[Summary] The isolated dissection of the superior mesenteric artery ( IDSMA) was once considered to be a rare disease .In recent years , a growing number of cases of IDSMA have been reported , especially by Chinese authors , because of the increasing use of contrast-enhanced computed tomography scans .To understand the real domestic status of IDSMA , the Chinese-language literatures were searched, and the clinical characteristics and treatment of IDSMA were analyzed .

Objective To analyze the clinical characteristics of deep venous thrombosis (DVT) of lower extremity in the elderly.Methods One hundred and eighty elderly inpatients with DVT and one hundred and forty-four non-elderly DVT inpatients were recruited in the study.The prevalence situation, risk factors, complications and curative effect were analyzed.Rcsulls The prevalence of DVT in patients aged 60-69 years was the highest(50.5%), followed by the patients aged 70-79 years(40.5 %), The five major risk factors were post-operation (27.8 %), malignant tumor (15.0 %), traumatic fracture ( 7.8 %), sequelae of cerebrovascular disease (7.2 %) and long-term bedridden(5.0%).49.4% of the elderly had Cockett's syndrome, including 14.0% of them with common iliac vein (CIV) occlusion(n=6), 48.8% of them with >50% stenosis of the CIV (n= 21) and 37.2% of them with <50% stenosis (n= 16).In acute stage of DVT, the curative effect of thrombectomy was superior to that of thrombolysis, while there were no statistically significant differences in curative effect between the two methods in non-acute phase.The curative effect between elderly group and non-elderly group did not show significant difference.Conclusions The elderly are easy to suffer from DVT, and malignant tumor and sequelae of cerebrovascular disease are the risk factors for DVT in the elderly.The curative effect of thrombectomy is better than that of thrombolysis in elderly patients with acute DVT.

Objective To investigate the therapeatic effects of chemical thoracic sympathectomy (CTS) for Raynaud disease. Methods A niddle was injected into the first or second thoraic vertebra from back. A X-ray examination was performed to definite the position of the niddle tip. One millilitre of urographine was injected to determine if it was infused into thoracic cavity. If not, 2 ml of 5% phenol was injected and the niddle was removed. Results Within 10 minutes both pairs of the hands of the two patients with Raynaud's disease turned into flushing and warm from pallor and cool after CTS. Ice-water test changed to negative. Conclusions CTS is of simple, microinvasive and low cost procedure for Raynaud's disease.

0.05). Neuralgia of the lower limb was complicated in 3 (8%)cases. 31 cases were followed up from 3 months to 9 years. 24 out of the 26 patients experincing immediate post-CLS relief remained asymptomatic, and 2 suffered symptom deterioration necessitating major amputation. ConclusionsCLS is a simple procedure with less complication offering an alternative for the treatment of lower limb ischemia.

Objective This study was to investigate the incidence of Cockett syndrome in patients with varicose veins of the lower extremity and the relationship between Cockett syndrome and varicose veins and deep venous insufficiency of the left lower extremity. MethodsDuring 1999～2001,a total of 148 patients with varicose veins of the lower extremity were investigated by descending deep phlebography and iliography preoperatively. Results (1) There were 40(65.6%), 37(68.5%), 13(39.4%) cases respectively with abnormalities of the left common iliac vein(ALCIV) in patients with varicose veins of the bilateral, left and right leg, respectively. (2) There were 72 cases with left great saphenous vein reflux(LGSVR). Fifty cases(55.6%) with LGSVR were found in patients with ALCIV and 22 cases(37.9%) in patients without ALCIV(P

Objective To study the causes, prevention and treatment of secondary thrombosis after vena cava filter placement. Methods We summarized the clinical experience regarding 7 cases of secondary thrombosis of the inferior vena cava from December 2001 to June 2004 in this hospital. Results Two patients underwent thrombectomy, 1 patient received interventional thrombolytic therapy, and the rest of 4 patients received conservative treatment. All the treatment had obtained good results. No pulmonary embolism took place in the study. Conclusions Thrombosis secondary to filtration can be completely prevented by adhering strictly to the indications of filter placement and conducting supplementary anticoagulation therapy. Interventional therapy is the first choice for the treatment of secondary thrombosis after filter placement.

Objective To summarize the experience of fluoroscopy-guided chemical thoracic sympathectomy(CTS) for the treatment of Raynaud's phenomenon.Methods A series of 73 cases of Raynaud's phenomenon(141 upper limbs) treated with CTS from March 2001 to September 2005 in this hospital was chronologically divided into two groups: the Group A between March 2001 and December 2002 and the Group B between January 2003 and September 2005.In the Group A,under the guidance of X-ray fluoroscopy,a needle was punctured through the back skin to the second or the third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected.In the Group B,when the needlepoint reached the rear edge of target thoracic vertebra,2~3 ml of anesthetic was injected.Then the needle was advanced sequentially untill the needlepoint reached the sympathetic ganglion.Other manipulation was the same with the Group A. Results The incidence of pneumothorax in the Group A(28.4%,19/67) exceeded greatly that in the Group B(4.1%,3/74)(?~2=15.773,P=0.000).The effective rate in the Group A(77.6%,52/67) was much lower than that in the Group B(97.3%,72/74)(?~2=12.851,P=0.000).Between the two groups,differences of the incidence of axilla pain(Group A,2 limbs;Group B,5 limbs)(?~2=0.411,P=0.521),bradycardia(Group A,1 case;Group B,nil)(?~2=0.002,P=0.967),and Horner's syndrome(Group A,1 case;Group B,1 case)(?~2=0.000,P=1.000) were not statistically significant.Conclusions Pneumothorax is a common complication of chemical thoracic sympathectomy.Improvement of procedure can reduce the incidence of pneumothorax and increase the effective rate.

Objective To observe pathological changes of varicose veins after electrocoagulation and endovenous laser treatment(EVLT) and to compare the efficacy between electrocoagulation and EVLT for the treatment of varicose veins of the lower extremity.Methods Twenty patients with varicose veins of the lower extremity were treated with either electrocoagulation(n=10) or EVLT(n=10).Histopathological changes of varicose veins were observed.Eight dogs were randomly divided into 2 groups and treated with electrocoagulation or EVLT.The treated veins were taken out at 0,7,and 14 days after operation,for histopathological examinations.Results After electrocoagulation or EVLT,the endothelial cells of varicose veins were absent,the structure of smooth muscle cells was indistinct,broken collagenous fibers and elastic fibers were observed,and thrombosis leading to occlusion was observed in the lumen.Incomplete thrombus organization and conglutination with the walls were observed 7 days after operation.Mild recanalization was found in both groups.On the 14th postoperative day,the hyperplasia of smooth muscle cells,collagenous fibers,and elastic fibers was detected.Complete thrombus organization was seen,and recanalization presented no obvious changes.ConclusionsBoth electrocoagulation and EVLT can lead to the occlusion of varicose veins,being effective therapeutic alternatives for varicose veins of the lower extremity.

Objective To evaluate the complicatio ns after thrombectomy for deep vein thrombosis (DVT) of the lower extremity. Methods Thrombectomy was under taken for 143 patients using Fogarty catheter, then local thrombolysis and antic oagulation was undertaken by a indwelling catheter in the great saphenous vein. Results The total recurren ce rate of DVT was 12.6%(18/143), whereas the early recurrence rate without loc al thrombolysis and anticoagulation was 29.8%(14/47). The recurrence rate was 1 8.9%(14/74) against the background of Cockett syndrome, and 5.8%(4/69) withou t Cockett syndrome. Other complications included lymphatic fistula in 4 cases (2 .8%), pulmonary embolism, vena cava thrombosis, massive haemorrhage, and incisi onal infection in one each, death ensued in 3 (2.1%). ConclusionsThe recurrence rate of DVT could be low ered by management of the stenosis or occlusion of common iliac vein and local thrombolysis and anticoagulation. Thrombectomy should be the first choice of the rapy for DVT.

Objective To study the long-term result of thrombectomy and thrombolysis for acute mixed deep vein thrombosis(DVT)of the lower extremity. Methods Clinical data of 142 patients treated for acute mixed DVT from September,1991 to June,2005 were reviewed.There were 77 patients treated by thrombectomy.Among these 77 patients there were 49 patients whose common iliac vein was occluded or stenosis.All the 77 patients received territorial transfusion with urokinase and hepafin after operation.The other 65 cases were treated by systemic thrombolysis with urokinase and heparin. Results Two weeks after thrombectomy or thrombolysis,the circumference difference between bilateral limbs was occlusive from (4.3±2.2)cm to(0.6±0.5)cm in thrombectomy group,and from(3.9±2.5)cm to(1.6±0.9)cmin thrombolysis group(t=-8.346,P=0.000).Patients were followed up for an average of(49±42)months.The circumference difference between bilateral limbs was reduced to(0.5±0.4)cm in thrombectomy group and(1.4±1.3)cm in thrombolysis group respectively(t=-5.764,P=0.000).The sequela morbidity in thrombectomy group was less than that in thrombolysis group(P＜0.05).The morbidity of edema,pigmentation,and ulcer was 29.9%,15.6%,0%in thrombectomy group and 50.8%,84.6%,6.2%in thrombolysis group.In thrombectomy group,89.6%veins regained patency and 72.7%valves had normal function compared with that in thrombolysis group 30.8%and 9.2%(Z=-8.502.P=0.000).The cure rate was 70.1%in thrombectomy group and 30.8%in thrombolysis group (Z=-4.740.P=0.000).Mortality rate was 3.9%in thrombectomy group,while there was no inhospital death in thrombolysis group. Conclusions For the treatment of acute mixed DVT.especially in protecting the normal valve function,thrombectomy was significantly superior to that of thrombolysis except for causing some mortality.