Bilateral subclavian steal syndrome: Treatment with percutaneous transluminal angioplasty and stent placement

A 66-year-old man presented with bilateral subclavian steal syndrome (SSS) due to proximal subclavian artery occlusions. He was treated by percutaneous transluminal balloon angioplasty (PTA) and stent implantation in the left subclavian artery and by PTA alone in the right subclavian artery. We could demonstrate that interventional treatment of symptomatic bilateral SSS is possible. If PTA alone is insufficient, stent implantation should be considered.     

锁骨下动脉损伤及创伤性假性动脉瘤手术方法探讨

目的探讨锁骨下动脉损伤及创伤性动脉瘤的外科治疗方略。方法1991—2005年对2例锁骨下动脉损伤，6例锁骨下假性动脉瘤根据病变的部位、程度及受伤时间、累及范围等选择手术入路，采用血管缝扎、血管壁修补、血管吻合、血管移植、辅助体外循环及球囊止血技术实施手术。结果6例痊愈，1例动静脉狭窄，1例动脉闭塞伴臂丛损伤。平均失血800mL。结论锁骨下动脉损伤及假性动脉瘤手术复杂，术前对病变进行仔细评估，选择合理的切口及手术方法是减少并发症的关键。     

主动脉弓畸形及其临床意义

目的研究主有及其临床意义。方法：在历时１５年对３２０例主动脉弓的解剖中,发现４例主动脉弓畸形,并对此弓变形及其周围诸结构进行解剖和观察。结果：在４例主动脉弓畸形的病例,,２例为右食管后锁骨下动脉并存右非喉返神经,另２例为右主工存左食管后锁骨下一左背主动脉分离。食管后锁上动脉起始部形成憩中产生食管受压性咽下困难,左锁骨下动脉或左背主动脉经支汛管连接或发自左肺动脉,可形成先天性肺动脉一锁骨下动脉窃血症     

Morphogenesis of the primary arterial trunks of the forelimb in the rat embryos: the trunks originate from the lateral surface of the dorsal aorta independently of the intersegmental arteries

It has been believed that the primary arterial trunk of the mammalian forelimb is derived from the 7th intersegmental artery. Here we examined the early morphogenesis of the arteries and nerves in the forelimb region by adopting a method that combined intravascular dye-injection with nerve staining to whole mounted rat embryos. The study was carried out on greater numbers of specimens at smaller intervals of embryonic stages and from earlier stages than those in previous reports. We report that: (1) The multiple primary arterial trunks in the forelimb region (primary subclavians) originate directly from the lateral surface of the dorsal aorta independently of the intersegmental arteries, previous to the formation of limb buds. (2) The tips of the 8th (and the 9th) primary subclavians that originate from the aorta near the origin of the 8th (or the 9th) intersegmental artery bend cranially and/or caudally. With the formation of limb bud, they extend to form the longitudinal trunks in the presumptive axillary region. The primary arteries in the free arm region branch off from this longitudinal trunk, and one of them develops into the axial artery. (3) The origins of the primary subclavians shift their positions on the surface of the dorsal aorta and approach the origins of the neighboring intersegmental arteries to join them, and then replace the latter. Consequently, the primary subclavians appear to be ”the lateral branches of the in tersegmental arteries.” (4) The 8th primary subclavian is dominant at first, but is replaced by the 7th primary subclavian, which develops into the definitive subclavian artery. (5) With the brachial nerve plexus formation, the axillary arterial plexus derived from the longitudinal trunk develops to form two stems of the axillary artery. Accepted: 15 April 1999     

Risk of stroke in imaging-proven subclavian steal syndrome

To determine the risk of stroke in patients with subclavian steal syndrome (SSS). We identified 165 patients with imaging-proven SSS from two hospitals. Demographic, clinical and imaging data were retrospectively collected. Patients were followed up for stroke events. Stroke occurred in 43 patients with a median follow-up of 28 months. Seven of these cases were identified prospectively and 36 cases retrospectively. On multivariate analysis, presence of symptoms at presentation (p = 0.029) was a significant predictor of stroke. Presence of symptoms at presentation predicted stroke in imaging-proven SSS.     

彩色多普勒超声诊断锁骨下动脉盗血综合征的临床价值

目的：探讨彩超对锁骨下动脉综合征（SSS）的检查技巧及临床诊断价值。方法选取我院2010年8月-2013年6月间确诊为锁骨下动脉盗血综合征患者53例，进行颈动脉、椎动脉及锁骨下动脉二维超声及彩色多普勒超声检查，分析血流动力学特点。结果53例患者中动脉粥样硬化38例，多发性大动脉炎15例。根据椎动脉频谱特点划分为隐匿型SSS共17例，患侧椎动脉频谱收缩期出现切迹；部分型SSS共26例，患侧椎动脉收缩期血流反向；完全型SSS共10例，患侧椎动脉血流收缩及舒张期均反向。结论彩超对于早期筛查SSS具有明显优势，并可对大多数SSS进行病因学诊断。     

两种深静脉置管术在 ICU 临床应用观察

目的：观察锁骨下和股静脉较两种深静脉置管术的难易程度及其主要的并发症。方法选择ICU内需做深静脉置管的患者300例,随机分为锁骨下静脉（A组）150例,股静脉（B组）150例,通过比较2组的穿刺的成功率及其主要并发症等指标,从而明确两个部位穿刺的优缺点。结果股静脉穿刺组成功率高,与锁骨下静脉组比较差异有显著性（P＜0．05）。锁骨下置管并发导管移位、气胸最高（P＜0．05）,而股静脉置管并发误入动脉,感染,及堵管较高（P＜0．05）。导管脱出并发症两者无显著性差异（P＞0．05）。结论2种置管方法各有其优缺点,操作者可以根据置管的目的,患者情况以及个人对两种置管术操作的熟练程度,合理选择置管方法,减少置管出现的并发症的可能。     

儿童完全植入式静脉输液港日间手术策略的选择和体会

目的比较同期儿童完全植入式静脉输液港(totally implantable venous access port,TIVAP)日间手术和住院手术情况,探讨开展儿童TIVAP植入日间手术的可行性。方法收集2015年4月至2020年4月在重庆医科大学附属儿童医院肿瘤外科接受TIVAP植入术的516例患儿的相关资料。其中,男311例,女205例;将321例接受日间手术的患儿作为日间手术组;将195例接受住院手术的患儿作为住院手术组。通过电子病历(electronic medical record,EMR)和医院信息系统(hospital information system,HIS)收集两组患儿的病史资料和手术情况,通过互联网医院、微信或者电话定期随访患儿TIVAP使用情况和主要并发症的发生情况。比较两组患儿住院天数、总费用和术后并发症情况。结果13例日间手术组和8例住院手术组患儿锁骨下静脉穿刺置管失败改为颈内静脉入路,两组之间的差异无统计学意义(P<0.05)。本研究所有TIVAP植入术成功。日间手术组住院时间为(1.00±0)d,住院手术组为(5.40±1.69)d,两组之间的差异具有统计学意义(P<0.01)。日间手术组总费用为(13125±568)元,住院手术组为(16125±1035)元,均除外其他疾病的治疗费用,两组之间的差异具有统计学意义(P<0.001)。术后主要并发症包括导管相关性血行感染、导管堵塞、港体周围皮肤感染和非计划取港,并发症的发生率在两组之间的差异无统计学意义。结论儿童TIVAP植入日间手术是高质量、低成本的治疗模式,具有推广使用价值。