Objective To summarize the methods and experiences of surgical treatment of aortic arch diseases with four branches aortic graft under deep hypothermia circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods In 2004 from September to December, surgical treatment of 12 patients with 7 aortic aneurysm（4 cases with ascending aorta and aortic arch aneurysm, 3 cases with aneurysm of aortic isthmus） and 5 aortic dissection（DeBakey Ⅰ 1 case, DeBakey Ⅱ 3 cases, DeBakey Ⅲ 1 case） were collected in Gunma Prefectural Cardiovascular Center. All operations were carried out under DHCA and ASCP, and four branches aortic graft were used to replace the aortic arch. The Bentall procedure, total and partial arch replacement and elephant trunk technique were undertaken in different patients. Results Total 12 patients recovered from the great vessel diseases smoothly without severe cerebral and other systematic complications, the time of operation was 5.5±1.7 h, the period of DHCA was 42.2±12.9min, 4 cases with no blood transfusion, the time of hospitalization was 22.3±7.2d. Conclusion ASCP is a safe. and effective method of cerebral protection during circulation arrest, and four branches aortic graft may shorten the time of DHCA and simplify the procedure of aortic arch replacement.
OBJECTIVE: To investigate the clinical effects of revascularization in lower extremity for severe ischemia. METHODS: Fifty-six lower limbs with severe ischemia in 49 patients were evaluated retrospectively, who underwent surgical intervention from January of 1995 to December of 2000. By arteriography, the actual anatomic distributions of occlusive disease included infrarenal aorta-bicommon iliac arteries, abdominal aorta-bicommon iliac arteries, iliac artery, and femoral artery or femoropopliteal artery. The indication for surgery was disabling claudication, rest pain and gangrene. Fourteen limbs in 12 cases received arterialization of femoral venous system by artificial venous-arterial fistula. Artificial vascular grafts were implanted in 33 limbs of 28 cases, endarterectomy and patch profundaplasty were performed in 5 limbs of 5 cases, and primary amputation was carried out in 4 cases. RESULTS: During 38 months follow-up in average, 4 limbs were amputated within 52 revascularizated limbs, and accumulated amputation rate was 14.3%. Patency rate was 68.4% in arterial revascularization limbs (26/38 limbs), and limb survival rate was 94.7%(36/38 limbs) by procedure of artificial vascular grafts, endarterectomy and patch profundaplasty. Limb survival rate in procedure of artificial venous-arterial fistula was 85.7%(12/14 limbs). CONCLUSION: In treatment of severe lower extremity ischemia, the effective revascularization can be achieved by artificial vascular bypass, endarterectomy and patch profundaplasty, or arterialization of femoral venous system. Options in the surgical management should depend on individual. Arteriography is essential for revascularization and properly planning a practicable surgical approach.
目的 探討布加綜合征腸房轉流術后頑固性腹水的治療。方法 對2008年收治的1例經多次治療(包括腸房轉流術)后均于短期內復發的布加綜合征患者進行回顧性分析。結果 臨床表現為重度腹水致呼吸困難，CT靜脈造影檢查示腸房人工血管通暢但血流量低，考慮吻合口狹窄所致。術中探查發現吻合口極度狹窄，用帶外支撐環的補片重建吻合口，療效滿意。結論 復雜或經多次手術或介入治療的布加綜合征患者，要遵循個體化治療原則，強調術前明確診斷及選擇正確治療方案和手術方式。
目的 探討肝外型門靜脈高壓分流術人工血管閉塞后血流重建的診治方法。方法 對2006年3月至2010年12月期間筆者收治的102例肝外型門靜脈高壓患者進行了開放手術治療，其中3例是再次手術患者并對已嚴重狹窄或閉塞的人工血管進行了血流重建。結果 3例患者人工血管均得以血流重建，分別隨訪了32、17及30個月，患者均已恢復正常生活。結論 合適的病例選擇、合理的手術方案以及術中和術后規范的抗凝治療是保證門靜脈高壓分流術后人工血管長期通暢的重要因素。
ObjectiveTo explore the role of arteriovenous axillary loop graft (AVALG) on chest for establishing hemodialysis access in patients with chronic renal failure. MethodsA retrospective analysis was made on the clinical data of 12 patients with chronic renal failure who underwent an AVALG on chest for hemodialysis access between December 2010 and May 2014. There were 2 males and 10 females with an average age of 65.25 years (range, 46-75 years). The main causes were chronic glomerulonephritis in 6 cases, diabetic nephropathy in 4 cases, and both kidney resection because of urinary tract tumors in 2 cases. The disease duration was 2-12 years (mean, 6 years). The 12 patients all underwent 5-14 times (mean, 7 times) failed prior vascular accesses [arteriovenous fistula (AVF）and arteriovenous graft (AVG)] leading to exhaustion of venous access sites on the upper extremities. ResultsThe AVALG on chest were functionally useful for hemodialysis access, 2-3 times per week, and the blood flow was 250-350 mL/minute; the average time for the first dialysis was 48 days (range, 42-93 days). All patients were followed up 12-54 months (mean, 20.92 months). There was no death during perioperative period. The primary patency rates at 6 and 12 months were 91.7% and 83.3% respectively, and the secondary patency rates at 6 and 12 months were both 100%. After operation, infection (1 case), thrombosis (2 cases), bleeding (2 cases), and swollen (1 case) occurred, which were all cured after corresponding treatment. ConclusionAVALG on chest is a supplementary option for chronic renal failure patients with inadequate upper extremity venous access sites after repeat occlusion.
Objective To summarize the current progress in the genetic modification of vascular prostheses and to look forward to the future of genetic modification in vascular prostheses. Methods PubMed onl ine search with the key words of “vascular prostheses, gene” was undertaken to identify articles about the genetic modification of vascular prostheses. Then these articles were reviewed and summarized. Results To improve long-term patency of vascular prostheses, various genes were transfected into seeded cells. The antithrombosis activity of local vessels increased. Conclusion Progresses in tissue engineering and molecular biology make possible endothel ial ization and genetic modification of vascular prostheses. However, because most relevant researches are still basic experiments, further study is needed before cl inical appl ication.
Objective To understand the value of pre-coating in artificial vessel endothelialization. Methods Literature concerning precoating in artificial vessel endothelialization was extensively reviewed. Results Pre-coating included chemical coatings(collagen, fibronectin, laminin, poly-l-lysin, gelatin andextracellular matrix), pre-clotting(plasma, blood, serum and fibrin glue), chemical bonding (heparin, RGD and lectins) and surface modification. Most of them could enhance the adhesion of the endothelial cells. Conclusion Pre-coating couldimprove endothelialization, but further research is needed to search for the appropriate concentration and incubation time.
我國血管外科在布加綜合征的研究和治療、血管腔內技術、人工血管內皮化、干細胞移植治療肢體缺血等方面均達到國際水平［1，2］。現就我國血管外科的進展和特點分述如下。......
目的 總結鎖骨下動脈-頸內動脈人工血管通路輔助頸內動脈支架置入術治療復雜頸總動脈閉塞的 可行性和有效性。 方法 在同側鎖骨下動脈-頸內動脈人工血管搭橋建立腔內治療的通路后，行頸內動脈支架置 入治療復雜頸總動脈閉塞，總結其可行性。 結果 該例患者的手術時間為125 min，術中出血量為10 mL。行鎖骨 下動脈-頸內動脈人工血管通路輔助頸內動脈支架置入術后，頸內動脈血流恢復通暢。術后沒有過度灌注綜合征 及其他并發癥發生。術后6 d 患者康復出院，出院后隨訪7 個月，未再發生頭暈及頭痛。 結論 鎖骨下動脈- 頸內 動脈人工血管通路輔助頸內動脈支架置入術適用于治療復雜頸總動脈閉塞患者。