PASI, and successful closure of the pseudoaneurysm was obtained after the second time of PASI. The time of the procedure was 14-30 min, with a mean of (19.2±8.0) min. The injection volume of saline was 40-150 mL, with a mean of (67.2±29.3) mL. The treatment process could be well tolerated by all patients, only one patient developed transient bradycardia due to vagus reflex. Postoperative 30-day follow-up examination showed that no recurrent blood flow was detected within the pseudoaneurysm, no complications such as venous thrombosis, limb ischemia or local infection were observed, and the pseudoaneurysmal hematoma was completely absorbed. Conclusion For the treatment of postcatheterization FAP, ultrasound-guided PASI is technically-simple and clinically-safe with low medical cost, besides, this therapy can be well tolerated by patients. Therefore, PASI is worthy of clinical application.
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So far, more than 20 types of inferior vena cava filter(IVCF) are used in clinical practice. Although several IVCFs have been unavailable in the market, most of the IVCFs are still in use. Clinically, the retrievable IVCFs have been widely employed, but their removal rate is low. Long term indwelling of these IVCFs in patient's body can induce many complications. This paper aims to summarize the characteristics and imaging manifestations of the commonly used IVCFs, so as to improve their clinical application and followup observation with imaging, as well as to improve the ability in identifying IVCF type and in early detecting IVCF-related complications.
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Objective To compare the incidences of skin ecchymosis,skin induration and pain degree occurring after subcutaneous injection of low molecular weight heparin between two injection methods in order to determine the optimal subcutaneous injection method and provide the basis for standardizing the nursing process.Methods A total of 123 patients,who received subcutaneous injection of low molecular weight heparin during the period from March 2016 to September 2016 at authors' department,were enrolled in this study.Self-contrast method was used to compare the results.Each patient received low molecular weight heparin with two different subcutaneous injection methods.On the left abdomen,used as the experimental side,slow injection of heparin,lasting for 10 s,was conducted,then,after the needle stayed there for 10s the needle was pulled out,and no compression was applied on the injection site.On the right abdomen,used as the control side,slow injection of heparin,lasting for 10 s,was carried out,and the needle was pulled out immediately after the injection was finished,then compression was applied on the injection site for 3 min.Two hours and 12 hours after injection,visual analogue scale (VAS) was used to assess the degree of pain at injection site,and the incidences of skin ecchymosis and subcutaneous induration on the experimental side and the control side were documented.Results Two-hour and 12-hour VAS pain scores of the experimental group were (0.88±0.66) and (0.34±0.47) respectively,which were significantly lower than (2.02±0.65) and (1.19±0.63) of the control group (P＜0.05).The incidence of skin ecchymosis in the experimental group was 10.5％,which was strikingly lower than 23.5％ in the control group (t=2.736,P＜ 0.05).The incidence of subcutaneous induration in the experimental group was 0.04％,which was remarkably lower than 15.4％ in the control group (t=2.946,P＜0.05).Conclusion Slow injection of low molecular weight heparin,lasting for 10 s with needle staying for 10 s,and no use of compression after the needle is pulled out can decrease the incidence of skin ecchymosis and subcutaneous induration,and this injection method can reduce the pain degree as well.
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Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.
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Objective:To explore the compression stability in left common iliac vein (LCIV) at different times by contrast-enhanced CT in the same patients.Methods:This retrospective study included 124 patients (without signs of lower extremity venous diseases),who underwent contrast-enhanced CT at pelvic cavity and reexamined within one year.The degree of compression changes in LCIV was calculated and compared between the two examinations.Moreover,the relationship between age and the compression rate of LCIV was analyzed.Results:In the two examinations for the same patient,the compression rate of LCIV was almost the same,and there was no significant difference (t=-0.957,P＞0.05).Moreover,the compression rate of LCIV did not significantly change between different gender (P＞0.05).No matter whether the compression rate was more than 50％,there was no significant difference in the rate of LCIV compression between two examinations (P＞0.05).There was no significant correlation between age and the compression rate of LCIV (age＜50 years:r=0.152,P＞0.05;age ≥ 50 years:r=-0.214,P＞0.05).Conclusion:The compression degree of LCIV is almost stable,which is not significantly correlated with the age.The contrast-enhanced CT for single time can accurately display and diagnose the compression degree of LCIV.
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Objective To compare the clinical efficacy of angioJet rheolytic thrombectomy (ART) and manual aspiration thrombectomy (MAT) combined with catheter-directed thrombolysis (CDT) in the treatment of acute iliofemoral venous thrombosis (IFVT).Methods 62 acute IFVT patients undergoing interventional treatment with either ART (group A,30 cases) or MAT (group B,32 cases) from 2014 to 2016,were enrolled in this study.Clinical efficacy and postthrombotic syndrome (PTS) rate were compared between the two groups.Results The instant thrombolysis rate in group A was 83.3％ (25/30),that was 59.4％ (19/32) in group B(P ＜ 0.05).Time used for adjunctive thrombolysis and dosages of UK in group A were (73.92 ±31.68)h and (110.71 ±44.83) × 104 U,while in Group B were (121.20 ±25.20)h and (313.49 ± 70.11) × 104 U,respectively (P ＜0.01).Final thrombolysis rate of these two groups were 93.3％ (28/30) and 87.5％ (28/32) (P ＞ 0.05).No severe complications occurred during the treatment of ART and MAT procedure.Fifty seven cases (91.9％) were followed-up,the valvular regurgitation rate in group A and group B were 14.3％ (4/28) and 37.9％ (11/29),respectively (P ＜ 0.05).PTS rate in group A was 25.0％ (7/28) and 37.9％ (11/29) in group B (P ＞0.05).Conclusions Interventional treatment for acute IFVT with ART and MAT can both achieve high clinical efficacy.ART are with higher instant thrombolysis rate and less valvular regurgitation compared with MAT.
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Objective To evaluate the clinical value of percutaneous AngioJet thrombectomy for acute iliofemoral deep venous thrombosis.Methods 50 patients were divided into AngioJet thrombectomy group(25 cases) compared with bolus injection of urokinase through catheter in control group (25 cases).When the thrombosis was completely dissolved,the PTA and stents were implanted in those patients presenting May-Thurner syndrome in both groups.Inferior vena cava filter was retrieved from the patients and the thrombolytic therapy was discontinued.The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure.Results The average dosage of urokinase in AngioJet patients was (880 000 ± 354 000) units.The mean duration time of catheter-directed thrombolysis was (42.2 ± 16.7) hours and the average hospitalization time is (3.8 ± 0.8) days.Grade Ⅲ thrombolysis was achieved in 18 limbs and grade Ⅱ lysis in 6 limbs,grade Ⅰ lysis in 1 limb.The mean duration time of catheter-directed thrombolysis was (129.6 ± 32.2) hours.The average dose of urokinase was (4 100 000 ± 1 060 000) units and the average hospitalization time was (7.9 ± 1.4) days in control group.Grade Ⅲ thrombolysis was achieved in 10 limbs,grade Ⅱ lysis in 9 limbs and grade Ⅰ lysis in 6 limbs.The dosage of urokinase,duration time of catheter-directed thrombolysis,time in hospital and clinical effects were statistically different between the two groups (all P ＜ 0.05).There were no recurrent thrombosis in all the patients after 6 months of treatment.Venous patency was maintained in all patients with implanted stent.Conclusions Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective,safe treatment modality in patients with acute iliofemoral vein thrombosis.
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Objective:To investigate the magnetic resonance imaging (MRI) features of Cryptococcus infection in central nervous system patients with acquired immune deficiency syndrome (AIDS).Methods:The retrospective study on magnetic resonance imaging (MRI) and clinical data of cryptococcal meningitis (CM) was carried out between July 2011 and March 2017.These patients had not received anti-retroviral treatment.Patients with other specific or suspicious diseases in the central nervous system were not included in the analysis.Results:A total of 39 patients were included in the analysis,with CD4 cell counts of 13.0×106/L [(0-205)×106/L],and 94.9％ (37/39) of patients with CD4 cell count ＜100×106/L.Of the 39 patients,26 patients showed abnormal MRI signals in the brain,which were most frequently involved in the basal ganglia (20/26,76.9％).The basal ganglia lesions showed dilated VirchowRobin space (VRS)/gelatinous spseudocysts (18/20,90％).Postcontrast T 1-weighted MRI revealed no significant enhancement (3/5,60％) and mild enhancement (2/5,40％).The incidence of cerebral cryptococcal granuloma were 35％ (7/20).Nineteen of 26 patients with lesions outside the basal ganglia,of which 13 patients also complicated with basal ganglia lesions.Postcontrast T1-weighted MRI revealed no significant enhancement.The incidence of cryptococcal granuloma and meningeal thickening were 15.7％ (3/19) and 26.3％ (5/19),respectively.Postcontrast T1-weighted MRI meningeal thickening revealed enhancement (5/5,100％).Conclusion:The incidence of brain MRI abnormality in AIDS complicated with central nervous system Cryptococcus infection may not be low,and the lesions are mostly located in the basal ganglia.It most frequently displays the dilated VRS/gelatinous spseudocysts.It can also be showed cryptococcal granuloma.Postcontrast T1-weighted MRI often reveals no enhancement or mild enhancement.
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Objective To evaluate non-enhancement magnetic resonance venography (MRV) of iliac vein in diagnosing Cockett syndrome.Methods Magnetic resonance iliac venography was performed with Ingenia 3.0 T superconducting type MRI system.Abdominal surface coil was employed.The scanning sequences included M2DIPEAR (TR/TE=45/5.8 ms,flip angle=60°),THRIVE (TR/TE=6.8/3.5 ms,flip angle=10°),BTFESPAIR (TR/TE=3.4/1.7 ms,flip angle=80°) and FLAIR (TR/TE=9 000/120 ms,flip angle 90°).The layer thickness of 3 mm was used in all scanning,and the average number of acquisition was 3 times.Results On MRV imaging,Cockett syndrome was characterized by narrowed anteroposterior diameter and broadened transverse diameter of the compressed iliac vein,and curved impression could be seen on its anterior border,and collateral vessel formation could be observed.The mean diameters of the left iliac veins in the light,mnedium and severe patients with Cockett syndrome were 7.52,4.83 and 2.76 mm respectively,with the average compression ratios being 37％,69％ and 83％ respectively.Conclusion Non-enhanced MRV is a feasible method for the diagnosis of iliac vein stenosis,this examination is especially suitable for the checking needs of specific population.
