Objective To evaluate the surgical and interventional therapy in patients with acute superior mesenteric vein thrombosis.Methods In this series,31 acute superior mesenteric vein thrombosis(SMVT) cases were reviewed from Oct 2006 to Feb 2012.According to varied clinical presence,patients received superior mesenteric vein thrombectomy with necrotic bowel resection or indirected catheter thrombolysis through superior mesenteric artery.Results 6 of 9 cases undergoing surgery were cured and other 3 still complained abdominal distension when discharged for not being able to bear anticoagulation and thrombolysis after operation due to alimentary tract hemorrhage,and residual thrombus was shown in superior veins by venography.17 of 22 treated by interventional therapy gained obvious relief within 72 hours after intervention,others gained symptomatic relief in 5-7 days.Indirected catheter thrombolysis were interrupted in 2 due to alimentary tract hemorrhage.One patient was shifted to surgery 48 hours after catheter thrombolysis due to deterioration.Mean duration of follow-up after hospital discharge was (19 ± 5) months in 25 cases,20 had no abdominal distension and pain,3 with postcibal abdominal distension.Conclusions Indirected thrombolytic therapy by way of the superior mesenteric artery is a technically simple,safe and effective therapy for patients with acute SMVT.

ObjectiveTo explore the causes of recurrence of Budd Chiari syndrome after radical resection and the key points of second surgery. Methods Venography was performed in 11 relapsing cases. The diseased IVC segment was resected and replaced with artificial vascular graft in 4 cases, membranectomy and thrombectomy were performed in 2 cases. Thrombectomy with artificial vascular patch cavoplasty in 4 cases, incision of the stenotic IVC and right hepatic venoplasty and IVC venoplasty with artificial vascular patch repairing was performed in 1 case. Result The mortality rate was zero. Acute heart failure occurred in 2 cases and thoracic hemorrhea in 2 cases. Symptoms disappeared or improved in all cases. Patients were followed up from 6 to 68 months, with excellent results in 9 cases and fair in 2 cases. Conclusion There were some factors influcing the long term results of the surgery including distal free length from diseased IVC, thrombus clearance, material and size of the patch used for venoplasty.

Objective To evaluate the efficacy of endovascular interventional treatment for infrapopliteal arterial ischemic diseases. Methods Sixty patients(65 limbs)of infrapopliteal arterial isehernia of the lower extremities received pereutancotm transluminal angioplasty(PTA)and/or stents implantation from November 2004 to July 2007.The symptoms,changes of ankle/brachial index(ABI),limb salvage rate and immediate patent rate were observed. Results PTA/stenting procedure was successful in 51 out of 60 patients(65 limbs)with the technical success rate of 83.3%.Symptoms were improved in 53 cases(88.3%)including complete symptom remission in 40 cases(66.7%),partial remission in 13 patients(21.7%).The procedure failed in 7 cases(11.6%).In successful cases,AB1 increased from preoperative 0.40±0.18 to postoperative 0.91±0.22(P＜0.01).The amputation below knee was performed in two cases and toe apodizers in four cases.The limb salvage rate was 91% during the same hospitalization.Discharged 54 cases were followed up with 14.5±1.2 months,during this period amputation above knee was performed in 2 cases,amputation below knee in 2 cases,and toe apodizers in 2 cases,with a limb salvage rate of 88.9%(48/54).Symptoms were recurrent in five cases,with recurrence rate of 9.2%.Vascular reocclusion or restenosis were found in 10 cases.the patent rate was 81.5% and the cumulative patent rate was 57.3% in one year. Conclusions Endovascular interventional treatment for infrapopliteal arterial ischemic disease is safe and effective.

Objective To evaluate a combination of interventional treatment and surgical exploration for acute lower limb ischemic disease.Methods We reviewed 42 cases admitted from July 2007 to January 2010,all patients complained pain,paralysis,pulselessness,pallor and paresthesia.After Fogarty thrombectomy angiography was taken in DSA room.Patients with angiostenosis greater than 50％ were then managed by interventional treatment(CDT,PTA,Stenting).Results Lives were saved in all patients,40 lower limbs were saved,and 2 patients received below knee amputation.The amputation rate was 4.76％.Dorsal or(and)posterior tibial artery of foot was felt in 33 patients,symptoms significantly improved.The other 7 patients still had painful and paralysis on the diseased limb.Conclusions The interventional treatment and surgical operation in acute lower limb ischemic disease is safe and result is satisfactory,which can improve the long-term patency and salvage rate of the lower limb.

Objective To evaluate the prevention and management for the complications in interventional therapy for the lower extremity arteriosclerosis obliterans (ASO). Methods In this study 207 ASO cases received interventional therapy. The relationship between complication rates and different TASC type and the influence of diabetes mellitus (DM) with coronary heart disease (CHD) on critical organs complication rates was analyzed. Results The intervention succeeded in 190 cases. There was 17 failures, including 13 procedure failures and 4 deaths due to postoperative critical organ complications. Among the complications there were puncture site hemorrhage in 12, pseudoaneurysm in 4, alimentary tract hemorrhage in 2, arteriorrhexis in 6, cerebral infarction in 8, acute heart failure in 9, respiratory failure in 13, renal failure in 6, thrombosis in 5 and blue-toe syndrome in 1. The intraoperative complication rate of femoral-political type (39.84%, 51/128) was high than that of aorta-iliac type (18.99%, 15/79) (P< 0.05). Those critical organ complication rates of patients with DM and patients with DM&CHD were 27.66% (13/47)and 24.49% (12/49)respectively, they were higher than that of patients without (5%, 2/40) (P<0.05). Conclusions The high complication rates during interventional therapy of ASO were because of misoperation and complicated pathological type and together with DM and CHD. These rates could be decreased when we treated DM and CHD before operation and chosen a reasonable method and shorten the duration of operation.

Objective To evaluate the methods and efficacy of interventional treatment for subclavian arterial stenosis or occlusion retrospectively. Methods From Oct 2003 to Sop 2009,25 patients with subclavian arterial lesions , including stenosis in 13 cases and occlusion in 12 cases, underwent interventional treatment. Four patients received percutaneous transluminal angioplasty (PTA) alone, and concurrent 22 stents placement were performed in 20 cases. Results The technical success rate in stenotic lesions was 100% and in occluded lesions was 91.6% with a interventional failure in 1 case. Blood pressure increased significantly after interventional treatment. The diseased side/healthy side blood pressure index increased from 0.60 ±0.11 mm Hg preoperatively to (0.95 ±0.12) mm Hg postoperatively( t = 10.53 ,P ＜0.01 ). Clinical symptoms improved, and there were no complications with strokes and embolism. 20 cases were followed up for 30 months ( from 2 months to 69 months ). Restenosis was found in 2 cases and the restenosis rate was 8.3%. The cumulative primary patency rate was 92.5% and 81.3% at 1 and 3 years,respectively. Conclusions Intervention was a less invasive and safe, effective treatment for subclavian arterial lesions.

Objective To discuss the methods and the efficacy of interventional treatment of vascular injuries. Methods From January 2006 to March 2008, interventional therapy was performed in 13 cases of vascular injuries including injuries of internal jugular vein, subclavical artery, axillary artery,inferior vena cave, abdominal aorta, superior mesenteric artery, arteria iliaca, vena iliaca and femoral artery.Types of these injuries included arteriovenous fistula in 3, vascular rupture complicating haematoma in 4,pseudoaneurysm in 3 and arterial stenosis ensuing from injury repair in 3. Covered stent-grafts were used in 9 cases (10 stent-graft), mesh stem in 1, sealed with balloon in 2 and introcoil embolism in 1.Result Interventional procedure was successful in all these 13 cases, there was no mortality nor severe complications. Small amount of endoleak developed in thoracic aorta pseudoaneurysm and contrast leaked from internal jugular vein in left subclavical arteriovenous fistula after stent-graft insertion, these were healedconservatively. Twelve cases were followed up from 1 to 26 months. Hemoptysis occurred in patient with thoracic aorta pseudoaneurysm 12 months after intervention but without abnormality in CTA. There were no stem break, shift, deformation or stennsis and there were no recurrence of primary disease.Conclusion Interventional therapy is of less invasion, short performation duration, simple manipulation and quick postoperative recovery for vascular injuries.

Objective To evaluate the safety and efficacy of SilverHawk directional atherectomy device in the treatment of arterial stenoses/occlusions of the femoropopliteal regions.Methods From April 2011 to May 2012,36 patients (28 men,8 women,age range 60 - 84y) with 40 arteriosclerotic lesions of femoro-popliteal arteries (de novo lesions in 25 arteries,in-stent restenosis in 15 arteries; Rutherford score of 3 - 5 ) were included in the treatment by SilverHawk directional atherectomy device.All the patients were diagnosed via low-extremity artery CTA and arteriography.The mean ankle brachial index (ABI) of treated limbs was 0.53 ±0.12.Results The overall technical success rate was 100％ (40/40).The procedural success rate was 87.5％ (35/40).There was no perioperative mortality with three cases developing complications,vascular injury occurred in two cases.One was treated by stent-graft while the other was managed conservatively; Procedure-related arterial embolization occurred in one case and was treated by suction through catheter.Symptoms were relieved in all patients,ABI increased to 0.72 ± 0.18.All the patients were followed up for an average of (6.4 ± 1.2) months.Postoperative restenosis developed in one case and treated with balloon angioplasty and stent placement after six month.Conclusions SilverHawk directional atherectomy device is effective and safe in treament of arterial stenoses/occlusions of the femoropopliteal lesions,with satisfactory early results.

Objective To summarize the experience on treatment for 15 cases of acute pulmonary embolism(PE).Methods Fifteen acute PE patients admitted from June 2009 to May 2011 were analyzed retrospectively.All patients were diagnosed as PE and deep vein thrombosis,and treated with placement of inferior vena caval filters(IVC).Five patients with main pulmonary artery embolism accepted intrapulmonary arterial interventional therapy of thrombus fragmenlation and suction and catheter-directed thrombolysis (CDT).Ten patients with embolization on pulmonary artery branch and acute iliofemoral vein thrombus accepted therapy of peripheral thrombolysis.During postoperative course improvement was observed on the clinical symptoms,occurrence of complications,Miller index,change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen(PO2),as well as the patency of pulmonary artery.Result Five main pulmonary artery embolization patients gained complete patency of pulmonsnary artery,and the clinical symptoms immediately improved.Miller index reduced from (0.51 ± 0.04) to (0.27 ± 0.38),mPAP decreased from (55.3 ± 3.1 ) mm Hg to ( 32.7 ± 2.2 ) mm Hg,and PO2 elevated from ( 40 ±3 ) mm Hg to ( 63 ± 4) mm Hg,showing a significant difference ( P ＜ 0.01 ).Ten patients with pulmonary artery branch embolization gained patency of pulmonary artery branch,iliofemoral venous thrombosis cleared,and clinical symptoms significantly improved.All patients recovered after two weeks of intravenous thrombolytic,anticoagulation and antiplatelet therapy.During three to twelve months' follow up,the therapeutic effects persisted and there was no recurrence.Conclusions Emergency intrapulmonary arterial interventional therapy of acute PE has remarkable effectiveness,safety and feasibility,improving pulmonary obstruction and clinical symptoms.

Objective To explore MSCT optimal examination time window for patients with occult rib fracture, and provide objective evidence for forensic injury. Methods Totally 105 cases with chest trauma were retrospectively analysed. They were examined in the first week after trauma and re-examined in different time windows by MSCT. The quantities of occult rib fractures in the first examination were compared to those in re-examinations. Results The quantities of occult rib fractures at different inspection time windows were mostly different. There was no statistically significant between the quantities of rib fractures in the first week and the second week, the first week and the sixth week later, the fourth week and the fifth to sixth weeks (P>0.05). There was statistically significant between the quantities of rib fractures in the first week and the thrid to sixth weeks, the second week and the third to sixth weeks, the third week and the fourth to sixth weeks (P<0.05). Conclusion The result of the study imply that the fourth to sixth week is the optimal time window of MSCT examination in the occult rib fracture.