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.

输注血小板是各类血液病治疗过程中的常用支持疗法,在预防和治疗因血小板减少导致的出血中,具有重要临床意义.随着临床上对血小板输注后效果的日益关注,临床医生会为某些输注血小板后治疗效果欠佳的患者申请配型.

Objective To evaluate the characteristics and diagnostic value of direct parameters of Doppler sonography in the diagnosis of renal artery stenosis(RAS)(diameter reduction≥50%).Methods A total of 89 patients with 177 renal arteries detected by color Doppler flow imaging and referred to renal arteriography were included.Five Doppler parameters including renal peak systolic velocity(RPSV),renal aortic ratio(RAR),renal-renal ratio(RRR),renal-segmental ratio(RSR)and renal-interlobar ratio(RIR)were measured.The arteries were stenosed on renal arteriography in case of a diameter reduction of 50%.The sensitivity,specificity,and negative predicting value,positive predicting value and accuracy at various cut-off values were calculated.Results In the 177 main renal arteries demonstrated by renal arteriography,there were 7 occlusion and 80 stenoses(diameter reduction 50%~99%).Among the 80 stenoses,46 were caused by atherosclerosis,20 by Takayasu's arteritis,12 by fibromuscular dysplasia and 2 by other etiological reasons.Doppler examination was technically successful in 98.9% of renal arteries(175/177).The best cut-off values for the 5 parameters(RPSV,RAR,RRR,RSR,RIR)were 170 cm/s,2.3,2.0,3.8,5.5,respectively.The parameters of RPSV,RSR and RIR had better diagnostic efficiency(87% accuracies).Both RAR and RRR had sensitivities of 79% and 80%,respectively.Conclusions For the detection of RAS(diameter reduction ≥50%),the RPSV,RIR and RSR are indicators with high quality,while both RAR and RRR have sensitivities with poor quality.The factors influencing the PSV in both renal artery and abdominal aorta can decrease diagnostic accuracy of RAR.However,the parameter of post-PSV ratios and the factors which make a proportional change in PSV in both main renal artery and intrarenal arteries are rarely influenced by PSV in abdominal aorta.