Objective: To investigate the risk factors and outcomes regarding acute kidney injury (AKI) after AngioJet thrombectomy for acute lower-extremity deep vein thrombosis (DVT).Methods: Patients were divided into AKI and non-AKI groups according to whether AKI occurred postoperatively. The demographic data, pre-operative and post-operative laboratory data and surgical differences were compared between the two groups. Logistic regression and Wilcoxon signed-rank test were used to identify the AKI risk factors and outcomes, respectively.Results: Among the 341 patients who met the inclusion criteria, 45 developed AKI (AKI group) and 296 had normal renal function (non-AKI group) post-surgery. There were significant differences between the two groups in the course (t = 10.885, P = 0.000); preoperative history of a major surgery within 3 months (3M-MS) (odds ratio [OR] = 5.492, P = 0.001); duration of aspiration thrombectomy (Z = -8.803, P = 0.000); volumes of aspiration (Z = -8.215, P = 0.000); contrast volume (Z = -3.204, P = 0.001) and pulmonary thrombectomy (OR = 18.200, P = 0.002); and preoperative complications of hypertension (OR = 4.637, P = 0.002), diabetes (OR = 18.088, P = 0.000), or pulmonary embolism (OR = 0.085, P = 0.011). Wilcoxon signed-rank test showed that the renal function of every patient in the AKI group returned to normal 3 months after the surgery.Conclusions: The course, preoperative complications of diabetes or hypertension, 3M-MS, contrast volume, duration and volume of aspiration thrombectomy, and pulmonary thrombectomy are risk factors for post-AngioJet-thrombectomy AKI, which is temporary.& COPY; 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

目的 探讨导管搅拌碎栓联合局部高压溶栓治疗急性肺栓塞(APE)的安全性和有效性.方法 回顾性分析2019年1月至2020年12月在甘肃省人民医院接受导管搅拌碎栓联合局部高压注射重组人尿激酶原(rhPro-UK)溶栓治疗的23例APE患者临床资料.观察术前和术后48 h患者临床指标变化、并发症发生情况.随访6个月,观察术后1、3、6个月肺动脉压(PAP)变化.结果 23例患者治疗均获临床成功.术前和术后48 h临床指标比较,差异有统计学意义(P<0.01);无死亡、胸腔积血、心包积液、颅内出血等主要不良事件发生.术后1、3、6个月PAP变化比较,差异无统计学意义(均P>0.05).结论 导管搅拌碎栓联合局部高压溶栓治疗APE安全有效,近期效果满意.

PURPOSE:To explore the efficacy and safety of Endostatin combined with continuous transcatheter arterial infusion (TAI) and transcatheter arterial chemoembolization (TACE) in the treatment of gastric cancer with liver metastasis, and analyze the prognosis.METHODS:96 gastric cancer patients with liver metastasis treated in our hospital from September 2013 to September 2016 were collected and randomly divided into TAI+TACE group (n=48) and Endostatin+TAI+TACE group (n=48). The clinical efficacy, changes in the level of vascular endothelial growth factor (VEGF) before and after treatment, adverse reactions, postoperative tumor recurrence and patient survival were observed and recorded, and the possible influencing factors for prognosis were analyzed.RESULTS:In the Endostatin+TAI+TACE group and TAI+TACE group, the objective response rate (ORR) was 70.8% (34/48) and 47.9% (23/48), and the disease control rate (DCR) was 91.7% (44/48) and 83.3% (40/48), respectively. After treatment, the concentration of VEGF declined significantly in both groups compared with that before treatment, more obviously in the Endostatin+TAI+TACE group than in the TAI+TACE group. According to the follow-up results, both overall survival (OS) and progression-free survival (PFS) in the Endostatin+TAI+TACE group were evidently higher than those in the TAI+TACE group. The Cox regression analysis revealed that the grade of tumor differentiation and Endostatin combination therapy were independent factors influencing the prognosis of patients.CONCLUSION:Endostatin combined with TAI and TACE can obtain good short-term clinical efficacy in the treatment of gastric cancer with liver metastasis. Compared with those treated with chemotherapy alone, patients receiving Endostatin+TAI+TACE have significantly improved OS and PFS, a reduced level of VEGF and a lower incidence rate of adverse reactions, so Endostatin+TAI+TACE is worthy of clinical popularization and application.

Background: We aimed to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in treating acute iliofemoral deep vein thrombosis (DVT). Methods: We retrospectively analyzed the clinical data of 82 acute iliofemoral DVT patients between November 2017 and December 2018. The therapeutic effects were evaluated based on the thrombus removal rate and circumference changes 10 cm above the affected knee. Incidence rates of pulmonary embolism were evaluated to determine the safety of the procedure. During follow-up, the incidence of postthrombotic syndrome (PTS) was evaluated using the Villalta score, whereas the patency rate of the iliac vein was evaluated via duplex ultrasonography and venography. Results: The surgical success rate was 100%. We identified 48 patients with iliac vein compression syndrome (IVCS) intraoperatively: three of these underwent stent implantation and the others underwent percutaneous transluminal angioplasty (PTA). Grade II and III thrombus removal was achieved in 32.9% (27/82) and 67.1% (55/82) patients, respectively. Postoperative venography revealed that four patients had many floating thrombi under their inferior vena cava filters, which were not removed. The circumference 10 cm above the affected knee decreased from 50.3 +/- 3.5 cm preoperatively to 46.3 +/- 3.3 cm postoperatively (P < 0.05). During follow-up, a PTS incidence rate of 9.8% was observed. The patency rate of the iliac vein was 66.6% after stent implantation and 93.3% after PTA. Conclusions: PMT is feasible, safe, and effective for acute iliofemoral DVT. With regard to IVCS, we suggest PTA alone as a one-stage surgery, and the need of secondary stent implantation should be determined based on follow-up results.

目的 观察SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄中的临床疗效.方法 回顾性分析34例股腘动脉支架内再狭窄患者的临床及随访资料,其中15例采用斑块切除术治疗(切除组),19例采用普通球囊血管成形术治疗(POBA组).术后观察两组患者临床症状改善情况,记录手术前后踝肱指数(ABI)及最小管腔直径(MLD)的变化,采用Kaplan-Meier生存函数分析术后靶血管通畅率.结果 两组手术治疗成功率均为100％.术后6、12个月切除组ABI(0.81±0.07、0.79±0.08)与POBA组(0.68±0.12、0.51±0.11)比较P均<0.05.术后12个月切除组MLD[(3.10±0.89)mm]与POBA组[(1.74±0.94)mm]比较P<0.05.术后12个月切除组靶血管一期通畅率(66.7％)高于POBA组(31.6％),P<0.05.结论 SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄病变方面具有理想的近中期临床效果,且安全有效.

目的 探讨SilverHawk斑块切除系统治疗膝下动脉硬化闭塞的临床效果.方法 采用SilverHawk斑块切除系统治疗34例(39条患肢)膝下动脉硬化闭塞患者,观察治疗效果及随访结果.结果 患者围手术期无死亡.39条患肢中,31条(28例患者)顺行开通成功,8条(6例)逆行开通成功,治疗成功率100％(39/39),技术成功率92.31％(36/39).术后1周患者跛行距离、趾肱指数(TBI)及踝肱指数(ABI)均高于术前(P均＜0.05).术后随访2～46个月,平均(23.63±9.71)个月,溃疡愈合率90.00％(9/10);4条坏疽患肢中,1条膝下截肢.术后6、12、24个月患肢一期通畅率分别为87.18％(34/39)、82.05％(32/39)及71.79％(28/39),二期通畅率分别为94.87％(37/39)、92.31％(36/39)和84.62％(33/39).结论 采用SilverHawk斑块切除系统治疗膝下动脉硬化闭塞效果良好.

Extracranial carotid artery pseudoaneurysms (ECAPs) are rare vascular lesions that, if untreated, can lead to severe neurologic deficits and significant mortality. Although conservative therapy, surgical ligation or reconstruction, and endovascular techniques can be curative, the literature demonstrates that the best therapy remains controversial and consensus is lacking. We report a case of a 53-year-old patient who developed a giant ECAP on the left side of her neck, which had been presented for 10 years and was successfully treated by covered stent-assisted open surgery. During the 6 months of follow-up, computed tomography angiography confirmed complete occlusion of the ECAP and patency of the carotid artery. In addition to this report, a brief review of the literature is presented.

Objective To compare the hemostatic safety and efficacy of a new butterfly femoral artery compression device (FACD) with those of manual compression (MC) in patients undergoing percutaneous peripheral endovascular interventions via femoral artery. Methods A total of 283 patients, who received percutaneous endovascular interventions via femoral artery during the period from September 2016 to December 2017, were enrolled in this study. After endovascular intervention, 167 patients received FACD to make hemostasis (FACD group), and 116 patients received MC hemostasis (MC group) . The patient's comfortableness, time used for hemostasis (min), limb immobilization time (h), and the incidence of vascular complications in both groups were analyzed. Results All 283 patients were included in analysis, the results indicated that the hemostatic success rates in FACD group and MC group were 96.4％ (161/167) and 94.0％ (109/116) respectively, the difference between the two groups was not statistically significant (P>0.05) . The postoperative Kolcaba Comfort Scale score of FACD group was (85.0 ±11.2) points, which was remarkably higher than (58.4±11.7) points of MC group (P<0.05), the time used for hemostasis in FACD group was (9.2 ±2.2) min, which was strikingly shorter than (18.5 ±2.9) min in MC group (P <0.05) . The limb immobilization time in FACD group was (10.4±2.4) hours, which was obviously shorter than (23.1±4.1) hours in MC group (P <0.05) . The incidence of vascular complications in FACD group was 3.6％, which was dramatically lower than 9.5％ in MC group (χ2=4.206, P=0.04) . Conclusion The use of the new butterfly FACD can promptly, safely and effectively stop bleeding of femoral artery puncture site. The new butterfly FACD is superior to MC in shortening hemostatic time and limb immobilization time, in reducing incidence of vascular complications, as well as in improving patient's comfortableness degree.

Objective To analyze the clinical effects of Viabahn covered stents and bare metal stents in treatment of femoral and popliteal arteriosclerosis. Methods The clinical data of 75 patients ( 75 limbs) with femoral and popliteal arteriosclerosis obliterans receiving endovascular surgery from January 2016 to January 2017 were retrospectively analyzed. There were 35 patients in the Viabahn covered stents group and 40 in the bare metal stents group. The condition of vascular recanalization was compared between the two groups and the factors which affected the primary patency rate were also analyzed. Results All the patients ( 75 limbs in 75 cases) were operated successfully. The follow-up time was 24 months. In the Viabahn covered stents group, the primary patency rates were97. 14％, 91. 43％, 80. 00％ and 68. 57％ 3, 6, 12 and 24 months after surgery, and the secondary patency rates were 100. 00％, 97. 14％, 91. 43％ and 85. 71％ respectively. In the bare metal stents group, the primary patency rates were 90. 00％, 75. 00％, 52. 50％ and 42. 50％ 3, 6, 12 and 24 months after surgery, and the secondary patency rates was 97. 50％, 92. 50％, 87. 50％ and 80. 00％ respectively. Log-rank test showed that there were a significant differences in the primary patency rates between the two groups ( χ2= 5. 318, P = 0. 021), but there were no significant difference in the secondary patency rates ( χ2= 0. 536, P = 0. 464). Smoking, hyperlipidemia and diabetes were the independent risk factors of primary patency rates ( P = 0. 007, 0. 003, 0. 063). Conclusion Viabahn covered stent is more effective than bare metal stent in the treatment of femoral popliteal arteriosclerosis.

患者 男性,49 岁. 因 "发现右下腹部搏动性包块 4年"于2017年11月16日入院.患者20年前有右大腿枪弹伤史,行伤口"清创缝合"后愈合良好.发现包块后于当地医院诊断为"右股动静脉瘘(arteriovenous fistula,AVF)"并已行"右股动脉造影并覆膜支架植入术"治疗,术后症状无明显缓解. 入院查体示右下肢较对侧粗,右下腹部可触及6 cm× 8 cm 搏动性包块,搏动频率与心率一致,可触及震颤,能闻及吹风样杂音. 实验室检查梅毒螺旋体抗体阴性、 血沉、C反应蛋白等均在正常范围.

目的： 评价应用 TurboHawk 斑块切除系统联合药物涂层球囊（DCB）治疗股腘动脉硬化闭塞性疾病的安全性和有效性。 方法： 2016 年 4 月—2017 年 10 月，对 17 例股腘动脉硬化闭塞性疾病患者应用 TurboHawk 斑块切除系统联合 DCB 治疗。17 例患者平均年龄（66.9±10.5）岁；其中男 14 例，女 3 例；股腘动脉狭窄病变 13 例，闭塞性病变 4 例；术前 Rutherford 分级 2~5 级；术前踝肱指数（ABI）为 0.49±0.18。 结果： 17 例患者的血管病变全部经腔内开通成功，其中 1 例股动脉穿孔患者行补救性覆膜支架植入术，另 1 例远端栓塞患者经股动脉切开球囊导管取栓后血流恢复通畅，技术成功率 88.2%。术后 ABI为 0.99±0.27，明显高于术前（P=0.03）。术后 3、6 个月一期通畅率分别为 94.1%，88.2%，二期通畅率 100%。 结论： TurboHawk 斑块切除系统联合药物涂层球囊治疗股腘动脉硬化闭塞性疾病安全有效，早期效果满意。

目的:探讨复合手术治疗慢性症状性颈内动脉闭塞的安全性及临床应用价值.方法:回顾性分析2016年12月—2018年3月应用复合手术治疗的9例颈内动脉闭塞患者的临床资料,其中男7例,女2例;中位年龄58岁.比较手术前后临床症状的变化并进行随访,记录手术前后改良Rankin量表(mRS)评分及大脑血流MR灌注(PWI)指标(CBF、TTP、MTT)变化.结果:9名患者均成功开通闭塞血管,技术成功率100％.术后临床症状均获得缓解,围手术期无新发脑卒中,无死亡患者;术后2例(22.2％)出现高灌注表现,经保守治疗后症状消失;术后PWI指标较术前均明显改善.9名患者均获得随访,中位随访时间8个月;1例患者靶血管6个月时出现再闭塞,表现为短暂性脑缺血发作频发,保守治疗后症状稍缓解;余8例病情均好转,mRS评分较术前改善均≥1分;术后3、6个月再闭塞率为0％、11.1％,提示总体通畅良好.

Objective To explore the value of retrograde recanalization technique in treatment of TASCⅡ C/D femoropopliteal arteriosclerosis obliterans.Methods Totally 36 patients with TASCⅡ C/D femoropopliteal arteriosclerosis obliterans were retrospectively analyzed.Preoperative and postoperative ankle brachial index (ABI) and intermittent claudication were compared,as well as postoperative vascular patency rate and complications were analyzed.Results The retrograde recanalization technique were successfully performed in all 36 patients.The walking distance and ABI of 7 days,and 3,6,12 months postoperation were increased significantly compared with preoperation (all P＜0.05).The postoperative vascular patency rate of 3,6 and 12 months was 97.22％,91.67％ and 72.22％,respectively.There was no death nor amputation during the follow-up period,and the incidence of perioperative complications was 11.11 ％ (4/36).Conclusion Retrograde recanalization technique can be used to treat TASC Ⅱ C/D femoropopliteal arteriosclerosis obliterans when anterograde access failed.