Objective To determine the clinical effect of sequence and cross bypass or combined with endovascular procedure for mutilevelarterial occlusive disease of lower extremity so as to investigate the credibletreatment for mutilevel arterial occlusive disease of lower extremity. Methods Between April 2004 and July 2005， 11 patients （14 limbs）underwent sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure. Among of them, 10 cases were male and 1 case was female, aging 62-79 years(mean 70.5 years), and including 8 cases of intermittent claudications (Fontaine stage Ⅱ), 3 cases of rest pain (Fontaine stage Ⅲ) and 1 case of toe ulcerwith gangrene (Fontaine stage Ⅳ). Colour Doppler ultrasonography showed that 14 lower limbswere diagnosed as having multilevel arterial occlusive disease and the preoperation and ankle brachial index(ABI) was 0.36±0.11 . Lower limb digital subtraction angiography(DSA) showed 3 cases of bilateral iliac artery stenosis，extrailiac artery occlusion and bilateral superficial femoral artery occlusions，1 case of right common iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions and 8 cases of unilateral extrailiac artery stenosis and superficial femoral artery occlusions. Postoperation tests of DSA,colour Doppler ultrasonography and ABI were done to observe cumulative patency rate after operation. Results The follow-up period was from 3 to 26 months(mean 14.5 months ). All patients survived. The symptoms of intermittent claudication and rest pain disappeard in all patients. ABI was improved by0.89±0.13 after procedure（Ｐlt;0.01）. The overall salvage rate of limb was 100%. DSA was performed from 3 to 280 days after operation, the overall primary graft patency rate was 92.86%（13/14）.Conclusion Sequence and cross bypass， thromboendarterectomy or combined with endovascular procedure in treatment of mutilevel occlusive disease of lower extremity was effective, less invasive and safe.
ObjectiveTo explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease.MethodsA retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity.ResultsAll patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis.ConclusionAlthough the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.