Objective To explore the methods of hepatic artery reconst ruction with iliac arterial interpositiongraf t in orthotopic liver t ransplantation (OL T) and influential factor of relevant complications postoperatively.Methods Analyzed ret rospectively 8 OL T , the hepatic artery reconst ruction with arterial inflow based on recipientinf rarenal aorta using donor iliac artery graf t tunneled through the t ransverse mesocolon and pancreas. Results Thetime required for hepatic artery reconst ruction with iliac arterial interposition graf t was 52 - 126 minutes. Amongthe 8 patient s , 2 patient s developed postoperative bililary t ract complications , 1 with biliary fistula , 1 with int rahepatic biloma , the others were recovered smoothly and liver function returned to normal about one week af ter livert ransplantation. No complications of hepatic artery were observed. Conclusion Iliac arterial interpositional graft is aneffective and reliable method of revascularization in liver transplantation when the use of hepatic artery is not possible.
ObjectiveTo discuss the risk factors of type Ⅱ endoleak after endovascular aneurysm repair(EVAR). MethodsThe clinical data of 197 cases of abdominal aortic aneurysm who underwent EVAR in our hospital from Jan. 2006 to Mar. 2011 were analyzed retrospectively, and risk factors of type Ⅱ endoleak were explored by logistic regression. ResultsOf the 197 cases, 18 cases suffered from type Ⅱ endoleak. Result of logistic regression showed that the risk of type Ⅱ endoleak increased per 1 of the increase of lumbar artery number(OR=1.822, P=0.010) and per 1 mm of the increase of lumbar artery diameter(OR=1.256, P=0.040). All of the cases were followed up for 1-36 months(median value of 16.8 months). Only 1 case was intervened by inferior mesenteric artery embolism for the growth rate larger than 5 mm during half a year, who was not found growth of diameter after the embolism. The type Ⅱ endoleaks of other 17 cases closed ultimately or keeping stable. ConclusionsType Ⅱ endoleak after EVAR is affected by the number and diameter of lumbar artery. Persistent type Ⅱ endoleak without enlargement of diameter of aneurysm sac needs to beclosely followed-up instead of re-intervention.
ObjectiveTo investigate the therapeutic effect of endovascular therapy for TASC-ⅡC/D lesion of iliac artery occlusion. MethodThe clinical data of 25 patients (28 limbs) who underwent endovascular therapy for TASC-ⅡC/D lesions of iliac artery occlusion were reviewed retrospectively. ResultsTwo limbs failed to recanalize the occlusions, recanalization rate was 92.86%. Twenty-six iliac arteries were successfully treated by percutaneous transluminal angioplasty and implanted stent. The ankle-brachial index increased from preoperative 0.23±0.18 to postoperative 0.76 ±0.19 (P < 0.05). Two patients had hematomas in puncture point, which were improved by conservative treatment. One patient had thrombosis in stent, which was disappeared by local thromblysis after thrombolytic catheter placement. Twenty patients (24 iliac arteries) were followed up for a mean time of 8 months (3-24 months). The follow-up rate was 85.71%. The limb patency rates of 6 months, 1-and 2-year was 85%, 80% and 73%, respectively. ConclusionEndovascular therapy for TASC-ⅡC/D lesion of iliac artery occlusion is safe and has a good short-term therapeutic effect, microtrauma and little complications.
ObjectiveTo evaluate short and medium term results of nitinol self-expending stent (LifeStent) implantation for iliac arteriosclerosis obliteran. MethodsThe clinical data of 75 limbs iliac artery occlusions in 64 patients from June 2011 to June 2014 in this hospital were analyzed retrospectively. The postoperative ankle brachial index (ABI), limb salvage rate, primary and secondary patency rate, and postoperative complications were evaluated. ResultsThere were 75 limbs iliac artery occlusions in 64 patients (54 males and 10 females), 11 lesions were type A of TASCⅡ, 26 lesions were type B of TASCⅡ, 29 lesions were type C of TASCⅡ, 9 lesions were type D of TASCⅡ. The postoperative ABI was significantly higher than that preoperative ABI (0.94±0.16 versus 0.29±0.20, t=-24.7, P < 0.01). The following-up time was (22±10) months, 5 patients were lost to follow-up. In 12 and 24 months after surgery, the cumulative primary patency rates were 79% and 60%, respectively, the cumulative second patency rates were 91% and 84%, respectively, the limb salvage rates were 96% and 94%, respectively. Complications occurred in 5 patients (7.8%). There was no severe complications and inhospital mortality. ConclusionClinical efficacy of short and medium term is satisfactory by nitinol self-expending stents implantation (LifeStent) for iliac arteriosclerosis obliteran, but long term efficacy remains to be further studied.