背景与目的:大隐静脉高位结扎剥脱术(HSL)是治疗下肢静脉曲张的经典术式,但存在创伤较大、恢复时间较长、切口瘢痕不美观等缺点.随着医疗技术的进步,以腔内热消融治疗为代表的微创治疗技术蓬勃发展.本研究旨在对比射频消融术(RFA)与传统HSL治疗下肢静脉曲张的临床疗效.方法:回顾性分析2021年5月—2022年6月期间因原发性下肢静脉曲张于首都医科大学附属北京安贞医院血管外科行手术治疗的272例患者(298条肢体)的临床与随访资料,其中96例(100条肢体)行RFA治疗(RFA组),176例(198条肢体)行HSL治疗(HSL组).比较两组患者的术前临床特征、手术情况、并发症情况、临床表现-病因学-解剖学-病理生理学(CEAP)分级、静脉临床严重程度评分(VCSS)和慢性静脉功能不全问卷-14问版(CIVIQ-14)评分的变化情况.结果:两组技术成功率均为100％,术后3 d复查超声提示大隐静脉主干缺如/闭合率为100％.共完成随访265例(290条肢体),平均随访时间(13.2±3.8)个月,随访期间超声提示大隐静脉主干缺如/闭合率为100％.两组患者的基本临床特征无明显差异(均P＞0.05);与HSL组比较,RFA组术中出血量(21.3 mLvs.46.8 mL)、术后第1天疼痛评分(3.1vs.3.3)、总并发症发生率(25.5％vs.38.0％)及皮肤感觉异常发生率(5.1％vs.24.0％)均明显降低(均P＜0.05),RFA组的深静脉血栓形成发生率升高(5.1％vs.0,P＜0.05);术后所有患者CEAP分级均较术前降级,RFA组81.7％的患肢降级为C0～C1级,HSL组83.9％的患肢降级为C0～C1级;所有患者的VCSS和CIVIQ-14评分均较术前有所改善,且HSL组的VCSS评分改善程度大于RFA组(均P＜0.05).结论:RFA短期疗效与HSL相当,相对于HSL而言,创伤更小、疼痛感更轻、并发症发生率更低,是一种下肢静脉曲张的有效治疗方案.

Background: The plaque imaging findings associated with the stent expansion rate (SER) of the carotid artery are not well known. The purpose of this study was to investigate the imaging findings associated with SER. Methods: It was a retrospective investigation. Based on the kind of carotid stents used, retrospective data from 89 patients who had carotid artery stenting (CAS) for atherosclerotic carotid stenosis were gathered and divided into two groups: open-cell stents and closed-cell stents. Patients underwent preoperative carotid high-resolution magnetic resonance vessel wall imaging (HR-VWI). Use HR-VWI to quantitatively evaluate carotid wall thickness and plaque components. Calculate SER using digital subtraction angiography (DSA). All patients' baseline and HR-VWI imaging features were retrospectively analyzed. Simple and multivariable linear regression analysis was used to determine the imaging findings associated with SER of open-cell and closed-cell stents. Results: A total of 89 patients (mean age, 70±8 years; 69 men) were included in the final analysis. Among 89 patients, 35 patients were treated with open-cell stents. Fifty-four patients were treated with closed-cell stents. In the open-cell stents group, the Maximum single-slice calcification circumference score, maximum wall thickness (WTmax), and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that only the Maximum single-slice calcification circumference score (β=−9.35; 95% CI: −18.15 to −0.56; P=0.03) was associated with SER of open-cell stents. In the closed-cell stents group, the Maximum single-slice calcification circumference score, WTmax, maximum area percentage of calcification, calcification volume, and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that the Maximum area percentage of calcification (β=−0.67; 95% CI: −1.29 to −0.05; P=0.03), Maximum single-slice calcification circumference score (β=−8.43; 95% CI: −13.36 to −3.49; P=0.001) and total calcification location score (β=−0.37; 95% CI: −1.08 to 0.09; P=0.02) were associated with SER of closed-cell stents. Conclusions: Calcified plaques are associated with SER of the carotid artery. Calcification circumference correlates with SER of open-cell stents. Calcification circumference, calcification area, and calcification location are related to SER of closed-cell stents, which may provide a new consideration for clinicians when choosing carotid artery stents.

目的:比较在颈动脉支架置入术(CAS)中常规后扩张与选择性后扩张的疗效和并发症发生率.方法:本研究回顾性收集北京安贞医院血管外科2016年1月至2019年12月,收治行CAS治疗并随访满1年的患者临床资料,基于术中接受常规后扩张和选择性后扩张进行分组,近远期通畅率及并发症发生率.结果:本研究共纳入314例患者,其中常规后扩张组150例,选择性后扩张组164例(选择性扩张61例,选择性未扩张103例).两组患者临床基线资料方面差异无统计学意义.术后均无手术相关死亡发生.常规后扩张组与选择性后扩张组术后以下并发症(缺血性卒中、急性心肌梗死、高灌注综合征)发生率,差异均无统计学意义;常规后扩张组持续低血压发生率显著高于选择性后扩张组(46％vs.28％,P=0.001).1年随访结果表明,常规后扩张组治疗侧颈动脉再狭窄(＞50％)发生率显著低于选择性后扩张组(8％vs.17.1％,P=0.016);选择性扩张治疗侧颈动脉再狭窄50％～70％发生率显著低于选择性未扩张(6.6％vs.17.5％,P=0.047);而两组治疗侧术后1年卒中发生率,差异均无统计学意义.结论:在颈动脉支架置入术中,常规后扩张较选择性后扩张可能会降低术后再狭窄的发生率.虽然血流动力学改变(持续性低血压)是CAS围手术期最常见的并发症,但经药物治疗使血压恢复后,症状可明显缓解,并避免发生永久性神经功能损伤.

Objective:To compare the clinical efficacy of endovascular aortic aneurysm repair (EVAR) and open surgery repair (OSR) in the treatment of complex abdominal aortic aneurysm (cAAA).Methods:The clinical data of 144 patients with cAAA were retrospectively analyzed. All patients were diagnosed and treated in Beijing Anzhen Hospital Affiliated to the Capital Medical University, The First Medical Center of Chinese PLA General Hospital, Beijing Hospital, and Xuanwu Hospital of Capital Medical University from June 2016 to December 2021. They were divided into EVAR group ( n=114) and OSR group ( n=30) according to different treatments. The preoperative clinical characteristics, operation, and follow-up results of the two groups were compared. Subgroup analysis was performed in the EVAR group according to different treatments. Two independent samples t-test was used for inter-group comparison of measurement data follow the normal distribution, rank-sum test was used for non-normal data, and Chi-square test or Fisher's exact probability test was used for count data. Results:In EVAR group, the diameter of proximal aneurysm neck was wider than in OSR group, and the proportion of trapezoidal neck was higher than in OSR group, and the differences were statistically significant [(22.03±3.59) mm vs (19.40±4.28) mm, P=0.002; 36.0% vs 16.7%, P=0.044). The operation time, intraoperative bleeding volume, and perioperative blood transfusion volume in EVAR group were lower than those in OSR group. There were statistically significant differences [(158.56±93.06) min vs (368.53±95.96) min, t=-10.915, P<0.001;(92.84±168.83)ml vs (1 370.00±1 019.52) ml, t=-12.579, P<0.001; (14.91±133.85) ml vs (1 375.00±1 300.18)ml, t=-11.055, P<0.001). 144 patients were followed up for (25.6± 10.4) months. The total complication rate and perioperative complication rate in EVAR group were lower than in OSR group. The differences had statistical significance(16.7% vs 40.0%, χ2=7.654, P=0.006; 9.6% vs 40.0%, χ2=16.301, P<0.001).There was no statistically significant difference in the quality of life scores between the two groups at 1-year follow-up. Subgroup analysis showed that the endoleak rate in the conventional EVAR group was significantly higher than that in the unconventional EVAR group (11.9% vs 0%, χ2=6.035, P=0.014). When cervical angle ≥52°, the complication rate of conventional EVAR was significantly higher than that of patients with narrower angle (29.6% vs 0%, χ2=6.486, P=0.011). In the treatment of patients with trapezoidal neck, conventional EVAR group had a higher endoleak rate than unconventional EVAR group (19.0% vs 0%, χ2=6.632, P=0.010). The incidence of complications in OSR group was correlated with concomitant diseases, and the proportion of patients with complications complicated with coronary heart disease and cerebrovascular disease was significantly higher than that of patients without complications (75% vs. 27.8%, χ2=6.451, P=0.011; 25% vs. 0%, χ2=5.000, P=0.025). Conclusion:In the treatment of patients with cAAA, the total complication rate of EVAR, especially the perioperative complication rate, is lower than that of OSR. Choosing appropriate patients and correct treatment may reduce the risk of postoperative complications and endoleak of EVAR.

目的:探讨杂交技术治疗髂股移行处闭塞性病变的临床疗效.方法:回顾分析我中心 2007年1月至2020年12月,采用股动脉内膜剥脱联合髂动脉球囊扩张支架置入治疗的72例髂股移行处闭塞性病变的临床资料.其中男性62例,女性10例,平均年龄(65.96±8.8)岁.采用Kaplan-Meier生存率分析术后12、24及60个月一期通畅率.结果:所有患者均成功完成手术,技术成功率为100％.踝臂指数(ABI)由术前0.37±0.18提高至术后0.92±0.18,P＜0.05,差异有统计学意义.手术相关并发症发生率13.9％(10/72).30d病死率为零.平均随访时间3 045.50(2052.50,4053.00)d.全因死亡率为12.5％.应用Kaplan-Meier生存率分析术后12个月一期通畅率为(94.29±2.77)％,术后24个月一期通畅率为(88.57±3.8)％,术后60个月一期通畅率为(79.71±4.84)％.结论:杂交技术治疗髂股移行处塞性病变早期结果满意,为治疗髂股移行处闭塞性病变提供了一种有效手段.

目的 分析胭动脉瘤外科及腔内治疗的策略与方法.方法 回顾性分析首都医科大学附属北京安贞医院2000年8月至2020年8月收治的19例胭动脉瘤病人临床资料.分析比较各病人的一般情况、围手术期情况及随访情况.结果 19例病人中,外科修复16例,其中行胭动脉瘤切除+间质移植术7例,行胭动脉瘤旷置+旁路移植术9例.覆膜支架腔内修复术3例.2例围手术期深静脉血栓形成予抗凝治疗,1例吻合口出血急诊再次手术.30d围手术期无心脑血管意外、死亡发生.4例失访,15例随访12～144个月,1例病人术后1年行截趾术,因感染重度性休克死亡.2例旁路移植病人出现切口周围麻木,营养神经治疗后好转.1例旁路移植病人术后1年复查桥血管再狭窄(50％),无下肢缺血症状出现.余病人下肢症状改善明确,无下肢缺血症状.结论 治疗指征明确的胭动脉瘤应积极手术.外科重建或腔内修复是安全有效的,个体化的治疗策略选择可获得更满意的治疗效果.外科重建应作为胭动脉瘤治疗的首选.腔内修复的手术选择仍需非常谨慎.

Objective:To compare carotid endarterectomy (CEA) and carotid artery stenting (CAS) in perioperative, medium and long term prognosis of patients with carotid artery stenosis.Methods:A retrospective analysis was performed on 1 329 cases of carotid artery stenosis treated at Department of Vascular Surgery, Beijing Anzhen Hospital from Jan 2011 to Aug 2020, as all cases being divided into CAS group and CEA group.Results:There were significant differences in age ( t=0.098, P=0.023) and drinking habits ( χ2=8.055, P=0.005) between the two groups. There were more unstable plaques in CEA group ( χ2=4.392, P=0.038), and more bilateral lesions in CAS group ( χ2=9.673, P=0.038). In perioperative period, there were more mannitol use in CEA group ( χ2=78.614, P<0.001), more incision/puncture site complications ( χ2=5.158, P=0.035), lung infection ( χ2=6.355, P=0.013), cerebral hyperperfusion syndrome (CHS) ( χ2=5.158, P=0.035) and extracranial nerve injury ( χ2=23.760, P<0.001) in CEA group than in CAS group, and more acute renal failure in CAS group ( χ2=10.393, P=0.001). There was no significant difference in survival rate and ischemic stroke, myocardial infarction, cerebral hemorrhage and renal insufficiency between the two groups (all P>0.05). The mean survival time of CAS group was 53.195 months (95% CI: 52.040-54.350), and 54.492 months (95% CI: 53.790-55.195) in CEA group ( P=0.051). Conclusions:Patients in CEA group had more unstable plaque and a lower perioperative stroke rate. CEA group had higher risk of CHS,while CAS was with lower postoperative lung infection rate and less wound local complications. There was no significant difference in long-term survival between the two groups.

作为国内最早开展血管外科工作的先驱者之一,吴庆华教授是医术高超、医德高尚的资深学者,更是桃李天下、培养了无数血管外科著名专家的前辈名师. 1 踏入血管外科之路 作为曾经的普外科医生,当谈起为何从事血管外科专业时,吴庆华教授这样讲述:"中国血管外科事业相比于其他国家起步比较晚, 20 世纪80 年代初,血管外科这个名词对医学界来说还很陌生,在国内几乎没有专攻血管外科方向的诊疗和技术的外科医生".

Objectives This study aimed to evaluate the effect of preventive collateral arteries embolization before endovascular aneurysm repair (EVAR) to reduce type II endoleaks (T2EL), aneurysm enlargement, and re-interventions. Methods A comprehensive search of PubMed, MEDLINE, Web of Science, and Embase was conducted to identify articles in English, related to preventive collateral arteries embolization before EVAR, published until October 2020. Results A total of 12 relevant studies, including 11 retrospective studies and one randomized controlled trial, were identified and fulfilled the specified inclusion criteria. A total of 1706 patients in 11 studies were involved in the meta-analysis. The overall incidence of T2EL was 17.3% in the embolization group vs. 34.5% in the control group (OR 0.36, p < 0.01). The incidence of persistent T2EL was 15.3% vs. 30.0% (OR 0.37, p < 0.01). Five studies reported the incidence of sac enlargement, with the rate 10.2% vs. 24.9% (OR 0.25, p < 0.01). Nine studies reported T2EL related re-interventions, and it was 1.3% in the embolization group and 10.4% in control (OR 0.14, p < 0.01). The technical success of collateral arteries embolization was 92.1% (455/494) in the 12 studies. 1.2% (10/829) patients suffered a mild complication of collateral arteries embolization, and 2/829 patients died because of the embolization. Conclusion Collateral arteries embolization is a promising measure to prevent the occurrence of T2EL, sac enlargement, and re-intervention. High-quality studies need to be conducted to provide stronger evidence-based medical suggestions about the embolize operation.

目的 探究腹主动脉瘤病人行择期腹主动脉瘤腔内修复术(EVAR)后出现并发症的可能危险因素,为并发症的出现提供预警分析.方法 回顾性分析首都医科大学附属北京安贞医院收治的286例行择期EVAR治疗的腹主动脉瘤病人资料,依据术后并发症的发生与否进行分组.比较有并发症的病人与无并发症病人在基线资料、动脉瘤解剖条件、术中情况及术前理化指标方面的差异.结果 有并发症组与无并发症组在年龄、有无肝脏病史、术前白蛋白水平等方面差异有统计学意义(P＜0.05).通过Logistic回归分析发现,肝脏病史和术前血红蛋白水平与术后并发症的发生密切相关(P＜0.05).回归方程的ROC曲线下面积为0.614(95％ CI 0.539～0.690,P=0.003).结论 既往存在肝脏病史和术前低血红蛋白水平对EVAR术后并发症的发生有预警意义.加强监测、及时纠正异常可能减少并发症的出现.

Background: Carotid artery stenosis has long been a critical cause of stroke and death, and it can seriously affect the life quality. Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) are both feasible therapies for this disease. This systematic review and meta-analysis aim to evaluate if the efficacy of the two approaches is comparable. Methods: Clinical studies up to March 2021 were searched through PubMed, Embase, and Scopus from a computer. The screening process was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Newcastle-Ottawa Scale (NOS) was used for methodological quality assessment of works of literature meeting the inclusion criteria, and Review Manager 5.4 was used for data synthesis. The I2 statistic was performed to measure the heterogeneity, and M-H/I-V fixed or random model was utilized depending on the I2 value. The evidence evaluation was accomplished based on grades of recommendation, assessment, development, and evaluation (GRADE) online tool. Results: A total of 14,200 subjects (six comparative studies) were finally included in this pooled study. There is no statistical discrepancy between the two treatments on reducing stroke/death/myocardial infarction (odds ratio [OR] 0.85, 95% CI 0.67–1.07), stroke (OR 1.03, 95% CI 0.77–1.37), or death (OR 1.14, 95% CI 0.67–1.94). Besides, TCAR is associated with a lower incidence of myocardial infarction (P = 0.004), cranial nerve injury (P < 0.00001), and shorter procedure time (P < 0.00001) than CEA among the overall cohort. Conclusions: TCAR is a rapidly developing treatment that reaches a comparable prognosis to CEA and significantly reduces the risk of myocardial infarction under the well-matched condition, which is a dependable choice for patients with carotid stenosis.

目的 应用肾动态显像评估单侧动脉硬化性肾动脉狭窄患者腔内治疗效果,并对可能改善分肾功能的影响因素进行分析.方法 回顾性分析北京安贞医院2016年1月-2018年4月收治的60例单侧动脉硬化性肾动脉狭窄患者,均行肾动脉支架成形术.收集患者的一般资料,术前及术后肾功能检查结果,肾动脉彩色多普勒超声(彩超)及肾动态显像结果,随访时间1年.根据术后随访肾动态显像结果中患侧肾小球滤过率是否较术前提高分为好转组及非好转组,建立线性回归模型进行影响因素分析.结果 全部患者均经肾动脉彩超及造影证实患侧肾动脉直径狭窄程度＞70％,均行患侧肾动脉支架成形术,手术即刻成功率100％,术后患侧肾动脉残存狭窄均＜20％,无围手术期严重并发症发生.术后收缩压、舒张压均较术前改善(均P＜0.01),患侧肾小球滤过率呈改善趋势(P=0.04),血肌酐水平基本稳定(P=0.25),患侧肾动脉狭窄程度明显减轻(P＜0.01).术后1年肾动脉支架Ⅰ期通畅率85％.分组后好转组40例(66.7％),非好转组20例(33.3％),建立线性回归模型进行影响因素分析,结果显示仅患侧分肾功能不全有统计学意义(B =0.50,P＜0.01),即如果患者术前患侧分肾功能不全,术后分肾小球滤过率改善.结论 肾动脉支架成形术治疗单侧肾动脉狭窄安全有效,1年Ⅰ期通畅率85％,1年内2/3患者术后分肾功能可改善,术前分肾功能不全患者能从肾动脉支架成形术中获益的可能性更大.

To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function. A retrospective analysis was made on 60 patients with >70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors. All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P < 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P < 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P < 0.01). Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

Objective:To compare the perioperative complications of carotid endarterectomy with patch angioplasty or primary closure.Methods:The clinical data of 492 carotid endarterectomy patients at the Vascular Surgery Department of Anzhen Hospital from Mar 2003 to Dec 2016 was analyzed retrospectively.Results:There were 364 cases (74%) in the patch angioplasty group and 128 cases (26%) in the primary closure group. The incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than that in the primary closure group (0.8% vs. 3.9%, P=0.031), and there was no difference in the incidence of the remaining perioperative complications. By subgroup analysis, the incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than in the primary closure group when the diameter of the internal carotid artery was <5 mm (0.7% vs. 6.0%, P=0.001), whereas there was no difference between the two groups when the diameter of the internal carotid artery was ≥5 mm. Conclusions:Carotid endarterectomy with patch angioplasty can reduce the incidence of perioperative cerebral infarction, especially in cases with an internal carotid artery diameter <5 mm.

The Objective was to review the prevalence of femoral artery occlusion (FAO) after cardiac catheterization in children up to 12 years old from two centers in China and identify its related risk factors. After collecting clinical data from patients who had undergone pediatric cardiac catheterization, univariate and multivariate analysis were used to evaluate the correlations between FAO and clinical factors, including sex, age, height, weight, sheath size, operation time, therapeutic strategy, sheath/age, sheath/height and sheath/weight. The ROC curve was also used to assess the influence of risk factors to predict FAO. FAO occurred in 19 (0.9%) out of 2,084 children following cardiac catheterization. Patients with younger age, lower height, longer operation time, electrophysiological (EP) diagnosis or/and therapy for arrhythmias, higher Sheath/Age, higher Sheath/Height and higher Sheath/Weight ratios had higher risk for FAO compared to their respective control groups (p<0.05). In the multivariate analysis, sheath/age and operation time were independent risk factors for FAO. Patients with operation time >77.5 min or sheath/age >0.5334 had a significantly higher risk for FAO. Operation time and sheath/age were confirmed as significant and independent risk factors associated with FAO. Operation time >77.5 min and sheath/age >0.5334 could effectively predict high risk of FAO after pediatric cardiac catheterization.

目的 探讨腹主动脉腔内修复(EVAR)治疗破裂性腹主动脉瘤(RAAA)的合理性、有效性和安全性.方法 回顾性分析2005年8月至2020年1月首都医科大学附属北京安贞医院收治的112例RAAA病人资料,对EVAR组和开放手术(OSR)组围手术期结果进行比较分析.结果 EVAR组和OSR组30d病死率分别为12.3％(8/65)和12.8％(6/47),两组差异无统计学意义(P=0.942),围手术期各种并发症发生率及二次手术干预率两组差异均无统计学意义.EVAR组和OSR组手术时间分别为(3.5 ±1.7)h和(7.2 ± 3.1)h,差异有统计学意义(P＜0.01);EVAR组和OSR组术中出血量分别为(267.7 ±433.9)mL和(2721.3±2112.1)mL,差异有统计学意义(P＜0.01);EVAR组和OSR组术中输红细胞量分别为(2.2 ±4.2)U和(7.2 ± 3.1)U,差异有统计学意义(P＜0.01);EVAR组和OSR组术中输血浆量分别为(147.7±324.6)mL和(1121.3±754.1)mL,差异有统计学意义(P＜0.01).EVAR组ICU时间为(6.9 ±8.0)d,低于OSR组(8.6 ±8.4)d,但差异无统计学意义(P=0.285);EVAR组住院时间为(13.3±10.4)d,低于OSR组(21.8± 11.1)d,差异有统计学意义(P＜0.01).结论 EVAR治疗RAAA有与OSR相似的30 d病死率和并发症发生率,而EVAR有更短的手术时间,更少的术中出血量和输血量、更短的住院时间.EVAR治疗RAAA是合理有效安全的.

目的:探究腔内修复治疗破裂性腹主动脉瘤后围术期并发症出现的相关特征.方法:回顾性分析自2013年10月到2019年10月期间,于首都医科大学附属北京安贞医院血管外科,住院并行腔内修复治疗的破裂性腹主动脉瘤患者53例.其中围术期未出现并发症者29例(54.7％),出现并发症者24例(45.3％).将并发症组患者分为术后介入相关并发症组8例,术后系统性并发症组13例,术中死亡3例.比较并发症患者与无并发症患者在基线资料、动脉瘤解剖条件、术中及术后理化指标方面的差异.结果:系统性并发症患者在年龄、就诊时收缩压及舒张压、有无反复搬动、近端瘤颈成角,以及术中尿量、术后24h内腹腔内压、PT、APTT、CKMB、TnI等改变较无并发症组,差异有统计学意义(P＜0.05);介入相关并发症患者在近端瘤颈成角方面较无并发症组,差异有统计学意义(P＜0.05).结论:患者年龄、就诊时血压、近端瘤颈成角以及术前多次搬动可能对破裂动脉瘤腔内治疗后系统性并发症产生影响,术中尿量和术后24 h内的腹内压、凝血功能及心肌标志物的监测,对预测系统性并发症发生十分重要.

Objective To determine the feasibility of neck vessel wall imaging technology with three?dimensional variable?flip?angle turbo spin?echo (3D T1w?SPACE) for the detection of carotid atherosclerotic disease before revascularization. Methods Thirty?one patients who underwent carotid endarterectomy (CEA) and fifty?three patients who underwent carotid stenting (CAS) were enrolled prospectively. Neck vessel wall imaging examination were performed in all patients whilecarotid artery DSA were performed in all CAS patients. Quantitative measurements including stenosis, lesion length, and the presence or absence of plaque ulceration obtained with 3D T1w?SPACE and DSA were independently determined. And images of the 3D T1w?SPACE were compared with corresponding histology to identify major plaque components including intraplaque hemorrhage (IPH), lipid rich necrotic core (LRNC), and calcification (CA). The consistency rate, sensitivity, specificity, positive predictive value and negative predictive value were used to assess diagnostic value. Bland?Altman plots, intraclass correlation coefficient (ICC), and Cohen Kappa were determined. Results DSA was served as the reference standard. There was an excellent correlation between 3D T1w?SPACE and DSA images in measuring stenosis (r=0.984, P<0.01) and luminal stenosis [ICC=0.98 (95% confidence interval: 0.96-0.99)]. Bland?Altman plots showed that the two examinations were in good consistency in evaluating the extent of stenosis. Sensitivity (89.5%) and specificity (95.1%) was high in 3D T1w?SPACE images compared to DSA for the detection of ulcers. The consistency rate between 3D T1w?SPACE images and histological results for IPH, LRNC and CA detection were 85.7%, 82.1% and 92.9%, respectively. Sensitivity and specificity were 90.0% and 75.0% for IPH;83.3% and 80.0% for LRNC; 91.3% and 100.0% for CA respectively. However, lesion length measurements by using 3D T1w?SPACE were longer than those measured by using DSA (P<0.01).Conclusion Neck vessel wall imaging technology with 3D T1w?SPACE is a noninvasive and accurate technique for the diagnosis of carotid artery atherosclerotic disease before revascularization.

Objective: To investigate the etiology, treatment method and prevention of gastrointestinal complications(GCs) after endovascular and open repair of abdominal aortic aneurysm (AAA). Methods: The clinical data of 716 cases who were diagnosed as AAA and underwent endovascular(EVAR) or open repair (OR) from Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University April 2009 to March 2017 were collected and analyzed retrospectively. There were 608 males (84.9%)and 108 females(15.1%), aging of 69.4 years (range: 52-86 years). There were 539 cases(75.3%) underwent EVAR and 177 cases(24.7%) underwent OR. The morbidity of GCs and mortality of GCs, such as acute pancreatitis, cholecystitis, ischemic colitis, intestinal obstruction and peptic ulcer, between EVAR and OR group were compared. The treatment of the GCs and the prognosis of the patients were reported. Results: The morbidity of GCs in EVAR and OR group were 4.6%(25/539)and 35.0%(62/177), respectively. There were 10 cases and 28 cases suffering from acute pancreatitis in EVAR and OR group, respectively; 4 cases and 6 cases suffering from cholecystitis in the two groups; 6 cases and 13 cases suffering from ischemic colitis in the two groups; 5 cases suffering from intestinal obstruction in OR group; 5 cases and 10 cases suffering from peptic ulcer in the two groups. Two patients died in EVAR group, and the peri-operative mortality was 0.37%, one died of ischemic colitis with acute myocardial infarction, the other died of ischemic colitis with septic shock. Six patients died in OR group, and the peri-operative mortality was 3.39%, two patients died of acute pancreatitis with intestinal necrosis, one patient died of cholangitis with peritonitis and septic shock, three patients died of ischemic colitis with acute renal failure or septicemia. Conclusions: The etiology of peri-operative GCs after AAA repair may include inferior mesenteric artery occlusion or ligation, pancreas injury, organ hypoperfusion and so on.

Objective: To evaluate the related risk factors of cerebrovascular complications after carotid endarterectomy (CEA) and to improve the efficacy of CEA in the treatment of ischemic stroke. Methods: The clinical data of 295 patients with atherosclerotic carotid artery stenosis who underwent CEA in the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2013 to March 2017 were retrospectively analyzed. Results: As the results of the single-factor analysis of logistics, severe lower limb artery stenosis (RR=5.667, P=0.017), systolic blood pressure before the carotid artery clamping (RR=6.659, P=0.010), diastolic blood pressure before the carotid artery clamping (RR=3.981, P=0.046), stump pressure (RR=5.359, P=0.021), diastolic blood pressure after surgery (RR=9.550, P=0.002), diastolic blood pressure of the first day after surgery (RR=7.932, P=0.005) were influencing factors of postoperative cerebrovascular complications after CEA. The results of multi-factor analysis of logistic regression indicated that diastolic blood pressure before the carotid artery clamping (RR=0.953, P=0.024) and stump pressure to basic systolic blood pressure index (SSI)>0.25 (RR=0.086, P=0.049) were independent risk factors for postoperative cerebrovascular complications after CEA. Conclusion: Systolic blood pressure before carotid artery clamping and SSI>0.25 are independent risk factors for postoperative cerebrovascular complications after CEA. Close follow-up and drug treatment for patients after CEA might be beneficial to reduce postoperative carotid artery restenosis.