Objective:To evaluate the efficacy and safety of heparin-bonded graft revascularization in patients with critical limb ischemia (CLI) after failed endovascular intervention.Methods:The clinical data of patients who underwent lower extremity bypass after failed endovascular intervention for CLIs from Oct. 2017 to Apr. 2019 were retrospectively analyzed. Individualized surgical therapy including stent removal, endarterectomy, graft or graft combined with autogenous vein bypass and other surgical methods to gain arterial revascularization of the lower extremity was designed based on the patients' symptoms and clinical features. Clinical characteristics, individual surgical therapeutic information, perioperative complications, symptom relief, ulcer wound healing, patency rate and limb salvage rate were analyzed.Results:A total of 27 patients were enrolled in this study. Resting pain of 16 cases relieved effectively. Among 11 cases of ulcer and tissue necrosis, 9 cases healed completely and 2 cases of ulcer reduced obviously half a year after operation. Postoperative complications occurred in 6 cases, with no perioperative death occurred. All patients were followed up for (13.0±8.9) months (range: 2-35 months). Kaplan-Meier estimated patency and limb salvage rate. Overall primary patency at 6-, 12- and 24-month was 83.3%, 73.7% and 49.1%, respectively; secondary patency was 91.8%, 82.1% and 70.8%, respectively; limb salvage was 91.8%, 86.9% and 76.6%, respectively. In the subgroup of femoropopliteal bypass, the 1- and 2-year primary patency rate was 86.7% and 49.5%, respectively; secondary patency was 93.3% and 81.7%, respectively; limb salvage was 93.3% and 81.7%, respectively. In the subgroup of femorocrural bypass, the 1- and,2-year primary patency rate was 45.0% and 45.0%, respectively; secondary patency was 58.3% and 58.3%, respectively; limb salvage was 58.3% and 58.3%, respectively.Conclusion:In the era of endovascular intervention, traditional arterial bypass can still provide a safe and effective alternative treatment for complex lesions of lower extremity arteries with failed endovascular intervention. It can efectively relive symptoms and improve limb salvage rate.

维持性血液透析目前是肾功能衰竭终末期患者的主要治疗方法.在血液透析过程中,肝素药物是主要的抗凝药物,而在使用过程中肝素诱导血小板减少症(heparin-induced thrombocytopenia,HIT)是其严重的不良反应之一,对患者的预后造成严重的影响,严重者甚至导致死亡.目前研究显示10％血液透析患者血浆中存在HIT抗体,而HIT发生率为0.5％～5.0％[1-2].本研究探讨1例维持性血液透析过程中出现HIT患者治疗过程,现报道如下.

随着腔内器械和介入技术的不断发展和进步,越来越多疾病可通过腔内介入的方法治疗.经皮股动脉穿刺的操作的增多,穿刺入路的医源性股动脉假性动脉瘤(iatrogenic femoral pseudoaneurysm,IPA)的发生也随之增加.目前其治疗方式主要包括手术切除瘤腔修复术、单纯局部压迫、超声引导下压迫(ultrasound-guided manual compression,UGC)、超声引导下注射凝血酶(ultrasound-guided thrombin injection, UGTI)、弹簧圈封堵、覆膜支架植入等.本文就其发生危险因素、临床表现、检查诊断及治疗进展作一系统的综述回顾.