Open surgery is an important part of vascular surgery. For vascular surgery diseases not suitable for endovascular therapy, adjuvant methods of endovascular therapy and the ultimate means of treatment after failure, vascular graft infection, open vascular trauma, various tumors involving blood vessels, vascular reconstruction and complications of organ transplantation, iatrogenic vascular injury, and so on, open surgical procedures still need to be provided for treatment and development. This paper lists the important role that open surgery plays in supporting the treatment of vascular related diseases and the development of the discipline in surgery and internal medicine, and emphasizes that open surgery is still a necessary quality for vascular surgeons, the basis and important guarantee for the development of the discipline, and the guarantee for the timely and effective treatment of various complex and difficult vascular surgical diseases.
Objective To investigate pathogenesy and therapeutic prospect of diabetes mellitus accompanied lower limb vascular lesion. Methods Relevant literatures of recent years were reviewed. Results Diabetes mellitus is one of the main risk factor causing peripheral artery disease. The site of vascular lesion often occur in major blood vessel and micrangium. The arterial sclerosis and decreased blood supply in microcirculation are important factors of lower limb ischemia. Lower limb ischemia in patients with diabetes mellitus is a common complication. Medical treatment and surgical treatment are the methods to improve symptoms of the complication. Conclusion Surgical therapy is an effective method for the treatment of diabetes mellitus accompanied lower limb vascular lesion.
Surgical intervention for chronic thoracoabdominal aortic dissecting aneurysms (cTAADA) is regarded as one of the most challenging procedures in the field of vascular surgery. For nearly six decades, open repair predominantly utilizing prosthetic grafts has been the treatment of choice for cTAADA. With advances in minimally invasive endovascular technologies, two novel surgical approaches have emerged: total endovascular stent-graft repair and hybrid procedures combining retrograde debranching of visceral arteries with endovascular stent-graft repair (abbreviated as hybrid procedure). Although total endovascular stent-graft repair offers reduced trauma and quicker recovery, limitations persist in clinical application due to hostile anatomical requirements of the aorta, high costs, and the lack of universally available stent-graft products. Hybrid repair, integrating the minimally invasive ethos of endovascular repair with visceral artery debranching techniques, has increasingly become a significant surgical modality for managing thoracoabdominal aneurysms, especially in cases unsuitable for open surgery or total endovascular treatment due to anatomical constraints such as aortic tortuosity or narrow true lumens in dissections. Recent enhancements in hybrid surgical approaches include ongoing optimization of visceral artery reconstruction strategies based on hemodynamic analyses, and exploration of the comparative benefits of staged versus concurrent surgical interventions.
Objective To study the major postoperative complications of abdominal aortic aneurysm （AAA） repair in high-risk patients， analyze its causes， and suggest the prevention methods. Methods From January 2009 to September 2011， 57 cases of high-risk AAA patients underwent AAA repair in our hospital were analyzed retrospectively. High-risk patients were defined as age≥60 years，the American Society of Anesthesiologists grade three or four，and at least one of complications about heart， lung， and kidney. Major postoperative complications were rated， and preoperative cardiac，pulmonary， and renal condition，anesthesia and surgical impact were taken into account while evaluating the risk factors of major postoperative complications. Results Forty-one of 57 high-risk patients with AAA were repaired by endovascular repair，16 of 57 high-risk patients with AAA were repaired by traditional open surgery. The early mortality （within 30d） was 1.8% （1/57）. The major postoperative complications rate of AAA repair was 19.3% （11/57） in total，and 8.8% （5/57），8.8% （5/57），and 1.8% （1/57） for cardiac complication，pulmonary complication， and acute renal failure，respectively. The patients with coronary heart disease had a higher cardiac complication rate 〔19.0% （4/21） versus 2.8% （1/36），χ2=4.387，P＜0.05〕 ， while with hypertension had no such effect for that〔10.3% （4/39） versus 5.6% （1/18），χ2=0.340，P＞0.05〕. Patients with abnormal pulmonary function was responsible for postoperative respiratory complications 〔20.0% （4/20） versus 5.6% （1/18）， χ2=4.387， P＜0.05〕 ， while with chronic obstructive pulmonary disease history was not responsible for that 〔13.2% （5/38） versus 0 （0/19），χ2=2.740，P＞0.05〕．Patients with preoperative renal function was not related to postoperative acute renal failure 〔0 （0/4） versus 1.9% （1/53）， χ2=0.077，P＞0.05〕. Compared with traditional open surgery，endovascular repair could effectively reduce the incidence of postoperative complications 〔12.2% （5/41） versus 37.5% （6/16）， χ2=3.980，P＜0.05〕. The incidence of postoperative respiratory complications in the local anesthesia patients was less than that in the general anesthesia patients 〔0（0/20）versus 19.0% （4/21），χ2=4.221，P＜0.05〕. Conclusions Cardiac and pulmonary complications are commonly seen after AAA repair in high-risk patients．Preoperative cardiac，pulmonary condition，anesthesia and surgical aspects greatly influence the major postoperative complications. Exhaustively assessment of each system before surgery，appropriate anesthesia and surgical options，postoperative active and effective symptomatic，and supportive treatment are the key to reducing the incidence of postoperative complications.
ObjectiveTo retrospective summarize the experience of endovascular repair and open surgery in the treatment of renal aneurysms in our single center.MethodsClinical data of 24 patients with renal aneurysm treated in our hospital from August 2012 to May 2018 were analyzed retrospectively. Nine patients undergoing surgical intervention were categorized as the open operation group, and ten patients who received endovascular repair were classified as the endovascular repair group. To compare and analyze the results of the two groups. Five patients who had refused surgery therapy will be analyzed separately.ResultsTwenty-four patients with seventeen females (70.8%) and seven males (29.2%) were enrolled in this study and nineteen patients with twenty-three aneurysms got repaired successfully. The endovascular repair group had shorter hospital stay compared with the open operation group [median: 10.5 (P25 6.3, P75 15.0) d vs. 21.0 (P25 17.0, P75 27.5) d］. One patient in the open operation group developed renal artery stenosis at 11 months after surgery and underwent reoperation by repair by successful stent placement. There were no other significant postoperative complications occurred in the two groups. No abnormal enlargement or rupture of the aneurysms were observed during the follow-up period in 5 unoperated patients.ConclusionsBoth open surgery and endovascular repair are effective means of treating renal artery aneurysms. Once the renal aneurysm ruptures, serious consequences will occur. Once a renal aneurysm is diagnosed, regardless of the size of the aneurysm, active surgical treatment is recommend.
ObjectiveTo present the diagnosis and treatment of a giant retroperitoneal liposarcoma (RPLS) involving the abdominal aorta, left renal hilum, pancreas, spleen, and left hemicolon under a multidisciplinary team (MDT) model. Methods A retrospective study of the clinical data of a 34-year-old female patient with RPLS who admitted to the Department of Vascular Surgery, West China Hospital of Sichuan University in July 2024. ResultsAbdomina contrast-enhanced CT revealed a large heterogeneous mass in the retroperitoneum and abdominal cavity, with the largest cross-section measuring approximately 31.4 cm×28.4 cm. The mass demonstrated poorly defined border, pressing and encasing the pancreas, stomach, duodenum, spleen, left kidney, left adrenal gland, pancreatic body and tail. Tumor showed indistinct demarcation to adjacent intestinal canal and closely adjacent to the abdominal aorta, inferior vena cava and its major branches. After the initial MDT discussion, the patient underwent extended retroperitoneal tumor resection, combined pancreaticosplenectomy, left hemicolectomy, and repair of the abdominal aorta and left renal vessels. The tumor was completely resected, and the left kidney was successfully preserved. The procedure lasted approximately 6 h, with an estimated blood loss of 4 000 mL. The patient received 8 U suspended red blood cells and 600 mL fresh frozen plasma. One week postoperatively, the patient developed grade B pancreatic fistula, abdominal infection, jaundice, and post-splenectomy thrombocytosis (peak platelet count 1 285×109/L), all of which were effectively managed after the second MDT consultation and coordinated treatment. The patient was discharged on postoperative day 20. Pathology confirmed dedifferentiated liposarcoma, graded as Fédération Nationale des Centres de Lutte Contre le Cancer grade 3. No tumor recurrence was observed during the 3-month follow-up. ConclusionIn the management of complex giant RPLS involving critical major vessels and organs, a comprehensive MDT-guided approach, including meticulous preoperative planning, precise intraoperative manipulation and protection of organ function, systematic perioperative care, are essential to achieving successful outcomes and patient recovery.
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
ObjectiveTo summarize the diagnosis, surgical management, and outcomes of one case of complex unilateral renal artery aneurysm repaired by in situ open surgery. MethodThe clinical data of a patient with complex renal artery aneurysm admitted to the Department of General Surgery, West China Hospital of Sichuan University in December 2021 who underwent in situ open surgery were retrospectively analyzed. ResultsThe patient was a middle-aged (41 years old) female with a left renal artery aneurysm detected on physical examination. The renal artery three-dimensional CT imaging showed that the aneurysm was large in size and complex in anatomical structure; the aneurysm was located at the renal hilum, demonstrating multiple outflow tracts and close proximity to renal parenchyma and the ureter. Surgical management included in situ aneurysm resection combined with renal artery branch reconstruction and great saphenous vein bypass grafting. The operation duration was 5 h and the intraoperative urine output was 250 mL, and the intraoperative blood loss was about 400 mL. Four units of erythrocyte suspension, 200 mL of autologous recycled blood, and 400 mL of plasma were transfused during the operation. The results of the 36-month postoperative follow-up showed that the reconstructed renal arterial branches and the bridging vessel had satisfactory blood flow, and renal function was unaffected. ConclusionsThe results of this case suggest that in complex renal artery aneurysms involving multiple branches, in situ resection of the aneurysm followed by revascularization and main renal artery bypass grafting to restore flow is safe and feasible, and the long-term prognosis is good. However, it should be emphasized that the anatomy of renal artery aneurysms should be evaluated in detail preoperatively to determine the method of in situ revascularization. The results of the study also need to be further validated by larger samples and multicenter studies.
Objective To present and summarize the data concerning the diagnosis and treatment of popliteal aneurysm in our hospital. Methods The data of popliteal aneurysm in our hospital from 1975 to 2004 were reviewed and analyzed. Eleven patients with 11 diseased limbs were treated, including 8 males and 3 females, age from 21 years to 64 years 〔(48.54±13.66) years〕. The combined diseases include syphilis, rheumatic heart disease and chronic obstructire pulmonary disease etc. Ten patients received operations, including endoaneurysmorrhaphy (n=4) and graft bypass after aneurysmal resection (n=6), through posterior approach (n=7) or medial approach (n=3). One patient, combined with advanced syphilis and heart failure, received conservative treatment because of his poor general condition. Results The common clinical manifestations included popliteal pulsating mass, claudication, difficulty in extension of the knee, pain etc. Acute ischemia occurred in 3 limbs. The diameter of popliteal aneurysms varied from 4-13 cm 〔（6.73±2.69) cm〕. There were 3 (27.3%) cases of ruptured aneurysms whose diameters were 7 cm, 7 cm and 11 cm respectively. Special examinations included arteriography and Doppler sonography. Pathological results of these patients were pseudoaneurysm (n=3), syphilitic aneurysm (n=3) and atherosclerotic aneurysm (n=4). Two patients were not followed up, and postoperative follow up of the other 8 patients ranged from 18 months to 30 years. In the group of endoaneurysmorrhaphy, postoperative gangrene of the affected limb occurred in one patient, and above-knee amputation was performed. One patient suffered from intermittent claudication in the group of endoaneurysmorrhaphy and of graft bypass respectively. No manifestations of limb ischemia were found in the other 5 patients during the time of follow up. Conclusion General utilization of Doppler sonography in screening high risk patients might be helpful to detect popliteal aneurysm. For symptomatic popliteal aneurysm or asymptomatic popliteal aneurysm with diameter larger than 3 cm, operation is indicated. Asymptomatic popliteal aneurysms no more than 3 cm in diameter could be monitored with care.
Objective To present and summarize the data concerning the treatment and prognosis of acute limb arterial embolism in West China Hospital. Methods Forty three patients with 52 limbs of acute arterial embolism were treated in West China Hospital from January 2003 to March 2006. There were 15 males and 28 females, aging from 26 years to 77 years 〔(58.88±13.90) years〕. The diagnosis was based on clinical manifestations and results of color Doppler sonography or DSA. The follow-up ranged from 1 month to 39 months. The following factors, which might influence the prognosis, were analysed through multiple linear regression of SPSS 10.0: age, sex, uper limb or lower limb, location of embolus, ischemic time, clinical categories of acute limb ischemia, history of smoking, atherosclerosis and other combined diseases, pervious history of acute limb arterial embolism, operative or nonoperative treatment, and postoperative complications. Results Clinical categories of acute limb ischemia include: Ⅰ (n=0),Ⅱa (n=16), Ⅱb (n=29), Ⅲ (n=7). The ischemic time varied from 3 h to 2 weeks. The sources of embolus: heart (n=39), vessle (n=7), iatrogenic origin (n=1), unidentidied origin (n=5). The therapies included embolectomy (n=38), catheter-directed thrombolysis (n=2) and medical treatment (n=12). The following postoperative complications occured: compartment syndrome (n=12), respiratory failure (n=3), alkalolsis (n=3), acute renal failure (n=2), wound infection (n=2) and pulmonary infection (n=1). Two patients died of cerebral infarction in hospital and one patient died of heart failure 3 months after discharge. Thirty-eight patients with 45 diseased limbs were followed up. The results were excellent in 13 limbs, good in 15 ones, fair in 8 ones and poor in 9 ones. The statistically significant influencing factors of prognosis include ischemic time, clinical categories of acute limb ischemia and history of smoking (P＜0.05). Conclusion The operation of embolectomy is the main treatment of acute limb arterial embolism. In selected patients, catheter-directed thrombolysis and medical treatment could be used to alleviate the limb ischemia. The treatment against the etiological factors should not be ignored. The prognosis of this disease could be influenced by ischemic time, clinical categories of acute limb ischemia and history of smoking.