糖尿病足动脉病变的介入治疗

目的探讨经皮腔内血管成形术（PTA）联合部分支架植入术治疗糖尿病足动脉病变的临床价值。方法选择我院2009年2月至2011年3月收治的60例糖尿病足动脉病变患者,共78条肢体,Fonfaine分期Ⅰ～Ⅱ期3例,Ⅱ—Ⅲ期35例,Ⅲ～Ⅳ期22例,采用新sedinger法穿刺股动脉,行糖尿病足动脉病变经皮腔内血管成形术（PTA）,部分联合支架植入术。结果78条肢体中技术成功69条（成功率885％）,临床成功73条（成功率925％）。观察术后1个月,3个月,6个月的皮肤温度,踝肱指数,跛行距离分别较术前增加,与术前相比较,下肢缺血症状明显改善,所有患者的肢体症状均没见加重或复发。结论经皮腔内血管成形术（PTA）联合部分支架植入术,可作为治疗糖尿病足动脉病变的首选治疗方法,有效改善远段肢体血供,有效防止糖屎病足动脉病变发展,促进肢端创面愈合,提高患者生存质量,近期疗效显著．值得临床应用和讲一步堆广．     

Clinical Evaluation of the Cook Advance Enforcer 35 Focal-Force PTA Balloon Catheter for Treatment of Hemodialysis Fistula Stenoses: A Feasibility Study

Purpose

A prospective, single-center, single-arm feasibility study evaluated procedural and short-term performance of the Advance Enforcer 35 focal-force percutaneous transluminal angioplasty (PTA) balloon catheter in treating stenoses of mature native arteriovenous (AV) hemodialysis access circuits.

Recanalization of Chronic Noncirrhotic,Nonmalignant Splanchnic Thromboses is Feasible: A Transsplenic Assisted Patient-Tailored Approach

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.     

Limitations to the Value of the Sapphire Trial

The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA’S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial’s conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified.     

关节镜辅导下球囊成形术在胫骨平台骨折的临床应用研究

目的：研究关节镜辅导下球囊成形术在胫骨平台骨折的临床应用效果。方法：选取2011年3月-2013年1月本院收治的50例胫骨平台骨折患者，按随机数字表法将这些患者分为观察组和对照组，每组25例。观察组患者给予关节镜辅导下球囊成形术复位并行小切口钢板固定治疗，对照组患者给予传统切开手术治疗。结果：与对照组比较，观察组的膝关节功能评分明显较高，膝关节间隙宽度明显较窄，膝关节间隙恢复明显较好，骨折愈合时间和住院时间明显较短，治疗优良率明显较高，术后并发症发生率明显较低，上述指标差异均有统计学意义（P＆lt;0.05）。结论：关节镜辅导下球囊成形术在胫骨平台骨折的治疗中能够有效改善患者的膝关节功能，缩短骨折愈合时间和住院时间等，应用效果良好，值得推广。