Abstract:

Objective：To explore the effect of endovascular treatment for aortoiliac occlusive disease (AIOD).
Methods：The clinical data of 113 patients with AIOD, who underwent endovascular treatment, were retrospectively analyzed.The patients’mean age was 62.5 years (range, 45 to 81 years);79 patients (69.9%) were men and 39 women.According to the Trans Atlantic InterSociety Consensus classfication, type A, B,C and D disease was respectively present in 37.17%，34.51%，11.50% and 16.81% of patients. With the approach from femoral artery or brachial artery, combined techniques, such as recanalization, balloon dilation, stent placement and concomitant common femoral endarterectomy, were applied in the treatment. 
Results：Technical success was achieved in 107 patients(94.7%). Clinical status was moderately improved in 39 cases and markedly improved in 68 cases. Mean time of followup was (26±2.3) months. At 6 months, primary patency of the occlusive artery was 82.76%, and secondary patency was 92.31%. At 12 months, primary patency was 76.21%and secondary patency was 81.67%. At 24 months, primary patency was 67.66% and secondary patency was 73.62%.
Conclusions：Combined multiple endovascular techniques are safe and effective methods in treatment of aortoiliac occlusive disease.

Abstract:

Objective：To study the rational surgical approaches for patients with juxtarenal abdominal aortic occlusion, with or without combined vascular regions of the body.
Methods：Clinical data of 17 patients with juxtarenal abdominal aortic occlusion admitted to our department form 2004—2008 were analyzed retrospectively.The 17 patients included 6 cases combined with severe arterial stenosis of lower extremity, 5 cases combined with renal arterial stenosis, 2 cases combined with subclavical arterial stenosis,1 case combined with renal  arterial stenosis and femoral arterial occlusion in one side,  and 1case combined with thoracic aortic aneurysm.Surgical approaches for the patients with juxtarenal abdominal aortic occlusion included aorto-iliac vascular prosthesis by-pass in 12 cases,axillary-double femoral vascular prosthesis by-pass in 4 cases, and bilateral femoral arteriotomy plus thrombus extraction in one case. The accompanying vascular disease in other vessels were treated by intravascular balloon dilatation and stent insertion, or by femoro-popliteal vascular prosthesis by-pass and aneurysmectomy plus prosthetic vascular replacement.
Results：There was one death in this series. The other 16 cases did not have any severe complications.Lower limb ischemia symptoms was relieved in 16 cases; and 7 cases of lower limb rest pain, 4 cases with hypertension, 2 cases with impaired renal funotion, and 2 cases with dizziness were markedly improved postoperatively.
Conclusions：It is very important that patients with juxtarenal abdominal aortic occlusion combined with vascular disease of other regions of the body should be treated by different surgical approaches, which is the key point to improve patients’survival rate and quality of life.

Abstract:

Objective：To study the clinical features, diagnosis and treatment outcome of aortic dissection in under 50 years old patients.

Methods： From March 2002 to February 2010, a total of 61 cases of aortic dissection were treated in our hospital. Among them, 23 patients were less than 50 years of age. Their clinical characteristics were analyzed and compared with 38 cases of aortic dissection in ≥50 years of age.
Results：Hypertension, hyperlipidemia and diabetes were  less present in younger-aged patients than in older-aged patients. But in younger aged group there were more patients with aortic rupture at time of admission. Also, more younger-aged patients required surgical reconstruction wiht right subclavian artery (RSA)- left subclavian artery(LSA)bypass, and more younger-aged patients had temporary ischemic complications of left upper extremity when LSA was not reconstructed. Mortality rate was higher in the young-aged patients than in older patients.
Conclusions：The etiology of aortic dissection in young-aged patients is complex. Arteriosclerosis is not the main cause of aortic dissection, while activated T cells and macrophages in the media of aorta may contribute to the elimination of smooth muscle cells and degradation of the matrix associated with aortic dissections. Aortic dissection in younger-aged patients progresses more rapidly and perioperational mortality is higher than in older patients. Etiological prevention, early diagnosis and timely therapy can improve the outcome of aortic dissection in younger-aged patients.

Abstract:

Objective：To evaluate the methods, applicability and results of cndovascular therapy for Stanford  type B aortic dissection.
Methods：The clinical data of 36 cases of Stanford type B aortic dissection were analysed retrospectively. The stent-grafts were introduced via  femoral arteriotomy. Stent-grafts were implanted to blockade tears of aortic dissection under the guidance of DSA.
Results：In all cases,the aortic dissection tears were blockaded, true lumens were opened,and organs function was restored.There were not complications such as internal hemorrhage due to trauma or stent displacement on CTA 3 and 12 months after endovascular therapywhile 2 cases developed new tears.The caliber of the 36 true lumens was restored to near normal. Twenty-two pseudocoeloms were obliterated,while the others were reduced is size and had varying degrees of thrombosis.
Conclusions：Endovascular  thcrapy  is  safe  and  effectivc  for  the  patients  with Stanford  type B  aortic dissection. Its clinical application has a favorable outlook.

Abstract:

Objective：To summarize and analyze the diagnosis and treatment status of abdominal aorta saddle embolism(ASE) in China.
Methods：Twenty-nine articles reported in Chinese journals from 1997 to 2009 were retrieved by searching the Chinese Journal Full-text Database. Retrospective meta-analysis was done.
Results：There were 230 cases with ASE.Of them, 65.2% of cases were diagnosed by color ultrasound image; 49.1%  had atrial fibrillation, 73.9% of cases were treated by Fogarty catheter with a sueess rate of 93.5%, and in 17.8% of cases embolectomy was done by direct laparotomy.There were 40.4% of patients (93 cases) who suffered from myonephropathic metabolic syndrome, and 44.1% of them (41 cases) died. The total case fatality rate was 26.5%, and the extremity amputation rate was 19.1%.
Conclusions：The mortality and amputation rate of ASE are quite high, so it is necessary to elevate the level of recognition and improve  the level of diagnosis and therapy.

Abstract:

Objective：To study the effect of  benazepril on abdominal aortic aneurysm(AAA) formation and the possible mechanism.
Methods：Twenty-four healthy male rabbits were randomly divided into three groups according to perfusion fluid(saline, elastase, and benazepril-treated elastase groups). The diameter of the aorta was measured, and the aortic tissue was excised for histologic examination using HE and VG stain. Total protein of matrix metalloproteinases-9(MMP-9) was measured by Western Blot test. MMP-9 mRNA of aorta was detected by RT-PCR. MMP-9 protein activity was detected by Gelatin zymography.
Results：Seven days after perfusion,the average dilation rate of the three groups was 7.50%（saline perfusion group,group A）,120.62%（elastase perfusion group,group B） and 39.20%（benazepril-treated elastase perfusion group,group C）respectively. The result showed that benazepril had an obvious inbitiory effect on AAA formation. The elastic fiber content was conserved better in group C than in group B（P<0.01）,meanwhile benazepril effectively inhibited inflammation infiltration.MMP-9 expression and activity was enhanced in group B,while group C showed weakened MMP-9 protein and mRNA expression（P<0.01）. MMP-9 activity in group C was also significantly decreased（P<0.01）.
Conclusions：Benazepril could obviously inhibit AAA formation in rabbit models.The mechanism may relate to inhibition of inflammation infiltration, down-regulation of extracellular matrix degeneration in multiple levels and preservation of elastic fiber.

Abstract:

Objective：To study an effective method for culturing of human vascular smooth muscle cells (hVSMCs) in tissue engineered blood vessels (TEBVs) in vitro.
Methods：A 3-cm segment of human long saphenous vein was harvested under sterile conditions. The primary culture and subculture were done by modified tissue-piece inoculation and trypsin digestion respectively. The cells were purified by mechanical treatment and differential attachment. PDGF was combined with high concentration of glucose DMEM as the culture medium. The cultured cells were identified by morphology and immunohistochemistry with contrast microscope and SABC kit，and RT-PCR method detected the expression of α-SMA and calponin 1.
Results：The cultured cells possessed“peak and valley”characteristics for VSMCs under microscope. Immunohistochemical staining showed positive expression of intracytoplasmic α-actin, and RT-PCR detected positve expression of α-SMA and calponin 1.
Conclusions：Culture medium of PDGF combined with high concentration of glucose DMEM,and with differential attachment method can provide highly purified hVSMCs with good structure and function.

Abstract:

Objective：To investigate the distribution and effect of  endothelial nitric oxide synthase (eNOS) on the zero-stress state of carotid arteries in rats at different ages.
Methods：Morphometry and microstructure of carotid artery in 3-month-old, 6-month-old and 12-month-old Sprague-Dawley rats were studied quantitatively by histological method and computer image analysis. Immunohistochemistry and the NADPH-diaphorase reaction were used to localize the endothelial nitric oxide synthas (eNOS) in different age rats.  The changes of opening angle in the zero-stress state was also observed.
Results：With increasing age, there was a significant reconstruction changes in morphometric parameters and microstructure parameters of the carotid arteries in rats. While the expression of eNOS protein of endothelium and vascular smooth muscle cells were decreased. Compared with 3-month-old rats, the zero-stress state. of opening angle in 6-month-old and 12-month-old group were increased. However, pre-incubation of vessel rings with L-arginine (30 mmol/L), a substrate of eNOS,  attenuated the changes of the zero-stress state.
Conclusions：The results suggest that the carotid arterial wall in different age rats shows unequal growth and different zero-stress state eNOS may be involved in the age-related changes of zero-stress state of the carotid artery in aged rats. The results may provid an experimental base for vascular transplantation and vascular reconstruction.

Abstract:

Objective：To investigate the protective efficiency of low molecular weight heparin (LMWH) on lung injury in severe acute pancreatitis (SAP).
Methods：SD rats were randomly divided into 3 groups: (1) Sham operation (S) group，(2) SAP group，(3) LMWH treatment (LT) group：LMWH was administrated 4 hours after SAP model was constructed. The levels of serum amylase, endothelin1(ET-1), tumor necrosis factor α (TNF-α), lung wet/dry weight ratios, pulmonary morphology, the expressions of P65 mRNA and P65 protein in pulmonary specimens were detected at 1d after the models were set up, and the 3 days survival rate in each group was also observed.
Results：(1) The levels of serum amylase, TNF-α,  ET-1 in SAP group were significantly increased than those in S group and LT group (all P<0.001), and the level of serum amylase in LT group was significantly increased than that in S group (P<0.05). (2) The expression of P65 protein and P65 mRNA in pulmonary specimens of SAP group was significantly lower than that in S group and in LT group (all P<0.05). (3)The lung wet/dry weight ratio in SAP group was significantly increased than that in S group and LT group (all P<0.001). (4)The inflammatory cells infiltration, hyaline membrane and increase of pulmonary microvascular permeability in alveoll in SAP group were significantly serere than those in LT group. (5) The 3 days survival rate in SAP group (25.0%) was significantly lower than that in S group (100.0%) and LT group (87.5%) (all P<0.05).
Conclusions：LMWH therapy can improve the survival rate of SAP, and might be related to the amelioration of the lung injury by down-regulating the levels of cytokines release through suppressing the activity of nuclear factor kappa B and improving the pulmonary microcirculatory by down-regulating the level of serum ET-1.

Abstract:

Objective：To investigate the method of surgical treatment of mixed type Takayasu′s arteritis(TA).
Methods：Clinical data of 12 cases of TA were retrospectively analyzed.
Results：All 12 patients were treated with operations, including arterial bypass with prosthesis-graft in 5 cases; percutaneous transluminal angioplasty (PTA) and intraluminal stent implantation in 3 cases; combination of the two methods in 4 cases. All patients were followed up for 3 to 60 months. 10 cases of organ ischemia or renal hypertension were very well controlled, 2 cases showed restenosis of renal artery and one of them died from cerebrovascular accident.
Conclusions：Combination of arterial bypass, PTA and intraluminal stent impantation can control the ischemia of the vital organs and reduce the blood pressure of renal hypertension in patients with TA.

Abstract:

Objective：To explore the surgical treatment and perioperative management of carotid body tumors.
Methods：Fifteen patients with carotid body tumor were operated upon after appropriate perioperative management.
Results：Among the 15 cases, 6 underwent simple tumor excision，7 had co-resection of carotid body tumor and carotid artery,and 2 cases had arterial anastomosis of common carotid artery and internal carotid artery after co-resection of carotid body tumor. There was no mortality after operation in this series. All patients were followed up from 1 year to 3 years (average, 15.3months). Operative incisions healed by primary intention. The pressure symptoms of carotid body tumor disappeared after operation, but two patients had temporary headache for 3months, and one patient died of cerebral infarction. Injury of hypoglossal nerve occurred in one patient  but it recovered after treatment. There were no recurrences of carotid body tumor after operation.
Conclusions：Adequate perioperative management can improve the effect and safety of operation, and decrease operative complications of patients with carotid body tumor.

Abstract:

Objective：To explore the early diagnosis and treatment of acute superior mesenteric arterial embolism (ASMAE).
Methods：The clinical data of 25 patients with acute superior mesenteric arterial embolism were retrospectively analyed.
Results：All 25(100%) patients had severe abdominal pain with abdominal signs, 21(84%) patients had  history of valvular heart disease or atrial fibrillation, and 17(68%) patients had hematochezia. All the cases were misdiagnosed preoperatively, including 11 patients were misdiagnosed as abdominal pain of unknown causes, 3 patients as acute pancreatitis, 3 patients as acute gastroenteritis, 2 patients as necrotizing enteritis. 1 patient as acute appenditis, 1 patient  as acute myocardial infarction,and 1 patient  as acute cholecystitis; but 3 patients were  preoperatively  suspected to have impairment of mesenteric blood flow. All of the  25 patients underwent necrotic bowel resection, 6 patients died,  and 7 patients abandoned treatment because of serious complications  such as short bowel syndrome etc. Mortality rate was 51%（13/25）.
Conclusions：Early diagnosis of patients with acute superior mesenteric arterial embolism is difficult; the main cause of misdiagnosis is lack of recognition of its clinical signs. Fully grasping the characteristics of patients with early stage disease and effective early intervention are the fundamental measures for reducing mortality.

Abstract:

Objective：To explore the application of autologous bone marrow stem celI transplantation in the treatment of chronic ischemic disease of lower extremity and evaluate the effect.
Methods：Forty patients with chronic ischemic limbs were treated from January 2008 to April 2009. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(GCSF), 300μg /d, for 2-3 days. Then,200 mL of bone marrow was withdrawn from the iliac spine and the stem cells were obtained. After the bone marrow separation and purification, they were transplanted into the more severely ischemic limb.  After the transplantation, they were foIlowed up by phone once a month for six months. The skin temperature, transcutaneous oxygen pressure(TcPO2), digital subtraction angiography（DSA）and ankle/brachial index(ABI)were rechecked at 6 months later, and the symptoms of pain, cold, numbness, intermittent claudication and physical signs of ulcer and gangrene were also evaluated. 
Results：All of the 40 patients were followed-up. At 6 months post-transplantation, the various indices were compared with before transplantation.（1）The skin temperature and TcPO2 had significante improvement (P<0.01).（2）ABI had no statistical significance (P>0.05).（3）DSA and all of the clinical symptoms showed general improvement in more than 60% of cases.（4）There were no serious complications.
Conclusions： Transplantation of stimulated autologous bone marrow stem cells is effective in the treatment of ischemic disease of lower limb, which is a simple, safe and effective treatment for ischemic disease of lower limb.

Abstract:

Objective：To explore the diagnosis and treatment of extensive portal venous system thrombosis.
Methods：The clinical data of 10 cases of extensive portal venous system thrombosis were analyzed retrospectively.
Results：Two cases were misdiagnosed and underwent exploratory laparotomy. The diagnosis was established in 8 patients by imaging angiography and selective superior mesenteric arteriography. Four patients were treated with emergency operation and five patients underwent thrombolytic therapy (two cases of thses were converted to open intestinal resection because of intestinal necrosis); 1 patient received thrombolytic therapy through peripheral vein. Six patients survived and 4 died. Six survivors were treated with long-term warfarin therapy. In 0.5-6 y follow-up for the six survivors, one developed short bowel syndrome, one had recurrence and another deveolped adhesive intestinal obstruction.
Conclusions：Extensive portal venous system thrombosis is very easy to be misdiagnosed. Imaging examination and selective angiography are of great importance for early diagnosis. Early treatment is pivotal to its prognosis.

Abstract:

Objective：To study the methods and outcome of treatment of superior mensenteric venous thrombosis(SMVT).
Methods：The clinical data of 35 patients with SMVT during the last twenty years were studied retrospectively.They were divided into two groups according to the dmission time:  the 1990—2003 group(groupⅠ) and the 2004—2009 group（groupⅡ）. Most patients in group Ⅰreceived surgical treatment, and most patients in group Ⅱreceived anticoagulation and thrombolysis therapy. Treatment modality, hospital stay days,cure rate and mortality between the groups were compared.
Results：The constitution ratio of treatment was significantly different between the two groups （P＜0.01）. The hospital stay days in two groups was （21.8±12.3）d vs.（11.7±6.2）d,the cure rate increased from 58.8% (group I) to 88.9%(group II), and the mortality decreased from 41.2%(group I) to 11.1%(group II). Significant difference were found in treatment,hospital stay days,cure rate and mortality between the two groups（all P＜0.05）.
Conclusions：The cure rate of SMVT has significantly increased in recent period of time. Timely diagnosis and prompt anticoagulant therapy can ensure satisfactory treatment outcomes in patients with SMVT.

Abstract:

Objective：To discuss the clinical effect of two different routes of thrombolysis for the treatment of acute deep vein thrombosis (DVT).
Methods：A total of 126 patients with DVT during December 2005 to March 2010 were randomly divided into two groups: (1)transcatheter popliteal vein thrombolysis method (group A); (2)thrombolysis therapy via peripheral vein (group B). The venous patency score and patency improvement were observed by venograms or Duplux.
Results：After treatment, the reduction rate of edema of leg (0.82±0.14)% and of thigh(0.89±0.07)%, and the venous patency improvement rate (55.41±3.21)% in group A were significantly higer than those in thrombol group B（0.63±0.11）%，（0.57±0.09）%and （32.34±3.77）%, respectively (all P<0.05-0.01).
Conclusions：This results suggest that recovery rate and long term results of transcatheter popliteal vein  thrombolysis therapy is better than that of thrombolysis therapy via peripheral vein.

Abstract:

Objective：To investigate the effect of endovenous laser (EVLT) and microwave treatment (EMT) in the treatment of chronic venous insufficiency(CVI).
Methods：According to CEAP classification, patients with CVI were divided into EVLT group (102 cases) and EMT group (94 cases) randomly. The incidence of postoperative recovery, complications and the pathological changes were compared.
Results：The incidence of suggillation was higher in EVLT (25.5%) than in EMT (14.6%) group (P<0.05), but there were no significant differences in numbness, burning pain, indurated cords, relapse rate, postoperative recovery and pathological changes between the two groups (all P>0.05).
Conclusions：Both EVLT and EMT can be used to treat CVI effectively, however,  long-term results merit further investigate.

Abstract:

Objective：To evaluate the effect of early surgical treatment for primary lower limb varicose veins complicated by thrombophlebitis.
Methods：The clinical date of 42 patients with primary lower extremity varicose veins complicated by thrombophlebitis treated in 4 years were analyzed retrospectively. The CEAP classification was adopted to establish the diagnoses of the all patieats. In the early stage, high ligation and stripping of the varicase veins were performed. After removal of varicose veins and thrombi, both anti-inflammation therapy and anticoagulant therapy were applied.
Results：All patients made a good recovery. After surgery, 3 patients had skin callous and swelling, and 3 patients had foot nerve paresthesia. But, no serious complications, such as deep venous thrombosis or pulmonary embolism, were observed. The was no recurrence during 2 months to 4 years follow-up.
Conclusions：Early surgical treatment for primary lower limb varicose veins complicated by superficial thrombophlebitis not only has good results but also helps control of deep venous thrombosis and pulmonary embolism, and other serious complications that can  result from superficial venous thrombosis.

Abstract:

Objective：To explore a method to improve the nutritional state and immune function of patients after radical gastrectomy, and to decrease postoperative complication rate and accelerate recovery from operation.
Methods： In line with the concept of fast tract surgery (FTS), a new perioperative nutritional schedule was made for patients prior to radical gastrectomy, ehich included preoperative nutritional risk screen and prophylactic enteral nutrition, early postoperative light enteral nutrition, early ambulation and perioperative nursing care. Patients with gastric cancer were randomly assigned into fast track group or a simple control group. New perioperative schedule was executed in the patients of fast track group and traditional nutrition support in control group. After operation, serum albumen was measured to evaluate the patient's nutritional state and serum IgA to evaluate gastrointestinal immune function. In addition, the time to passage of flatus, postoperative recovery time and complication rate after operation were compared.
Results：Patiens in FTS group (n=35) showed higher serum albumin and serum IgA on d1 and d3 after operation than those in the control group (n=25) (P＜0.05-0.01). Patients in FTS group had earlier food intake because of earlier passage of flatus, compared to those in the control group.
Conclusions：Our study demonstrates that the nutritional and nursing concepts of FTS can be employed in the perioperative therapy of patients with gastric carcinama. Patients will benefit from less complications and early discharge from hospital, and with no increase of the operative risk.