Objective To evaluate the clinical features,diagnostic methods and treatment of venous thromboembolic disease (VTE) during pregnancy.Methods From June 2006 to June 2011,a total of 20 pregnant women were diagnosed VTE at the Department of Obsterics and Gynaecology,Qilu Hospital of Shandong University.Clinical data of these patients were analyzed retrospectively.Results (1) Characteristics of patients:the symptoms of all the 20 patients commenced in pregnancy.Of these,6 (30％) happened in the first trimester,7 (35％) in the second trimester,and 7 (35％) in the third trimester.Twelve (60％) patients went to hospital in one week after they had symptoms,while 8(40％ ) went to hospital after one week.(2)Clinical manifestation:18 patients were diagnosed deep venous thrombosis (DVT),one was diagnosed pulmonary embolism (PE).One patient was diagnosed DVT and PE simultaneously.Among the 19 DVT patients,16 (16/19)were on the left side,3 (3/19)were on the other.They all came with sudden swelling and pain of the affected lower extremity.In 17(17/19) patients,the circumference differences between two legs were beyond (4.0 ±0.5) cm.In all the 20 patients,12 (60％) had elevated plasma level of D-dimmer.The diagnosis of DVT was made mainly by a Doppler ultrasound.Among the 19 DVT events,7 (7/19) were proximal DVT,2 (2/19) were distal,and 10( 10/ 19) were mixed type.(3)Anticoagulant therapy:patients with VTE during pregnancy were treated with low molecular weight heparin (LMWH) (enoxaparin,once 1 mg/kg subcutaneous,twice a day).After delivery,patients were treated with subcutaneous LMWH and warfarin simultaneously for at least 5 days,until the prothrombin time-international normalized ratio ( PT-INR ) was ＞ 2.0 for 24 hours.( 4 ) Thrombolytic therapy:for most patients with VTE,we are against the routine use of thrombolytic therapy,especially before delivery.For patients with acute massive PE,urokinase of 600 000 units intravenously daily was recommended for 3 days.For those patients with DVT whose standard anticoagulation therapy was ＜ 30 days,an inferior vena cava filter(IVCF) placement was recommended before delivery or abortion.If it was ≥30 days,IVCF was not recommended as a routine,and anticoagulant therapy was used 24 hours after delivery.If there was no recurrent DVT or PE,IVCF was retrieved routinely in 12 days.(5)Outcome:among patients treated with LMWH (95％,19/20).Three received IVCF placement,which was retrieved successfully in 12 days,with no interventional complication.All patients recovered well after 2 weeks,and the circumference differences between two legs were within (2.0 ± 0.3 ) cm.Of the 18 patients maintained to the third trimester,17 received anticoagulant therapy,and no abnormal findings were found during antenatal examination.Ten patients received cesarean section (50％,10/20),while 8 had vaginal delivery (40％,8/ 20).Neither neonatal asphyxia nor malformation was observed.The patients were followed-up for 1 - 24 months,no venous thrombus extension was found in 17 cases by Doppler ultrasound,thrombus disappeared in 2 cases of distal DVT after 4 weeks and 8 weeks respectively.By echocardiography,the pulmonary arterial pressure of the 2 patients with PE was found normal 3 months after hospital discharge.There was no maternal death during the study,no recurrent PE or bleeding occured.Conclusions LMWH is safe and effective for VTE during pregnancy.Routine use of thrombolytic therapy is not recommended.VTE in pregnancy is not the absolute indication of termination of pregnancy.The indication of an IVCF placement should be stricter,and a retrievable suprarenal IVCF is recommended under certain circumstances.

Objective To investigate the clinical effect of interventional therapy in the treatment of acute iliofemoral venous thrombosis.Methods A total of 20 patients with acute iliofemoral venous thrombosis was treated by interventional therapy from February 2004 to April 2006.Under the guidance of ultrasonography,intravenous thrombolysis through the popliteal vein combined with iliac vein stenting was employed.The venous patency was assessed with angiography.Results The catheter-based thrombolysis through the ipsilateral popliteal vein was effective for all the patients.Balloon dilatation angioplasty combined with endovascular stenting was applied in 15 patients,while balloon dilatation angioplasty alone was utilized in other 5 patients.The implantation of a temporary cava filter was required in 10 patients.After intravenous thrombolysis through the popliteal vein,the recanalization rate was 30%～90%(mean,55%) in the iliac vein and 40%～80%(mean,65%) in the femoral vein.Postoperative hematuria was encountered in 1 patient.No symptomatic embolism of pulmonary artery was seen.Postoperatively,clinical symptoms on the effected limb significantly subsided or completely disappeared.The hospitalization expenditure was 52 000～81 000 yuan(mean,74 000 yuan).Follow-up observations for 1～24 months(mean,12 months) were carried out in the 20 patients.The patency rate was 100%(15/15) in 15 patients receiving iliac vein stenting.Out of 5 patients with balloon dilatation,the iliac vein was completely obstructed in 2 patients and was recanalized by 10%～20% in 3 patients.Conclusions Catheter-based thrombolysis through the popliteal vein combined with endovascular stenting is an effective therapeutic strategy for acute iliofemoral venous thrombosis,but it is very expensive.

Objective: To observe the synergistic inhibitory effect of angiostatin gene combined with antisense hypoxia inducible factor-1? (aHIF-1?) gene on implanted human ovarian carcinoma in nude mice. Methods: BALB/C nude mice were subcutaneously transplanted with SKOV3 tumor cells and the tumors were allowed to grow till the diameter reached 0.4 cm, then the mice were randomly divided into 4 groups: PcDNA3 control group, PcDNA3-Angiostatin group, PcDNA3B-aHIF-1? group and PcDNA3-Angiostatin+PcDNA3B-aHIF-1? group; plamids PcDNA3, PcDNA3-Angiostatin, PcDNA3B-aHIF-1? and PcDNA3-Angiostatin+PcDNA3B-aHIF-1? were injected intra-tumorally in the above groups, respectively. The tumor samples were harvested on the 7 th day after gene transfer. Angiostatin, HIF-1?, vascular endothelial growth factor (VEGF) and microvessel density (MVD) of tumors were determined by immunohistochemical methods. Tumor cell apoptosis was determined with TUNEL staining. Results:The growth of tumors of PcDNA3-Angiostatin+PcDNA3B-aHIF-1? group was significantly inhibited, with local low expression of HIF-1? and VEGF (lower than those of the other 3 groups). MVD in combined transfection group(13.6?2.3) was lower than that of Angiostain group (24.5?2.7); the apoptosis index in combined transfection group (5.32?0.62)was higher than those of Angiostatin group(2.89?0.45), aHIF-1? group(2.98?0.51)and contrl group(1.56?0.41). Conclusion: Our results suggest a synergestic effect between Angiostain gene and aHIF-1? gene in inhibiting implanted human ovarian tumors in nude mice, which may contribute to drug resistance in antiangiogenic therapy of tumors.

Objective To report deep venous thrombosis (DVT) after greater saphenous vein ligation and stripping and to evaluate diagnosis,treatment and prophylaxis. Methods The clinical characteristics, diagnosis and treatment of 12 inpatients with postoperative DVT were analyzed retrospectively. Results Of these 12 cases there were 7 cases of central type DVT,2 cases of peripheral DVT,and 3 cases of mixed type DVT.Secondary pulmonary embolism was complicated in 2 cases.Clinical symptoms in these 10 cases of proximal DVT were all severe.Catheter-directed thrombolysis(CDT) through the ipsilateral popliteal vein with protective(IV)CF was applied for these 10 cases.Of 10 cases,femoral vein was found ligated in 1 case,which was repaired under open surgery. Residual greater saphenous vein thrombus extending into deep vein was proved and managed by successful thrombolectomy in one case.Cockett syndrome were found as the causes in the other 8 cases,6 cases were treated with balloon dilatation angioplasty and endovascular stenting of the iliac vein.The 2 cases of with distal DVT were treated by anticoagulation therapy.All patients were cured. Conclusions Cockett syndrome,femoral vein injury and too long residual greater saphenous vein are common causes of DVT after greater saphenous vein ligation and tripping.Careful selection of cases,correct diagnosis,standard operative manipulation,early ambulation were all important in the prevention of DVT after great saphenous vein varix procedure.

Objective To study the treatment of multilevel atherosclerotic occlusive disease of the lower(extremity).Methods From March 2004 to January 2006,intraoperative iliac balloon angioplasty and stenting combined with simultaneous vascular bypass and profundoplasty were performed on 24 limbs in 21 patients(suffering) from lower extremity multilevel atherosclerotic occlusive disease.In 24 limbs iliac balloon angioplasty and stent placement were performed with simultaneous profundoplasty in 12 limbs and femoro-popliteal bypass in 14 limbs.Results Surgical procedures were technically successful in all patients.There were no severe postoperative morbidity or mortality.Before-operative vs postoperative ABI was 0.24?0.13 vs 0.63?(0.18)(P

Objective To evaluate bone marrow mesenchymal stem cells combined with VEGF gene in the treatment of limb ischemia in rabbits.Methods The right hind limb ischemia model of New Zealand rabbit was established by superficial femoral artery excision and deep femoral artery ligation.Rabbits then were divided randomly into 4 groups: empty plasmid control group(EP group),bone marrow mesenchymal stem cells group(BMSC group),VEGF gene therapy group(VEGF group),combination bone mesenchymal stem cells and VEGF gene therapy group(BV group).There were 8 rabbits in each group.Angiogenesis was detected by arteriography on day 28 after treatment and expression of VEGF was detected by immunohistochemical staining on day 30 after treatment.Results There were no differences of collateral vessel count between the EP group,BMSC group and VEGF group.The collateral vessel count in BV group was higher than that of the other three groups.Immunohistochemistry of VEGF showed that the integrated optical density(IOD)in BMSC and VEGF groups increased significantly compared with the EP group; the IOD in BV group was the highest compared with the other three groups.Conclusions Combination bone marrow mesenchymal stem cells and VEGF gene in the treatment of limb ischemia in rabbits can obtain stable and effective expression of VEGF along with significant improvement of limb ischemia.

OBJECTIVE: We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. MATERIALS AND METHODS: The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and post-treatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. RESULTS: A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in five iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During follow-up (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. CONCLUSION: Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity deep venous thrombosis.
Adult ; Aged ; Angioplasty, Balloon ; *Catheterization, Peripheral ; Combined Modality Therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; *Infusion Pumps ; Infusions, Intravenous ; Leg/*blood supply ; Male ; Middle Aged ; Phlebography ; *Thrombolytic Therapy/methods ; Ultrasonography, Doppler ; Urokinase-Type Plasminogen Activator/*administration & dosage ; Vascular Patency ; Venous Thrombosis/*drug therapy/radiography/ultrasonography

Objective To evaluate the diagnosis and treatment of 37 cases of popliteal vascular entrapment syndrome (PVES).Methods The clinical data of 37 PVESA cases (44 limbs) from July 2004 to July 2016 was retrospectively analyzed.There were 28 men and 9 women,age ranging from 7 to 74 years.They all underwent B-us,CTA,MRA or DSA examination before the operation.Surgical procedures performed on 38 limbs included musculo-tendinous division,popliteal-popliteal interposition,femoralpopliteal bypass.Result One patient died of PE one day after operation.The ankle brachial index (ABI)increased from 0.54 ±0.31 to 0.87 ±0.23 after operation (P ＜0.01).30 cases were followed-up with a mean followup time of 43.8 months and intermittent claudication were relieved in all cases.Conclusions PVES is an extremely important cause of non-arteriosclerotic lower extremity arterial chronic ischemia which need early,active and appropriate surgical intervention.

Objective To explore the preliminary results of application of reserving the left subclavian artery by fenestration of domestic stent graft in the thoracic endovascular aortic repair (TEVAR) of type B dissection with unfavourable proximal landing zone.Methods From October 2015 to January 2018,a total of 13 patients with type B aortic dissection without healthy proximal landing zones underwent TEVAR using fenestration of domestic stent graft in our hospital.Computed tomography angiography (CTA) data were measured before surgery.Digital subtraction angiography (DSA) was conducted after surgery.All patients underwent CTA or ultrasound examination during follow-up.Operation success rate,survive rate,patency of left subclavian artery and complications were analyzed.Results All the patients were deployed fenestrated endografts successfully.No proximal endoleak happened during perioperative period.Delirium occurred in 1 case during 7 postoperative days and fully recovered with the medical treatment.The mean follow-up period was (9.8 ± 9.5) months (range,1-29 months).11 patients underwent CTA and 2 patients underwent ultrasound examination during follow-up.During period of following up,no patients died,no proximal endoleak appeared,and all the left subclavian arteries reserving by fenestration.Conclusions Reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with hostile proximal sealing zone is economical,safe and feasible,which expand the indication of TEVAR for aortic dissection,and the long-term outcomes of this technique need to be assessed in the future.

Objective    To evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing. Methods    The clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment. Results    All the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion    3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.