Anaesthesia for vascular surgery on the extremities

Peripheral arterial surgery is challenging; operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.     

Anaesthesia for vascular surgery on the extremities

Peripheral arterial surgery is challenging, operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.     

Anaesthesia for vascular surgery on the extremities

Peripheral arterial surgery is challenging; operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.     

程序化降温保存血管内皮功能的研究

目的：探讨程序化降温对体外大鼠血管内皮的影响。方法：对大鼠腹主动脉进行0．7℃／min（新鲜血管组和常规方法组）及1℃／min（试验组）程序化降温，低温保存3个月后对比观察血管内皮形态和功能变化。结果：试验组的平均收缩张力及非依赖性血管舒张均较常规组高（P〈0．05），但对于Ach引起的内皮依赖性血管舒张，两组差异不明显（P〉0．05）；光镜下试验组皿管内皮细胞较常规组完整。结论：改良的降温程序能够较好保持内皮的收缩功能以及非内皮依赖性舒张功能，但对内皮依赖性舒张功能效果欠佳。     

小口径脱细胞基质人工血管移植的研究

目的 探讨脱细胞基质( DCM)人工血管用于小口径血管移植的可行性.方法 40条雄性杂种犬随机分为DCM、膨体聚四氟乙烯(ePTFE)人工血管及自体颈外静脉3组行右颈总动脉置换术,彩超监测移植物通畅率.术后4、8周活体取材,标本行苏木素-伊红(HE)、免疫组织化学染色及扫描电镜检查.结果 3组移植物1周通畅率(75.0％、64.3％、100.0％)差异无统计学意义(P＞0.05);自体颈外静脉组4、8周通畅率( 100.0％、88.9％)优于DCM组(56.3％、26.7％)及ePTFE组(57.1％、23.1％,P＜0.05),后两组差异无统计学意义(P＞0.05).DCM人工血管4、8周血栓形成面积小于ePTFE人工血管,吻合口内膜内皮化程度高于后者.结论 小口径DCM人工血管在抑制血栓形成及加快内皮化方面优于ePTFE人工血管.     

腘血管损伤的处理体会

目的探讨血管损伤的诊断、手术方法及肢体缺血时间等因素对挽救肢体的影响。方法在显微镜下行血管修复，术后行小腿筋膜室切开减压术。结果２１例中，１８例肢体血运良好，动脉搏动可扪及，功能恢复好，２例出现小腿缺血性肌挛缩，１例截肢。结论早期诊断并应用显微外科技术及时精确修复血管损伤，是提高肢体成活率、减少并发症和降低截肢率的关键     

Studies on the elastic properties of vascular prostheses

The difference of mechanical properties between a vascular prosthesis and its host arteries is suggested to be a contributing factor in graft failure and different methods have been used to evaluate the elasticity of arterial graft. In this study, a new type ultrasonic displacement meter combined with B-mode imaging was developed and dynamic compliance of four types of arterial grafts currently available for clinical use, human saphenous vein, human umbilical vein, velour Dacron and expanded polytetrafluoroethylene (EPTFE), were measured in vitro and in vivo. Dynamic compliance was derived from intraluminal pulsatile pressure and diameter change of the vessel obtained from the displacement meter. The in vitro examination showed that the human umbilical vein was the most compliant among human saphenous vein, velour Dacron and EPTFE. The human saphenous vein was compliant in low intraluminal pressure less than 50 mmHg, and became more stiff than the human umbilical vein with increasing pressure. After experimental implantation, the compliance of human umbilical vein and EPTFE showed similar characteristics in vitro, with the exception of velour Dacron, which was progressively less compliant. In comparison of compliance of human arteries to that of arterial grafts, a mismatch in compliance between grafts and host arteries was obviously demonstrated.     

真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因子的关系

为了探讨真皮下血管网薄皮瓣的成活机理，以兔为实验动物，在其背侧形成１５ｃｍ×３ｃｍ的真皮下血管网薄皮瓣，利用微循环显微镜、病理切片、组织化学染色等手段进行观察。结果表明真皮下血管网薄皮瓣术后远、中、近段血管构筑具有明显差别：近段同正常皮肤，中段为极度活跃的血管增生，远段为中度血管增生。皮瓣中段血管构筑的变化起一个“中介蒂”的作用，是皮瓣能够早期断蒂及超过传统长宽比例可以成活的基础。成纤维细胞生长因子是促使皮瓣血管构筑变化的重要因素之一。     

真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因子的关系

为了探讨真皮下血管网薄皮瓣的成活机理,以兔为实验动物,在其背侧形成15cm×3cm 的真皮下血管网薄皮瓣,利用微循环显微镜、病理切片、组织化学染色等手段进行观察。结果表明真皮下血管网薄皮瓣术后远、中、近段血管构筑具有明显差别:近段同正常皮肤,中段为极度活跃的血管增生,远段为中度血管增生。皮瓣中段血管构筑的变化起一个“中介蒂”作用,是皮瓣能够早期断蒂及超过传统长宽比例可以成活的基础。成纤维细胞生长因子是促使皮瓣血管构筑变化的重要因素之一。     

219 vascular fellows' perception of the future of vascular surgery

In an attempt to identify the fellows' concerns about the future of the field of vascular surgery, we conducted a survey consisting of 22 questions at an annual national meeting in March from 2004 to 2007. In order to obtain accurate data, all surveys were kept anonymous. The fellows were asked (1) what type of practice they anticipated they would be in, (2) what the new training paradigm for fellows should be, (3) to assess their expectation of the needed manpower with respect to the demand for vascular surgeons, (4) what were major threats to the future of vascular surgery, (5) whether they had heard of and were in favor of the American Board of Vascular Surgery (ABVS), (6) who should be able to obtain vascular privileges, and (7) about their interest in an association for vascular surgical trainees. Of 273 attendees, 219 (80%) completed the survey. Males made up 87% of those surveyed, and 60% were between the ages of 31 and 35 years. Second-year fellows made up 82% of those surveyed. Those expecting to join a private, academic, or mixed practice made up 35%, 28%, and 20% of the respondents, respectively, with 71% anticipating entering a 100% vascular practice. Forty percent felt that 5 years of general surgery with 2 years of vascular surgery should be the training paradigm, while 45% suggested 3 and 3 years, respectively. A majority, 79%, felt that future demand would exceed the available manpower, while 17% suggested that manpower would meet demand. The major challenges to the future of vascular surgery were felt to be competition from cardiology (82%) or radiology (30%) and lack of an independent board (29%). Seventeen percent were not aware of the ABVS, and only 2% were against it; 71% suggested that vascular privileges be restricted to board-certified vascular surgeons. Seventy-six percent were interested in forming an association for vascular trainees to address the issues of the future job market (67%), endovascular training during fellowship (56%), increasing focus on the vascular fellows at national meetings (49%), and representation for the fellows on the national councils (37%). This survey suggests that several significant issues exist in the minds of vascular trainees that have not been addressed and may present opportunities for further dialogue.