Long-term patency and comparisons of venous outflow in hemodialysis forearm arteriovenous grafts.

INTRODUCTION: This retrospective study investigated the factors and the effects of different venous outflows on forearm arteriovenous graft patency. METHODS: The venous outflow sites included basilic, cephalic, median antecubital, and deep veins. Comparisons among multiple groups were analyzed. FINDINGS: A total of 179 patients with forearm loop arteriovenous grafts met the inclusion criteria. Of these, 72 were basilic, 48 were cephalic, 44 were median antecubital, and 15 were deep. The median observation period was 19 months. The survival rate was 84.9% at 24 months and 78.2% at 48 months. Primary, secondary, and assisted primary patency rates for all arteriovenous grafts were 48.9%, 72.4%, and 68.4% at 12 months; 13.8%, 33.9%, and 23.6% at 24 months; and 0.6%, 4.6%, and 2.3% at 48 months, respectively. Differences in primary patency were statistically significant compared with those of secondary and assisted primary patency (P < 0.05). Primary patency rates for cephalic, median antecubital, basilic, and deep were 47.9%, 48.6%, 47.7%, and 40.0% at 12 months and 12.5%, 13.9%, 22.7%, and 0% at 24 months, respectively. Secondary patency rates for cephalic, median antecubital, basilic, and deep were 75.0%, 69.4%, 75.0%, and 73.3% at 12 months and 39.6%, 30.6%, 38.6%, and 13.3% at 24 months, respectively. There was no significant difference in primary thrombosis among basilic, cephalic, median antecubital and deep. There were no significant differences observed in primary or secondary patency rates among all the groups. Stenoses in the venous anastomosis and outflow vein were frequently observed in all types of arteriovenous grafts. Central venous stenosis was most commonly seen in deep (26.67%). On average, 1.9 interventions per patient were performed on the graft to maintain function. CONCLUSION: Different venous outflow selections were not associated with long-term patency and the occurrence of thrombosis in hemodialysis forearm loop arteriovenous grafts.

[Surgical management of penetrating cervical vascular trauma].

OBJECTIVES: To discuss diagnosis and surgical management of penetrating cervical vascular trauma. METHODS: A retrospective clinical analysis of 22 penetrating carotid artery injuries. RESULTS: Twenty-two patients presented 32 vascular injuries, including innominate artery (n = 1), innominate vein (n = 2), subclavian artery (n = 6), subclavian vein (n = 2), common carotid artery (n = 3), internal carotid artery (n = 3), external carotid artery (n = 4), jugular vein (n = 8) and vertebral artery (n = 4). There were 12 patients with stab wounds, 2 with blast wound and 8 with iatrogenic injuries. Of these, there were 12 zone-1 injuries (38%), 19 zone-2 injuries (59%) and 1 zone-3 injury (3%). The distribution of 4 vertebral artery injuries were V1 (n = 1), V2 (n = 2) and V3 (n = 1). All patient received surgical and endovascular managements and got survival. CONCLUSIONS: Patients with penetrating cervical vascular injuries have high rate of mortality. Emergent surgical exploration is necessary for patients with hard signs of vascular injury such as hemodynamic instability, exsanguinating hemorrhage, or expanding hematoma. Those patients that are hemodynamically stable and who are without respiratory compromise should undergo further diagnostic imaging evaluation.

[Effect of ischemic pretreatment on expression of heat shock protein 70 and injury of spinal cord in canine].

OBJECTIVE: To evaluate effect of ischemic pretreatment on expression of heat shock protein 70 (HSP70) and injury of spinal cord in canine. METHODS: Fourty-one canine were divided into three groups: the sham-operative group, the pretreatment group and the control group. In the pretreatment group aorta was obstructed for 6 min, and then was opened for 6 min, this procedure was repeated twice, finally aorta was obstructed for 35 min. In the control group aorta was obstructed for 35 min. Nervous function were assessed and HSP70 expression were detected in tissue of spinal cord. RESULTS: In the pretreatment group, HSP70 expressed in cytoplasm and nucleus at 6, 24 hour after reperfusion, and intensity of HSP70 expression was stronger than that in the control group; The score of nervous function in the pretreatment group was higher than that in the control group. On 7 day after reperfusion the score of nervous function in pretreatment group had no obvious variation, and HSP70 expression was still observed. CONCLUSIONS: Ischemic pretreatment can improve ischemic tolerance of spinal cord; HSP70 expression in cytoplasm and nucleus may play a role in ischemic tolerance.