Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
Objective To study the feasibility of transplanting human saphanous vein endothelial cells to luminal surface of blood vessel prosthesis and to play a theoretical foundation for the clinical application of autologous endothelial cell transplantation. Methods Human saphanous vein endothelial cells were harvested with 0.1% collagenase and cultivated in vitro for 13.08±1.24 days. The cultures were confirmed as endothelial cells with the fourescent linked anti-Ⅷ antigen antibodies. The content of both 6-keto-PGF1α and Von Willebrand factor (vWF) in the supernatant were detected with ELISA and radioimmunoassay. The multiplied cells were lined in vitro onto the luminal surface of expanded polytetraflouroethylene (ePTFE) grafts precoated with fibrin glue and fibronectin, then cultivated again for 9 days. Results 11.46±2.69×１０６ of available endothelial cells could be regularly obtained, the number of endothelial cells increased 147.93±88.68 times when culture were terminated. All the cells diploid cells with a purity of 99%. The content of both 6-keto-PGF1α and vWF in the media showed no significant difference between the primary and subculture passages. The luminal surface of grafts was covered completely by a spindlelike endothelial monolayer and an even fibrin glue matrix could be seen underneath. Conclusion Endothelial cells derived from human saphanous veins might be feasible to be transplanted onto the luminal surface of ePTFE and present a potential clinical application.
Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.
ObjectiveTo summarize our experience of surgical treatment for right pulmonary artery originated from the ascending aorta by using adult diameter artificial vascular and study the operative indication, design, method, and therapeutic efficacy. MethodsWe retrospectively analyzed clinical data of 11 patients with right pulmonary artery originated from ascending aorta in The Second Affiliated Hospital of Harbin Medical University from May 2008 through December 2013, who were treated by using adult diameter artificial vascular. The patients ranged from 4 months to 25 months old, weighted 4-15 kg. Among of them, 4 patients had persistent truncus arteriosus and 7 had aortopulmonary septal defect. All patients were complicated with moderate pulmonary hypertension. All the patients underwent one stage surgical repair under extracorporeal circulation and cardiac arrest. During the surgery, end to side anastomosis was done between the right pulmonary artery and 16-18 mm diameter artificial blood vessels. And artificial blood vessel was connected to the main pulmonary artery or right ventricle outflow tract incision from the aorta above. ResultsThe average operation time was 179-325 (224±68) min. The average cardiopulmonary bypass (CPB) time was 81-208 (117±54) min. The average aortic clamping time was 29-63(42±21) min. The mean residence time in ICU was 71-197 (109±42) hours. The average assisted mechanical ventilator time was 59-191 (91±26) hours. The average length of stay in hospital was 21-39 (28±11) days. Low cardiac output syndromes caused by pulmonary arterial hypertension occurred in 5 patients including 2 deaths and 3 patients with good recovery by reducing the pulmonary arterial pressure and peritoneal dialysis. The result of postoperative cardiac color ultrasound examination of 9 survival patients showed vascular prosthesis, no distortion, no stenosis of the anastomosis, deformity correction satisfaction. Nine patients were followed up for 3-60 months. The results of echocardiography showed no anastomosis and artificial vascular stenosis, and the pulmonary arterial pressure decreased significantly. ConclusionThe right pulmonary artery originated from the ascending aorta in children should be operated as soon as possible. Compared the adult diameter artificial vascular treatment for one stage repair of right pulmonary artery from the ascending aorta with other operation methods, both short-term and long-term effects are good. Postoperative low cardiac output syndrome is a common complication.
Objective To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak. Methods Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary. Results Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement. Conclusion The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.
Objective To study the effect of preparation conditions for small-diameter polyurethane(PU) vascular graft on microstructure and mechanical properties. Methods The small-diameter microporous PU artificial vascular grafts were prepared by dipping and leaching method. The dimension and microstructure were controlled by changing mold diameter, PU materials, salt sizes, salt to polymer ratio, times of dipping layers etc. The mechanical properties of PU grafts including radical compliance, water permeability, longitudinal strength, burst strength, and suture tearing strength were measured and the effect of the graft dimension and microstructure on their properties were studied. Results The internal diameter of grafts prepared was 2-4 mm depending on mold diameter. The wall thickness was 0.6-1.2 mmafter dipping 4-8 layers. The density was 0.23-0.49 g/cm3. The pore was 42-95 μm in diameter. The porosity was 56%80%. The radical compliance was 1.2%-7.4%·13.3 kPa-1 and higher compliances could be obtained by using moreelastic polyurethane, higher salt to polymer ratio, longer diameter and less wall thickness. The water permeability, mainly depending on salt to polymer ratio,diameter, and wall thickness, was 0.29-12.44 g／(cm2·min). The longitudinal strength was 1.55-4.36 MPa correlating with tensile strength of polyurethane and salt to polymer ratio. The burst strength was 60-300 kPa also depending on tensile strength of polyurethane and salt to polymer ratio. The suture tearing strength was 19.5-96.2 N／cm2 depending on tensile strength of polyurethanebut not on the angle of tearing and graft axial directions. The compliance and water permeability of Chronoflex grafts were higher than those of PCU1500 grafts, but longitudinal strength, burst strength, and suture tearing strength of PCU1500 grafts were better than those of Chronoflex grafts. Conclusion Small-diameter grafts with proper pore sizes, porosity, matching compliance can be obtained by selecting PU materials and optimizing the preparation conditions.
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To select levorotatory polylactic acid (PLLA) and polycaprolactone (PCL) as the main materials, use electrostatic spinning and ultrasonic broaching processing technique to prepare a similar to natural vascular diameter gradient structure of large diameter artificial blood vessels, and evaluate its potential applications. Methods Using PLLA and PCL as raw materials, through the electrospinning process, using core shafts of different diameters as collection devices, artificial vascular materials with a natural-like structure were constructed. Using end to end anastomosis method to experimental pig thoracic descending aorta replacement of artificial blood vessels. Results Computed tomography angiography (CTA) results showed that the artificial vascular graft was patent at 1 week and 6 weeks after operation. Animal experimental pathology examination revealed, artificial blood vessels unobstructed, the lining of endothelial cells, and elastic fiber, roughly three layer structure formed similar natural aorta. Artificial blood vessel wall visible elastic fibers, elastic fibers and collagen fibers with natural blood vessels distribution was similar. Immunohistochemical examination showed that the artificial blood vessels had a strong immune response to ERG staining, Actin staining, and Vementin staining. Scanning electron microscopy showed that endothelial cells were formed in the inner layer of the artificial blood vessel. Conclusion PLLA and photo as raw material, the use of electrostatic spinning and ultrasonic reaming technology preparation of large diameter artificial blood vessels, imitation of natural structure may have potential good flow resistance, good endothelial and may have induced in-situ natural function of angiogenesis.