Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

A three-dimensional color-printed system allowing complete modeling of arteriovenous malformations for surgical simulations

To develope a colored realistic AVM model using three-dimensional (3D) printing for surgical planning and research. Raw computed tomography angiography (CTA) and magnetic resonance venography (MRV) data were integrated and used for reconstruction. Each AVM model included the nidus, the feeding arteries, the draining veins, the sinuses, the adjacent principal arteries, and the skull. The models were employed to plan surgical and endovascular treatments. Surgical feedback was obtained using a survey. Five AVM cases were included. The AVMs and the models thereof did not differ significantly in terms of length, width, or height, as measured via magnetic resonance imaging (all p > 0.05). The 3D AVM models were thus accurate. The overall score on the questionnaire survey was >4 point; the model thus aided the planning of interventional surgery. All surgeons were confident that the 3D models reflected the true lesional boundaries. Our 3D-printed intracranial AVM models were accurate, and can be used for preoperative planning and training of residents. The models improved surgeons’ understanding of AVM structure, reducing operative time.     

近端血流阻断加压技术在硬脊膜动静脉畸形血管内治疗中的应用

目的探讨近端血流阻断加压技术在硬脊膜动静脉畸形(SDAVF)血管内治疗中应用的安全性和有效性。方法回顾性分析2017年2月至2018年9月海军军医大学附属长海医院神经外科采用血管内治疗的6例SDAVF患者的临床资料。所有患者术中均应用近端血流阻断加压技术,其中1例因未能完全栓塞,改为显微外科手术治疗。术后即刻行数字减影血管造影(DSA),以判断栓塞情况。对所有患者行门诊或电话随访,随访内容为行Aminoff-Logue评分,判断脊髓功能的恢复情况;门诊随访的患者同时复查脊髓MRI,以判断栓塞情况。结果6例患者的手术均成功。术后即刻DSA显示,5例完全栓塞,1例瘘口残留。所有患者术后均未出现永久性神经系统并发症;其中1例术中造影显示肋间动脉夹层的患者,采用弹簧圈闭塞近端肋间动脉后复查胸椎CT,显示肋间肌内血肿形成,术后持续胸背部疼痛3 d后缓解。6例患者中,5例为门诊随访,1例为电话随访;中位随访时间(范围)为5.5个月(4.0~22.0个月)。术后3个月,6例患者的Aminoff-Logue评分均较术前降低[(2.0±0.7)分、(4.0±1.5)分,P<0.05];脊髓功能得到明显改善。术中因拔管困难而留置体内的1例患者,术后6个月随访时无相关并发症。经显微手术治疗的1例患者出院后10个月行DSA随访,未见瘘口显影。结论初步推测近端血流阻断加压技术在SDAVF血管内治疗中是安全、有效的。     

Management of patients with complex perianal fistulas in Crohn's disease: Optimal patient flow in the Italian clinical reality

Perianal fistulizing Crohn’s disease (PFCD) is a common, disabling and aggressive phenotype that negatively impacts on the quality of life of affected patients. Its successful treatment is still a struggle for both physicians and patients. Significant advances in the management of this condition have occurred in the last two decades holding promise for a better future. This culminated into the concept of a collaborative multidisciplinary approach using the latest medical therapies combined with modern surgical and endoscopic techniques. Despite this, PFCD management and treatment have not been standardized yet. Thus the gastroenterologist and surgeon have to be familiar with several approaches and/or techniques. The positioning of each therapeutic option will certainly evolve with new data, but for the time being it should be driven by patient’s characteristics, physician’s preference and/or experience, costs and availability in local practice. Additionally, patient’s perception of benefits and risks of treatment may differ from those of physicians and recognition of this difference is a starting point for difficult clinical decision-making.In this paper, a multidisciplinary group of Italian IBD experts explore and discuss current medical and surgical therapeutic options, highlighting areas of unmet needs in PFCD, with particular focus on the optimal patient flow within the Italian clinical reality.     

Embolization biomaterial reinforced with nanotechnology for an in-situ release of anti-angiogenic agent in the treatment of hyper-vascularized tumors and arteriovenous malformations

A polymer based material was developed to act as an embolic agent and drug reservoir for the treatment of arteriovenous malformations (AVM) and hyper vascularized solid tumors. The aim was to combine the blocking of blood supply to the target region and the inhibition of the embolization-stimulated angiogenesis. The material is composed of an ethanolic solution of a linear acrylate based copolymer and acrylate calibrated microparticles containing nanospheres loaded with sunitinib, an anti-angiogenic agent. The precipitation of the linear copolymer in aqueous environment after injection through microcatheter results in the formation of an in-situ embolization gel whereas the microparticles serve to increase the cohesive properties of the embolization agent and to form a reservoir from which the sunitinib-loaded nanospheres are released post-embolization. The swollen state of the microparticles in contact with aqueous medium results in the release of the nanospheres out of microparticles macromolecular structure. After the synthesis, the formulation and the characterization of the different components of the material, anti-angiogenic activity was evaluated in vitro using endothelial cells and in vivo using corneal neovascularization model in rabbit. The efficiency of the arterial embolization was tested in vivo in a sheep model. Results proved the feasibility of this new system for vascular embolization in association with an in situ delivery of anti-angiogenic drug. This combination is a promising strategy for the management of arteriovenous malformations and solid tumors.     

复合手术在战、创血管伤救治中的应用研究

目的 探讨复合手术在颈部与邻近躯干大血管战、创伤救治中的应用价值和方法。方法 总结我院神经外科与骨科自1978年以来应用复合手术救治42例颈部与邻近躯干大血管战、创伤大出血及晚期合并动静脉瘘与假性动脉瘤的临床资料。大部分病例复杂且已破裂，或即将破裂，又无法解剖出病变上游血管或用止血带控制出血进行血管重建手术。我们采用“放风筝”法治疗4例（其中3例外伤性颈内动脉海绵窦瘘，1例战时多发弹片伤致颅底高位颈内动静脉瘘合并颈外动脉假性动脉瘤），采用“血管内”止血带辅助外科手术切除假性动脉瘤与动静脉瘘行血管重建血运35例，酌情选择介入与开放手术相结合治疗3例（战伤致左椎动脉动静脉瘘1例，左椎动脉动静脉瘘合并假性动脉瘤破裂大出血1例，医源性颈内动脉损伤大出血1例）。结果 42例全部治愈，无死亡或因治疗加重残废。全部病人随访1年以上，病变消失且血运重建良好。结论 复合手术在救治颈部与邻近躯干大血管战、创伤出血及晚期并发假性动脉瘤与动静脉瘘时，能有效防止出血，增加手术安全性，将复杂、风险大的手术简单化，可在临床中推广应用。     

整合素αV在脑海绵状血管瘤和动静脉畸形中表达的研究

目的通过比较整合素亚单位αV在人脑海绵状血管瘤、动静脉畸形和对照血管中的表达,探讨脑海绵状血管瘤以及动静脉畸形的发生和发展机制.方法采集人脑海绵状血管瘤标本19例,动静脉畸形标本26例,以及对照血管组织9例.扩增3种标本中整合素αV的对应mRNA序列,比较其相对含量.观察3种标本血管成分中整合素αV的免疫组化染色.结果脑海绵状血管瘤、脑动静脉畸形和对照血管之间整合素αV的表达分别为0.7510±0.1872、0.5959±0.1354、0.5277±0.1383,具有显著性差异(P=0.001),整合素αV在脑海绵状血管瘤中的表达明显高于脑动静脉畸形和对照血管.结论人脑海绵状血管瘤、动静脉畸形中的血管生长可能与整合素αV相关.