Psoas abscess associated with iliac vein thrombosis and piriformis and gluteal abscesses

BACKGROUND: A 14-year-old boy was admitted because of lumbago and high fever. METHODS/RESULTS: Computed tomography scans revealed psoas, piriformis and gluteal abscesses as well as right iliac vein thrombus. A right femoral venogram demonstrated compression from the psoas abscess and thrombosis of the common iliac vein. Appropriate surgical drainage, administration of antibiotics and anticoagulant therapy were effective in the present case. CONCLUSIONS: This is the first report of primary psoas abscess associated with vein thrombosis and is also unique in that abscesses were multiple without predisposing diseases or trauma.     

Spontaneous rupture of the iliac vein: Report of a case

We reprot a rare case of a spontaneous rupture of the iliac vein which was then surgically treated with good results. A 66-year-old woman was admitted complaining of leg swelling and lower abdominal pain. On the 3rd day after admission, an operation was performed because of a gradually increasing hematoma in the retroperitoneal space. Laparotomy revealed a 17 mm longitudinal tear on the anterior surface of the left external iliac vein with a thrombus inside the lumen. Most of the previously reported 14 cases of this nature have required emergency operations.     

A new technique for bilateral iliac vein and inferior vena cava reconstruction using reinforced polytetrafluoroethylene

We report on the management of a patient with intractable venous claudication and ulceration due to bilateral iliac vein and inferior vena cava occlusion. An inverted V graft was constructed from two 8 mm diameter reinforced PTFE grafts. The upper end was anastomosed to the inferior infrarenal vena cava and the lower ends anastomosed to the common femoral veins. Bilateral arteriovenous fistulas were fashioned. Nine months later the graft is patent and the patient's only symptom is mild ankle edema. The theoretical advantage of this type of graft is that occlusion of one limb will not compromise the other, thus leaving a number of secondary options open if this should happen.     

带旋髂深血管蒂髂骨瓣治疗股骨头缺血性坏死

目的探讨股骨头缺血性坏死治疗的方法。方法 应用带旋髂深血管蒂髂骨植入治疗８８例股骨头缺血性坏死。结果 ８８例随访２－９年，根据成人股骨头缺血性坏死疗效评价法，优良率９０．９％。结论该手术可以增加股骨头血运，骨瓣可以起支撑作用。对于Ｆｉｃａｔ分期Ⅰ－Ⅲ期的患者是一种较好的治疗方法。     

支架植入术后导管接触性溶栓治疗髂静脉重度狭窄伴急性深静脉血栓形成

目的观察支架植入术后导管接触性溶栓(CDT)治疗髂静脉重度狭窄伴急性深静脉血栓形成(DVT)的效果。方法对42例髂静脉重度狭窄伴急性DVT行支架植入术联合CDT治疗,对其中22例(观察组)于植入支架后行CDT治疗,20例(对照组)于CDT治疗后植入支架。对比2组尿激酶用量、导管溶栓时间、静脉系统评分、患肢消肿率、并发症及随访情况。结果 2组技术成功率均为100%。观察组尿激酶用量和导管溶栓时间均低于对照组(P均0.05)。术后2组静脉系统评分均较术前降低(P均0.05),但组间术前及术后评分差异均无统计学意义(P均0.05)。术后2组患肢(大腿及小腿)消肿率差异均无统计学意义(P均0.05)。术后4例(观察组、对照组各2例)导管留置部位轻微出血,未见肺栓塞、颅内出血等严重并发症。随访3个月时观察组1例出现左侧小腿肌间静脉血栓,增加利伐沙班剂量至15 mg/d抗凝后复查深静脉超声显示静脉血流通畅;随访6个月时2组髂静脉支架通畅率均为100%。结论支架植入术后CDT治疗髂静脉重度狭窄伴急性DVT安全有效,且相比先溶栓后植入支架可缩短溶栓时间、减少尿激酶用量。     

NCE-MRA在评价髂静脉受压分型中的应用价值

目的 探讨盆腔无对比剂增强的磁共振血管成像（NCE-MRA）在评价髂静脉受压分型中的应用价值。方法 收集2020年5月至2021年9月在重庆医科大学附属第一医院行盆腔NCE-MRA检查的126例患者临床资料,通过多平面重组及容积再现技术分析髂静脉压迫的特征。结果 126例患者共244处受压部位,最常见的髂静脉受压部位为左髂总静脉（77.46%）,其中左髂总静脉与腔静脉交界处受压患者比例为47.13%。根据髂静脉受压部位的特征确定了4种压迫类型,Ⅰ型为左髂总静脉与腔静脉交界处受压（30.16%）,Ⅱ型为左髂总静脉与腔静脉交界处和左髂总静脉两处受压（27.78%）,Ⅲ型为左髂总静脉与腔静脉交界处、左髂总静脉和右髂总静脉三处受压（17.46%）,Ⅳ型为其他类型（24.60%）。结论 NCE-MRA有助于对髂静脉根据受压部位进行分型,4种分型的建议可能有助于临床医师预测髂静脉压迫综合征患者是否受益于腔内介入治疗。     

Repeated femoral vein puncturing for maintenance haemodialysis vascular access.

BACKGROUND: When access cannot be achieved using a native arteriovenous fistula or a synthetic prosthetic graft, central venous catheters are usually placed. This mode of access is short-lived, prone to infection, stenosis and thrombosis of central veins. To overcome access problems, we developed a new native vascular access ('femoral vein access') and devices. We report here on our experience with the availability, longevity, procedure and morbidity of haemodialysis (HD) using femoral vein access. METHODS: Repeated (three times a week) patient's native femoral vein puncturing has been used as the vascular access (femoral vein access) for maintenance HD in 30 patients (mean age +/- SD: 61.70 +/- 15.27 years old; 18 female/12 male). The femoral vein was punctured beneath the inguinal ligament (on a length ranging from 30 to 100 mm) after disinfection and local anaesthesia. Long (effective length 56 mm) 19- and 18-gauge needles with four side holes were used for the femoral vein puncture as an arterial site of the extracorporeal circuit of HD and shorter (effective length 40 mm) similar gauge needles for the subcutaneous vein puncture used as the return site. The needle is inserted blind into the femoral vein after the femoral artery has been located by palpation and the perception of a pulse. Patients returned home the same day. RESULTS: The mean duration of HD treatment using femoral vein repeated puncture was 4.99 +/- 3.42 years (up to 16.0 years). This represented a total experience of 23 369 femoral vein punctures. The mean blood flow achieved on dialysis was 165 +/- 20 ml/min. The average Kt/V was 1.74 +/- 0.48 per session. CONCLUSIONS: The femoral vein repeated puncture technique has substantial advantages over venous catheters. It does not require surgery, while permitting adequate blood flow. This method can be used as a long-term (over 10 years) blood access. Apart from a few local haematomas, no serious complications have been observed. Moreover, it does not carry a heavy financial burden.     

Dialysis catheter insertion with and without peel-away sheaths

Tunnelled central venous line (TCVC) as a long-term vascularaccess in haemodialysis patients started to be used in our unitin 1993. Although it is certainly not the optimal access type,its use is increasing because of increasing patient age associatedwith various comorbidities such as compromised cardiovascularsystem condition, peripheral vascular disease (diabetes mellitus,ischemic     

带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死

目的 探讨应用带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的疗效.方法 2002年6月-2006年12月,采用带血管蒂髂骨瓣移位治疗股骨颈骨折内固定术后ANFH 22例22髋.男18例,女4例;年龄28～48岁,平均37.5岁.左...     

带旋髂深血管蒂髂骨瓣移植加折断式加压螺钉内固定治疗成人股骨颈骨折

目的；探讨成人股骨颈骨折的手术治疗方法及疗效。方法：在解剖复位的基础上对96例成人股骨颈骨折植入带旋髂深血管蒂的髂骨瓣，并用3根折断式加压螺钉内固定。结果：96例平均随访2年，骨折愈合91例，愈合率94．8％，髋关节功能按Jacobs等标准评定，优72例，良15例，差9例，总优良率达90．6％。结论：带旋髂深血管蒂髂骨瓣移植加折断式加压螺钉内固定联合治疗成人股骨颈骨折疗效肯定，操作较简单。     

右侧髂窝移植肾失功合并同侧髂总动脉夹层动脉瘤及髂外静脉狭窄1例

正患者女,45岁,因慢性肾功能不全接受右侧髂窝肾移植术,术后4h血压进行性下降,给予多种大剂量血管活性药物后血压波动于30～50/20～40mmHg,心率130～150次/分,失血性休克,伴右下肢肿胀逐渐加重。急诊床旁超声:右侧髂窝移植肾大小正常,各级动脉血流树稀疏,可见三级动脉,频谱呈针状高速高阻型(图1A),移植肾静脉内未见明确血流信号(图1B),肾周血肿;右股动脉纤细,远端流速减低;右下肢深、浅静脉内径增宽,其内未见血流信号,未见明确血栓。     

The impact of standardized methods of hepatic vein reconstruction with an external iliac vein graft

BackgroundLiver tumors that invade the hepatic vein are surgically challenging, especially in patients with liver dysfunction. Preservation of as much of the parenchyma as possible is important; thus, when feasible, we perform hepatectomy with hepatic vein reconstruction (HVR) using an external iliac vein (EIV) graft. We conducted a retrospective study to investigate the benefit of HVR and to evaluate our procedure.MethodsThe study included patients treated by hepatectomy with HVR using EIV grafts and vascular clips. We reviewed the surgical outcomes, including total operation and HVR times, postoperative complications, and postoperative liver function.ResultsThe surgeries included right HVR (n=13), left HVR (n=3), and middle HVR (n=1). The total operation time was 277±72 minutes (155–400 minutes), and the HVR time was 27±5 minutes (19–40 minutes). Graft patency was confirmed in 14 (82%) of the patients. One patient who underwent HVR with running sutures required emergency surgery due to graft thrombosis. Clavien-Dindo > grade IIIa postoperative complications occurred in 4 (23.5%) patients, but there were no treatment-related deaths.ConclusionsIn conclusion, our hepatic resections with HVR using the same techniques and graft materials showed acceptable surgical outcomes. From our experience, we believe that preparatory hepatic resection with HVR is an effective treatment, especially for patients with decreased liver function or with a small residual liver parenchyma.     

低分子量肝素预防股静脉置管后血栓形成的临床疗效

目的：观察低分子量肝素预防股静脉置管术后深静脉血栓形成的效果。方法122例下肢深静脉置管患者随机分为治疗组（63例）和对照组（59例）。治疗组每日皮下注射低分子量肝素5000IU,对照组采取下肢主被动活动等常规预防方法。观察2组深静脉血栓的发生率及治疗组治疗前后凝血功能及血小板有无变化。结果治疗组有7例出现深静脉血栓,对照组有15例出现,2组间差异具有统计学意义（P〈0．05）。治疗组治疗前后APTT、PT、INR、PLT均无显著差异。结论股静脉置管术后使用低分子量肝素可以有效预防下肢深静脉血栓形成。     

旋入式自锁髓内钉在股骨骨折中的应用

目的探索旋入式自锁髓内钉在股骨骨折中的应用效果。方法对57例不同类型的股骨骨折采用旋入式自锁髓内钉内固定。结果随访8周~3年,57例中,优38例,良17例,可2例,优良率96·5?。膝关节功能全部恢复,无畸形愈合及断钉。结论旋入式自锁髓内钉在股骨骨折固定中具有切口小、创伤小、操作方便、固定牢固、愈合快、取出简便等优点,临床应用疗效确切。     

股／腘静脉损伤的手术治疗

目的探讨股／腘静脉损伤的手术治疗方法。方法1998年4月至2007年5月治疗股／胭静脉损伤26例。单纯静脉伤12例，合并股／腘动脉损伤14例，分别采用血管修补术、血管补片修复、端端吻合术、大隐静脉移植及“并管法”大隐静脉移植修复动、静脉。结果23例肢体术后血运恢复。合并股／腘动脉损伤14例中，1例并发肾功能衰竭，3例肢体坏死截肢，4例肢体肌肉部分坏死清创后残留部分功能障碍，单纯股／胭静脉损伤者血管修复后肢体无显著肿胀，血运良好。随访3个月～7年，23例肢体血运良好。结论股／腘静脉损伤修复有助肢体恢复正常血供，优先处理合并动脉损伤，“并管法”大隐静脉移植修复股／腘静脉损伤有一定临床使用价值。     

经股静脉置入PICC堵管现状及影响因素分析

目的 了解经股静脉置入PICC堵管现状及其影响因素,为开展相关护理措施提供参考。 方法 回顾性分析241例经股静脉置入PICC患者临床资料,经单因素和logistic回归分析发生导管堵管的影响因素。 结果 24.07%患者发生了导管堵管,回归分析结果显示,导管堵管的独立危险因素为伴有导管脱出、首次置管、经常行走以及导管类型为耐高压材质（均P＜0.05）。 结论 经股静脉置入PICC堵管发生率较高,临床实践中应加强关注导管堵管的独立风险因素,并开展针对性干预或相关健康教育,降低堵管发生率。