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 探讨肾病综合征并发血栓形成的外科治疗特点。方法 从笔者所在单位收治的肾病综合征并发血栓形成的患者中选取4例血栓形成部位罕见、治疗难度大的病例，对其临床资料进行分析。结果 1例在下肢深静脉血栓形成基础上发生下腔静脉血栓形成；1例腹主动脉急性血栓形成伴下肢动脉栓塞导致下肢坏疽行高位截肢；1例股动脉支架内反复血栓形成导致下肢坏疽行高位截肢；1例人工血管及下肢动脉支架内短时间内血栓形成，经干细胞移植后下肢缺血得到缓解。结论 在血栓形成的诊治过程中提高对肾病综合征的认识，针对肾病综合征患者高凝状态在围手术期进行预防性抗凝治疗，以及充分认识肾病综合征并发血栓形成抗凝治疗的特殊性，可能会降低肾病综合征患者血栓形成的发生率，提高肾病综合征并发血栓形成的外科治疗水平。
ObjectiveTo evaluate the safety and efficiency of SilverHawk plaque excision in treatment of sympto-matic infrapopliteal arterial occlusive disease (IPAD). MethodsThe clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were 29 males and 25 females. The age was (65.8±4.5) years, the period was (25.1±3.3) months. All the patients were Fontaine gradeⅡb-Ⅳ. The patients were divided into plaque excision group (n=9) and angioplasty group (n=45) according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups. Results①There were no significant differences in the gender, age, complications, ankle brachial index (ABI), outflow tract score, lesion length, and other clinical data between the 2 groups (P > 0.05).②The technical success rate had no significant difference between the plaque excision group and the angioplasty group[100% (9/9) versus 86.7% (39/45), P=0.574]. Six cases were failed because the guide wire could not pass through the diseased segment in 4 cases and there were 2 cases of serious residual stenosis in the angioplasty group.③There was no significant difference in the incidence of vascular complications between the 2 groups[11.1% (1/9) versus 11.1% (5/45), P=1.000].④The follow-up results:One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 groups (P> 0.05). The ABI and ABI average improvement also had no significant significances between the 2 groups (P > 0.05). ConclusionPlaque excision is a safe and acceptable method to treat symptomatic IPAD, and its efficacy is better than angioplasty.
ObjectiveTo evaluate efficacy and safety of treatment of Kommerell diverticulum with endovascular technique.MethodThe retrospective analysis was made on the preoperative clinical data, surgical treatment, and postoperative status of patient with Kommerell diverticulum who underwent the endovascular treatment in the Department of Vascular Surgery, Xuanwu Hospital of Capital Medical University.ResultsAccording to the different types and clinical symptoms, the effective endovascular treatment was adopted. The thoracic endovascular aortic repair and coil embolization of Kommerell diverticulum were successfully performed. The postoperative aortic blood flow was unobstructed and the aneurysmal lesion was completely isolated. No endoleakage and intracranial and upper limb ischemia were occurred. The operation time was 55 min and the blood loss was 20 mL. The patient was discharged on day 6 after the operation. No endoleakage, dizziness, and upper limb numbness were found following-up for 12 months.ConclusionFor patient with different types of Kommerell diverticulum and different symptoms, who could be treated by appropriate endovascular treatment and it is effective and safety.
Objective To explore the effective surgical approaches in treating subclavian artery occlusion. Methods Between December 2005 and February 2010, 53 patients with subclavian artery occlusion were treated, including left subclavian artery occlusion (35 cases) and stenosis (5 cases), right subclavian artery occlusion (5 cases) and stenosis (4 cases), and bilateral subclavian artery occlusion (4 cases). There were 40 males and 13 females with an average age of 64 years (range, 22-77 years), including 49 cases of arteriosclerosis obl iterans and 4 cases of aortic arteritis. The disease duration was 15 days to 20 months (6.5 months on average). In 49 patients with unilateral subclavian artery occlusion, 39 cases compl icated by carotid or / and cerebral artery lesion underwent axillo-axillary bypass grafting, and 10 cases without carotid or /and cerebral artery lesion underwent carotid-subclavian bypass grafting. Ascending aorta to bisubclavian bypass graftings were performed on 4 cases with bilateral subclavian artery occlusion. After operation, patients received routine treatment with anticoagulant and antiplatelet agents. Results The operations were successfully performed in 52 cases with a successful rate of 98.11%. Thrombogenesis at anastomotic site occurred in 1 case of aortic arteritis after 48 hours. Two cases had brachial plexus crush injury and 4 had hematoma around the bilateral anastomosis after axillo-axillary bypass grafting, and all recovered with nonoperative therapy. A total of 52 patients were followed up 1-52 months (24.5 months on average). All patients survived and the symptoms of basilar and upper l imb artery ischemia disappeared. Doppler ultrasonography showed that the blood flow was patent through anastomosis and polytetrafluoroethylene graft, and the vertebral artery flow was normal. Pseudoaneurysm at anastomosis was found in 1 case after 18 months and treated by interventional embol ization. The postoperative graft patency rate was 100% at 1 year and at 2 years. Conclusion Both thoracic and extrathoracic surgical approaches are effective for treating subclavianartery occlusion. The reasonable surgical approach should be selected according to the arteriopathy and the patient’s condition. Perioperative treatment and strict intraoperative manipulation are important to guarantee the success of surgery.
目的 总结锁骨下动脉-颈内动脉人工血管通路辅助颈内动脉支架置入术治疗复杂颈总动脉闭塞的 可行性和有效性。 方法 在同侧锁骨下动脉-颈内动脉人工血管搭桥建立腔内治疗的通路后，行颈内动脉支架置 入治疗复杂颈总动脉闭塞，总结其可行性。 结果 该例患者的手术时间为125 min，术中出血量为10 mL。行锁骨 下动脉-颈内动脉人工血管通路辅助颈内动脉支架置入术后，颈内动脉血流恢复通畅。术后没有过度灌注综合征 及其他并发症发生。术后6 d 患者康复出院，出院后随访7 个月，未再发生头晕及头痛。 结论 锁骨下动脉- 颈内 动脉人工血管通路辅助颈内动脉支架置入术适用于治疗复杂颈总动脉闭塞患者。