Objectives To characterize the clinical features, treatment, and prognosis of superior mesenteric artery aneurysms and provide evidence for clinical decision-making. Methods We retrospectively reviewed the diagnosis and treatment of 18 cases of superior mesenteric artery aneurysm admitted to our center from 2003 to 2020, including demographic data, risk factors, clinical manifestations, diagnosis, treatment strategies, and follow-up results. Results The average age of the patients was 49.1 years, and males accounted 83.3%. The development of the disease was associated with infection, hypertension, pancreatitis, and trauma, but no significant associations with atherosclerosis were noted by our results. Nine patients were diagnosed with true aneurysm, seven patients with pseudoaneurysm, and two patients with dissecting aneurysm. Rupture of aneurysm occurred in three patients (16.7%), and one of them died before surgery. The surgery success rate was 94.1%, and open surgery was performed on nine patients, endovascular surgery on three patients, and conservative treatment on three patients. The follow-up rate was 77.8% (14/18), and the average follow-up time was 48.2 months. The mortality and reintervention rate during follow-up was 0. The two-year patency rate of artificial vessels and covered stents was 50%. Conclusion The clinical manifestations and features of superior mesenteric artery aneurysms vary between patients. Careful evaluation of vascular anatomy and personalized treatment strategy are critical in the management of superior mesenteric artery aneurysms. Midterm follow-up results of superior mesenteric artery aneurysms are satisfactory.

Objective To summarize the experience of the diagnosis and treatment of the masses located on carotid bifurcation,and to observe the treatment effect and follow up the long-term result of the patients.Method Forty-six patients with carotid bifurcation masses treated from January 2010 to March 2017,were enrolled in this study.Of them,6 patients were treated conservatively,when 40 patients underwent surgical resection.Regular follow up was performed for both conservative treatment patients and surgery treatment patients.The life quality and complications situation have been followed up.Result Surgical mortality was 2.5％.The size of mass ranged as 2-6.5 cm× 2-5 cm × 1-4 cm.The lymph nodes were found in 29 patients (72.5％),and the number of lymph node was1.94± 0.82.Sixteen (40.0％) patients received mass resection without any other maneuver.Eighteen (45％) patients required external carotid artery ligation except for resection of the mass,7 (17.5％) patients required internal carotid artery reconstruction and 1 (2.5％) patient required internal carotid artery ligation.Unilateral vagus resection was performed in 5 patients (12.5％).And 7 patients' internal carotid arteries were reconstructed (17.5％).Complication result:8 patients (20％) had hoarseness and 4 patients (10％) had dysphagia.One patient (2.5％) had stroke.Surgical complications were frequent and ralated to surgical methods (arterial reconstruction or ligation of vessels/ vagus)(r=0.3658,P=0.0203).Pathological diagnosis was:carotid body tumor,31 (77.5％);Neurilemmoma,7 (17.5％);angioleiomyoma,1 (2.5％);mesenchymal tissue tumor,1 (2.5％).There was one malignant carotid body tumor (CBT) (3％).Follow-up showed no differences between surgery and conservative treatment (P=0.7728).Conclusion Carotid body tumors are the most common carotid bifurcation mass.Surgical removal of these tumors is necessary due to their malignant potential and compression to vessels or nerves.Long-term survival after surgery is satisfactory and comparable to conservative treatment.

目的:探讨胸主动脉腔内修复术(TEVAR)中封堵左锁骨下动脉(LSA)是否增加术后近期脑梗死、截瘫及远期脑梗死的风险.方法:回顾性分析2004年1月-2013年3月629例行TEVAR患者资料.其中LSA未封堵399例,部分封堵63例,完全封堵且未重建159例,LSA封堵并重建8例.单因素分析比较LSA封堵与未封堵患者术后近期脑梗死及截瘫的发生率;多因素Logistic回归分析患者发生远期脑梗死的危险因素.结果:629例患者术后均无左上肢严重缺血;3例(0.5％)术后发生脑梗死,其中2例(0.5％)LSA未封堵,1例(0.4％) LSA封堵;4例(0.6％)术后发生截瘫,其中3例(0.8％) LSA未封堵,1例(0.4％) LSA封堵;LSA封堵与未封堵患者术后近期脑梗死、截瘫的发生率差异无统计学意义(均P＜0.05).平均随访31.4(1～123)个月,多因素分析显示,LSA封堵不增加远期脑梗死风险(OR=1.03,P=0.088),但术前有既往脑梗死病史与年龄＞70岁的患者远期发生脑梗死风险有所增加(OR=3.41,P=0.023; OR=1.90,P=0.034).结论:左上肢可很好耐受LSA封堵,且LSA封堵不增加术后近期脑梗死、截瘫及远期脑梗死风险.

目的：探讨解剖条件复杂的肾下型腹主动脉瘤实施主动脉腔内覆膜支架修复技术治疗的安全性和有效性。<br>　　方法：从2003年1月至2011年3月，我科采用主动脉腔内覆膜支架修复技术治疗了427例腹主动脉瘤患者，对其中48例解剖条件复杂的患者的临床资料进行回顾性研究。本组男性37例，女性11例，年龄50~81岁，平均年龄71.4岁。14例患者腹主动脉瘤近端瘤颈长度<15毫米，13例患者近端瘤颈成角严重（>60°），15例患者同时伴有严重扭曲的髂动脉，6例患者髂动脉狭窄（<8 mm）。所有患者均采用了分叉型腹主动脉覆膜支架治疗。

目的：探讨胸主动脉覆膜支架修复技术（Thoracic Endovascular Aortic Repair，TEVAR）联合相关的辅助技术治疗累及主动脉弓部的Stanford B型主动脉夹层的方法。<br>　　方法：回顾性研究我院自2002年7月至2013年2月采用主动脉覆膜支架腔内修复技术治疗的109例第一破口邻近或累及左锁骨下动脉起始端的Stanford B型主动脉夹层患者的临床资料。其中27例合并Marfan综合症，47例为夹层逆撕累及升主动脉和主动脉弓部的Stanford B型夹层，78例合并内脏动脉或周围动脉缺血，41例合并严重的胸腔积液。治疗中，106例患者采用腔内技术封堵了左锁骨下动脉起始端，其中28例采用了PDA封堵器；26例采用了颈部动脉搭桥手术；1例采用联合升主动脉至主动脉弓部分支动脉搭桥手术和主动脉腔内修复技术的杂交手术；43例采用了“烟囱”技术，3例采用“双烟囱”技术；1例采用主动脉覆膜支架开窗技术。

>患者1男性,26岁,因"右下肢肿胀6个月"于2002年4月11日入院。患者无胸闷、气促、咯血等症状。体格检查:双肺呼吸音清,未闻及啰音,右下肢轻度凹陷性水肿,腘窝饱满,未扪及明显肿块,无压痛。多普勒超声示:腘静脉局部扩张,约25 mm×31mm,其内血流通畅,未见血栓,患者于2002年4月15日接受手术治疗、。手术取腘窝"S"形切口,术中见瘤体大小约30 mn×40 mm,与周围组织分界清。分离游离瘤体近、远心端。静脉给予0.5 mg/kg肝素5 min后,用血管阻断钳

Purpose: To report the immediate and follow-up outcome of thoracic endovascular aortic repair (TEVAR) in highly selected patients with retrograde type A aortic dissection (RAAD) and an entry tear in the descending aorta.Materials and Methods: TEVAR was performed in 17 patients with RAAD and an entry tear in the descending aorta. None of the patients had severe aortic regurgitation, cardiac tamponade, coronary artery involvement, or brain ischemia. The false lumen in the ascending aorta was patent in nine patients. Two patients had acute malperfusion of the branched artery. Computed tomography (CT) was performed V days, 3 months, and 6 months after the intervention and annually thereafter.Results: All procedures were technically successful, with complete coverage of the entry tear and complete thrombosis of the false lumen in the ascending aorta. All patients survived through the follow-up period (25.7 months +/- 17.2). TEVAR resulted in thrombosis of the false lumen, real:sorption of the false lumen thrombus, and enlargement of the true lumen. The mean maximal diameter of the ascending aorta and the false lumen in the ascending aorta significantly decreased after TEVAR. At the distal edge of the stent graft, the mean diameter of the descending aorta and the false lumen markedly decreased after TEVAR. Complete thrombosis of the false lumen was observed at the distal edge of the stein graft in 16 (94.1%) patients and at the diaphragmatic level in 9 (52.9%) patients.Conclusions: TEVAR for RAAD with an entry tear in the descending aorta is a safe and effective technique in highly selected patients.

Thirty seven patients with venous thromboembolic disease in puerperium were admitted to hospital from January 2005 to December 2008; the clinical data of patients were retrospectively analyzed.The average age of patients was (33 ± 6)years (21 -42 years); the average onset time was ( 10 ± 6) d( 1 -50 d) after delivery.Seven patients had vaginal birth and 30 by cesarean section.The risk factors included pregnancy,cesarean section,age,infection,thrombophilia.All were diagnosed by ultrasonography and treated by anticoagulant,antiplatelet and thrombolytic therapy in the acute phase,followed by wearing elastic compressive stockings for more than 2 years.Pulmonary embolism was diagnosed in 8 patients by CT angiography,in 7 of whom inferior vena cava filter was administrated emergently.The patients were followed up for (29 ± 10)months ( 12 -60 months); during the follow-up 3 developed deep vein post-thrombosis syndrome,while others kept in good condition.The results indicate that initial anticoagulant,antiplatelet and thrombolytic therapy followed by elastic compressive stockings administration is effective for venous thromboembolic disease during puerperium.

Objectives: To analyse the experience of a single centre and evaluate the early and mid-term results of endovascular repair of complicated acute type B aortic dissection with stentgrafts.Method: From July 2002 to January 2009, 45 patients (12 women, 33 men) with complicated acute type B aortic dissection (mean age, 42.6 years; range, 31-47 years) were treated with Thoracic Endovascular Aortic Repair (TEVAR). Indications for treatment included rupture in 6(13%), hemathorax with impending rupture in 27(60%), malperfusion syndrome in 11(22%), and transient paraplegia in one patient (2.2%). Five kinds of commercially available thoracic stentgrafts were used. Follow up was 100% during a period of 13 months (range, 1-36 months).Results: Technical success (coverage of the primary tear site) was achieved in all 45 patients(100%) including deliberate partial or total coverage of the LSA in 7 patients (15.6%). The 30-day and in-hospital mortality was 4.4% including one late rupture case. Overall survival was 95.6% at 1 and 3-years' follow-up. None of the patients with malperfusion required adjunct distal stents All hemothoces resolved within 3 months including 5 patient required thoracentesis and one had tube thoracostomy. And 7 patients required temporary dialysis In-hospital complications occurred in 26.7% of patients and re-intervention was required in one patient and no patient had postoperative paraplegia Postoperative CT angiography showed 25 patients (58.1%) with complete thrombosis of the false lumen and re-expansion of the true lumen.Conclusions: Endovascular repair of complicated acute type B aortic dissection with stentgraft is proven to be a technically feasible and effective in this relatively difficult patient cohort, The short and mid-term efficacy are persuasive, however, the long-term efficacy needs to be evaluated further. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Aim:To analyze the clinical characteristics of the extracranial vertebral artery dissection(VAD),and improve the technical levels on diagnosis and therapy.Methods:5 missed cases of the extracranial vertebral artery dissection and relevant literature were summarized and analyzed.Results:The clinical manifestations of 55 patients of VAD were summarized.It was concluded that the incidence of cervicodynia or headache was 52.7%,vertigo was 36.4%,TIA was 14.5%,tinnitus or the descent of audition was 9.1%,disorder of sensation or motion was 7.3%,and asymptomatic was 7.3%.Conclusion:Regarding the patient,30-50 years old,who complained of CNS ischemia,for instance vertigo,TIA,and even attacking infarction of brain,there is the possibility of VAD.DSA,CTA,MRA are helpful to the diagnosis.Anticoagulation and interventional surgery are effective therapy methods.

Objective To explore the indications and effects for interventional and surgical treatment of Budd-Chiari syndrome.Methods A retrospective analysis of the clinical data of 39 B-CS patients treated by interventional and surgical therapy has been carried out.Among these patients,percutaneous transinferior vena cava angioplasty was performed in 3 cases,inferior vena cava PTA with stent deployed in 12 cases,radical resection in 9 cases,shunt or bypass procedure in 15 cases.Results The immediate successful rate for interventional and surgical treatment was 100%.The perioperative mortality was 0%.The inferior vena cava pressure was reduced by 5～24 cm H2O.A follow-up study showed that 13 cases returned to normal life,11 could be engaged in light manual work,8 could not do any manual work but take care of themselves.Among the radical resection group,one had recurrent pleural effusion until one year postoperatively,another had a relapse and was lost to follow-up thereafter.Conclusions Interventional therapy may be the first choice for most B-CS patients,but surgical treatment including radical resection and shunt also has their indications and unreplacement.Patients with different clinical types and different hemodynamic changes should be undergone different operations.

Objective To analyse the management of splanchnic artery aneurysms by open surgery and endoluminal therapy. Methods The clinical data of 10 splanchnic artery aneurysm patients (four male, six female) hospitalised from January 2002 were analysed retrospectively. The average age was (56 ± 13) years (28 - 74). Surgical or endoluminal treatment for six cases of splenic artery aneurysms or pseudoaneurysms were applied, among which multiple splenic artery aneurysms was found in one, and aberrant aneurysms at the proximal section of the splenic artery originating from a spleno-mesenteric trunk was found in three, splenic artery pseudoaneurysm in one and single aneurysm with normal splenic artery in anatomy in one. Besides, there were two superior mesenteric artery aneurysm, one of tuberculous celiac artery pseudoaneurysm and one renal artery aneurysm. Results The tuberculous celiac artery pseudoaneurysm was successfully managed by deploying a stent-graft endoluminally. One case was converted to open surgery after the splenic artery aneurysm was only paitially covered by a stent-graft. The other 8 cases were successfully treated by open surgery. All of the operations are successful. All patients were followed up from three months to six years, during which no death or other severe complications occurs. Conclusions The splanchnic artery varies from one to another anatomically. Preoperative CT scan or digital substraction angiology are helpful for the diagnosis of the splanchnic arterial aneurysms and choosing an appropriate management. Conventional open surgery is effective and reliable, while endoluminal therapy is a minimally invasive alternative.

目的探讨孤立性腹主动脉夹层动脉瘤的诊疗体会。方法回顾性分析2002年8月—2009年11月经手术治疗和腔内治疗的4例孤立性腹主动脉夹层动脉瘤的临床资料。患者术前均通过CT血管成像(CTA)或血管造影明确诊断,3例采用传统的腹主动脉夹层动脉瘤切除、人工血管置换术,1例行分叉型带膜支架腔内治疗。结果所有患者夹层均得到完全修复,未出现内脏动脉缺血、肾缺血、下肢缺血等并发症的发生,术后患者随访3个月至3年,效果满意。结论孤立性腹主动脉夹层发病率低,CTA是诊断腹主动脉夹层最常用的方法 ,手术治疗和腔内治疗都能取得良好的治疗效果,相比手术治疗,腔内治疗并发症少,住院时间短,但仅适用于解剖学条件良好的患者。

Pseudo-aneurysms involving the coeliac artery caused by tuberculosis infection are extremely rare and are highly susceptible to rupture.(1) It's difficult to make the correctly diagnosis preoperative and select reconstructive procedures. We report a case of tuberculous pseudo-aneurysm in the abdominal aorta involving the coeliac artery. The active phase of the tuberculous makes it impossible to perform open surgery, so endovascular percutaneous treatment was performed, inflow to the pseudo-aneurysm was excluded by placing a custom-made stent graft at the coeliac artery orifice. The patient recovered very well and was prescribed anti-tuberculosis treatment for up to 6 months. Endovascular repair for tuberculous pseudo-aneurysm may be a life-saving option, covering the coeliac artery with stent graft is considered safe and suitable.

Objective To evaluate the methods and results of endovascular therapy for Stanford type B aortic dissection.Methods A retrospective review was conducted of 158 patients with Stanford type B aortic dissection who were treated with endovascular therapy in the past six years.There were 19 cases of emergency operation and 139 cases of elective operation.Fellow-up was performed regularly after operation.Aortas were dynamically observed.Results After the stent-graft implantation,92.4% blockade rate of the first tear of the Stanford type B aortic dissection was obtained.After operation,22 cases were complicated by hemothorax,13 cases by ischemia of superior mesenteric artery,9 cases by acute renal insufficiency,and 5 cases by ischemia of artery of lower extremity.Three cases of huge chronic dissection aneurysm achieved clinical cure after operation.No subclavian steal syndrome occurred in the 19 cases whose left subclavian artery was sealed by the stent-graft during operation.There was no hospital death.One hundred and forty-one cases were followed up for 3～48 months.Continuous endoleaks were found in 2 cases;1 case of the stent-graft migration was successfully treated after another stent-graft implantation;and 1 case of cerebral arteries infarction recovered well.Conclusions Endovascular therapy is safe and effective for the patients with Stanford type B aortic dissection in the early and mid-term periods of postoperation.

Objective To summarize the experience of surgical treatment of ruptured abdominal aortic aneurysm in 17 cases.Methods The data of 17 cases with ruptured abdominal aortic aneurysm(RAAA) in our department from May 2002 to March 2008 were retrospectively analyzed.Results Open surgery was performed on 15 out of 17 patients with RAAA.Other treatments included Foley catheters emergently blocking artery to stop bleeding,cell saver for autohemotransfusion and vascular prosthesis replacement.The other 2 patients underwent endovascular stent-graft repair,1 succeed and 1 converted into open surgery.Of all cases,there were 3 deaths and 14 survivals.Conclusion Once the precursory symptoms such as abdominal pain presented,patients with abdominal aortic aneurysm must be treated by surgery as soon as possible.The balloon catheter may block artery to significantly short hemorrhagic shock.Reducing intraoperative blood loss and blood transfusion is the key to successful treatment.

Objective To evaluate the early and midterm results of endovascular therapy for acute Stanford type B aortic dissection complicated with hemothorax.Methods 20 patients of acute Stanford type B aortic dissection with hemothorax treated by endovascular therapy were reviewed retrospectively.Fellow-up was performed at 3、6、12 months and yearly thereafter. Results Total 20 stent-grafts were implanted.The blockade rate of the first crevasse was achieved 100% after the stent-graft implantation.13 cases of progressive decreasing hemothorax were recovered after stent-graft placement.In the 7 cases with progressive increasing hemothorax,2 were controlled after the operation,but 5 were progressively increased within 3 days and then controlled in 3 to 6 days after operation.Respiratory functions were maintained due to multiple controlled thoracentesis aspirations performed in the 5 cases of progressive increasing hemothorax in 3 to 12 days after the stent-graft implantation.There was no death case during perioperative period.19 cases were followed up for 3 to 57 months.The outcomes showed aortic stabilization was achieved in the stented segments.Thorax complications were found in the 5 cases of progressive increasing hemothorax after surgery.Conclusions The short-and medium term efficacy of endovascular therapy are safe and effective for acute Stanford type B aortic dissection with hemothorax.Moreover,prostecdtive efficacy would be further observed.

Objective To explore the management of particular types of abdominal aortic aneurysms(AAA).Methods The clinical data of 31 patients with particular types of AAA were reviewed retrospectively.Results Ruptured abdominal aortic aneurysms(RAAA) were found in 17 cases,mycotic abdomianl aortic aneurysms(MAAA),inflammatory abdominal aortic aneurysms(IAAA) and tuberculous AAA.were found in 3,4 and 2 cases respectively.The lesions involved the suprarenal artery in 5 cases.One RAAA patient died of shock in emergency room.Emergency operation was done in 16 patients,elective operation in 14 cases.Replacement of the aneurysm by vascular prosthesis in 27 cases,and endoluminal treatment in 3 cases.Five cases developed mild postoperative complications.No paralysis or lower extremity arterial embolism occurred in any of the cases.Operative mortality was 6%(2 cases).Twenty-eiggy patients were followed-up for 3 months to 3 years,all of the patients were living well.Conclusions Timely surgical therapy for particular types of AAA is important,traditional operation is still effective with improvement of surgical skills,and endoluminal therapy is a new modality gradually applied in the treatment of particular types of AAA.

腹主动脉瘤破裂(ruptured abdominal aortic aneurysm,RAAA)来势凶险、手术难度大、死亡率高,已成为对血管外科医师的一个挑战.我科自2002年5月至2005年7月期间共收治RAAA患者10例,现报告如下.

目的 探讨复杂主动脉病变的腔内血管外科治疗方法.方法 对21例合并有内脏动脉缺血等复杂的主动脉病变,双球管定位下经锁骨上动脉到股动脉交换导丝以确保真腔内植入带膜支架,对真腔完全被假腔压闭的患者采取真腔内加压推进以通过导丝,用超长带膜支架来封堵大破口治疗夹层合并巨大假性动脉瘤形成,对夹层合并腹主动脉瘤患者采取血管腔内技术联合开腹手术等方法.结果 术后内漏3例,其中2例7 d后停止,1例漏血持续存在.3例主动脉创伤术后完全康复,余18例复杂主动脉夹层术后即时造影示瘘口已被完整覆盖,假腔无血漏入,内脏动脉等恢复真腔供血.18例中6例合并肠管缺血,3例合并肾动脉缺血,3例肠管缺血、肾动脉缺血,2例腹主动脉真腔完全被假腔压迫,以及2例合并下肢缺血术后均逐渐恢复,无脏器及肢体缺血坏死发生.2例合并腹主动脉瘤夹层行支架型人工血管封闭夹层破口后行开腹手术切除腹主动脉瘤、人工血管置换.16例随访5～36个月,平均22.3月,1例内漏持续存在,但假腔未继续加大,其余患者存活良好.结论 对复杂的主动脉病变的治疗,通过对腔内血管外科技术进行改进,并适当结合传统手术方法,使某些过去被认为不能够治疗的复杂主动脉病变可得以成功治疗.