Objective To compare the early compl ications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the rightside in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major cl inical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local compl ications were compared between 2 groups within 7 days after operation. Results In CEA group, encephalon compl ications occurred in 3 cases (8.3%), heart compl ications in 2 cases (5.6%), and local compl ications in 5 cases (13.9%); while in CAS group, encephalon compl ications occurred in 8 cases (29.6%), heart compl ications in 1 case (3.7%), and local compl ications in 3 cases (11.1%). The encephalon compl ication ratio of CAS group was significantly higher than that of CEA group (χ2=4.855, P=0.028); and there was no significant difference in other compl ications ratios between 2 groups (P gt; 0.05). Conclusion CEA is the first choice to treat carotid artery stenosis.
ObjectiveThis study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis.MethodsThe clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system. Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy wasanalyzed.ResultsEighteen (90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was (4.2±1.4) d and (1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were (35.80±12.30) ×104 U and (45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheter-directed thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after surgery, and 2 patients had lower extremity ulcer caused by lower extremity ischemia symptoms. During the follow-up period, no lower limb necrosis, amputation, and death occurred in the remaining patients.ConclusionsThe AngioJet mechanical thrombectomy system is safe and effective. Combined with the use of catheter-directed thrombolysis and stent implantation, the AngioJet mechanical thrombectomy could lead to quick recovery of the perfusion of the lower extremity and improve the limb salvage rates, exhibiting excellent clinical value.
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。
Objective To explore the effect of endovascular treatment guided by ultrasonography combined with portosystemic shunts on the patients with Budd-Chiari Syndrome （BCS）.Methods The clinical data of 136 patients with BCS treated by balloon angioplasty and stent implantation guided by Doppler ultrasonography in our hospital from January 1995 to January 2011 were retrospectively analyzed.After balloon angioplasty,53 patients were treated by inferior vena cava （IVC） stent implantation and 31 patients with hepatic venous occlusion underwent portosystemic shunts （PSSs） at one week after endovascular treatment.The long-and short-term effects after treatment were studied.Results After endovascular procedures,the IVC pressure of patients significantly decreased （P＜0.01）,while IVC diameter, flow velocity in the lesion,and right atrial pressure of patients showed significant increase（P＜0.01）.Slight heart dysfunction appeared in 13 cases of patients.After shunting,acute pancreatitis occurred in 3 cases, and 1 patient died of upper gastrointestinal hemorrhage on the 10 d after PSSs.Doppler ultrasonography for IVC and shunt vessels showed：the swollen liver and spleen lessened on 3d after endovascular procedures.The swollen liver lessened 2-7cm （mean 5.5cm）,swollen spleen lessened 3-8cm （mean 5.8cm）, and the time of ascites disappearance was 3-60d （mean 14d）.All the patients were followed up for 1 month to 15 years with an average of 3 years.Restenosis of the distal part of stent was found in 1 patient in 2 years after operation, hepatic vein occlusion occurred in 1 case in 1 year after treatment,hepatocellular carcinoma occurred in 1 patient in 3 years after stent implantation,and 1 patient died of C type hepatitis after 1 year,and 5 out of 6 cases of patients with infertility had babies after 1 year.All patients had no stent migration or occlusion of shunts and the symptoms of portal hypertension were obviously relieved.Conclusions Endovascular treatment guided by Doppler ultrasonography is a convenient,safe,and effective method for BCS.Portosystemic shunts are commended to patients with hepatic venous occlusions.The above mentioned methods provide a feasible and effective means for IVC stenosis and short segment occlusion with hepatic vein occlusion of BCS.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
ObjectiveTo summarize the feasibility and effectiveness of endovascular treatment for vertebral artery stenosis ectopic originating from the aortic arch. MethodThe clinical data of 5 patients with vertebral artery stenosis ectopic originating from aortic arch admitted to Xuanwu Hospital of Capital Medical University from January 2020 to May 2023 were retrospectively analyzed. ResultsAll 5 patients underwent magnetic resonance angiography and CT angiography before treatment. The vertebral arteries of all patients originated from the aortic arch and were severe stenosis, with a median diameter of 1.3 mm (range, 1.1–1.5 mm) by CT angiography. All 5 patients were successfully treated with endovascular intervention. The operation time was 37–45 min, with a median of 39 min. There were no complications of vertebral artery rupture, embolism or occlusion, cerebral infarction, plaque abscission, hematoma at puncture site, pseudoaneurysm, postoperative hemorrhage, or perioperative pulmonary infection. The patients were followed-up for 13–30 months, with a median follow-up time of 20 months. The blood vessels of 5 patients remained unobstructed and no clinically significant vascular restenosis occurred. ConclusionsBased on the experiences of 5 cases of vertebral artery stenosis ectopic originating from the aortic arch, it is safe and effective to choose endovascular treatment for severe symptomatic vertebral artery stenosis. Especially, it is necessary to evaluate the stenosis degree of vertebral artery using CT angiography before treatment.
目的 探討經皮經肝穿刺膽道引流術（PTCD）聯合膽道支架置入術治療惡性梗阻性黃疸的操作技巧及其臨床應用價值。方法 2009年8月至2011年5月期間中國醫科大學附屬第四醫院介入科對39例惡性梗阻性黃疸患者施行了PTCD聯合膽道支架置入術，對其臨床資料和效果進行回顧性分析。結果 39例患者全部穿刺成功，穿刺成功率為100％。穿刺左葉膽管11例，穿刺右葉膽管19例，左右膽管均行穿刺9例；單純外引流22例，內外引流17例；引流管保留7～14d后均成功行膽道支架置入術。 33例患者自覺癥狀有緩解。患者術后14d時，其白蛋白、堿性磷酸酶、丙氨酸轉氨酶、總膽紅素、直接膽紅素和間接膽紅素水平均較術前降低（P＜0.05）。術后發生膽道感染3例（7.69％），發生急性胰腺炎4例（10.26％），發生支架脫落移位1例（2.56％），無膽汁性腹膜炎等并發癥發生。本組32例患者獲訪，隨訪時間為8d～16.5個月，平均9.4個月。隨訪期間，27例患者死于腫瘤進展及多臟器功能衰竭；5例患者存活，無黃疸加重癥狀。結論 PTCD聯合膽道支架置入術是一種姑息治療惡性梗阻性黃疸的有效方法，具有簡便、有效、安全、可重復性等優點，但需注意其適應證的選擇和并發癥的預防。
Objective To analyze the influencing factors of short-term curative effect and long-term survival time of patients with tumor-induced malignant central airway obstruction (MCAO) after airway stent implantation. Methods A total of 120 patients with tumor-induced MCAO who underwent airway stent implantation in the hospital from January 2017 to June 2019 were enrolled. According to the cause of stenosis, the patients were divided into two groups: external pressure stenosis group (n=72) and non-external pressure stenosis group (n=48). The general data such as types and staging of tumor, differentiation degree, sites of airway obstruction, obstruction degree and preoperative level of lactate dehydrogenase (LDH). Before and at 7d after stent implantation, partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2) and saturation of arterial blood oxygen (SaO2) were detected. Before and at 1 month after stent implantation, diameter at airway obstruction segment, degree of airway obstruction and forced expiratory volume in the first second (FEV1) were detected. Dyspnea index (DI) and scores of Karnofsky performance status (KPS) were evaluated. The survival status at 1 year after surgery was followed up. The survival at 1 year after surgery was analyzed by Kaplan-Meier. The influencing factors of survival after stent implantation were analyzed by COX proportional hazard regression analysis. Results After stent implantation, PaO2, SaO2, diameter at airway obstruction segment, FEV1 and KPS score were significantly increased (P<0.05), while PaCO2, degree of airway obstruction and DI were significantly decreased in external pressure stenosis group and non-external pressure stenosis group (P<0.05). After stent implantation, the KPS score was significantly higher in external pressure stenosis group than that in non-external pressure stenosis group, and the shortness of breath index was significantly lower than that in non-external pressure stenosis group (P<0.05). The survival rate of patients with external pressure stenosis group was 29.17%, and the median survival time was 7.35 months, the survival rate and median survival time in non-external pressure stenosis group was 22.92%, and the median survival time was 6.10 months, and there was no significant difference between the two groups (log-rank χ2=1.542, P=0.214). COX proportional hazard regression analysis showed that tumor staging at stage IV (OR=2.056, P=0.020), preoperative KPS score lower than 50 points (OR=2.002, P=0.027) and no postoperative chemoradiotherapy (OR=4.292, P=0.039) were independent influencing factors of 1-year survival time after stent implantation in MCAO patients. Conclusions The clinical curative effect of airway stent implantation is good on patients with tumor-induced MCAO. Tumor staging at stage IV, preoperative KPS score lower than 50 points and no postoperative chemoradiotherapy are risk factors that affect survival time.