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1.
Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.
Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.
Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to  相似文献   

2.
The extracranial-intracranial (EC-IC) bypass surgery has been widely used in the treatment of cerebral ischemia,intracranial aneurysms,and other diseases for more than 40 years.In terms of treating atherosclerotic cerebral ischemia,the surgery is presumed to be helpful for the subgroup of hemodynamic compromise in prevention of subsequent stroke.However,two multicenter trials presented with high perioperative stroke rate and failed to demonstrate the profit of the surgery.1-3 On this point,one of the crucial issues currently is how to lower down the perioperative stroke rate,the centerpiece of which is early postoperative infarction (EPI).3  相似文献   

3.
Background Compared with traditional arthrotomy procedures, arthroscopic treatment for osteochondral lesions of the talus has some advantages. However, there has been considerable debate about the outcome predictors for this surgical technique. This study aimed to investigate the outcomes of arthroscopic treatment for osteochondral lesions of the talus, and analyze its outcome predictors. Methods Clinical data of 48 patients with osteochondral lesions of the talus who underwent ankle arthroscopy were studied. Arthroscopic debridement was performed on all patients, and microfracture was also performed in 36 cases. Scores on a subjective satisfaction questionnaire, visual analog scale (VAS) for pain, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores were obtained before and after surgery. Results Five patients lost to follow up. The other forty-three patients, 8 of whom were athletes, were followed up for an average of 23.9 months. The average AOFAS post-operative score was 90.16±9.96, compared with 70.81±6.96 before surgery (t=9.353, P 〈0.001). The VAS pain score after the operation (2.51±2.45) was significantly lower than that before the operation (6.95±.40) (t=8.647, P 〈0.001 ). Of the 43 patients, 35 (81.4%) had good or excellent results. There was no significant difference in outcome between the medial and lateral groups (z=0.205, P=0.838), while a better outcome was found with lesions smaller than 10 mm than those with larger lesions (z=2.199, P=0.028). Age, sex, athletic profession and location of the lesion did not significantly correlate with outcomes. Conclusions Arthroscopic treatment is effective and safe for osteochondral lesions of the talus. A strong correlation was found between the size of the lesion and successful outcome.  相似文献   

4.
Background The patients with unprotected left main coronary artery (ULMCA) stenosis and chronic total occlusion (CTO) lesions at the left anterior descending (LAD) artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO. Methods From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients (7.7%) refused surgery due to their young age (S40 years), and the other 72 patients (92.3%) were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age (〉80 years), chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE ≥6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex. Results Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients (6.4%) experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up ((52±28) months), there were 3 cardiac deaths (3.8%) and 4 (5.1%) nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients (64.1%), and target vessel revascularizations were required in 10 patients (12.8%), among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% (13/78).Conclusions This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.  相似文献   

5.
The interventional radiology in China took off in early 80's. Even with a late start, it has nevertheless made a tremendous progress in the past 15 years in areas such as basic research, diagnostic technology as well as the related equipment and devices. Interventional therapy, more significantly has gained national and international recognition due to its successful treatment of multi-large series of cases with excellent to good results. Among those are interventional tumor therapy especially chemo-embolization of advanced hepatocellular carcinoma; transjugular intrahepatic portosystemic stent shunt (TIPSS); the interventional therapy of Budd-Chiari Syndrome; bronchial arterial infusion/embolization in the treatment of lung cancer and massive hemoptysis; percutaneous transluminal valvuloplasty (PTV) in the treatment of mitral and pulmonary stenosis; percutaneous transluminal coronary angioplasty (PTCA) and stent placement; and the interventional management of cerebral vascular disorders like arteriovenous malformation (AVM).  相似文献   

6.
Takayasu arteritis (TA) is a chronic progressive nonspecific vasculitis that involves the aorta and itsmain branches, resulting in luminal stenosis in the large vessels. Steroid therapy is the foundation for TA treatment and the guarantee of surgery. When a patient presents with uncontrolled symptoms, surgical treatment is the only measure that may be adopted to prevent greater risk to life. However, surgical repair for extensive arteriopathy requires an ingenious design to avoid morbidity in response to the complexity of the pathophysiology of TA. A 41-year-old woman presented with pulselessness, recurrent dizziness, and visual disturbance for the past 23 years. The patient had been diagnosed with TA 13 years ago and had received steroid therapy. However, the symptoms of dizziness and visual disturbance had increased in intensity and duration over the last 2 years. Upon admission, physical examination revealed that pulse in both arms were absent. Her blood pressure was 98/63 mmHg (1 mmHg=0.133 kPa) in the left arm,  相似文献   

7.
Objective To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. Results At the follow-up examination 116 of the 158 patients were available and 36(31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery(OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function(P=0.11) or quality of life scores(P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need(50.0%), feeling of being "too old"(19.2%), and worry about the quality of surgery(9.6%). Cost was cited by 1(1.9%) subject as the main reason for not seeking surgery.Conclusions The data suggest that in China’s capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people’s perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.  相似文献   

8.
Objective: To probe the curative effect of acupuncture and medication on transient cerebral ischemia attack. Method: 30 patients with transient cerebral ischemia attack in the treatment group were acupunctured at Fengchi (GB 20), Wangu (GB 12) and Tianzhu (BL 10) and given orally leech capsules and centipede capsules. 30 patients with transient cerebral ischemia attack in the control group were given intravenous drip of compound Danshen injection and orally aspirin. At the end of two treatment courses, the curative effects were evaluated and the changes in blood rheology and in 3 indexes of blood coagulation were observed before and after treatment in the 2 groups. Results: The total effective rate in the treatment group was 86.7% with obvious difference as compared to the control group (P<0.05). There were remarkable differences in blood rheology and 3 indexes of blood coagulation before and after treatment in the treatment group (P<0.05, P<0.01). There were remarkable differences after treatment between the 2 groups (P<0.05). Conclusion: Acupuncture at Fengchi (GB 20), Wangu (GB 12) and Tianzhu (BL 10) and medication with leech capsules and centipede capsules are effective methods in treating transient cerebral ischemia attack.  相似文献   

9.
Percutaneous transluminal stenting in patients with carotid artery stenosis   总被引:4,自引:0,他引:4  
ObjectiveTo assess the efficacy and safety of percutaneous transluminal stenting for pati ents with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with sym ptomatic carotid artery stenosis (luminal narrowing ≥70%). Success rates and c omplications associated with the procedures were observed. During six months of follow-up, both recurrent symptom and restenosis rates were recorded. Results There were 17 bifurcating lesions among 27 stenoses in 26 patients, of whom 18 had concomitant coronary artery diseases. The acute procedural success rate was 96.3% (26/27), and the degree of stenosis was reduced from 88.6%±8.9% (ran ge 70-100) to 0.4%±2.0% (range 0-10). Six patients developed severe brady cardia and hypotension, and 3 experienced transient loss of consciousness during balloon dilatation. During hospitalization, 2 patients experienced loss of con sciousness and convulsion, respectively, due to hyperperfusion, and both recover ed 12 hours later. There were 2 minor stroke cases (7.4%) but no cases of majo r stroke or death. At the 6-month follow-up, there were no cases of TIA or ne w onset of stroke. There was no restenosis detected in 16 cases using angiograp hy and in 10 cases using MRI in 6 to 16 months of follow-up. Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications. Few pati ents suffered from recurrent symptoms or showed restenosis in long-term follow -up.  相似文献   

10.
Six patients with 95% to 100% occluded atheroseleroticlesions underwent percutaneous transluminal excimer lasercoronary angioplasty (PTELCA). Among them, 5 were maleand ! was female; their age ranged from 28 to 66 years. Fourpatients had LAD stenosis and 2 LCX lesions.Acuteangiographic and clinical success was achieved in all patientsbut one, with a success rate Of 83.3%. It was demonstratedthat PTELCA is a safe and effective therapy for selected pa-tients with coronary artery disease.  相似文献   

11.
重症下肢缺血的血管腔内治疗   总被引:12,自引:0,他引:12  
目的评价血管腔内治疗下肢动脉硬化闭塞症重症下肢缺血的临床效果。方法2005年4月-2006年5月采用血管腔内治疗重症下肢缺血24例共29条肢体,主要临床症状均为静息痛,其中合并溃疡或肢端坏疽12例(50%)。本组29条肢体均接受血管腔内治疗,其中有4条肢体行单纯球囊扩张,4条肢体术中同时行股胭动脉人工血管旁路术联合膝下胭胫动脉血管腔内球囊扩张成形术,21条肢体行支架植入。结果股胭动脉球囊扩张和支架植入技术成功率为100%,膝下动脉球囊扩张成功率为88%,术后患者临床症状明显好转,静息痛消失,溃疡愈合。围手术期膝下截肢1例,截肢率为3.4%。结论血管腔内治疗下肢动脉硬化闭塞症重症下肢缺血是一种安全有效的治疗方法。  相似文献   

12.
目的探讨以脑缺血为主要症状的主动脉弓上血管狭窄性病变的介入治疗效果。方法52例患者的共56处主动脉弓上狭窄性病变接受了血管腔内治疗,其中锁骨下动脉狭窄22处,锁骨下动脉闭塞14处,颈内动脉狭窄12处,无名动脉狭窄8处。病变的狭窄程度均大于60%(65%~100%)。所有患者均表现出脑缺血的症状,如头痛、头晕、发作性肢体无力、黑朦等,其中部分患者锁骨下动脉和无名动脉病变的病例还同时伴有上肢缺血症状。56处病变中,单纯行血管扩张术15例、放置支架39例,有2例锁骨下动脉闭塞的病例因闭塞段坚硬无法打通而改行外科手术治疗。4例颈内动脉狭窄的病例在支架放置过程中使用了保护伞装置。11例锁骨下动脉闭塞病变由于顺行打通比较困难,采用经股动脉和肱动脉联合入路进行治疗。结果手术技术成功率为96·4%(54/56),成型后血管残余狭窄均小于30%。所有患者的临床症状均明显改善。发生手术相关并发症3例,占所有接受治疗患者的5·8%(3/52),无死亡病例。随访46例,随访率88%,平均随访时间24个月,无死亡及严重脑卒中发生。有2例只接受经皮血管腔内成型术治疗的患者发生术后再狭窄。结论对于以脑缺血为主要症状的主动脉弓上血管狭窄性病变,血管成型术和/或支架置入术是安全有效的治疗方法。  相似文献   

13.
用经皮经腔动脉成形术(PTA)治疗锁骨下动脉狭窄或闭锁24例,用血管旁路术治疗14例。结果:2种治疗方法的近期通畅率相似,2年通畅率分别为66.7%和72.7%。提示:PTA和血管旁路术均是治疗锁骨下动脉狭窄或闭锁的有效方法  相似文献   

14.
秦汉林  高斌 《安徽医学》2011,32(3):346-349
目的 探讨应用小口径长球囊经皮腔内血管成形术(PTA)治疗糖尿病足患者下肢血管病变的近期临床价值.方法 对25例患者36条糖尿病足下肢病变血管行数字减影血管造影(DSA)检查,并对狭窄处实施PTA.结果 术后即刻16例22条患肢疼痛明显缓解.术后24 h,患肢皮温及踝肱指数(ABI)均较术前显著升高;术后跛行距离是持续...  相似文献   

15.
目的探讨经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)在糖尿病足治疗中的价值。方法对32例临床诊断糖尿病足的患者行患侧肢体下肢数字减影血管造影(DSA)技术,并对狭窄处实施PTA,术后给予控制血糖,抗感染,抗凝治疗,其中4例6个月后行血管造影对比观察。结果在动脉造影中,4例病人显示有狭窄,血管直径〈50%,在28例狭窄〉50%的病人中,23(82.1%)进行了PTA。在2例病人中(8.7%)仅在近端主干施行了PTA。11(47.8%)病人仅在下主干施行了PTA,10(43.5%)在股及下主干施行了PTA。PTA之后,患肢动脉血液灌注获得明显的改善。仅在3例病人中出现临床复发。其中2例成功进行了第二次PTA。进行过PTA的23例病人中,1(4.3%)进行了踝上截肢术。结论作为一项高度准确的成像技术和微创治疗方法,经皮腔内血管成形术(PTA)可用于治疗大多数糖病病人的局部缺血性足溃疡。对于足部血管再生是极为有效的。  相似文献   

16.
下肢深静脉血栓形成病例中髂静脉压迫综合征的外科治疗   总被引:8,自引:0,他引:8  
目的总结治疗下肢深静脉血栓形成(DVT)病例中髂静脉压迫综合征(Cockett综合征)的经验。方法1991年2月至2005年9月在我院血管外科接受手术治疗的160例DVT患者中,95例合并Cockett综合征。其中左髂总静脉闭塞20例,狭窄>50%者53例,狭窄<50%者22例。全部病例均经左腹股沟切口行股静脉切开取栓术,术中发现并同时处理Cockett综合征(1)对左髂总静脉闭塞的患者,10例行闭塞段切除重建术,3例行左髂总静脉-下腔静脉人工血管搭桥术,3例行健侧大隐静脉耻骨上转流(Palma)术;(2)对狭窄>50%的患者,5例行扩张后支架植入术,8例行单纯球囊扩张成形术,4例行狭窄切开隔膜切除成形术;36例狭窄>50%的患者,用F8-10 Fogarty取栓管反复取栓扩张2~4次后,可使狭窄率小于50%。全部病例术后均经左大隐静脉分支留置的导管行局域性抗凝和溶栓及静脉造影。结果治愈82例(86.3%),1例死于心肌梗死,其余12例均有不同程度好转。结论同时处理Cockett综合征是提高DVT治愈率的关键。闭塞的左髂总静脉以闭塞段切除重建术治疗为好,严重狭窄的以血管成形或支架植入术治疗为好。  相似文献   

17.
目的探讨动脉粥样硬化性股-腘动脉闭塞性疾病介入治疗的方法和临床疗效。方法本组43例58处病变,狭窄性36处,闭塞性22处,采用球囊成形、支架成形、腔内旋切和内膜下血管成形等多种介入手段干预、治疗。结果58处病变:单纯球囊成形8例,辅助支架成形的17例(15例自膨式支架,4例弹簧式支架),均成功;单纯腔内旋切6例,辅助支架成形的11例(15例自膨式支架,1例弹簧式支架),手术失败1例;单纯内膜下血管成形3例,辅助支架成形的8例(13例自膨式支架,2例弹簧式支架),手术失败4例。31例临床症状明显改善,18例症状和体征得到缓解,5例疗效欠佳。4例患者因术后缺血再灌注损伤行切开解压后好转,2例因小腿骨筋膜室综合征行膝关节以下离断术。术后平均随访10.5个月(2~33月),2例术后6月症状复发未予进一步治疗,1例术后1年再次介入治疗,余患者疗效稳定。结论股-腘动脉闭塞性疾病的介入治疗方法多种多样,针对不同程度的病变采用不同的介入治疗手段,临床治疗效果安全、可靠。  相似文献   

18.
  目的  探讨开放手术辅助经皮腔内血管成形术(percutaneous transluminal angioplasty, PTA)治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效。  方法  90例已建立上肢自体动静脉内瘘(autogenous arteriovenous fistulas,AVF)并出现Ⅰ型合并Ⅱ型狭窄接受血透治疗患者,随机分为3组,每组30例,A组:超声引导下PTA,B组:数字减影血管造影(digital subtraction angiography, DSA)引导下PTA,C组:开放手术辅助PTA。比较3组手术成功率、手术前后血管内径、肱动脉血流量、AVF通畅率及术后并发症情况。  结果  C组患者手术成功率分别高于A、B组,并发症分别低于A、B组,差异均有统计学意义(P < 0.05);术前3组患者的血管内径、肱动脉血流量比较差异无统计学意义(P > 0.05),术后即刻和术后1周C组分别大于A、B 2组,差异有统计学意义(P < 0.05);C组术后6、12月时的AVF通畅率及稳定性分别高于A、B 2组,差异有统计学意义(P < 0.05)。  结论  开放手术辅助经皮腔内血管成形术治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效显著,能恢复内瘘功能,保证患者有效透析,且操作简单,创伤小,并发症少,可作为部分病例的首选治疗方案。  相似文献   

19.
We report three cases of iliac artery rupture during percutaneous transluminal angioplasty (PTA). In all three cases, bleeding was temporarily controlled by inflating an angioplasty balloon at the site of bleeding. Two patients underwent subsequent surgical revascularization, and one underwent endovascular stent grafting but ultimately required a surgical bypass. Arterial rupture is a rare but potentially fatal complication of PTA. Although stent grafts for peripheral arteries are not yet covered by Japanese medical insurance, it is a useful treatment for arterial injury during PTA.  相似文献   

20.
目的 观察血管成形术治疗血液透析动静脉内瘘狭窄中的作用.方法 选择21例血液透析动静脉内瘘狭窄患者进行血管成形术治疗,比较血管成形术治疗前后的血管造影表现、透析血流量及静脉压变化.结果 血管成形术后造影显示狭窄血管扩张.术后透析血流量由扩张前(135.41±20.89)mL/min增至(265.37±12.28 )mL/min,在血流量为250 mL/min时,静脉压由扩张前的(189.58±12.32) mmHg降至扩张后(100.62±13.76)mmHg;术中未出现血管破裂、出血及血栓形成等并发症.结论 血管成形术是治疗血液透析动静脉内瘘狭窄的有效方法,对血液透析动静脉内瘘的维持有重要价值.  相似文献   

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