DSA引导下血管腔内成形术治疗下肢动脉硬化闭塞症的临床研究

目的:探讨DSA引导下血管腔内成形术(TA)治疗下肢动脉硬化闭塞症(ASO-LE)的临床效果。方法:2017年3月至2019年4月,手术治疗的ASO-LE患者93例,依据治疗方式的不同分为A组(行TA,n=49)和B组[行下肢动脉旁路移植术(LEABG),n=44],两组患者均在数字减影血管造影(DSA)引导下进行。对比两组患者手术成功率;两组患者术前即刻(T1)、术后1 d(T2)、术后3 d(T3)及术后1周(T4)时刻视觉模拟疼痛评分(VAS);对比术前(T1')、术后1个月(T2')及术后3个月(T3')时刻两组患者下肢缺血程度[患者踝肱指数(ABI)、趾肱指数(TBI)];对比T1'、T2'及T3'时刻两组患者足背动脉血流动力学[足背动脉内径(D)、血流峰速(PV)、血流量(BF)];对比T1'、T2'及T3'时刻两组患者下肢感觉神经传导速度(SNCV)和运动神经传导速度(MNCV);术后6个月,对比两组患者并发症发生率。结果:两组患者手术成功率无显著差异(P>0.05);患者VAS评分组间、时间、交互对比差异均有统计学意义(P<0.05),与T1相比,T2、T3及T4时两组患者VAS评分均降低(P<0.05),与T2相比较,T3及T4时两组患者VAS评分均降低(P<0.05),与T3相比较,T4时两组患者VAS评分均降低(P<0.05),A组T2、T3及T4时刻VAS评分均低于B组(P<0.05);ABI、TBI、D、PV、BF、SNCV和MNCV组间、时间、交互对比差异均有统计学意义(P<0.05);与T1'相比,T2'及T3'时两组患者ABI、TBI、D、PV、BF、SNCV和MNCV均升高(P<0.05);与T2'相比较,T3'时2组患者ABI、TBI、下肢SNCV和MNCV均升高(P<0.05),A组T2'及T3'时刻ABI、TBI、D、PV、BF、SNCV和MNCV均高于B组(P<0.05);A组患者并发症发生率显著低于B组(P<0.05)。结论:相比LEABG,DSA引导下对ASO-LE患者进行TA治疗能够减轻疼痛,改善下肢缺血及足背动脉血流动力学,提高下肢SNCV和MNCV,降低并发症的发生率。     

Transcatheter ductus arteriosus stenting in paediatric cardiology: Indications,results and perspectives

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Arterial endofibrosis in endurance athletes: Prospective comparison of the diagnostic accuracy of intra-arterial digital subtraction angiography and computed tomography angiography

PurposeTo prospectively compare the diagnostic capabilities of computed tomography angiography (CTA) to those of digital subtraction angiography (DSA) in endurance athletes with suspicion of arterial endofibrosis.Materials and methodsForty-five athletes (39 men, 6 women; median age: 30 years, interquartile range: 23–42 years) prospectively underwent DSA and CTA without (n = 5) or with (n = 40) electrocardiogram gating. DSA was interpreted by a single expert (experience of 15 years). CTA was independently interpreted by three other readers (experience of 5–8 years). Readers assessed the presence and degree of stenoses on iliac and femoral arteries and the overall diagnosis (negative, uncertain, positive) of endofibrosis at the limb level. Sensitivities and specificities of DSA and CTA were estimated at the limb level using histological findings and long-term follow-up as reference, and compared using the McNemar test.ResultsFor diagnosing and quantifying stenoses, concordance between DSA and CTA was moderate-to-good for common and external iliac arteries, moderate for lateral circumflex arteries and poor-to-moderate for the other branches of the deep femoral artery. It was good for all readers for the overall diagnosis of endofibrosis. After long-term follow-up (median, 95 months; interquartile range: 7–109 months), DSA sensitivity and specificity were respectively 88.6% (39/44; 95% confidence interval [CI]: 76–95%) and 75% (24/32; 95% CI: 57.9–86.7%); CTA sensitivity and specificity were respectively 88.6% (39/44; 95% CI: 76–95%; P > 0.99) and 84.4% (27/32; 95% CI: 68.2–93.1%; P = 0.51), 86.3% (38/44; 95% CI: 73.3–93.6%; P > 0.99) and 75% (24/32; 95% CI: 57.9–86.7%; P > 0.99), and 84.1% (37/44; 95% CI: 70.6–92.1%; P = 0.68) and 75% (24/32; 95% CI: 57.9–86.7%; P > 0.99) for the three readers.ConclusionCTA shows performances similar to those of DSA in predicting the long-term diagnosis of endofibrosis in endurance athletes with suggestive symptoms.     

探究128层CT血管造影心肌桥-壁冠状动脉图像特征及与冠脉动脉粥样硬化的相关性

目的探讨128层CT血管造影心肌桥-壁冠状动脉(MB-MCA)图像特征及与冠脉动脉粥样硬化的相关性。方法收集2018年1月至12月于我院进行冠状动脉成像检查的126例患者临床及影像学资料,总结所有患者MB-MCA检出率情况及与冠状动脉硬化的相关性。结果126例患者MB-MCA检出率为65.08%,其中LAD中段检出率最高,浅表型最为多见;CT检出位于MB-MCA近侧动脉硬化斑块发生率最高(63.41%,P<0.05),检出MB-MCA患者斑块检出率为(52.22%)与未检出MB-MCA患者斑块检出率(45.45%)比较无差异(P>0.05);且CT检出MB-MCA患者累及段数和斑块的狭窄程度与未检出MB-MCA患者相比较无统计学意义(P>0.05),但检出MB-MCA患者的斑块主要分布于动脉近段,而未检出MB-MCA患者的斑块主要位于中段和远段(P<0.05)。结论128层CT血管造影可较好地检出MB-MCA,且主要好发于LAD,以浅表型更为多见。但MB-MCA的形成与冠状动脉硬化无直接联系,当MB出现收缩和功能血流减少的时候可能会导致冠状动脉硬化的形成。     

How to tackle complications in radial procedures: Tip and tricks

Transradial interventions (TRI) are becoming increasingly popular because of accumulating recent evidence suggesting improved survival and reduced morbidity. Complications, though rare, do occur, especially for operators on their learning curve. The complications are best prevented by utilization of proper technique. Forearm hematoma are preventable and easy to treat, but a delay in detecting and managing them can lead to disastrous consequences compartment syndrome being the most dreaded one. This review deals with tips and tricks to prevent as also treat the common and rare complications.     

The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair

ObjectiveCommon iliac artery aneurysms are present in more than a third of patients with abdominal aortic aneurysm and may pose a challenge during open and endovascular repair. Although embolization of the internal iliac artery is an established method, it may be complicated with buttock claudication, erectile dysfunction, colon ischemia, and pelvic necrosis. Iliac branch devices (IBDs), which permit preservation of the hypogastric artery, have been used to prevent these complications. We conducted a meta-analysis to assess the safety and outcomes of IBDs and to explore potential differences between the commercially available types of IBDs.MethodsThe meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After review of the literature, 36 eligible studies with a total of 1502 patients were included in our study. A meta-analysis was performed with investigation of the following outcomes: technical success rate, 30-day mortality, 30-day patency, follow-up patency, endoleak, buttock claudication, and IBD-associated reintervention. Furthermore, we conducted a subgroup meta-analysis by commercial type of endograft among the outcomes of interest.ResultsAmong all eligible studies, technical success of the method was 97.35% (95% confidence interval [CI], 96.27-98.29). The endoleak rate postoperatively and during the follow-up period was 12.68% (95% CI, 8.80-17.07). The 30-day patency of IBDs was estimated at 97.59% (95% CI, 96.49-98.54), whereas follow-up patency was 94.32% (95% CI, 91.70-96.54). Furthermore, reintervention rate associated with IBDs was 6.96% (95% CI, 5.10-9.03), and buttock claudication during the follow-up period was 2.15% (95% CI, 1.25-3.22).ConclusionsIBD seems to be a safe, feasible, and effective technique for the treatment of aortoiliac aneurysms in select patients with suitable anatomy. Further results are awaited to explore the long-term efficacy and durability of these devices.