目的 总结颈动脉损伤患者救治的临床经验。 方法 2003年1月－2006年6月，抢救5例颈动脉损伤患者。男3例，女2例；年龄21～35岁。其中左右颈总动脉各1例，左锁骨下动脉2例，左椎动脉1例。合并损伤：左颈内静脉贯通伤1例，左胸导管及交感神经损伤1例，食道损伤1例，左锁骨骨折1例。受伤至入院时间20 min～3个月。受伤原因：刀刺伤3例，误食缝衣针伴感染1例，车祸伤1例。采用血管吻合修复颈总动脉及椎动脉3根、侧壁修补修复左锁骨下动脉1根、左颈内静脉1根及自体血管移植术修复左锁骨下动脉1根。术中输血量1 000～11 000 mL,平均3 800 mL。 结果 所有患者均抢救成功，伤口Ⅰ期愈合，经1～3年随访，无神经功能障碍。 结论 颈动脉损伤救治成功的关键在于尽早做出诊断，快速有效的急救及选择正确的治疗方法。
Objective To develope a novel rabbit carotid body and carotid common artery model in vivo for the simulation of various intermittent hypoxia ( IH) intensities, IH durations, IH reoxygenation ( ROX) durations and continuous hypoxia ( CH) modes. Methods Forty-five adult New Zealand rabbits ( 2. 5-3. 0 kg) were anesthetized while spontaneous breathing kept intact. The tissue surrounding the right carotid common artery and carotid sinus nerve ( CSN) were cleared and " single" chemoreceptor bundle of the CSN was revealed. Then suction electrodes were placed and CSN afferent activity was monitored and recorded carefully. The right common carotid artery was exposed, cannulated to distal part and its proximal part was ligated. Preparations were challenged by changing the PO2 of the gas mixture equilibrating the perfusate. Alternatively perfusion ( 2 mL/min) of equilibrated perfusate bubbled with normoxia or hypoxia gas mixtures formed IH/ROX cycles in carotid common artery, simulating the pattern of hypoxic episodes seen in obstructive sleep apnea syndrome ( OSAS) , or with continuously perfusing hypoxia perfusate to form CH modes. All the perfusing procedures were regulated by a customized computer-controlled set and monitored using O2 gas analyzer. After the systematic exposures, carotid body, carotid common artery part distal to cannula, and carotid bifurcation were harvested as samples. Results The frequencies and average amplitudes of CSN chemoreceptor bundles afferent activities with normoxia perfusion were ( 0. 17 ±0. 03) impulse/ s and ( 46. 2 ±4. 4) μV, and with hypoxia perfusion were ( 0. 64 ±0. 09) impulse/ s and ( 87. 4 ±6. 6) μV, respectively. PO2 was ( 139 ±1. 5) mm Hg in normoxia perfusate and ( 35. 2 ±1. 3) mm Hg in hypoxia perfusate. Conclusion This new carotid body and carotid common arterymodel is a valuable tool to study neurological and biochemical changes in various IH and CH modes.
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。
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.
ObjectiveTo achieve a better early clinical result by modifying the total arch replacement and optimi-zing the procedure of operation. MethodWe retrospectively analyzed the clinical data of 38 patients patients with stanford a aortic dissection underwent the modifed total arch replacement in our hospital from September to December 2014. There were 26 males and 12 females with a mean age of 52.5 years ranging from 21-76 years. Three artery conduits were adopted during the surgical procedure. Right axillary artery and femoral artery cannulation were performed for cardiopulmonary bypass. The artificial graft and the left common carotid artery was anastomosed to provide simultaneous perfusion. Low rate bilateral brain perfusion began when circulation arrested at 26℃. Reperfusion restoration was obtained after the four-branch vascular graft anastomosed to the stent and aortic wall and completed the implantation of the elephant trunk. Then the aortic root and the vascular graft anastomosis were performed to reconstruct the ascending aorta. At last, the left subclavian artery and innominate artery were anastomosed to the branch of the vascular graft under the beating heart. ResultAll 38 operations were successful. The mean hypothermic circulatory time of the whole group was 18.8±4.2 min, the time of ascending aorta blocking was 86.1±14.2 min, the time of cardiopulmonary bypass was 178.4±71.4 min, the time of postoperative awakening was 4.7±2.0 h, the time of assisted mechanical ventilator was 38.7±19.9 h. One patient died because of multiple organ dysfunction syndrome (MODS), 3 patients accepted the hemodialysis, 6 patients suffered from transient neurological dysfunction, 1 patient suffered from paraparesis. There was no further complication during the follow-up of 1-3 months. ConclusionThe modified total aortic arch replacement can shorten the circulatory arrest time, cardiac arrest time and cardiopulmonary time, provide effective organ perfusion, and reduce the neurological complication and visceral damage.
Objective To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Methods The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one. Results There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of the anastomotic site between the left subclavian artery and the left common carotid artery. Conclusion Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.
ObjectiveTo investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention.MethodsA retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.ResultsAll patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened.ConclusionSCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.
ObjectiveTo investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery.MethodsA retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years.ResultsThe operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention.ConclusionModified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.
Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P＞0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.