《欧洲血管外科学会2022年慢性下肢静脉病管理临床实践指南》解读：髂静脉疾病

欧洲血管外科学会（European Society for Vascular Surgery,ESVS）2022年1月发表了《欧洲血管外科学会2022年慢性下肢静脉病管理临床实践指南》（简称《ESVS指南》）。在髂静脉疾病方面,与2015年版指南相比,保留了一些指南观点,对一些指南观点进行了升级,也新增了部分观点,对于医务人员和患者均具有很好的指导及参考意义,现就指南髂静脉疾病相关部分进行解读。     

静脉阻塞性疾病最新指南及专家共识的比较

静脉阻塞性疾病主要包括急性的深静脉血栓以及慢性的髂静脉受压综合征和血栓形成后综合征。这些静脉阻塞性疾病会引起急慢性的下肢静脉高压，显著影响生活质量，为此国内外血管外科界均推出了相关的指南或者共识。其中最新的有中国医师协会血管外科医师分会静脉学组的《常见静脉疾病诊治规范（2022年版）》以及欧洲血管外科学会的《静脉血栓临床管理指南（2021年版）》和《下肢慢性静脉疾病管理指南（2022年版）》。本文就上述国内外的指南及专家共识进行比较和解读，为静脉阻塞性疾病的诊治及管理提供参考和指导。     

肝静脉重建术在肝切除中的应用

肝静脉重建技术已逐渐应用于肝切除中，该技术可能避免单纯肿瘤切除后所引起的残余肝血管栓塞形成及肿瘤对血管侵犯后引起的肿瘤复发。笔者对目前的肝静脉重建技术应用范围、围手术期准备及其优缺点进行综述，以为临床应用参考。

     

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目的 分析先天性血管畸形的治疗经验。方法 从1995年7月至2003年5月上海第二医科大学附属第九人民医院共治疗先天性血管畸形204例，其中先天性动静脉瘘58例，海绵状血管瘤72例，静脉畸形骨肥大综合征74例。先天性动静脉瘘采用手术、栓塞和手术联合栓塞等方法进行治疗；海绵状血管瘤采用手术和手术联合Nd：YAG激光治疗；静脉畸形骨肥大综合征采用保守治疗、外侧畸形静脉和曲张静脉切除、受压的深静脉段松解和胭动脉分支结扎等治疗。结果 经过治疗的先天性血管畸形大部分在临床均能取得一定的疗效，部分病人症状复发甚至加重。结论 先天性血管畸形的治疗仍是临床所面临的难题之一，积极的并根据病情所采用的个体化和联合的治疗方法是非常必要的，常可取得一定的临床效果。     

先天性静脉畸形骨肥大综合征合并膀胱血管瘤一例报告并文献复习

目的 提高对先天性静脉畸形骨肥大综合征合并膀胱血管瘤患者的诊治水平. 方法 患者,女,23岁.主因间断无痛性全程肉眼血尿1个月,发现膀胱肿物20 d于2010年11月入院.外院膀胱活检病理提示血管瘤病.既往:左下肢血管瘤23年,分别于3个月、3岁、13岁时行左下肢血管瘤切除术.查体见左下肢膝关节以下明显增粗并长于右侧,左小腿及足踝部软组织增生.B超检查提示膀胱左前壁实性占位,范围4.1 cm ×3.0 cm ×2.5 cm.膀胱镜检可见膀胱顶部略偏左侧黏膜隆起并可见曲张静脉血管,范围3.0 cm x5.0 cm. 结果 患者诊断为膀胱血管瘤,先天性静脉畸形骨肥大综合征.行膀胱部分切除术.术后病理为膀胱肌间血管瘤.术后肉眼血尿消失.术后3个月复查B超,膀胱未见异常. 结论 先天性静脉畸形骨肥大综合征可能合并膀胱血管瘤,膀胱部分切除术可以作为治疗方法之一.     

第八届中国静脉外科论坛暨国际静脉联盟中国静脉大会、第二届河南血管外科学年会第二轮通知

<正>由中华医学会外科学分会血管外科血组、国际静脉联盟中国静脉学分会、河南医学会联合举办,由郑州大学第一附属医院和首都医科大学附属北京世纪坛医院联合承办的第八届中国静脉外科论坛暨国际静脉联盟中国静脉大会、第二届河南血管外科学年会将于2017年12月8~10日在郑州举行。     

肝移植治疗先天性肝外门体静脉分流Abernethy畸形1例

Abernethy畸形是一种先天性肝外门体静脉分流的血管畸形.临床表现包括门静脉高压、消化道出血、肝性脑病、肝肺综合征和肝脏多发结节等.该疾病相对罕见,极易漏诊或误诊.现就本院确诊为Ⅱ型Abernethy畸形并行肝移植的病例报道如下,旨在使临床医生充分认识该病.     

体表软组织内静脉畸形的影像学表现与分类

静脉畸形是先天性血管病变的一个亚类,本文结合其生物学分类、病理结构及临床表现特点,对体表软组织内静脉畸形的影像学表现作一综述,细     

第八届中国静脉外科论坛在郑州召开

<正>由中华医学会外科学分会血管外科学组、国际静脉学联盟中国静脉学分会、河南省医学会联合主办,郑州大学第一附属医院、首都医科大学附属北京世纪坛医院共同承办的第八届中国静脉外科论坛暨国际静脉学联盟中国静脉大会、第二次河南血管外科学年会于2017年12月8日~10日在郑州国际会展中心隆重召开。     

下肢静脉性溃疡的治疗进展

下肢静脉性溃疡(VLU)是血管外科常见的疾病,其多迁延不愈,愈后易复发,现今仍然是临床上颇为棘手的难题。现有的治疗方法可分为保守治疗和手术治疗两大类,笔者概述其药物治疗、压力治疗、传统手术、腔内和腔镜手术以及针对穿通静脉和溃疡面处理等方法的进展,以期为临床上以外科手术为主的VLU综合治疗方法提供借鉴。     

欧洲血管外科学会2024版《腹主动脉-髂动脉动脉瘤管理临床实践指南》解读

欧洲血管外科学会发布了2024版《腹主动脉-髂动脉动脉瘤管理临床实践指南》,对腹主动脉瘤和髂动脉病变的诊疗策略进行了全面而详细的介绍。该指南基于截至2023年8月的最佳证据,依据修改后的欧洲心脏病学学会评分系统制定了160条建议,较2019年版本新增59项全新建议。新版指南针对质量控制、流行病学与诊断筛查、小型腹主动脉瘤管理、腹主动脉瘤择期修复、破裂及症状性腹主动脉瘤管理、复杂腹主动脉瘤管理等方面的重要内容进行了证据总结与分级推荐。该指南对于指导国内血管外科腹主动脉-髂动脉瘤临床工作具有重大借鉴意义,但同时也需注意结合本土患者的实际情况开展个体化诊疗。本文对指南中相关部分进行了解读,供学者们参考讨论。     

《欧洲血管外科学会（ESVS）2021年静脉血栓管理临床实践指南》临床热点解读

欧洲血管外科学会（ESVS）于2021年在《European Journal of Vascular and Endovascular Surgery》发表了该协会首个静脉血栓诊疗领域的指南：《欧洲血管外科学会（ESVS）2021年静脉血栓管理临床实践指南》,该指南包括了下肢深静脉血栓形成（DVT）、上肢DVT、浅静脉血栓形成（SVT）以及特殊部位血栓形成等方面,共给予了72条推荐意见;同时,除了关于治疗方法的推荐,还包括了健康经济学以及特殊患者人群的相关问题。该指南中的建议是通过对目前可以得到的研究证据进行分析及评估制定的,会对临床实践有较大的借鉴意义,但是,随着技术、证据以及知识的发展,指南可能需要不断更新。笔者团队根据指南更新的循证医学证据,结合临床中的热点问题,对指南给出的推荐意见做重点解读,以期更好地理解指南原则及实用建议。     

欧洲血管外科学会2023版《动脉粥样硬化性颈动脉和椎动脉疾病管理的临床实践指南》解读

欧洲血管外科学会（ESVS）发布了2023版《动脉粥样硬化性颈动脉和椎动脉疾病管理的临床实践指南》，对颈动脉和椎动脉病变的诊疗策略进行了全面而详细的介绍。该指南一共包含了133条推荐，其中11条推荐更新了证据等级或推荐强度，38条为新发布的推荐。动脉粥样硬化性颈动脉和椎动脉狭窄是缺血性卒中的重要病因，合理的管理治疗策略能够降低卒中风险。因此，笔者根据指南的循证医学证据，结合我国临床实际，对指南内容进行解读，以期帮助临床医务人员更好地管理动脉粥样硬化性颈动脉和椎动脉患者。     

欧洲血管外科学会2023版《血管疾病抗血栓治疗临床实践指南》解读—下肢动脉硬化性疾病

欧洲血管外科学会（ESVS）首次发布了2023版《血管疾病抗血栓治疗临床实践指南》，对下肢动脉硬化性疾病（LEAD）的抗血栓策略进行了详细的介绍和更新，并给出了21条具体的推荐。LEAD患病率和相关的公共卫生费用都在不断增加，抗血栓治疗是LEAD患者的治疗基石。因此，笔者根据指南的循证医学证据，结合临床实际，重点对LEAD的抗血栓策略进行解读，希望能够帮助医务工作者更好地理解和遵循指南。     

Evolution of congenital malformations of the umbilical-portal-hepatic venous system

ObjectiveThe objective of this study is to describe the evolution of 8 cases of congenital malformations of the umbilical-portal-hepatic venous system diagnosed before the first month of life.Materials and methodsAll cases of congenital malformation of the portal and hepatic venous system diagnosed prenatally or during the first month of life in our institution were systematically reviewed since November 2000. Clinical features, imaging, and anatomical findings were reviewed, focusing primarily on clinical and radiologic evolution.ResultsEight cases of congenital malformation of the umbilical-portal-hepatic venous system were studied. Fifty percent of these malformations were diagnosed prenatally. We report 4 portosystemic shunts. Three involuted spontaneously, and the fourth one required surgical treatment. We report a variation of the usual anatomy of portal and hepatic veins that remained asymptomatic, an aneurysmal dilatation of a vitelline vein causing portal vein thrombosis that needed prompt surgical treatment with good result, a complex portal and hepatic venous malformation treated operatively, and a persistent right umbilical vein that remained asymptomatic.ConclusionPrenatal diagnosis of malformations of the umbilical-portal-hepatic venous network is uncommon. Little is known about the postnatal prognosis. Clinical, biologic, and radiologic follow-up by ultrasonography is essential to distinguish pathologic situations from normal anatomical variants.     

下肢静脉阻塞性疾病相关指南与共识解读北大核心CSCD

下肢静脉阻塞性疾病包括非血栓性髂静脉受压综合征、急性下肢静脉血栓以及血栓后综合征等,是临床常见的一类下肢静脉疾病。近年来,中华医学会外科学分会血管外科学组和中国医师协会血管外科医师分会静脉曲张与VTE学组先后推出了多项涵盖下肢静脉阻塞性疾病相关指南和共识,使得越来越多的病人受益,但是仍旧存在诸多诊治不规范带来临床不良结局。对于静脉阻塞性疾病,应尽早开展评估、筛查与诊断,并开展规范化的抗凝、抗栓和腔内治疗以及其他外科治疗,同时加强疾病综合管理,更好提升病人治疗预后和生活质量。     

Intraosseous venous malformation of the zygoma: A case report and literature review

IntroductionVenous malformations of the zygoma are rare. Historically, venous malformations have been misrepresented as “hemangiomas”. The International Society for the Study of Vascular Anomaly (ISSVA) classification is a reasonable classification that leads to appropriate clinical diagnosis and treatment strategies. Collaboration between surgeons, radiologists, and pathologists is necessary for accurate diagnosis and management.Presentation of caseWe present here a case of an IOVM in a 59-year-old woman who was treated with a multidisciplinary approach. Superselective arteriography and embolization were effective for diagnosis as well as for prevention of large hemorrhage during surgery. En-bloc resection of the zygoma was performed within hours after embolization and autologous calvarial bone graft was used for primary reconstruction.DiscussionWe performed a literature review consisting of reviewing 52 cases of IOVM of the zygoma discussing optimal material for reconstruction of the defect for intraosseous venous malformation of the zygoma nationally and internationally.ConclusionThe combination of surgery and preoperative angiography makes it possible to prevent high risk of hemorrhage. For primary reconstruction of the zygoma, use of autologous calvarial bone can maintain the volume and reconstruct the natural malar contour.     

Guía anestésico-quirúrgica en el tratamiento de la cirugía de aorta ascendente y del arco aórtico. Documento de consenso de la Sociedad Española de Cirugía Cardiovascular y Endovascular y la Sociedad Española de Anestesiología,Reanimación y Terapeútica del Dolor

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving “Aortic teams” made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of “AORTIC TEAM”(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.     

Vaskuläre Malformationen

The therapy of extended vascular anomalies necessitates a differentiated interdisciplinary treatment regime; therefore, exact knowledge of the classification of these anomalies is essential. The system was established by the International Society for the Study of Vascular Anomalies (ISSVA) and classifies vascular anomalies into proliferating vascular tumors and congenital vascular malformations. The vascular malformations are subdivided into high-flow and low-flow malformations. To confirm the initial clinical diagnosis it is necessary to obtain diagnostic tomographic images of the vascular lesion and magnetic resonance imaging (MRI) is the imaging modality of choice complemented by magnetic resonance angiography (MRA). The indications for therapy depend on the clinical characteristics of the vascular malformation and should be planned in an interdisciplinary setting. In addition to open surgery interventional radiology including percutaneous sclerotherapy and transarterial embolization have evolved as crucial elements of the interdisciplinary treatment management of vascular malformations.     

Carotid artery disease: clinical features and management

The most common single cause of ischaemic carotid territory stroke is thromboembolism from stenoses in the extracranial internal carotid artery (ICA). In the majority, embolism is preceded by an acute change in plaque morphology predisposing the patient to overlying thrombus formation and embolization. The management of patients with carotid artery disease mandates risk factor modification, antiplatelet and statin therapy in everyone. There is grade A, level I evidence that recently symptomatic patients with 50–99% NASCET stenoses gain significant benefit from carotid endarterectomy (CEA), despite a small risk of perioperative stroke. Maximum benefit is conferred if the patient undergoes surgery as soon as possible after onset of symptoms. The management of patients with asymptomatic disease remains controversial. The 2018 European Society for Vascular Surgery (ESVS) carotid guidelines now advise that asymptomatic patients with a 60–99% stenosis who have one or more clinical/imaging features that might make them at higher risk for stroke on medical therapy should be considered for CEA, with the remainder being treated medically. The 2018 ESVS carotid guidelines also advise that carotid artery stenting may be an alternative to CEA in ‘average risk’ symptomatic and asymptomatic patients, although CEA is still the preferred option when treating patients within 14 days of symptom onset.