近日欧洲肠外肠内营养学会(European Society for Parenteral and Enteral Nutrition,ESPEN)组织专家对《危重症患者营养支持治疗指南》进行了更新,全文发表于《临床营养杂志》(Clin Nut r.2018 Sep 29.pii.S0261-5614 (18) 32432-4.doi.10.1016/j.clnu.2018.08.037),笔者对指南内容进行了摘译供广大同仁参考.

Objective To explore surgical experiences of endovascular and open operations treating visceral artery aneurysms.Methods Twenty-three patients with visceral artery aneurysms from June 2009 to October 2016 in Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University were retrospectively enrolled.In 23 patients,there were 10 cases of splenic artery aneurysm,7 cases of renal artery aneurysm,3 cases of superior mesenteric artery aneurysm,3 cases of celiac trunk aneurysm,22 cases of nonruptured aneurysm and 1 case of aneurysm rupture.The perioperative data were analyzed.Results All cases were successfully operated;22 cases had endovascular operation;1 case had open operation.One patient who had arterial embolization died of multiple organ failure 43 d after operation.Major perioperative complications included gastrocnemius venous thrombus in 1 case and upper abdominal pain in 3 cases.No arterial recanalization or rupture,in-stent restenosis or occlusion occurred during 6-48 months of follow-up.Conclusions Endovascular operation is a safe and effective method in treating visceral artery aneurysms;open surgery can be a second choice for patients with contraindications of endovascular therapy.

Objective To evaluate retrograde transpopliteal access for femoral-popliteal artery total occlusion with blind puncture.Methods Clinical data of 22 cases admitted from Sep 2014 to June 2016 undergoing endovascular treatment of the femoral-politeal artery occlusion with transpopliteal artery retrograde access by blind puncture were analyzed.Results A total of 22 patients underwent retrograde popliteal access with blind puncture after antegrade attempts failed.Puncture above the knee was performed in 18 cases and below the knee in 4 cases.The average increase of ABI was 0.57.Hematoma of puncture site was observed in 2 patients,other complications included pneumonia in 1 case and renal insufficiency in 2 cases.The mean follow-up time was (13 ± 5)months.Restenosis occurred in 8 patiens(36.4％)during the follow-up time.The primary patency was (86.4 ± 0.07) ％ at 6 months and (70.7-± 0.12) ％ at 12 months.There was no major amputation rate and mortality during the follow-up.Conclusions Retrograde transpopliteal access for femoral-popliteal artery occlusion with blind puncture is safe and effective.