Pancreaticoduodenectomy (PD) is the procedure for treating adenocarcinoma in periampullary region.This involves resection of multiple organs and complex reconstructions.The modern surgery has witnessed the dramatic improvement in outcomes after PD.Mortality has dropped to less than 4％,however,the complication rate remains high,making this procedure still a big challenge for most surgeons. PD is so complicated that even small mistakes could jeopardize the whole procedure and outcomes.With experiences of over 1000 PDs,we discuss the challenges of this procedure and strategies to deal with them.

Objective Endovascular stenting or combined stenting and Guglielmi detachable coils packing for the treatment of intracranial fusiform and wide necked aneurysms were reported to access the feasibility of the procedures.Methods The coronary stents were implanted across the neck of 3 vertebral fusiform aneurysms and 6 wide necked aneurysms. Microcatheters were introduced into the aneurysm sacs through stent mesh, and finally GDCs were used to embolize the aneurysms. Results The stents were precisely deployed resulting in total occlusion of 7 cases with more than 90% occlusion in 2 cases. All patients recovered well with patency of the parent arteries.Conclusions Endovascular therapy with combined stent implantation and microcoil placement maybe a valid alteration for the treatment of intracranial fusiform or wide necked aneurysms.

Objective To analyze the causes, prevention and treatment of repture druing procedure for intracranial aneurysm embolization with GDC.Methods All the seven patients were embolized. Six patients were ruptured during the procedure and continuously embolized until the bleeding was halted. Another one was identified by post procedure CT. Results Four patients recovered unevent fully with one only suffering from mild deficit. Another 2 patients died of hyper intracranial pressure within one week. Conclusions Rupture during procedure of intracranial aneurysm embolization with GDC may be related to manipulation, properties of the parent artery and arneurysm. Continuous embolization with GDC will provide favorable prognosis for the patients.

Objective To evaluate the endovascular embolization treatment of large and giant ophthalmic aneurysms. Methods Three aneurysms were embolized with coils only and 5 aneurysms were treated with stent placement togather with subsequent coiling. Results In the 3 aneurysms treated only with GDC, total embolization was achieved in 1 and partial embolization in 2. In the stent placement and coiling case, 4 aneurysms were densely packed and another one was partially packed. Conclusions Combined stenting and coiling is effective and safe for the treatment of large and giant ophthalmic artery aneurysm with the preservation of parent artery.

Objective To evaluate three dimensional digital subtraction angiography (3D DSA) in endovascular treatment of carotid stenosis. Methods In 138 patient with ischemic stroke, the shape and stenosis of carotid artery, the feasibility of endovascular treatment and the choice of the stent were analyzed by 2D DSA and 3D DSA. Results Comparing with 2D DSA,3D DSA could clearly depict the carotid artery in shape and stenosis with correct figuring of the feasibility for endovascular treatment and choice of the stent. Conclusions 3D DSA shows the major importance in endovascular treatment of carotid stenosis providing more valuable informations than 2D DSA.

Objective To evaluate the safety and short term outcome of stent assisted angioplasty for extracranial carotid stenosis. Methods From October 2000 to September 2002, 93 cases of extracranial carotid stenosis, including 86 cases of carotid bifurcation stenoses, 4 of extracranial internal carotid stenoses, 2 of common carotid stenoses and 1 of functional external carotid stenosis, were treated by self expandable stent placement and angioplasty. Results Stent placement and angioplasty were successfully administered in all the 93 patients. The average stenosis rate was reduced from (79.5?14.6)% before treatment to (11.2?7.8)% after stent assisted angioplasty. There were only 1 case of TIA (1.1%) and 1 case of minor stroke (1.1%) during the operation, without mortality or major stroke. No cerebral ischemic attach occurred in the 91 patients during clinical follow up for a period of 3 25 months with an average of 7.9 months. Twenty nine patients were angiographically followed up 6 months after treatment with only one asymptomatic restenosis (3.4%). Conclusions Endovascular stent assisted angioplasty for extracranial stenosis is safe and effective with considerable good short term outcome.

90%) and 1 incompletely (

Objective To summarize experiences in diagnosis and interventional management for intracranial vertebral arterial dissection. Methods Clinical symptoms and imaging results were analysed in 23 cases of intracranial vertebral dissection, and corresponding interventional managements were reviewed. Results Clinical symptoms consisted of spontaneous SAH and vertebrobasilar insufficiency. DSA usually showed "pearl and string" sign. Interventional management included stent assisted coiling of the dissection, embolization of the affected artery with GDC and to learn the details of the stenotic ICA and draw up and appropriate operation plan.Conclusions Direct energetic intervention should be undertaken promptly for intracranial dissection.

Objective To report experience of endovascular stenting combined with coiling for intracranial wide necked aneurysms and to investigate its indication, technical tip, prevention and treatment of complication, safety and efficacy. Methods The coronary stents were implanted across the neck of intracranial wide necked aneurysms in 105 patients (78 located in anterior circulation and 27 in posterior circulation). Microcatheters were introduced into the aneurysm sac through stent mesh. GDCs were used to embolize the aneurysms . Results The stents were deployed in 104 patients and total occlusion was obtained in 80 cases and more than 90% in 24 cases. The patients recovered well with patency of the parent arteries except one with cerebral infarction and another with carotid dissection during the procedure. The stent collapsed in one case after coiling.No re bleeding or symptom related to thrombosis occurred during clinical follow up for 3 28 months. Follow up angiogram in 62 cases showed no recanalization in all patients, but two with further thrombosis and one with mild stenosis in proximal segment of the stent. Conclusions Endovascular therapy combined stent implantation and microcoil placement would be a valid alteration for the treatment of complicated intracranial aneurysms. However, long term outcome need further study.

90%) and partial in 46 (