大鼠慢性肢体缺血模型的建立及其与急性肢体缺血模型的比较

目的建立大鼠慢性后肢缺血模型并与其急性后肢缺血模型比较,分析两者术后血流灌注和基因表达的差异。方法 40只SD大鼠随机均分为2组,分别建立大鼠慢性(结扎、离断右侧髂股动脉分支,股动脉内置入抗凝硅胶管并固定)和急性后肢缺血模型(结扎、离断右侧髂股动脉分支后直接结扎并切除股动脉)。用激光多普勒血流检测仪记录术前至术后连续4周肢体血流灌注情况。用实时荧光定量PCR法检测术后24 h患肢股内收肌缺氧诱导因子1α(HIF-1α)和血管内皮生长因子(VEGF)基因的表达。结果术后24 h,急性缺血组患肢股内收肌HIF-1α和VEGF表达水平均明显高于慢性缺血组(均P<0.05)。急性缺血组血流灌注在术后即刻降至对侧肢体的24%,但恢复较迅速,至术后28 d达到并稳定在82%;慢性缺血组于术后7 d达到血流灌注谷值(48%),随后缓慢恢复,至术后28 d至最高值(67%)。两组血流灌注水平在各观察时间点均有统计学差异(均P<0.05)。结论大鼠慢性和急性后肢缺血模型的病变特点及基因表达存在差异,慢性后肢缺血模型更符合临床严重肢体缺血的病理过程。     

2型糖尿病大鼠后肢缺血模型的建立及评价

目的建立2型糖尿病大鼠后肢缺血模型并进行评价,为后续的干预实验提供研究平台。方法将15只SD大鼠随机分为正常对照组、糖尿病组及糖尿病后肢缺血组,每组5只。糖尿病组及糖尿病后肢缺血组的10只大鼠均给予高脂饮食喂养4周后,腹腔注射链脲佐菌素（STZ,40mg／kg）以建立2型糖尿病模型。糖尿病后肢缺血组大鼠建模成功后行双侧髂总动脉结扎术以建立后肢缺血模型,正常对照组和糖尿病组大鼠仅分离髂总动脉,不予结扎。2周后对3组大鼠股动脉的起始段行彩色多普勒超声检查,以检测股动脉的血流峰值速度和血流加速时间;取缺血部位的小腿三头肌及大腿股四头肌组织,分别行HE染色及免疫组化SP染色,以观察3组大鼠肌细胞的营养状况及血管再生情况。结果后肢缺血模型建模2周后,正常对照组、糖尿病组和糖尿病后肢缺血组大鼠的血流峰值速度分别为（22．49±3．02）cm／s、（17．36±2．60）cm／s和（11．23±1．26）cm／s,血流加速时间分别为（0．080±0．009）S、（0．120±0．009）S和（0．160±0．020）s,糖尿病后肢缺血组大鼠的股动脉血流峰值速度小于正常对照组和糖尿病组（P〈0．05）,而血流加速时间较长（P〈0．05）。HE染色结果显示：糖尿病后肢缺血组大鼠小腿三头肌的结构破坏,有大量炎症细胞浸润,肌肉损伤程度重于正常对照组和糖尿病组。免疫组化sP染色结果显示：糖尿病后肢缺血组大鼠大腿股四头肌的毛细血管密度[（1．40±0．55）个／HPF]小于正常对照组[（6．80±0．84）个／HPF]及糖尿病组[（4．60±0．55）个／HPF],差异均有统计学意义伊〈O．05）。结论对SD大鼠给予高脂饮食联合小剂量STZ注射可以成功诱导2型糖尿病模型,在此模型基础上结扎髂总动脉可以成功制备糖尿病后肢缺血模型。     

兔缺血再灌注后骨骼肌病理改变与一氧化氮分泌量的关系

我们旨在通过制做兔后肢缺血再灌注模型 ,分别在缺血及再灌注不同时间行骨骼肌病理检查 ,并测股静脉血一氧化氮 (ＮＯ)含量 ,以了解缺血再灌注对骨骼肌组织分泌ＮＯ的影响。一、材料与方法1 动物造型与分组 :雄性新西兰兔 8只 ,2 5～ 3ｋｇ ,按动脉阻断平面不同分为 2组。 (1)髂总动脉阻断 6ｈ组 (Ｉ组 ,4只 ) :实验兔经 2 %戊巴比妥钠静脉麻醉 ,下腹部正中切口进腹 ,游离右侧髂总动脉 ,双道银夹阻断。 (2 )股浅动脉阻断12ｈ组 (Ｆ组 ,4只 ) :实验兔同法麻醉后 ,右后肢内侧纵切口 ,解剖并游离股动脉及其侧支 ,同法阻断股动脉 ,保留股深动脉…     

大鼠缺血后肢骨骼肌血管内皮生长因子及其受体的表达

目的 研究大鼠缺血后肢侧枝代偿和血管内皮生长因子（VEGF）及其受体表达的动态变化。为外源性VEGF治疗下肢缺血性疾病提供理论依据。方法 切除SD大白鼠右后肢全长股动脉，随机分为9个时间组：造模后1、3d、1、2、3、4、6、8及12周，各组5只动物。分别于造模前后和观察期末检测双后肢大、小腿肌肉Fit-1、Flk-1蛋白及mRNA表达，各组观察期末实验动物后肢动脉DSA检查。结果 （1）缺血后3d，5只大鼠右后肢出现溃疡（11．11％）；2周后，4只大鼠后肢溃疡愈合，而1只趾端坏疽（2．22％）。（2）缺血后2周，患肢侧枝形成达到高峰，12周时仍可见侧支血管显影。（3）缺血早期（3周内），VEGF及其受体的表达均较健侧显著增强（P〈0．05）；缺血中期（3～8周）。VEGF和Flt-1表达迅速下降，Flk-1仍表达；缺血后期（8周后），VEGF及其受体的表达均低至极低水平，与对侧差异无统计学意义（P〉0．05）。结论（1）肢体缺血后自身的血管新生不能完全满足缺血组织的需要。（2）缺血早期外源性的VEGF补充是不必要的；缺血中期补充VEGF是适宜的；缺血后期在应用VEGF治疗的同时，也需要干预受体的表达。     

CO2促缺血下肢侧支循环建立的实验研究

目的：观察经股动脉主射CO2对兔缺血下肢侧支循环形成作用。方法：采用新西兰大白兔，建立兔急性下肢缺血模型。将模型兔分成两组，实验组10条，每日经股动脉注射95％的CO2（2ml/kg）；对照组6条，每日只注射与实验组等量的肝素生理盐水，共20d，20d后行血管造影、病理、免疫组化染色检查，评价各组侧支血管形成状况。结果：实验组较对照组动物下肢缺血部位新生血管明显增多，侧支循环形成。结论：CO2能加速扩张下肢动脉侧支血管，加速缺血区动物侧支循环的建立，增加下肢缺血区微血管的密度，改善缺血区的血液供应，并有效的保护下肢功能。     

髂内动脉栓塞后观察侧支循环重建的实验研究

目的 观察犬髂内动脉栓塞后侧支循环重建的时间,为骶骨肿瘤术前选择性靶动脉栓塞减少术中失血,提供最佳手术时机。方法 用直径为 200～ 400μ m明胶海绵颗粒对 10只犬双侧髂内动脉进行栓塞,分别于栓塞后第 12、 24、 48、 72、 108 h摄 DSA片,对髂内动脉侧支循环重建的情况进行对比观察。结果 栓塞后 12 h DSA显示有少数侧支循环重建,参与栓塞区供血, 24 h显示有较多侧支循环重建,参与栓塞区供血, 48 h DSA显示侧支循环数量成倍增加。结论 靶动脉栓塞后 24 h以内是治疗骶骨肿瘤的最佳手术时机。     

碱性成纤维细胞生长因子促进兔缺血后肢血管新生的实验研究

目的:了解局部应用碱性成纤维细胞生长因子(bFGF)对促进兔缺血后肢血管新生的作用。方法:25只日本大耳白兔随机分2组,外科结扎切断各兔股动脉及其分支,制作兔后肢缺血模型。试验组各兔在缺血后肢肌肉内多次注射重组人bFGF蛋白(n=15);对照组给予等剂量生理盐水(n=10)。术后4周,各兔行腹主动脉造影观察侧支血管形成情况,取内收肌和腓肠肌肌肉行病理切片HE染色应用图像分析系统统计血管密度,并用免疫组织化学方法检测内收肌和腓肠肌中VEGF阳性表达的血管数。结果:试验组兔侧支循环血管条数、血管密度及VEGF阳性表达的血管数均大于对照组(P<0.01),缺血状态得到改善。结论:在兔缺血后肢肌肉中注射bFGF蛋白可促进血管新生,增加兔缺血后肢血液灌注,改善肢体缺血状态。     

结扎腹主动脉加双侧腹壁阴部动脉在大鼠后肢缺血模型中的应用

目的探讨结扎腹主动脉加双侧腹壁阴部动脉在SD大鼠后肢动脉缺血模型中的应用价值。方法将38只大鼠按随机数字表法随机分为假手术组(n=12)、结扎腹主动脉组(n=12)和结扎腹主动脉加双侧腹壁阴部动脉组(n=14)。氯胺酮6mg/100g腹腔注射麻醉大鼠,开腹后按各组不同的处理方法处理血管,观察术后2周和4周时各组后肢肌力、苍白等情况,同时取股静脉血做血气分析,并取后肢骨骼肌行HE染色。结果结扎腹主动脉加双侧腹壁阴部动脉组术后3d内死亡2只大鼠,其余大鼠均存活。假手术组术后无明显异常。结扎腹主动脉组术后立即出现后肢苍白、活动差;2周时后肢苍白、皮温低有好转;4周时恢复正常。结扎腹主动脉加双侧腹壁阴部动脉组术后2周时后肢缺血明显,肢体苍白、运动差;4周时仍有较明显的肌力异常、苍白等表现。各组均无后肢坏死。结扎腹主动脉加双侧腹壁阴部动脉组在术后2和4周时的肌力和苍白情况均较假手术组差(P0.05);与结扎腹主动脉组比较,在术后4周时肢体苍白情况仍较差(P0.05)。各组内不同时相间比较,差异均无统计学意义(P0.05)。结扎腹主动脉加双侧腹壁阴部动脉组的静脉血氧分压在术后2及4周时明显低于其他2组(P0.05)。HE染色:对照组显示正常的横纹肌结构;结扎腹主动脉组术后2周可见细胞染色不均,肿胀,横纹消失,部分细胞核染色深,4周时恢复正常;结扎腹主动脉加双侧腹壁阴部动脉组术后2周及4周见骨骼肌染色不均,细胞肿胀明显,横纹消失,部分细胞核染色深,密集,细胞间隙加大,但未见明显的细胞坏死。结论结扎腹主动脉加双侧腹壁阴部动脉可制作稳定的SD大鼠后肢缺血模型。     

肢体缺血预处理对大鼠肝脏缺血再灌注致心肌损伤的影响

目的 探讨单侧后肢缺血预处理对大鼠肝脏缺血再灌注致心肌损伤的影响.方法 成年雄性Wistar大鼠72只,体重200～250 g,随机分为3组(n=24),假手术组(S组)仅暴露肝门;肝脏缺血再灌注组(IR组)肝脏缺血60min后恢复灌注;后肢缺血预处理组(LIP组)阻断右侧后肢动脉、静脉和肌间侧支血流10 min后恢复灌注,30 min后建立肝脏缺血再灌注模型.于肝脏再灌注即刻、1、6 h各处死8只大鼠,测定血清脑钠素(BNP)浓度和心肌细胞膜Na+-K+-ATP酶活性,观察心肌超微结构.结果 与S组比较,IR组和LIP组心肌细胞膜Na+-K+-ATP酶活性降低,血清BNP浓度升高(P＜0.05或0.01).与IR组比较,LIP组心肌细胞膜Na+-K+-ATP酶活性升高(P＜0.05),心肌病理损伤程度减轻.结论 单侧后肢缺血预处理可减轻大鼠肝脏缺血再灌注致心肌损伤的程度.     

多次缺血预处理诱导脑侧枝循环重建对脑缺血保护的实验研究

目的：采用右侧颈总动脉多次缺血预处理,并逐次递增缺血时间,诱导右侧大脑侧枝循环建立,观察右侧颈动脉永久性阻断缺血后的脑保护作用。方法：家兔48只随机分为对照组和实验组,每组24只。对照组为假手术组．手术操作同实验组．但实验期间不实施球囊充气阻断颈动脉血流。实验组为右颈总动脉压迫组,压迫方法采用颈总动脉外充气球囊压迫技术．实施压迫时囊内充气压为160mmHg;每次压迫时间根据,预实验公式计算：次缺血时间：次数X5＋40（min）进行,每日2次,直到压迫时间达4h（总时间为20d）。各组分别在实验开始后第1、10和20d,分别采用数字剪影脑血管造影（DSA）方法．观察家兔右侧大侧枝循环建立情况：并于实验第20d用注射器将内囊充气压力达160mmHg后不放气．持续完全阻断右侧右侧颈总动脉血流．观察记录家兔神经功能评分：随后取脑组织标本。光镜下对比观察二组相同部位神经元的病理学及新生血管数量的变化．并比较两组缺血侧脑组织含水量。结果：实验期间二组家兔之间均没有观察到兴奋、躁动．嗜睡．活动、行为及胺。体运动障碍等异常症状。从DSA显像结果表明,在实施右侧颈总动脉外压造缺血预处理的第10d。造影剂已经通过willis环进入右侧大脑动脉,与压迫第1d比较右侧血管显影非常清晰．但与左侧比较右。后外上段侧枝未见显影。在实旗压迫处理的第20d,DSA血管显像左右两侧无差异．右后外上段血管显影也非常清晰。神经功能缺失评分和脑组织含水量实验组明显小于对照组。（P〈0．05）。右侧（缺血i：侧）,病理标本。在400倍镜一个视野下的毛细血管密度,实验组为5．3±0．5对照组为3．5±0．4,实验明显多于对照组（P〈0．05）。结论：多次缺血预处理能够诱导大脑Willis环及其相应的侧枝循环重建．对右侧颈总动脉完全缺血具有明显的保护作用。     

腹腔动脉重度狭窄的影像学表现及经肝动脉介入治疗中的应对策略

目的 分析腹腔动脉重度狭窄的CTA及DSA表现,探讨对该类患者行经肝动脉介入治疗的应对策略。方法 回顾分析11例经腹部CTA和腹腔动脉-肠系膜上动脉DSA确诊的腹腔动脉重度狭窄患者,评估其腹腔动脉狭窄的原因、程度,侧支循环和介入手术的处理。结果 11例患者腹腔动脉狭窄均为中弓韧带压迫所致,均有明显的侧支循环形成;对其中10例采用不同方法成功进行了经肝动脉介入治疗。结论 行经肝动脉介入治疗腹腔动脉狭窄时,适宜的应对策略具有重要临床意义。术前腹部CTA对于该类患者的后续治疗有重要指导价值。     

Salvage angiogenesis induced by adenovirus-mediated gene transfer of vascular endothelial growth factor protects against ischemic vascular occlusion

Purpose: Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis, and transgene expression from adenovirus vectors can provide in vivo delivery of proteins. On the basis of this knowledge, we hypothesized that local administration of a replication-deficient adenovirus vector expressing complementary DNA for VEGF (AdVEGF) would induce collateral vessel formation in the setting of ischemia that could protect against subsequent acute vascular occlusion. Methods: Hindlimb ischemia was induced in Sprague-Dawley rats by means of unilateral ligation of the common iliac artery immediately followed by administration of 4 × 10⁹plaque-forming units VEGF, the control vector AdNull, or phosphate-buffered saline solution into the iliofemoral adipose tissue and thigh muscles. Untreated rats with common iliac ligation were used as an additional control group. Results: Local VEGF expression was observed for 5 days in AdVEGF-treated rats but not in controls. Three weeks after ligation and vector administration, the ipsilateral femoral artery was ligated for a model of an acute vascular occlusion in the setting of preexisting ischemia. Blood flow to the ischemic hindlimb relative to the contralateral hindlimb evaluated with color microspheres demonstrated significantly increased blood flow in the AdVEGF-treated rats compared with each control group (p < 0.0001). Relative blood flow assessed by means of ^99mTc-sestamibi radionuclide scans also demonstrated increased blood flow to the ligated hindlimb of AdVEGF-treated rats compared with each control group (p < 0.002). AdVEGF-treated rats also demonstrated increased vascularity in the ligated limb compared with each control group as assessed by means of angiography (p < 0.0001) and histologic quantification of blood vessels less than 80 μm diameter in local adipose tissue and capillaries per muscle fiber (p < 0.0002). AdVEGF treatment prevented a rise in femoral venous lactate femoral venous concentrations 1 hour after femoral artery ligation in control rats (p < 0.04). Conclusions: An adenovirus vector expressing VEGF complementary DNA is capable of stimulating an angiogenic response that protects against acute vascular occlusion in the setting of preexisting ischemia, suggesting that in vivo gene transfer of VEGF complementary DNA might be useful in prophylaxis of advancing arterial occlusive disease. (J Vasc Surg 1998;27:699-709.)     

带旋髂深血管蒂髂骨瓣转移对股骨头血供重建的影像学评价

目的：通过对术后股骨颈骨折患者两侧旋髂深血管的数字减影血管造影（DSA）或计算机断层扫描血管造影（CTA）,以及股骨头的ECT、MRI检查,探讨带旋髂深血管蒂髂骨瓣转移对股骨颈骨折术后股骨头血供重建的作用。方法：45例股骨颈囊内骨折,男30例,女15例;年龄16-50岁,平均36．5岁;病程乱25d,平均10．2d。头下型20例,头颈型10例,经颈型15例。应用带旋髂深血管蒂髂骨瓣转移结合空心拉力螺钉固定治疗,术后平均随访3年6个月,对术后两侧旋髂深血管的数字减影血管造影（DSA）或计算机断层扫描血管造影（CTA）,并行股骨头的ECT、MRI检查,动态观察转移血管的充盈情况并监测受区血供重建变化。结果：术后3周,38例行DSA检查显示,转移的旋髂深血管均通畅;7例行CTA的患者中2例显影不确切,再次DSA检查见血管通畅。术后1年以后的DSA或CTA检查均显示转移血管通畅。术后3、6、12个月ECT检查显示患侧的股骨头内核素浓集,分布均匀,两侧股骨头的放射性比值（ROI）的患侧与健侧的比值（D／N）均大于1．0,D／N平均值术后3个月为（2．12±0．21）,术后6个月为（2．04±0．14）,术后12个月为（1．71±0.11）,术后3、6个月之间的D／N值无明显差异（P〉0．05）,术后12个月的D／N值较术后3、6个月明显下降（P〈0．05）。但MR检查未发现股骨头密度下降、形态改变。结论：DSA、CTA、ECT、MRI证实带旋髂深血管蒂髂骨瓣可以为股骨头提供有效的血供,有利于股骨颈骨折后股骨头血供的重建。     

Acute arterial insufficiency of the male genitalia

Three patients developed severe ischemia of the penis or scrotum from acute arterial occlusion. In one case, nonhealing ulceration of the glans developed after atheroembolism to the dorsal penile artery. One patient had penile ischemia after ligation of pelvic and femoral collateral circulation during repair of an aorto-bilateral-iliac artery aneurysm. A third patient had ischemia of the penis and scrotum from thromboembolism to the iliac arteries during repair of an aortoenteric fistula. Only seven patients have been described with acute arterial occlusion and severe ischemia of the male genitalia. A rare phenomenon because of rich collateral circulation, acute ischemia of the genitalia nevertheless must be recognized as a sign of severe vascular disease and a consequence of major arterial ligation or occlusion in the pelvis and groins.     

Variations in Surgical Procedures for Hind Limb Ischaemia Mouse Models Result in differences in Collateral Formation

ObjectiveTo identify the optimal mouse model for hind limb ischaemia, which offers a therapeutic window that is large enough to detect improvements of blood flow recovery, for example, using cell therapies.Materials and MethodsDifferent surgical approaches were performed: single coagulation of femoral and iliac artery, total excision of femoral artery and double coagulation of femoral and iliac artery. Blood flow restoration was analysed with Laser Doppler Perfusion Imaging (LDPI). Immuno-histochemical stainings, angiography and micro-computed tomography (CT) scans were performed for visualisation of collaterals in the mouse.ResultsSignificant differences in flow restoration were observed depending on the surgical procedure. After single coagulation, blood flow already restored 100% in 7 days, in contrast to a significant delayed flow restoration after double coagulation (54% after 28 days, P < 0.001). After total excision, blood flow was 100% recovered within 28 days. Compared with total excision, double coagulation displayed more pronounced corkscrew phenotype of the vessels typical for collateral arteries on angiographs.ConclusionThe extent of the arterial injury is associated with different patterns of perfusion restoration. The double coagulation mouse model is, in our hands, the best model for studying new therapeutic approaches as it offers a therapeutic window in which improvements can be monitored efficiently.     

髂动脉硬化闭塞性病变的介入治疗技术及体会

目的探讨应用内膜下血管成形术(SIA)联合经皮血管腔内成形术(PTA)介入治疗髂动脉硬化闭塞性病变的技术方法和疗效。方法对15例伴有严重缺血症状的髂动脉硬化闭塞性病变患者,采用顺行途径穿刺,经左肱动脉穿刺3例,经对侧股动脉穿刺12例。通过SIA对闭塞段动脉进行再通,应用球囊扩张成形并植入支架(裸支架18枚,覆膜支架4枚)。结果内膜下血管成形术技术成功率100%,支架植入后髂动脉闭塞段管腔形态良好,血流通畅,无严重并发症出现,临床症状消失或明显改善。患肢踝肱指数由术前的0.41±0.12增至术后7天的0.81±0.13(t=8.76,P0.0001)。近中期随访2例发生再狭窄,经PTA解除,术后12个月支架一期通畅率为85.71%(12/14)。结论 SIA联合支架植入术治疗髂动脉硬化闭塞性病变安全、有效,近、中期疗效良好。     

Absence of the genicular arterial anastomosis as generally depicted in textbooks

IntroductionTextbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg.MethodsDissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: ‘direct communication’, ‘approaching communication’ or ‘no evident communication’.ResultsA constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation.ConclusionsModern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray’s Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT is removed for bypass or flap surgery. A direct communication is rarely present and is never as robust as generally depicted in textbooks.     

腹主动脉瘤腔内修复术中封闭髂内动脉后的并发症及其与侧支血管形成的关系

背景与目的：腹主动脉瘤腔内修复术（EVAR）由于其安全性和有效性,已逐步成为腹主动脉瘤的一线治疗方法,虽然目前已有各种微创腔内器具和介入技术运用于髂内动脉（IIA）的保留,但临床上需封闭IIA的情况仍不少见,而一旦封闭IIA,尤其进行双侧IIA栓塞的患者,可能出现臀肌缺血、肠道缺血、性功能障碍等并发症。同时,部分IIA侧支建立良好患者行双侧IIA封闭后无明显封闭相关并发症的发生。因此,本研究探讨分析EVAR中封闭单侧或双侧IIA后,臀肌、肠道、生殖器缺血等并发症情况及其与侧支代偿之间的关系。方法：回顾性收集并分析2011年7月—2021年7月在中国人民解放军海军军医大学附属长海医院行EVAR的1 902例患者的基线资料及术前、术中、术后影像学资料,筛选出426例行IIA封闭的患者（62例行双侧IIA封闭,264例行单侧IIA封闭）,并进行并发症相关症状电话随访。统计患者围手术期和随访期患者臀肌缺血、肠道缺血、性功能障碍等相关并发症情况,根据术中及术后影像观察侧支代偿情况,并分析侧支建立与并发症的关系。结果：426例患者中,73例（17.1%）出现臀肌缺血症状,7例（1.6%）出现肠道缺...     

Intra-arterial bone marrow cell transplantation induces angiogenesis in rat hindlimb ischemia

BACKGROUND: Bone marrow (BM) cells have been shown to augment local angiogenesis by differentiating vessels themselves and/or secreting paracrinally angiogenic growth factors. Herein, the angiogenic effects of intra-arterial BM mononuclear cell (BM-MNC) transplantation were evaluated in a rat ischemic hindlimb model. METHODS: Unilateral hindlimb ischemia was created by excising the femoral artery and its branch in Lewis rats. BM-MNCs were isolated by centrifugation through a Histopaque density gradient. One week after excision of the unilateral femoral artery, BM-MNCs (5 x 10(6) cells, Group A, n = 6) or PBS (Group B, n = 7) were injected into the ischemic thigh skeletal muscles at the six points with a gauge needle. Another injection of BM-MNCs (3 x 10(7) cells, Group C, n = 6) or PBS (Group D, n = 7) was administered via the indwelling catheter in the right common iliac artery. RESULTS: Four weeks after the BM-MNC transplantation, angiographic examination revealed the development of collateral vessels in both BM-MNC-transplanted groups. The difference in skin temperature between right and left hindlimbs was significantly reduced in both BM-MNC-transplanted groups (0.93 +/- 0.15 vs. 2.84 +/- 0.35 vs. 1.20 +/- 0.26 vs. 2.61 +/- 0.37 degrees C, Group A vs. Group B vs. Group C vs. Group D, p < 0.05). Moreover, immunohistochemical analysis demonstrated that capillary endothelial cells were increased in both BM-MNC-transplanted groups. CONCLUSION: BM-MNC implantation was able to induce functional neovascularization in rat ischemic hindlimb. The intra-arterial administration offered similar levels of angiogenic activity as intramuscular injection.