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1.
Chaoyi Cui Xintian Huang Xiaobing Liu Weimin Li Xinwu Lu Min Lu Mier Jiang Minyi Yin 《Journal of vascular surgery》2017,65(1):82-90
Objective
To evaluate efficacy, safety, and midterm patency of endovascular treatment of obstructive popliteal artery (PA) disease.Methods
A retrospective evaluation of patients with atherosclerotic PA disease who underwent percutaneous transluminal balloon angioplasty and provisional stent, based on both conventional and dynamic angiographies, was conducted from June 2011 to June 2014. Forty-three patients were included in the study, and most patients had limited surgical revascularization options. Demographic characteristics, angiographic findings, interventional data, complications, vessel patency, limb salvage rates, and survival rates were analyzed.Results
The median lesion length was 5 cm with 72.1% having total occlusions. The second popliteal segment (P2) was involved most frequently (60.5%, n = 26). Critical limb ischemia was present in 69.8%. The technical success rate was 92.9% (42/43 limbs), with 29 cases requiring adjunctive nitinol stents after balloon angioplasty (47.6% based on conventional angiography, 21.4% based on dynamic angiography, and 4.8% additional stents based on dynamic angiography). Complications included thromboembolism (2.3%), perforation (2.3%), pseudoaneurysm (2.3%), and myocardial infarction (2.3%). Stent fracture was present in three cases (7.1%) during the mean follow-up period of 18.3 months. The baseline ankle-brachial index significantly improved after the intervention, from 0.49 ± 0.11 to 0.92 ± 0.14 (P < .01). The Rutherford-Becker class decreased from 3.95 ± 0.76 to 1.76 ± 0.95 (P < .01) at 12 months. The 1-year primary, primary-assisted, and secondary patency rates were 75.2% ± 6.8%, 82.4% ± 6.0%, and 89.9% ± 4.8%, respectively. The limb salvage and amputation-free survival rates at 12 months were 91.6% and 87.0%, respectively.Conclusions
Balloon angioplasty with a provisional stent based on dynamic angiography is a feasible, safe, and effective therapy for patients with obstructive PA disease. Although the occurrence of stent fracture is still inevitable, patients with critical limb ischemia who have limited surgical options may get more benefits from the endovascular treatment of PA obstructive diseases. 相似文献2.
Tao Ma Zhi Hui Dong Wei Guo Fu Da Qiao Guo Xin Xu Bin Chen Jun Hao Jiang Jue Yang Zhen Yu Shi Ting Zhu Yun Shi Bao Hong Jiang Xiao Yun Xu 《Journal of vascular surgery》2018,67(4):1026-1033.e2
Objective
Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this.Methods
From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed.Results
There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length <165 mm. The SG length <165 mm increased the overall proximal and distal SINE incidence in multivariate analysis.Conclusions
The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length <165 mm increases the risk of RTAD and SINE after TEVAR. 相似文献3.
Jin Okazaki Daisuke Matsuda Kiyoshi Tanaka Masaru Ishida Sosei Kuma Koichi Morisaki Tadashi Furuyama Yoshihiko Maehara 《Journal of vascular surgery》2018,67(3):817-825
Background
Traditional end points, such as amputation-free survival, used to assess the clinical effectiveness of lower limb revascularization have shortcomings because they do not account independently for wound nonhealing and recurrence or patient survival. Wound healing process and maintenance of a wound-free state after revascularization were not well-studied. The aim of this study was to elucidate the long-term clinical course of ischemic wounds after revascularization. We focused on initial wound healing process as well as the maintenance of a wound-free state after achievement of wound healing. We introduced a wound-free period (WFP; the period during which limbs maintained an ulcer-free state) and Wound Recurrence and Amputation-free Survival (WRAFS) as parameters and tested their effectiveness in evaluating clinical outcomes of limbs treated using endovascular therapy (EVT) and surgical revascularization.Methods
The medical records of patients developing lower critical limb ischemia with tissue loss who underwent surgical or endovascular revascularization of the infrainguinal vessels between 2009 and 2013 were reviewed retrospectively. The risk factors for achieving wound healing and WRAFS were analyzed using Kaplan-Meier survival curves and Cox regression model. Risk factors to prolong wound healing time (WHT) and reduce WFP were determined by the least squares method.Results
In total, 233 patients underwent 278 limb revascularizations; 138 endovascular and 140 surgical procedures were performed as first treatments. The proportion of healed wounds 1, 2, and 3 years after primary revascularization was 64.0%, 69.7%, and 70.5%, respectively. Significant risk factors for wound healing were an EVT-first strategy (risk ratio [RR], 2.47), congestive heart failure (RR, 2.05), and wound, ischemia, and foot infection wound grade (RR, 1.59). The mean WHT was 143.7 days. An EVT-first strategy and wound infection contributed to significantly longer WHT. The mean WFP was 711.0 days. An EVT-first strategy, history of coronary artery disease, and dialysis dependence were associated with significantly shorter WFPs. WRAFS at 1 and 2 years after achievement of wound healing were 76.9% and 64.2%, respectively. Significant risk factors against WRAFS were a history of coronary artery disease (RR, 1.68), dialysis dependence (RR, 2.03), and being wheel chair bound (RR, 1.64).Conclusions
EVT revascularization was associated with longer WHT, reduced wound healing rate, and a shorter WFP compared with surgical revascularization. wound, ischemia, and foot infection grade was associated with longer WHT and reduced wound healing rate, but not associated with a shorter WFP. Systemic conditions such as dialysis dependence, congestive heart failure, and being wheel chair bound were associated with reduced wound healing rate and shorter WFP, presumably because they limited life expectancy. WHT and WFP are useful criteria for evaluating limb outcomes in patients with critical limb ischemia. 相似文献4.
5.
Ke Wang Peng Deng Yuan Sun Ping Ye Anchen Zhang Chuangyan Wu Zhang Yue Zhaolei Chen Jiahong Xia 《Journal of vascular surgery》2018,67(3):933-944.e3
Objective
Arteriovenous fistula (AVF) suffers from a high number of failures caused by insufficient outward remodeling and venous neointimal hyperplasia formation. The aim was to investigate the exact mechanism by which microRNA-155 (miR-155) in the outflow vein of AVF is regulated.Methods
AVFs between the branch of the jugular vein and carotid artery in an end-to-end manner were created in C57BL/6 and miR-155?/? mice with a C57BL/6 background. The venous segments were harvested at day 7, 14, 21, and 28, and the AVFs were analyzed histologically and at a messenger RNA level using real-time quantitative polymerase chain reactions. The outflow vein of AVF and the normal great saphenous vein, collected from patients with chronic kidney disease and coronary artery bypass surgery, were analyzed by histologic and molecular biologic approaches.Results
Venous neointimal hyperplasia is significantly alleviated in miR-155?/? mice, and the expression of several chemokines and cytokines in the vessel wall, including regulated on activation, normal T-cell expressed and secreted factor (RANTES), monocyte chemoattractant protein 1, and vascular endothelial growth factor, was inhibited. miR-155 promoted the RANTES expression of smooth muscle-like cells, which in turn facilitated cell proliferation and extracellular matrix production.Conclusions
miR-155 enhances venous neointima formation through the autocrine and paracrine effects of smooth muscle-like cell-derived RANTES in a nuclear factor κB-dependent manner during the entire AVF process, especially at the advanced stage. 相似文献6.
Over the past 11 years, 51 patients (36 male, 15 female) underwent operation to correct ruptured sinus of Valsalva at the Shanghai Chest Hospital. Associated lesions were present in 36 patients. All patients had cardiac enlargement, pulmonary plethora, and prominence of the main pulmonary arterial trunk. Preoperative arterial pressure averaged 135/46 mm Hg (range, 200–96/95–0 mm Hg).At operation the cardiac chamber into which the ruptured aneurysm emptied was opened. The projecting aneurysmal sac was resected at its base, leaving a fringe of 2 to 3 mm for suturing. A double-layer suture closure was used, first a row of figure-of-eight sutures, followed by a row of buttressed mattress sutures.Forty-five patients survived operation; 6 died shortly after operation, a perioperative mortality of 11.8%. Follow-up averaged 4 years 8 months. Thirty-eight patients were symptom free and working; 7 had returned to part-time work. There were no late deaths. A grade II systolic murmur persists in 2 patients, and in 1 of them a loud continuous murmur and thrill were both noted. All patients who survived have shown remarkable reduction in cardiothoracic ratio and improvement in symptoms. These results justify early surgical intervention. 相似文献
7.
Dean J. Arnaoutakis Rebecca E. Scully Gaurav Sharma Samir K. Shah C. Keith Ozaki Michael Belkin Louis L. Nguyen 《Journal of vascular surgery》2017,65(6):1713-1718.e1
Objective
Wound complications (WCs) after lower extremity arterial surgery (LEAS) are common, resulting in readmissions and reinterventions. Whereas diabetes and obesity are known risk factors for WCs, gender-specific variability in body fat distribution (android vs gynoid) may drive differential risks of WCs after LEAS. We analyzed the independent and synergistic effects of gender and body mass index (BMI) on WCs.Methods
We performed a retrospective review of prospectively collected data from a published, randomized, multicenter trial assessing the incidence of WCs (dehiscence, surgical site infections, seroma, and hematoma) after LEAS. Postoperative outcomes were compared between genders. A multivariable regression model assessed the impact of gender and BMI on WCs. Subanalysis focused on the synergy of gender and body habitus, groin-only incisions, and clinical outcomes.Results
There were 502 patients who underwent LEAS between October 2010 and September 2013. The cohort was elderly (67.6 ± 10.5 years), mostly male (72%), and overweight (BMI, 27.6 ± 5.7); 225 (45%) patients had a groin-only incision. In 171 patients (37.9%), a WC developed within 30 days, 85% of which were infectious in etiology. On multivariable regression, obesity (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.17-3.77), morbid obesity (OR, 2.87; 95% CI, 1.32-6.23), and female gender (OR, 1.17; 95% CI, 1.06-2.75) were independent predictors of infectious WCs at 30 days. When stratified by groin-only incision, BMI was no longer significant, but female gender (OR, 2.70; 95% CI, 1.24-5.87) was predictive of infectious WCs at 30 days. There was no synergistic effect of BMI and gender on WCs.Conclusions
WCs are common after LEAS. BMI is an independent risk factor for the development of any WC. Female gender, a potential surrogate for high hip to waist ratio body habitus, is also an independent predictor of groin WCs, suggesting the clinical importance of gynoid vs android fat distribution. 相似文献8.
Hallie E. Baer-Bositis Taylor D. Hicks Georges M. Haidar Matthew J. Sideman Lori L. Pounds Mark G. Davies 《Journal of vascular surgery》2018,67(6):1788-1796.e2
Objective
Tibial interventions for critical limb ischemia are now commonplace. The aim of this study was to examine the impact of pedal runoff on patient-centered outcomes after tibial endovascular intervention.Methods
A database of patients undergoing lower extremity endovascular interventions at a single urban academic medical center between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (Rutherford 5 and 6) were identified. Preintervention angiograms were reviewed in all cases to assess pedal runoff. Each dorsalis pedis, lateral plantar, and medial plantar artery was assigned a score according to the reporting standards of the Society for Vascular Surgery (0, no stenosis >20%; 1, 21%-49% stenosis; 2, 50%-99% stenosis; 2.5, half or less of the vessel length occluded; 3, more than half the vessel length occluded). A foot score (dorsalis pedis + medial plantar + lateral plantar + 1) was calculated for each foot (1-10). Two runoff score groups were identified: good vs poor, <7 and ≥7, respectively. Patient-oriented outcomes of clinical efficacy (absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (survival without major amputation), and freedom from major adverse limb events (above-ankle amputation of the index limb or major reintervention [new bypass graft, jump/interposition graft revision]) were evaluated.Results
There were 1134 patients (56% male; average age, 59 years) who underwent tibial intervention for critical ischemia, with a mean of two vessels treated per patient and a mean pedal runoff score of 6 (47% had a runoff score ≥7). Overall major adverse cardiac events were equivalent at 30 days after the procedure in both groups. At 5 years, vessels with compromised runoff (score ≥7) had significantly lower ulcer healing (25% ± 3% vs 73% ± 4%, mean ± standard error of the mean [SEM]) and a lower 5-year limb salvage rate (45% ± 6% vs 69% ± 4%, mean ± SEM) compared with those with good runoff (score <7). Patients with poor pedal runoff (score ≥7) had significantly lower clinical efficacy (23% ± 8% vs 38% ± 4%, mean ± SEM), amputation-free survival (32% ± 6% vs 48% ± 5%, mean ± SEM), and freedom from major adverse limb events (23% ± 9% vs 41% ± 8%, mean ± SEM) at 5 years compared with patients with good runoff (score <7).Conclusions
Pedal runoff score can identify those patients who will not achieve ulcer healing and patient-centered outcomes after tibial intervention. Defining such subgroups will allow stratification of the patients and appropriate application of interventions. 相似文献9.
Hooman Hennessey Elna Luckham Ahmed Kayssi Mark David Wheatcroft Elisa Greco Mohammed Al-Omran John Harlock Mohammad Qadura 《Journal of vascular surgery》2019,69(1):242-248.e1
Objective
In the treatment of an infected aorta, open repair and replacement with a rifampin-impregnated Dacron vascular graft decrease the risk of prosthetic graft infections, with several protocols available in the literature. We hypothesize that the same holds true for endovascular aneurysm repair, and after studying and optimizing rifampin solution concentration and incubation period to maximize the coating process of rifampin on Dacron endovascular stent grafts (ESGs), we propose a rapid real-time perioperative protocol.Methods
Several prepared rifampin solutions, including a negative control solution, were used to coat multiple triplicate sets of Dacron endovascular aortic stent grafts at different but set incubation periods. Rifampin elution from the grafts was studied by spectroscopic analysis. Once an optimized solution concentration and incubation time were determined, the elution of rifampin over time from the graft and the graft's surface characteristics were studied by ultraviolet-visible spectroscopy and atomic force microscopy.Results
All coated ESGs with any concentration of prepared rifampin solution, regardless of incubation time, immediately demonstrated a visible bright orange discoloration and subsequently after elution procedures returned to the original noncolored state. At the 25-minute incubation time (standard flush), there was no statistical difference in the amount of rifampin coated to the ESGs with 10-mg/mL, 30-mg/mL, and 60-mg/mL solutions (0.06 ± 0.01, 0.07 ± 0.05, and 0.044 ± 0.01, respectively; P > .05). This was also true for a 10-minute incubation time (express flush) of 10-mg/mL and 60-mg/mL rifampin solution concentrations (0.04 ± 0.007 and 0.066 ± 0.014, respectively; P = .22). The elution-over-time of coated rifampin ESG, although not statistically significant, did seem to plateau and to reach a steady state by 50 hours and was confirmed by surface characteristics using atomic force microscopy.Conclusions
Having studied two variables of rifampin coating techniques to Dacron ESGs, the authors propose a rapid real-time perioperative coating protocol by using a 10-mg/mL rifampin solution for a 10-minute incubation period. As rifampin loosely binds to Dacron ESGs by weak intermolecular forces, a rifampin-coated ESG would need to be inserted in a timely fashion to treat the diseased aorta and to deliver its antibiotic affect. A rapid perioperative coating protocol followed by immediate deployment makes our proposed technique especially useful in an urgent and unstable clinical scenario. 相似文献10.
Shih Hao-ruan Chao Linag Shih Tsi-siang 《Burns : journal of the International Society for Burn Injuries》1984,10(3):164-169
Free transplantation of subaxillary lateral thoracodorsal flap is recommended. The thoraco-dorsal artery and its accompanying veins may nourish and drain a large musculo-cutaneous flap. The calibres of both the artery and the veins are big enough to be anastomosed to the recipient vessels using the naked eye. The donor area can be closed by first intention suture without interfering with the functional recovery of the donor area. Both the functional and cosmetic results after free transplantations of this flap are good.In acute electrical or other deep burns, this flap can be used to prevent infection, to protect the deep vital structures, and to lessen the amputation rate. A better condition is created for functional recovery and facilitating reconstructive surgery.The muscular branch of the thoraco-dorsal artery was always present in our 50 patients whereas only 20 cases (40 per cent) had an independent cutaneous branch which nourishes the flap. We stress the point of preserving and using the muscular branch as the main blood vessel to be anastomosed for this free flap. 相似文献
11.
A regimen of multiple intermittent intensive doses of chemotherapy (chiefly 5-fluorouracil) was used in a series of 806 women with choriocarcinoma and malignant mole. The rate of complete remission of choriocarcinoma was 78.6%, and approximately 85% of the patients survived for more than 5 years. From 1962 through 1982, pulmonary metastatic choriocarcinoma was found to be resistant to chemotherapeutic agents in 43 of these patients; they subsequently underwent lung resection. There were no postoperative deaths, and the 5-year survival was 50%. These are relatively good results for patients with long-standing and widely disseminated choriocarcinoma. Human chorionic gonadotropin titer in urine and blood and variations of lung shadows are important criteria in selecting candidates for lung resection. For preservation of lung function, simple lobectomy is the first choice. Better long-term survival was obtained in patients who had a solitary lung lesion on admission without other major organ metastases and in those in whom the lung lesion was well encapsulated and became necrotic after chemotherapy. 相似文献
12.
Seyed Ameli-Renani Vyzantios Pavlidis Robert A. Morgan 《Journal of vascular surgery》2017,65(2):346-355
Objective
This study reports the technical success and follow-up results of transcatheter embolization of type I endoleak (ELI) in 25 patients after endovascular aortic repair (EVAR).Methods
Twenty-five patients with ELI (20 men, five women; mean age 80 years; range, 64-96 years) underwent embolization of abdominal ELI (23 proximal, 2 distal endoleaks) after EVAR. All patients were unsuitable for standard endovascular methods for treatment of ELI. The average aneurysm sac size before embolization was 8.2 cm (range, 5.3-12.9 cm). The average time between EVAR and endoleak diagnosis was 685 days (range, 1-4220 days) and from endoleak diagnosis to embolization was 27 days (range, 2-94 days). Onyx (ev3 Endovascular, Inc, Plymouth, Minn) alone or with detachable coils was used for embolization.Results
A total of 27 embolization procedures were performed, with two patients having undergone a repeat procedure. Onyx alone was used in 16 cases and Onyx and coils were used in 11. Immediate technical success with complete isolation of the endoleak on completion angiography was achieved in all procedures. Six procedural complications occurred: three puncture site hematomas and three cases of non-target Onyx embolization. None of the complications had long term sequelae. During the follow-up period (average, 311 days; range, 1-1357 days), seven patients (28%) developed endoleak recurrence, and two underwent a second embolization procedure. Of these, one has had no further endoleak recurrence, but the other developed a recurrent endoleak and died of sac rupture. Two of the other five cases of endoleak recurrence were successfully managed by other procedures, one had a persistent endoleak despite aortic cuff placement, and the other two were deemed unsuitable for further intervention. Three of the four patients with persistent endoleaks died of sac rupture. At the average follow-up time of 311 days, freedom from endoleak recurrence was 80%, and freedom from sac growth was 85%.Conclusions
Transcatheter embolization of ELI offers a safe, feasible, and sustainable treatment option for patients who are unsuitable for standard methods of ELI treatment. Additional coil embolization before Onyx injection may result in better outcome. 相似文献13.
Pekka Aho Leena Vikatmaa Leila Niemi-Murola Maarit Venermo 《Journal of vascular surgery》2019,69(6):1758-1765
ObjectiveDifficulties in distributing endovascular experience among all operating room (OR) personnel prevented full-scale use of endovascular aneurysm repair (EVAR) in emergencies. To streamline the procedure of EVAR for ruptured aneurysm (rEVAR) and to provide this method even to unstable patients, we initiated regular simulation training sessions.MethodsThis is an observational study of 29 simulation sessions performed between January 2015 and December 2017. We analyzed the development of time from OR door to aortic balloon occlusion during simulations and OR door to needle times in real-life rEVARs as well as the outcome of the 185 ruptured abdominal aortic aneurysm (rAAA) patients who arrived at the university hospital between January 2013 and December 2017. A questionnaire was sent for simulation attendants before and after the simulation session.ResultsIn the first simulations, the door to occlusion time was 20 to 35 minutes. After adding a hemodynamic collapse to the simulation protocol, the time decreased to 10 to 13 minutes in the 10 recent simulations, including a 5-minute cardiopulmonary resuscitation (P = .01). The electronic questionnaire performed for attendees before and after the simulation session showed significant improvement in both confidence and knowledge of the OR staff regarding rEVAR procedure. In the real-life rEVARs, 75 of the 185 patients with rAAAs underwent EVAR. Among rEVAR patients, the median OR door to needle time was 65 minutes before and 16 minutes after the onset of simulations (P = .000). The overall 30-day mortality among all rAAA patients was 44.8% and 30.6% accordingly (P = .046). When patients who were turned down from the emergency surgery were excluded, the 30-day operative mortality was 39.2% and 25.1% during the periods, respectively (P = .051). The 30-day mortality was 16.2% after rEVAR and 40.6% after open surgery (P = .001).ConclusionsSimulation training for rEVAR significantly improves the treatment process in real-life patients and may enhance the outcome of rAAA patients. 相似文献
14.
Study design
Analyze the position of the aorta in patients with Pott's thoracolumbar angular kyphosis by computed tomography.Objective
To investigate the anatomic position of the aorta relative to spine in patients with Pott's thoracolumbar angular kyphosis.Summary of background data
The complication of aorta injury is rare in the procedure of spinal osteotomy for the correction of Pott's thoracolumbar angular kyphotic deformity. However, there would be a disastrous consequence once it happened. Therefore, knowing about the position of aorta relative to the spine is of great importance. From the authors' knowledge, there are no reports about the research on the position of the aorta relative to the spine in patients with Pott's thoracolumbar angular kyphosis.Methods
Thirty patients with Pott's thoracolumbar angular kyphosis and thirty patients without spine deformity were recruited and divided into two groups. The CT images of both groups from T10 to L1 were obtained to evaluate the left pedicle-aorta angle and distance. In the patients with Pott's thoracolumbar angular kyphosis, the affected vertebral bodies were fused, so we measured the left pedicle-aorta angle and distance of the fused vertebral bodies. For the normal group, we measured the left pedicle-aorta angle and distance from T10 to L1 and got the average data, then compared with the Pott's group with independent sample t test. The Pearson correlation analysis was used to evaluate the association between the change of the aortic position and Konstam's angle and LL.Results
The left pedicle-aorta angles (?8.95 + 2.89°) in Pott's group are smaller and the distances (6.36 + 0.77 cm) are larger than those in normal group (P < 0.05). In patients with Pott's thoracolumbar angular kyphosis, with increased Konstam's angle, the left pedicle-aorta angles becomes smaller (r = ?0.495, P < 0.05) and the left pedicle-aorta distances becomes larger (r = 0.486, P < 0.05). However, there is no remarkable correlation between lumbar lordosis and the left pedicle-aorta angles or distances.Conclusion
In patients with Pott's thoracolumbar angular kyphosis, the aorta of the fused vertebrate shifts anteromedially to the vertebral body, and the aorta is relatively farther away from the vertebral body compared with the normal subjects. Therefore, the surgeon should be aware of the change of the position of the aorta to avoid the disastrous complication vessel injury. 相似文献15.
Ding Yue-Liang Pu Shu-Sung Wu De-Zhen Ma Chi Pan Zhong-Lian Lu Xin Miao Shou-Gen Yao Zhu-Xiu He Jian-Ru 《Burns : journal of the International Society for Burn Injuries》1983,9(6):381-386
Escharectomy and skin grafting with both homograft and porcine skin has become an effective method in treating massive third degree burns. Seventeen patients and 21 operations of intermingled transplantation of auto- and fresh porcine skin heterografts after escharectomy of the severe burn wounds have been carried out since March 1973. Clinical and histological data are summarized, among which we observed the 'fusing phenomena' of auto- and porcine skin heterografts in 6 patients. Vascularization, 'turning red', viability and rejection as well as ways to improve the results of the grafting method are discussed. No vascular communication between fresh porcine skin and the host wound has been observed during the early postoperative period. The cause of 'turning red' is a reddish transudation between the graft and the host wound seen through the thin porcine skin. Based on histological observations, porcine skin is viable after transplantation. With nutritional support apparently coming from the underlying plasma and tissue fluid. Eventually the process of rejection is similar to that of homograft Better results are found with porcine skin grafts 0.4-0.5 mm in thickness placed 0.5-0.75 cm apart. In order to avoid large sloughing wound surfaces less than 20 per cent area of porcine skin coverage is advisable. 相似文献
16.
Sheraz R. Markar Alberto Vidal-Diez Viknesh Sounderajah Hugh Mackenzie George B. Hanna Matt Thompson Peter Holt Jesper Lagergren Alan Karthikesalingam 《Journal of vascular surgery》2019,69(6):1776-1785.e2
ObjectiveEndovascular aneurysm repair (EVAR) has increasingly been used as the primary treatment approach for abdominal aortic aneurysm (AAA). This study examined the hypothesis that EVAR leads to an increased risk of abdominal cancer within the radiation field compared with open AAA repair.MethodsThe nationwide English Hospital Episode Statistics database was used to identify all patients older than 50 years who received an AAA repair in 2005 to 2013. EVAR and open AAA repair groups were compared for the incidence of postoperative cancer using inverse probability weights and G-computation formula to adjust for selection bias and confounding.ResultsAmong 14,150 patients who underwent EVAR and 24,645 patients who underwent open AAA repair, follow-up was up to 7 years. EVAR was associated with an increased risk of postoperative abdominal cancer (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.03-1.27) and all cancers (HR, 1.09; 95% CI, 1.02-1.17). However, there was no difference between the groups in the risk of lung cancer (HR, 1.04; 95% CI, 0.92-1.18) or obesity-related nonabdominal cancer (HR, 1.12; 95% CI, 0.69-1.83). Within the EVAR group, use of computed tomography surveillance was not associated with any increased risk of abdominal cancer (HR, 0.94; 95% CI, 0.71-1.23) or all cancers (HR, 0.97; 95% CI, 0.81-1.17).ConclusionsThis study suggests an increased risk of abdominal cancer after EVAR compared with open AAA repair. The differential cancer risk should be further explored in alternative national populations, and radiation exposure during EVAR should be measured as a quality metric in the assessment of EVAR centers. 相似文献
17.
Y. Lu Q. Xia Y. Yang P. Wan J. Hou Y. Wang B. Qiu M. Feng K. He M. Huang X. Ren L. Gao J. Zhang 《Transplantation proceedings》2017,49(8):1848-1854
Objective
The aim of this study was to evaluate the impact of preoperative growth status on clinical outcomes of infantile living-donor liver transplantation (LDLT).Methods
From January 2009 to December 2014, 131 LDLT recipients ≤1 year of age met the eligibility criteria of this study, of whom 31 patients with weight z-scores less than ?2 constituted the abnormal growth group. Patients in the abnormal growth group were randomly matched (1:1) to patients with normal growth status by means of a multivariate case-matched method, and thus 31 patients in the normal growth group and 31 patients in the abnormal growth group were finally enrolled into the study. We compared the 2 groups regarding demographic characteristics, liver functions, postoperative complications, survival outcomes, and effects of catch-up growth.Results
Baseline characteristics were well matched between the 2 groups except that patients from the abnormal growth group were significantly inferior in terms of body weight (7.5 kg vs 6.0 kg; P < .01), height (65 cm vs 63 cm; P < .01), and body mass index (17.0 kg/m2 vs 14.8 kg/m2; P < .01) before LT. After LT, alanine transaminase, aspartate transaminase, alkaline phosphatase, γ-glutamyltransferase, albumin, and total bilirubin were all similar between the 2 groups. We also did not identify significant difference in any specific early complications or patient and graft survival rates (5-year: 90.2% vs 96.8%; P = .313). However, LT brought forth notable catch-up growth in both groups, especially for children with more serious growth retardation before LT. Differences of height z-scores between the 2 groups gradually diminished and lost significance 18 months after LT, and body weight z-scores between the 2 groups became similar 6 months after LT.Conclusions
Preoperative growth status had no impact on liver function recovery, postoperative complications, or survival outcomes after infantile LDLT. Although biliary atresia caused severe growth impairment in infants, LT brought forth notable catch-up growth, especially for children with more serious growth retardation before LT. 相似文献18.
An-Hsun Chou Ching-Chang Chen Yu-Sheng Lin Ming-Shyan Lin Victor Chien-Chia Wu Pei-Chi Ting Shao-Wei Chen 《Journal of vascular surgery》2019,69(5):1395-1404.e4
BackgroundEndovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatments for high-risk surgical candidates. However, information about the management of EVAR and TEVAR in liver cirrhosis (LC) is lacking. The aim of our study was to evaluate outcomes after EVAR and TEVAR in patients with LC.MethodsUsing Taiwan's National Health Insurance Research Database, we retrospectively evaluated patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013.ResultsA total of 146 patients with LC and 730 matched patients without LC were eligible for analysis after propensity score matching. In-hospital mortality and perioperative complications were not statistically significantly different between the two cohorts, although the LC group had an increased volume of blood transfusion and a trend toward a lower survival rate (P of stratified Cox = .092). However, patients with LC had a higher adjusted hazard ratio for death (1.66; 95% confidence interval, 1.31-2.12; P < .001) in the sensitivity analysis by traditional multivariable adjustment. The LC cohort had a higher risk of liver-related death (4.1% vs 0.7%; P = .001) and liver-related readmission (6.2% vs 0.3%; P < .001). As expected, the advanced LC group had a higher mortality rate than the early LC group (P = .022). The risk for reintervention, redo open aortic surgery (P = .859), and redo stent graft therapy (P = .179) was not statistically significantly different between the two cohorts.ConclusionsShort-term results after EVAR and TEVAR are promising in patients with LC, despite poor long-term outcomes, because of the nature of LC. Innovations in endovascular therapy for aortic disease have improved surgical outcomes, even in high-risk patients with LC. 相似文献
19.
Nelson F.G. Oliveira Frederico M. Bastos Gonçalves Marie Josee Van Rijn Quirina de Ruiter Sanne Hoeks Jean-Paul P.M. de Vries Joost A. van Herwaarden Hence J.M. Verhagen 《Journal of vascular surgery》2017,65(6):1608-1616