快速二期动脉转位术纠治新生儿完全型大动脉转位

目的总结快速二期动脉转位术的临床应用效果.方法 2002年9月至2003年5月,5例完全型大动脉转位患者行快速二期动脉转位术.手术平均年龄83.0±72.2 天,平均体重4.7±0.9 kg.由于求诊时已经超过最佳手术年龄,左心室退化,不能承受体循环压力,则先行肺动脉环缩和体肺动脉分流术,术后6～9天行第二期动脉转位术.结果一期手术中,1例术后32小时发生室上性心动过速,少尿,经腹膜透析和药物处理无效死亡;其余4例分别在术后6～9天行二期动脉转位术,无死亡.术后随访2～10个月,生长发育良好,超声心动图检查显示心内无残余分流,主动脉和肺动脉干吻合口通畅,左心室射血分数(EF)0.68～0.77,短轴缩短率(FS)0.24～0.37,1例主动脉瓣轻度反流.结论对失去最佳手术时间的新生儿完全型大动脉转位,行快速二期动脉转位术是最佳的选择.     

生长激素对髂内动脉结扎大鼠勃起功能和nNOS神经纤维的影响

目的 :研究生长激素 (GH)对髂内动脉结扎大鼠勃起功能和神经型一氧化氮合酶 (nNOS)神经纤维的影响。方法 :36只成年雄性Wistar大鼠随机均分为 3组 :假手术组、髂内动脉结扎组和GH干预组。于术后 4周末、8周末 ,分别取各组 1/ 2大鼠 ,观察大鼠勃起功能 ,并用免疫组化SP法检测阴茎组织中nNOS神经纤维的数目。　结果 :4周末 ,GH干预组和髂内动脉结扎组在勃起次数和nNOS神经纤维数目上与假手术组相比差异有显著性 (P<0 .0 5 ) ,前两组之间差异无显著性 (P >0 .0 5 ) ,而勃起率 3组之间差异不明显 (P >0 .0 5 )。 8周末 ,3组在勃起次数和勃起率上差异均不明显 ;而阴茎组织中nNOS神经纤维数目 ,GH干预组高于髂内动脉结扎组 (P <0 .0 0 1) ,而与假手术组比较差异无显著性 (P >0 .0 5 )。　结论 :GH可以改善髂内动脉结扎大鼠勃起功能 ,这种作用可能与其增加大鼠阴茎海绵体nNOS神经纤维数目有关     

子宫动脉栓塞治疗子宫肌瘤和子宫腺肌症(附24例报告)

目的评价子宫动脉栓塞(uterine arterial embolization,UAE)治疗子宫平滑肌瘤和子宫腺肌症的疗效. 方法22例子宫肌瘤和2例子宫腺肌症行双侧子宫动脉栓塞23例,单侧1例,栓塞剂为PVA微球. 结果子宫动脉栓塞成功率为95.8%(23/24),未发生严重并发症.术后6个月子宫体积及肌瘤体积与栓塞前比较均显著缩小(t=2.391,3.990;P=0.022,0.000).1例子宫动脉单侧栓塞术后肌瘤逐渐长大,行子宫切除术.2例子宫腺肌症术后痛经、月经过多症状减轻,但术后4个月复发. 结论 UAE治疗子宫肌瘤微创,安全,疗效满意,但远期疗效尚待观察.对子宫腺肌症疗效不满意.     

A simple modification for a longer and larger internal thoracic artery as a composite Y-graft

Abstract

Objectives. Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) has been proven to improve survival. Many surgeons use the composite Y-graft which is made of left ITA (LITA) and right ITA (RITA) grafts. The LITA is typically anastomosed to left anterior descending artery (LAD). However, we have used RITA for LAD instead of LITA and reviewed the patency of ITA grafts and their clinical outcomes. Methods. We analyzed 48 patients who underwent CABG using a BITA composite Y-graft from 2002 to 2012. In 30, LITA was anastomosed to LAD (Group L). The other 18 had RITA to LAD anastomosis (Group R). Results. The mean age of Group R was higher than that of Group L (p = 0.009). Postoperative angiography was performed in 35 patients (73%). Two patients in Group L and none of the patients in Group R had an ITA graft failure. The incidence of ITA graft failure and new adverse cardiovascular events were not different between the two groups. Conclusion. The clinical outcome of RITA to LAD anastomosis is comparable with anastomosis of LITA to LAD in CABG using BITA composite Y-grafts. This technique may be useful when longer and larger ITA grafts are needed.     

Evaluation,Severity and Prognostic Significance of Silent Myocardial Ischaemia in Vascular Patients

This paper intends to make an update of recent publications and guidelines for evaluation in coronary symptom-free patients undergoing vascular surgery. It emphasizes the role of preoperative clinical evaluation that should identify the most appropriate testing, and treatment strategies to optimize care of the patient and avoid unnecessary testing in this era of cost containment. Selective preoperative coronary artery disease screening and revascularization achieve excellent perioperative and late results after high-risk vascular surgery. Supplemental preoperative evaluation is discussed (exercise ECG, stress echocardiography and stress tomoscintigraphy). Asymptomatic patients with good functional capacity can undergo intermediate-risk surgery without further non-invasive testing. Conversely, further noninvasive testing is often considered for patients with poor functional capacity or moderate functional capacity but higher-risk surgery especially for patients with 2 or more intermediate risk predictors. Additional testing may be considered on an individual basis for patients without clinical markers but with poor functional capacity prior to vascular surgery, particularly those with several minor clinical risk predictors. Because of a higher prevalence of silent myocardial ischaemia in diabetes mellitus, these patients require specific care. Until further data are available, indications for myocardial revascularization in the perioperative setting are similar to those in the ACC/AHA guidelines for use of myocardial revascularization in general. General practioners, cardiologists, angiologists, vascular surgeons and anaes-thesiologists should collaborate and aim to slow down the progression of atherosclerosis by giving their patients an optimum secondary cardiovascular prevention.     

Phase 0 Study of Vandetanib-Eluting Radiopaque Embolics as a Preoperative Embolization Treatment in Patients with Resectable Liver Malignancies

PurposeTo assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies.Materials and MethodsThe VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7–21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging.ResultsEight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441–404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%–100%). There were no significant changes in perfusion imaging parameters after TACE.ConclusionsBTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies.     

Assessing the Effects of Geniculate Artery Embolization in a Nonsurgical Animal Model of Osteoarthritis

PurposeTo create a nonsurgical animal model of osteoarthritis (OA) to evaluate the effects of embolotherapy during geniculate artery embolization (GAE).Materials and MethodsFluoroscopy-guided injections of 700 mg of sodium monoiodoacetate were performed into the left stifle in 6 rams. Kinematic data were collected before and after induction. At 10 weeks after induction, Subjects 1 and 4–6 underwent magnetic resonance (MR) imaging with dynamic contrast enhancement (DCE) and Subjects 1, 3, and 4–6 underwent angiography with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75–250-μm microspheres). Target vessel size was measured. At 24 weeks after angiography, DCE-MR imaging, angiography, and euthanasia were performed, and bilateral stifles were harvested. Medial/lateral tibial and femoral condylar, patellar, and synovial samples were cut, preserved, decalcified, and scored using the Osteoarthritis Research Society International criteria. The stifle and synovium Whole-Organ Magnetic Resonance Imaging Score and Multicenter Osteoarthritis Study score were determined. The volume transfer constant (K_trans) and extracellular volume fraction (v_e) were calculated from DCE-MR imaging along the lateral synovial regions of interest.ResultsThe mean gross and microscopic pathological scores were elevated at 38 and 61, respectively. Mean synovitis score was elevated at 9.2. Mean pre-embolization and postembolization angiographic scores were 5 and 3.8, respectively. Mean superior, transverse, and inferior geniculate artery diameters were 3.1 mm ± 1.21, 2.0 mm ± 0.50, and 1.6 mm ± 0.41 mm, respectively. Mean pre-embolization and postembolization cartilage and synovitis scores were elevated at 35.13 and 73.3 and 5.5 and 9.2, respectively. The K_trans/v_e values of Subjects 4, 5, and 6 were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51, respectively. Altered gait of the hind limb was observed in all subjects after induction, with reduced joint mobility. No skin necrosis or osteonecrosis was observed.ConclusionsA nonsurgical ovine animal knee OA model was created, which allowed the collection of angiographic, histopathological, MR imaging, and kinematic data to study the effects of GAE.     

Changes in the National Endovascular Management of Femoropopliteal Arterial Disease: An Analysis of the 2011–2019 Medicare Data

PurposeTo describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).Materials and MethodsThe Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011–2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).ResultsThe use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).ConclusionsThe national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.     

The hidden aspect of carotid lesions in traffic accidents: A little-known phenomenon

Vascular injuries that occur during traffic accidents are a commonly neglected aspect that can add more detail to the framework of a case. In this study, we analysed a case series of 150 traffic accidents, 39 of which were marked by microscopically identifiable vascular lesions. The purpose was to identify the presence of carotid injuries in individuals who died due to traffic accidents and had nonpenetrating trauma of the neck. We focused on the discrepancies regarding the macroscopical aspect and the histology and demonstrated how histological analysis of the carotids in cases of trauma can reveal injuries that are attributable to the trauma itself. We conducted a histological analysis of the lesions to describe their distribution and type and investigate potential correlations. The study offers insight on how to examine road accidents that involve traumatic injury of the carotid arteries. Indeed the main task of the forensic pathologist in the case of death is to establish the existence of a causal relationship between the micro- or macroscopic alterations observed in the autopsy and the traumatic event that led to the death of the subject. Thus, further morphological elements were provided to the forensic practitioners that may reveal injuries attributable to the trauma itself and should be evaluated in cases of trauma in traffic accidents.