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電解可脫彈簧圈聯合微彈簧圈治療寬基底腎動脈瘤一例

腘動脈陷迫綜合征外科治療療效分析

目的探討外科治療腘動脈陷迫綜合征（popliteal artery entrapment syndrome，PAES）的療效。 方法回顧分析2006年4月－2014年4月收治的14例PAES患者臨床資料，其中男13例，女1例；年齡20～54歲，平均35.5歲。左側4例，右側9例，雙側1例。10條患肢足背動脈搏動消失，5條患肢足背動脈搏動減弱；踝肱指數0.51±0.07。病程2周～12個月，平均5.2個月。根據PAES不同診斷及分型對9例患者行腘動脈周圍異常組織松解術及腔內治療術，余5例腘動脈功能性陷迫行保守治療。 結果1例行肌切除、閉塞動脈取栓動脈成形術者，術后5 d腘動脈再次閉塞，行插管溶栓術后再通。其余患者經手術治療及保守治療后踝肱指數上升至0.93±0.22，與術前比較差異有統計學意義（t=5.634，P=0.000），跛行癥狀均緩解。14例均獲隨訪，隨訪時間5～81個月，平均29.7個月。8例行腘動脈松解術后下肢活動正常，腘動脈血流通暢；1例介入下行球囊擴張術后11個月腘動脈再狹窄，給予抗血小板、抗凝保守治療后癥狀未見反復。5例保守治療患者治療后下肢活動正常，腘動脈血流通暢。 結論PAES患者早期確診并及時外科干預能獲較好近、中期臨床療效。

EFFECTIVENESS OF COVERED Cheatham-platinum STENT FOR TREATMENT OF COARCTATION OF AORTA

ObjectiveTo evaluate the effectiveness of covered Cheatham-platinum (CP) stent for treatment of coarctation of aorta (CoA). MethodsBetween January 2007 and September 2013, 15 patients (16 lesions) with CoA underwent covered CP stent implantation, and the clinical data were analyzed retrospectively. Of 15 cases, 8 were male and 7 were female, aged 13-56 years (mean, 27.7 years). Fifteen lesions located beyond the origin of the left subdavian artery, and 1 lesion located between the origin of the left common carotid artery and the origin of the left subdavian artery. Proper covered CP stent and balloon-in-balloon (BIB) catheter were selected according to the data of computed tomography angiography or digital subtraction angiography examination. Under fluoroscopic guidance, the covered CP stent was placed at lesion accurately by expanding the inner balloon and the outer balloon sequentially. The variation of the systolic pressure gradient across the lesion and the stenosis extent of the aorta before and after the procedure were recorded. ResultsFifteen patients were all treated by covered CP stent implantation successfully. The systolic pressure gradient across the lesion decreased from (58.1±19.5) mm Hg (1 mm Hg=0.133 kPa) at preoperation to (6.2±5.6) mm Hg at immediate after CP stent implantation, and the stenosis extent of the aorta decreased from 73.8%±12.8% at preoperation to 16.7%±5.6% at immediate after CP stent implantation, all showing significant difference (t=12.483, P=0.000; t=15.631, P=0.000). All puncture points healed well with no aortic dissection, pseudoaneurysm, or obvious subcutaneous hematoma. All the patients could walk moderately within 48 hours after procedure. The average hospitalization time was 11.1 days (range, 6-18 days). During a mean follow-up of 29.7 months (range, 1-81 months), the symptom of dizziness and exercise tolerance were improved obviously, and the systolic pressures gradient between upper and lower extremity was below 20 mm Hg. The systolic and diastolic pressures at last follow-up were significantly improved when compared with preoperative values (t=7.725, P=0.000; t=3.651, P=0.000). According to radiography, the location and shape of the stent were good, and no aortic dissection, aneurysm, or recoarctation occurred. ConclusionAccording to the initial and midterm results, the covered CP stent is an effective treatment for CoA in adolescents and adults with a low rate of complication. However, long-term results still require further follow-up.

EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY

ObjectiveTo investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT). MethodsA retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually. ResultsThe surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58±9.54) mm Hg (1 mm Hg=0.133 kPa) at pre-operation to (5.50±2.39) mm Hg at immediate after operation (t=15.492, P=0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17±6.24) mm Hg and (82.67±6.51) mm Hg from (152.83±14.80) mm Hg and (94.17±11.30) mm Hg at pre-operation (t=5.751, P=0.000; t=4.976, P=0.000). ConclusionVascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.