Objective To assess clinical results of three different conduit materials （Gore-Tex synthetic graft，bovinejugular vein and autologous pericardium）for palliative right ventricle-to-pulmonary artery （RV-PA） shunt，and explore the correlation between suitable conduit size and patients’ body weight and McGoon ratio. Methods We retrospectively analyzed clinical data of 24 patients with congenital heart diseases who underwent palliative RV-PA shunt in Department of Pediatric Cardiovascular Surgery of Fu Wai Cardiovascular Hospital from July 2010 to July 2012. There were 11 males and 13 females with their age ranging from 60 days to 6 years and body weight of 10.22±7.41 kg. There were 22 patients with pulmonary atresia and ventricular septal defect （PAVSD），1 patient with tetralogy of Fallot （TOF） and 1 patient with doubleoutlet right ventricle （DORV）. Among different conduit materials，autologous pericardium was used for 17 patients，Gore-Texsynthetic graft was used for 5 patients，and bovine jugular vein was used for 2 patients. Conduit size and children’s body weight were analyzed with linear regression，then the equation was corrected with McGoon ratio. Results There was no perioperative death. Postoperative percutaneous saturation （SpO2）of the 24 children was 20.37%±28.33% higher than preoperative SpO2 . Electrocardiogram showed sinus rhythm in all the patients. Twenty-three patients were NYHA classⅡ，and 1 patient was NYHA classⅢ. Postoperative mechanical ventilation time of patients with autologous pericardium were significantly shorter than those of patients with other 2 materials （P=0.017）. Sixteen patients were followed up from 10 months to 2 years after discharge，including 12 patients with autologous pericardium，3 patients with Gore-Tex synthetic graft and 1 patient with bovine jugular vein. During follow-up，McGoon ratio of patients with autologous pericardium，Gore-Tex synthetic graft and bovine jugular vein were 1.98±0.46，1.83±0.33 and 1.68 respectively，all of which weresignificantly higher than preoperative McGoon ratio （P＜0.05）. Six patients underwent radical corrective surgery，including5 patients with autologous pericardium and 1 patient with Gore-Tex synthetic graft. There was no complication directly related to surgery during follow-up. Linear regression was performed to form an equation between suitable conduit size and patients’ body weight：conduit diameter （mm）=0.327×body weight （kg）＋4.599. McGoon ratio，conduit size and equationresult were compared to find a practical choice of conduit size. If McGoon ratio＜0.8，the first integer greater than the equation result could be chosen. If McGoon ratio＞1.2，the first integer less than the equation result could be chosen. If 1.2＞McGoon ratio＞0.8，the first integer either less or greater than the equation result could be chosen. Group analysis showed that patients who recovered better postoperatively were those whose conduit sizes were closer to equation results as well as equation results corrected with McGoon ratio. Conclusion All the 3 materials can be conventionally chosen for RV-PA shunt. Appropriate conduit size can be decided upon patients’ body weight and McGoon ratio for RV-PA shunt.
Objective To explore whether 125I-vascular endothel ial growth factor (VEGF)-coated artificial vascular patch accelerate the vessel endothel ial ization and inhibit thrombosis. Methods Ten adult male New Zealand rabbits (weighing 2.5-3.0 kg) were allocated into experimental group (n=5) and control group (n=5). In experimental group, the right common jugular vein was exposed for vascular clamping between proximal location and distal location, and then a 10 mm × 5 mm 125I-VEGF-coated artificial vascular patch was implanted into the right common jugular vein and sutured with 8-0 thread.In control group, the artificial vascular patch was implanted. After 2 weeks, the vein specimens were collected to measure the residues of 125I-VEGF by γ-ray counter. HE staining and immunohistochemical staining for smooth muscle actin (SMA) and CD34 were performed. The vascular endothel ial cells were counted and the intimal thickness was measured. Results The γ-ray counter showed the residues of 125I-VEGF in experimental group was (427.5 ± 194.9) CPM after 2 weeks, equivalent to 2.0% ± 0.8% of the preoperative value. Thrombosis formed in 2 rabbits of control group; no thrombosis formed in experimental group. There was significant difference in the intimal thickness [(41.1 ± 6.6) μm vs (49.0 ± 6.9) μm, P lt; 0.05]; but no significant difference in the vascular endothel ial cells count between experimental group and control group (60.0 ± 6.8 vs 58.0 ± 5.7, P gt; 0.05). Conclusion 125I-VEGF-coated artificial vascular patch can reduce thrombosis and inhibit intimal prol iferation at the acute phase. A consecutive l ine of endothel ial cells can form after implantation of patch in the rabbit jugular vein, however, the function of endothel ial cells may be premature.
Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
Objective To explore the method of surgical treatment and endoluminal repairs of infrarenal abdominal aortic aneurysm (AAA)so as to improve the safety of surgical treatment. Methods The information of surgical treatment was analysed restrospectively in 195 cases of infrarenal AAA treated from January 1981 to December 2004. Of the patients, 155 were males, 40 were females with a mean age of 56.5 years. The diametersof the aneurysm were larger than 5 cm in 183 patients (93.8%) and 4 to 5 cm in12 patients (6.2%). Of the 175 patients who underwent selective operation, graft replacements were performed in 139 and endovascular aneurysmal repairs in 36. Twenty patients (10.3%) suffering from aneurysm rupture were given emergency operation. Results There were 6 deaths in the patients underdingselective operation(6/175, 4.3%) and in those undergoing emergengcy surgery (6/20, 30%) respectively within 30 days. The other patients were followed up from 1 month to 21 years ( 8.7 years on average), and there were 16 deaths (8.9%) during the follow-up. Nodeath was found in the endoluminal repaired group. Endoleak occurred in 8 patients, including 5 cases of type Ⅰand 3cases of type Ⅱ. After 6 months, CT scan showed that endoleak disappeared in 6 and rernained in 2. Late type Ⅱ endoleak occurred in 1 and endoleak disappearedafter endoluminal embolization. Conclusion With improvement of vascular surgical technique and development of endogafting, the safety of AAA both on surgicaland interventional means would be improved.
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。......
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.
ObjectiveTo explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease.MethodsA retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity.ResultsAll patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis.ConclusionAlthough the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.