ABSTRACT
Objective: To explore the surgical treatment strategy of stent graft infection after interventional treatment of major iliac artery related diseases. Methods: Retrospective analysis was performed on the clinical data of 6 patients with secondary stent graft infection after interventional treatment for major iliac artery related diseases admitted to the Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2021 to August 2022.There were 5 males and 1 female,with a mean age of 64 years (range:49 to 79 years).The infection time was 53 to 3 165 days.All the 6 patients received surgical treatment,including 3 patients who underwent anatomic bypass grafting (axillary arterial-femoral artery bypass,femoral arterial-femoral artery bypass) using artificial vessels,and 3 patients who underwent in situ abdominal aorta reconstruction using bovine pericardium.The perioperative situation,postoperative infection and the occurrence of serious adverse events were recorded,and the safety of different treatment methods and materials was evaluated. Results: All patients successfully completed the operation and no death occurred during hospitalization.Intraoperative blood loss was 2 000~5 000 ml,and intraoperative blood transfusion was 1 600 to 5 350 ml.All the patients were followed up for 81 to 395 days after surgery,and the incision healed well,and no reinfection occurred.Postoperative gastrointestinal bleeding occurred in 1 patient,secondary surgery (retroperitoneal hematoma removal) was performed in 1 patient due to postoperative bleeding at the vascular anastomosis,both lower limb amputations were performed in 1 patient due to postoperative lower limb ischemia,and intermittent claudication occurred in 2 patients.All patients were alive at the last follow-up. Conclusion: For patients with aortic stent graft infection,when the infection is not serious and there is enough space to block the proximal and distal aorta,in situ aortic reconstruction is an effective treatment,and different materials can achieve satisfactory results in a short period of time.
ABSTRACT
Objective To investigate the correlations among brain functional connectivity,hippocampal subregion volume and cognitive score in the patients with carotid artery stenosis(CAS)based on resting state functional magnetic resonance imaging.Methods Forty CAS patients treated in the Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University from January to December in 2019 and 31 healthy volunteers were enrolled in this study.All the participants underwent cognitive assessment,structural MRI for the measurement of hippocampal volume,and resting state functional magnetic resonance imaging for the examination of brain functional connectivity(FC).We compared the cognitive function,hippocampal subregion volumes,and brain functional connectivity between the two groups and investigated the correlations between the three indicators.Results The CAS patients had lower mini-mental state examination(MMSE)(F=13.346,P=0.001)and Montreal cognitive assessment(MoCA)(F=52.005,P<0.001)scores than the healthy volunteers.Compared with healthy volunteers,CAS patients showed small whole hippocampus(right side:t=2.176,P=0.033;left side:t=2.881,P=0.005;especially on the left side),small hippocampal tail(right side:t=2.394,P=0.019;left side:t=3.158,P=0.002),small hippocampal body(right side:t=2.336,P=0.022;left side:t=3.165,P=0.002),small subiculum(right side:t=2.211,P=0.030;left side:t=2.430;P=0.018),and small molecular layer(right side:t=2.103,P=0.039;left side:t=2.702,P=0.009).The whole hippocampal volume was positively correlated with MoCA and MMSE scores(left MoCA:r=0.289,P=0.015;right MMSE:r=0.249,P=0.038;left MMSE:r=0.316,P=0.008).The volume changes in the subiculum,presubiculum,and left molecular layer were positively correlated with MoCA(right subiculum:r=0.290,P=0.015;left subiculum:r=0.382,P=0.001;right presubiculum:r=0.293,P=0.014;left presubiculum:r=0.440,P<0.001;left molecular layer:r=0.259,P=0.031)and MMSE scores(right subiculum:r=0.278,P=0.020;left subiculum:r=0.419,P<0.001;right presubiculum:r=0.296,P=0.013;left presubiculum:r=0.506,P<0.001;left molecular layer:r=0.298,P=0.012),while the volume changes in the remaining hippocampal subregions were not correlated with cognitive scores(all P>0.05).Compared with healthy volunteers,the CAS patients presented low FC values of the left hippocampus to the occipital lobe and frontal lobe and of right hippocampus to the occipital lobe,temporal lobe,prefrontal lobe,and middle frontal gyrus(Gaussian random field correction,voxel P<0.01,cluster P<0.05).The volume changes of the left whole hippocampus,hippocampal head,and cornu ammonis 1(CA1)were positively correlated with the FC value of right hippocampus to the temporal lobe(left whole hippocampus:r=0.358,P=0.025;right hippocampal head:r=0.325,P=0.044;left hippocampal head:r=0.360,P=0.024;right CA1:r=0.326,P=0.043;left CA1:r=0.341,P=0.034).MoCA and MMSE scores were positively correlated with the FC value of right hippocampus to the frontal lobe(MoCA middle frontal gyrus:r=0.389,P=0.014;MoCA prefrontal lobe:r=0.363,P=0.023;MMSE prefrontal lobe:r=0.321,P=0.046).Conclusions CAS patients have different levels of cognitive impairment.Hippocampal atrophy and a decline in the FC value of hippocampus to the occipital lobe may play a role in cognitive impairment in CAS patients.This discovery lays a foundation for the future research on the mechanism of cognitive dysfunction in CAS patients.
