目的 探討四肢動脈損傷的診斷和治療方法。方法 回顧分析我院1996年1月至2006年7月共診治的23例四肢動脈損傷患者的臨床資料。分別采用直接動脈修補、動脈結扎、端端吻合、自體大隱靜脈移植及人工血管吻合。術中取栓6例,合并靜脈損傷修復8例。結果 截肢3例（13.0%）。獲得隨訪12例，隨訪時間3個月~5年，11例多普勒超聲證實損傷血管血流通暢，下肢肌肉攣縮1例； 下肢血供不足1例。結論 早期診斷是提高肢體存活率和避免假性動脈瘤發生的關鍵。手術方式的合理選擇、Fogarty導管常規取栓和早期筋膜切開可提高治愈率。
Objective To evaluate the effectiveness and safety of surgical thrombectomy for acute deep venous thrombosis of lower extremities. Methods Randomized controlled trials of surgery versus conservative treatment were sought from MEDLINE (1966-Jun.2006), EMbase (1974-Jun.2006), The Cochrane Library (Issue 2, 2006), CBM (1989-Jun. 2006) and CMCC (1994-Jun. 2006). Collections of Chinese Congress on Vascular Surgery (1991-Jun.2006) and the journal of Vascular Surgery (2000-Jun. 2006) were handsearched. Two reviewers independently extracted data into a designed extraction form. The guidance in The Cochrane Collaboration’s Handbook was consulted for quality evaluation and data analysis. Results Six potentially eligible studies were identified. Six were included according to the inclusion criteria. The 6-month total patency was significantly higher in the surgical treatment group than in the conservative treatment group with OR 7.26 and 95%CI 2.40 to 21.94, while the 5-year total patency was not different between the two groups with OR 2.59 and 95%CI 0.88 to 7.67. At month 6 and year 5, the incidence of post-thrombosis syndrome (PTS) was significantly higher in the conservative treatment group than in the surgical treatment group with OR 0.11, 95%CI 0.59 to 1.59, OR0.18, 95%CI 0.06 to 0.60 respectively. The incidence of 10-year PTS and the results of valvular function measurements were similar between the two groups. The incidence of pulmonary thrombosis was also comparable between the two groups with OR 1.40 and 95%CI 0.39 to 4.97. Conclusion Surgical thrombectomy may improve the extent of patency and venous valvular sufficiency in the short term, but without increasing the patency rate. There is no enough evidence to assess whether surgical throbectomy improves long-term outcomes. It is safe to preform surgical thrombectomy. The small number of patients randomised and the low quality of the trials decreases the reliability of the current evidence. Therefore, more high quality randomised controlled studies should be done, to determine the long-term outcomes of surgical thrombectomy.
Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.
Objective To discuss the early diagnosis and surgery of intestinal necrosis caused by superior mesenteric venous thrombosis （SMVT）. Methords The clinical data of 32 patients with intestinal necrosis caused by SMVT were reviewed retrospectively and analyzed, which included 6 cases of primary SMVT, 26 cases of secondary SMVT, 9 cases with pylethrombosis, 24 patients had been dignosed definitely as SMVT by imageology examination before surgery. All the patients accepted surgery therapy, within which 9 patients accepted Fogarty catheter, and anticoagulation and thrombolytic therapy were administrated postoperatively. Results All patients had recovered except for one with short bowel syndromle and one died. Conclusions SMVT is a rarely ischemic intestinal disease, which has complicated pathogenesis and difficulty in early diagnosis. Intestinal necrosis often occurs as a result of delayed treatment and the effective way is to cut off necrotic intestines in time. Intra-and postoperative anticoagulation and thrombolytic therapy could reduce recurrency effectively.
ObjectivesTo review the efficacy and safety of mechanical thrombectomy in patients with cerebral venous sinus thrombosis (CVST).MethodsWe searched The Cochrane Library, PubMed, EBSCO, Web of Science, CBM, CNKI and VIP databases to collect studies on mechanical thrombectomy in CVST patients from inception to April, 2018. Two reviewers independently screened literature, extracted the data and qualitative analysis of the included studies.ResultsA total of 33 studies including 552 patients were included for data analysis. Specifically, 157 (30%) patients had a focal neurological deficit, 145 (28%) patients had a pretreatment intracerebral hemorrhage or infarct, and 152 (29%) patients were stuporous or comatose. Wire was the most commonly used device. Overall, 483 (88%) patients had good outcome, while 35 (6%) patients deceased. Moreover, 333 (65%) patients had complete recanalization, 148 (29%) patients had partial recanalization, and 14 (2.5%) patients had worsen or new intracranial hemorrhage.Conclusions?The current evidence suggests that mechanical thrombectomy is reasonably safe in the majority of cases. Due to limited quality and quantity of included studies, more high quality studies are required to verify above studies.
Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.
Endovascular treatment for acute ischemic stroke has become the main therapy for large vessel occlusion. In addition to stent thrombectomy, in recent years, the application of aspiration thrombectomy is becoming more and more common. The physical principles of aspiration and stent thrombectomy extraction are different. The thrombus is captured by the negative pressure generated by suction through the contact between the reperfusion catheter and the thrombus, thus achieving cerebrovascular recanalization. Currently, more and more researches support the application of aspiration thrombectomy. What are the advantages and disadvantages of the aspiration thrombectomy compared with the stent thrombectomy and how to apply the aspiration technology reasonably are the hot issues concerned by everyone. This paper reviews the application and research progress of aspirating thrombectomy in order to provide reference for clinical treatment decisions.
ObjectivesTo systematically review the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) on the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages from inception to August, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 13 studies involving 2 995 patients were included. The results of meta-analysis showed that compared with the control group, patients aged 80 and above had no statistically significant difference in reperfusion success rates (OR=0.90, 95%CI 0.71 to 1.14, P=0.378), and incidence of symptomatic intracranial hemorrhage (OR=1.30, 95%CI 0.86 to 1.94, P=0.212), however, with higher incidence of arbitrary intracranial bleeding events (OR=1.61, 95%CI 1.28 to 2.04, P<0.001), 3-month mortality (OR=2.14, 95%CI 1.73 to 2.64, P<0.001) and lower good functional prognosis rate at 3 months (OR=0.46, 95%CI 0.30 to 0.71, P<0.001).ConclusionsCurrent evidence suggests that people aged 80 and above can obtain effective perfusion through mechanical thrombectomy, however, the incidence of postoperative adverse outcome events is higher and the prognosis is relatively poor. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Stroke is a disease that seriously affects the quality of life of patients. Its main characteristics are that the incidence rate is increasing year by year, the risk of death is high, and the prognosis of the disease is poor. For patients with acute cerebral artery occlusive ischemic stroke, intravenous thrombolysis alone has a low recanalization rate and poor long-term prognosis. With the development of interventional treatment technology for cerebrovascular disease, intravascular interventional treatment methods such as arterial thrombolysis, stent placement, and mechanical thrombectomy are more and more applied in the ultra-early stage of acute ischemic stroke. This article reviews the progress of mechanical thrombectomy in the treatment of cerebral artery occlusion in patients with acute ischemic stroke.
Objective To summarize the clinical outcome of combined operation for patients with Cockett syndrome complicated with acute symptomatic deep venous thrombosis （DVT）. Methods From October 2008 to March 2012， a total of 23 patients （male 8 cases and female 15 cases；mean age 59.3 years old， range 36-76 years old） with Cockett syndrome complicated with acute symptomatic DVT were underwent combined surgical venous thrombectomy and endovascular stenting in ipisilateral iliac vein in our hospital. All the patients were underwent duplex ultrasonography for diagnosis of DVT. The location of thrombosis in the left iliofemoral vein was 21 cases， right iliofemoral vein was 2 cases. The affected limb of all the patients were severely swell and pain. The mean time of symptomatic DVT occurring at operation was 2.53d. All the operations were performed under general anesthesia. The inferior vena cava filter was inserted before thrombectomy， iliac vein compression was diagnosed by angiography and treated with self-expandable stent after thrombectomy. Twenty-eight self-expandable stents were placed successfully. Results In all the cases， the procedural successful rate was 100%， the 30-day mortality rate was 0. One case suffered from hematoma at incision after operation. Median follow-up was 11.7 months （range 3-26 months）. There was no case of rethrombosis. Symptoms were disappeared in 21 cases， the leg slightly swelled in 2 patients. Conclusion Combined surgical thrombectomy and endovascular treatment for patients with Cockett syndrome complicated with acute symptomatic DVT is an effective and safe technique with low morbidity and good clinical results.