The actual incidence of gastrointestinal stromal tumor (GIST) is underestimated.With the progression of awareness and development of examination methods,the detection rate of small GIST (diameter ＜ 5 cm) is increasing year by year.These patients always had no obvious clinical symptoms,and were often detected with small GIST in physical examination unexpectedly.Combination of endoscopic ultrasound and radiographic examination is helpful in detecting small GIST.Aggressive surgical complete resection should be considered in case of a definitive diagnosis.Laparoscopic resection is becoming the standard surgical treatment currently.For micro GIST (diameter ＜2 cm),especially micro gastric stromal tumor,current guidelines recommend close observation.Some scholars advocate that endoscopic resection is feasible for the treatment of micro GIST,while we think that the efficacy of individualized treatment is better after identifying the potential malignancy of micro GIST.

Objective To explore the clinical effect of renal artery embolization for renal graft dysfunction.Methods A total of 17 patients with renal graft dysfunction were treated by embolizing the renal graft artery.Coil embolization was performed on 7 of the cases,and gelfoam combined with coil was used in the other 10.Results Among the 17 patients,14 discontinued immunosuppressant in 3 weeks after the embolization,and 2 discontinued after receiving low-dose cortisones for about 6 months,and showed good recovery during follow-up.The other patient underwent resection of the renal graft because of continuous fever and graft pain.After the embolization,14 cases developed 'post-embolization syndrome'.Coil migration occurred in 1 case during the procedure.One patient experienced angina during the operation,and developed myocardial infraction the day after the embolization.Conclusions Renal artery embolization is safe and effective for patients with renal graft dysfunction.By using the method,open surgery can be avoided.Attention should be paid to potential complications.

Objective To evaluate selective retention of the great saphenous vein (GSV) belowknee in the prevention of saphenous nerve injury during varicose veins surgery.Methods From January 2009 to January 2012,280 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups.Patients in the experimental group underwent stripping restricted to the below knee level,patients in control group underwent GSV stripping to the ankle level Patients in the two groups were treated with transilluminated powered phlebectomy,and foam sclerotherapy.Primary end points were postoperative pain,saphenous nerve injury,quality of life and recurrence rate.Results After one month follow-up:5.71％ patients had symptoms of nervous system in the observation group,14.29％ patients had symptoms of nervous system in the control group (P =0.02).After 1 year follow-up,1.47％ patients had symptoms of nervous system in the observation group,7.14％ patients had symptoms of nervous system in the control group (P =0.02).Conclusions Selective retention of great saphenous vein below-knee decreases saphenous nerve injury.

Objective To analyze complications of carotid artery stenting (CAS) and preventions.Methods Clinical data and treatment outcomes of 72 consecutive patients ( 80 stents ) from July 2006 to January 2012 with carotid stenosis were analyzed.Asprin 100 mg and clopedigrel 75 mg were given orally 5 days before CAS.Distal embolic protection device were implanted in all patients,pre-dilatation was done for those with carotid stenosis ＞ 90％ and post-dilatation was done for those of residual stenesis ＞ 30％.Severe complications of CAS mean death,myocardial infarction (MI) and stroke.Other minom included transient ischemic attack ( TIA ),hyperperfusion and intracranial hemorrhage ( ICH ),bradycardia and/or hypotension,hypertension,access hematoma or bleeding.Results In 72 patients a total of 80 self-expandable bare stents were successfully implanted.Distal embolic protection devices were used in all cases.Combined procedure was taken in 5 cases including OPCABG in 2 cases,left subclavain artery stenting in 2 cases and renal artery stenting in 1 case.The overall in-hospital complications was 37.5％ (27 of 72).Of these events,1 case had minor strokes defined as a modified Rankin Scale score less than 3 at 1-year follow-up,2 patients (2.78％ ) experienced a hemispheric TIA (neurological symptoms that resolved within 24 hours),1 patient experienced hyperperfusion syndrome.The overall mortality rate was 0,21 cases (29.2％ ) experienced hemodynamic instability (hypotension in 15 cases,bradycardia in 5 cases and hypertension in 1 case) and 2 others had access hematoms.The 30-day death/stroke/myocardial infarction risk was 1.39％ (1 minor stroke).Conclusions Hemedynamic instability (hypotension and bredycardia) is main complications of carotid artery stenting in patients with carotid artery stenosis,severe complications are rare.

Objective To compare the outcome and early patency rate of revascularization treatment for patients with iliac artery occlusion or stenosis.Methods Retrospective analysis was made on 105 cases of iliac artery occlusion or stenosis from January 2009 to April 2014.49 were with iliac artery occlusion and 56 with iliac artery stenosis.Results The demographics,and comorbidities were not statistically different between the 2 groups.The occlusion group had more critical limb ischemia and the ankle-brachial index was lower than the stenosis group.The occlusion group underwent more hybrid surgery and used more covered stents in the operation.The peri-operative complication was higher in the occlusion group,but the difference was not statistically different.The ABI improved significantly for all patients after surgery.The early patency rate was similar in the 2 groups.Conclusions Revascularization treatment for patients with iliac artery occlusion and stenosis was safe and effective,with similar early patency rate and peri-operative complications between the two groups.

Objective To explore the changes of cardiac structure and funetion in the patients with type 2 diabetes mellitus(T2DM).Methods Thirty T2DM patients were included in the study,color Doppler echocardiography was performed in all of the cases,to compare and analyze the results of cardiac structure and function.Results IVS,LVPW,LAD,LVM of T2DM group were significantly larger than those in healthy group(P＜0.05,P＜0.01).T2DM group of LVEF and E/A ratio were significantly lower than those of normal group(P＜0.05).BMI,FBG,TG were positive correlation with IVS,LVPW,LVM and negative correlation with LVEF,E/A.Conclusion The patients of T2DM can lead to change of cardiac structure and function which dependent with BMI and glucose degree.

Objective To summarize the etiologic factors and evaluate the clinical outcome of reoperations on 119 limbs of recurrent varicose veins.Methods Retrospective analysis was made on etiologic factors of 119 limbs (113 patients) of recurrent varicose veins admitted to our hospital from January 2007 to June 2013.All patients underwent color duplex ultrasonography and anterograde venography of the lower extremity and were treated by reoperations.Results In the 119 limbs,102 limbs (85.7％) had residual main great saphenous veins or tributaries,97 limbs (81.5％) had incompetent perforator veins,23 limbs (19.3％) had neovascularization,9 limbs (7.6％) had incompetent small saphenous veins,21 limbs (17.6％) had incompetent femoral veins,6 limbs (5.0％) had iliac vein compression syndrome,and Budd Chiari syndrome was found as the cause of recurrence in 1 limb (0.8％).Postoperative patients were followed-up for 6-72 m (32-± 7 m).The cure rate of varicose veins were 100％.There was not recurrence of varicose veins,postoperative VCSS was 0-5 (1.2 ±0.5) vs preoperative 1-17 (6.2 ±2.5)(P ＜ 0.01).Conclusions Residual and incompetent great saphenous veins or tributaries and incompetent perforator veins were the main etiologic factors of postoperative recurrent varicose veins.Therapeutic principle for recurrent varicose veins is to eliminating the reverse flow of superficial vein system and ligate incompetent perforator veins.

Objective To evaluate carotid endarterectomy (CEA) for bilateral moderate to severe carotid stenosis.Methods The clinical data of 59 patients with bilateral moderate to severe carotid stenosis who were treated with CEA in our hospital from October 2010 to August 2014 were retrospectively analyzed.There were 50 males and 9 females age ranging 42-80 years (mean:65 ± 9 years).48 patientsunderwent ipsilateral CEA and 11 underwent staged bilateral CEA.In patients who were confirmed to have coronary artery disease or peripheral vascular disease by preoperative angiography,6 received coronary artery bypass graft (CABG)simultaneously,1 received iliac artery balloon angioplasty and stent implantation simultaneously,and 1 received renal artery stenting simultaneously.Results A total of 70 endarterectomies were performed,shunt and patching were used in all patients,the surgical success rate was 100％.2 patients suffered from vagus nerve injury,4 patients suffered from hypoglossal nerve injury,and 3 patients presented with hyperperfusion syndrome.Follow-up period was 2-36 months (mean:19 ± 10 months).1 patient died of heart attack during the follow-up,the other patients were relatively stable with no restenosis.Conclusion CEA should be performed in patients with bilateral moderate to severe carotid stenosis,and the prognosis is good.

The clinical data of 21 patients with carotid body tumor (CBT) were analyzed retrospectively.The lesions were unilateral (n =20) and bilateral (n =1).Among 20 surgical cases, the procedures included tumor resection alone (n =11) , tumor resection along with external carotid artery (n =6) and vascular reconstruction of carotid artery after resection of tumor body (n =3).No mortality occurred during perioperative period.CBT was confirmed by pathologic examination in all cases and 1 case was malignant.Follow-up period ranged from 3 months to 7 years and the follow-up rate was 85％.Five cases of cranial nerve impairment recovered completely over 3 months.One case of bilateral CBT underwent contralateral tumor resection at another hospital 1 year later and 1 case with malignant tumor died from metastases 3 years later.The remainder survived recurrence-free.CBT tends to be misdiagnosed.Therefore ultrasonography, digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance angiography (MRA) are important for preoperative diagnosis and evaluation.Surgical resection is a first choice for CBT.

Objective To study the clinical outcome of endoscopic vessel harvesting system (EVH) for the treatment of lower limbs varicose veins.Methods Patients (n =41) with varicose veins admitted from Jan 2011 to May 2013 were randomly divided into EVH group (n =20) and stripping group (n =21).Indexes as postoperative VAPS (48 hours and 1 week),subcutaneous ecchymosis (1 week),hematoma(1 week),skin numbness (1 week),CEAP classification (3 months),surgery effect and satisfaction scores(3 months) were compared between the two groups.Results 48 hours and 1 week VAPS was lower in EVH group(P ＜0.01).After EVH there was less subcutaneous ecchymosis (1 week),hematoma(1 week) and skin numbness (1 week) (all P ＜ 0.01).Postoperative CEAP classification improved significantly in both groups (P ＜ 0.01),while surgery effect and satisfaction scores (3 months) were better in EVH group (P ＜ 0.05).Conclusions EVH is a safe and minimally invasive technique in treatment of varicose veins of the lower limbs.