Objective To summarize the diagnosis and treatment of 33 cases of Leriche syndrome. Methods A retrospective review of the clinical data of 33 cases of Leriche syndrome was done. Results Claudication and impotence occurred in 79.9% and 70.4% of the cases. Color Doppler ultrasonography, especially combining with CTA or MRA, was helpful for the diagnosis. Aortic angiography or DSA was necessary for the determination of the clinical patterns and selecting the therapeutic methods. Surgical patterns selestion should be considering the patients' general status and conditions of the affected vessels. Surgical treatment was performed on 25 cases, including12 aortoiliac artery bypasses , 6 aortobifemoral artery bypasses , 4 axillo bifemoral artery bypasses, 2 embolectomies by Fogarty tube only and 1 aortal interposition with artificial vessel plus renal artery plasty. Aorta iliac artery bypasses get the best results with 1 year patency rate(100%) in all cases, and 5 year patency rate of 75.0%, which was significantly superior to those axillo bifemoral artery bypass grafts with 5 year patency rate of 37.5%. All the other 8 patients without operation died within 5 months. Conclusions Early diagnosis and comprehensive therapy should be adopted to improve the long term patency rates of grafts transplantation in Leriche syndrome.

Objective To summarize our experience of the diagnosis and treatment in patients with abdominal aortic aneurysm(AAA).[WT5”HZ]Methods [WT5”BZ]From 1980 to 1999 sixty five AAA patients were hospitalized with 40 cases of general type, 18 cases of rupture type,4 cases of inflammatory type and 3 cases of infective type. In situ artificial graft transplantation was performed in 62 cases and nonanatomy pathway in 2 cases. The remaining one with inflammatory type was treated by interventionel therapy.[WT5”HZ]Results [WT5”BZ]57 cases were cured and were followed up from 1 to 12 years without complications.Death occurred in 7 cases.[WT5”HZ]Conclusions [WT5”BZ]The abdominal pulsate mass should draw much attention. Ultrasound is the selected examination and DSA, helix CT are accurate image appliance. It can elevate the curative ratio and decrease the mortality through rational operation based on the location, type and individual condition of AAA patients.

ObjectiveTo investigate the management of myonephropathic-metabolic syndrome (MNMS) after acute arterial occlusion. Methods17 cases of MNMS caused by acute arterial occlusion were restrospectively reviewed. Results5 cases were cured, 6 cases died of sudden cardiac arrest induced by hyperkalemia, and another 6 cases died of multiple organ dysfunction syndrome (MODS) complicated by acute renal failure. The total mortality rate was 71% and the amputation rate was 41%.ConclusionEarly revascularization should be performed in acute arterial occlusion. In patients with compartment syndrome, fasciotomy should be performed as soon as possible. Early amputation of gangrene limb is very important to prevent MNMS. Early and effective fluid resuscitation and alkalinization is the key point to prevent ARF, early hemodialysis for ARF is very important in treating MNMS.

Objective To study the cell apoptosis and the dynamic expression and significance of apoptosis-related genes in graft veins. Methods A rat experimental model of autogenous graft vein was established by transplanting the right external jugular vein to infrarenal abdominal aorta in 100 Wistar rats. TUNEL and immunohistochemistry were used to detect the apoptosis, the expression of apoptosis related genes bcl 2 and bax in vascular smooth muscle cells (VSMCs) of graft veins. Results Within the 8 weeks after transplantation, the apoptotic VSMCs in the graft veins were much more than those in the control group with the apoptotic rate reaching the peak〔(28.5?16.6)%〕 on the 2nd week and dropping to (8.1?2.8)% during the 4th to 8th week. There was statistical difference compared to the control group 〔(0.5?0.2)%, P

Objective To investigate the expression of extracellular signal regulated kinase (ERK) and p38 mitogen activated protein kinase (p38 MAPK) in autogenous vein grafts during vascular remodeling.Methods An autogenous vein graft model was established by transplanting the right jugular vein to infrarenal abdominal aorta in 80 Wistar rats. Vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after surgery. Gene expression of ERK and p38 MAPK was measured by reverse transcription PCR. Western blot was used to detect the expression of protein products and phosphorylation protein products of ERK and p38 MAPK. Apoptosis of vascular smooth muscle cells (VSMCs) was determined by TUNEL. Proliferating cell nuclear antigen(PCNA) of VSMCs also was studied.Results The expression of ERK 1 mRNA and p38 MAPK mRNA increased considerably after surgery. ERK 1 mRNA reached the peak on the 7th day 〔(33.2?14.2)%, P

Objetive: To investigate the operative method of the true aneurysm in the initial part of splenic artery, and to summary clinic therapeutic experiences. Methods: To summary the 7 patients who suffered from the initial splenic true aneurysm from 1996 to 2006, and which cases were identified by color ultrasound, CT scan and angiography. All splenic aneurysm were cut off including splenic artery revascularlization on 5 patients. Results: All patients were cured and discharged from hospital in the 10th-14th day, and which patients were followed-up for 1-9 years. 5 cases were healthy except one died of acute myocardiac infarction 2 years later post operation. Conclusion: To cut off the initial splenic true aneurysm and to revasculize splenic artery is a better operative method to cure this disease.

Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.

Objective To evaluate risk factors of the prognosis in acute arterial embolism of the upper extremities. Methods The clinical data of 62 consecutive patients admired in our hospital with the diagnosis of acute arterial embolism in the upper extremities, from July 1988 to January 2008, were retrospectively reviewed. The risk factors including age, gender, cardiac function, location of embolism, embolectomy and duration of iaehemia were analyzed by cumulative Loots regression. Results There were 62 patients, 33 men and 29 worsen, with a mean age of 63. 5 years (35～86 years). Among them, 37 patients received Fogarty embolectomy and 25 patients received medical treatment including thrombolysis, anticoagulation and antiplatelet therapy because of poor risk for surgery. The iachemic status meliorated in 55 patients (88.7%) with 2 patients receiving amputation and 2 patients dying during the peri-operative period. The result of cursulative Logits regression shewed that the duration of ischemia, cardiac function and embolectomy played the significant role on the prognosis (P < 0.01 ), but age, sex and the location of embolism did not show the significant role. In those only receiving the medical treatment, 23 patients restored blood flow to different degree. Conclusions Embolectomy with Fogarty catheter within 8 hours of onset was the most effective treatment for acute arterial embolism in the upper extremities. For peor-risk patients, early medical treatment including thrombolysis, antieoagulation and antiplatelet treatment, can also restore the blood flow in the isehemie limbs.

Objective To assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes of patients with abdominal aortic aneurysm. Methods The apoptotic pathway was triggered by anti-Fas monoclonal antibody in cultured and activated peripheral T-cells from 20 AAA patients. Control groups consisted of 15 patients with aortic atherosclerotic occlusive disease(AOD)and 25 healthy individuals. Cell survival and death rate were assessed. Results Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, while the effect on T cells was very limited from that of AAA patients. The evaluation of cell Survival rate showed a significantly higher percentage in AAA group(98.9%±10.3%)than in the AOD subjects(58.9%±15.2%)or the healthy group(59.4%±12.9%;P＜0.001＝.Apoptosis assessment by annexin V and propidium iodide staining and flow cytometry showed similar results. The defect in AAA group was not due to decreased fas expressed at normal levels. Moreover,it specifically involved the Fas system because cell death was induced in the normal way by methylprednisolone. Conclusions Fas-induced apoptosis in activated T cell from AAA patients is impaired. This may disturb the normal down-regulation of the immune response and thus provide a new insight into possible mechanisms and routes in the pathogenesis of AAA.

Objective To evaluate surgical therapies in patients with popliteal aneurysms (PA).Method The clinical data of 25 PA patients admitted from January 1988 to January 2012 were retrospectively analyzed.There were 21 men and 4 women,the mean age was (56 ± 16)years.There were 27 PA in these 25 patients,with bilateral PA in 2 cases.The main symptoms were pulsatile mass in the popliteal fossa,limb pain,acute or chronic distal limb ischemia and limb edema.Result In this series 23out of 25 PA cases recieved operations,17 of them were treated with aneurysmectomy and saphenous vein interposition or bypass grafting,4 of them were treated with aneurysmectomy and prosthetic grafts interposition,1 was treated with aneurism ligation and 1 underwent end-to-end anastomosis after aneurysm resection.There was no perioperative mortality.One patient recieved amputation for distal anastomotic thrombosis and severe limb ischemia.The mean follow-up time is (6.5 ± 0.5) years.After 4 years,a right subclavian artery aneurysm was found in a bilateral PA case and treated surgically.Conclusions Early elective surgical treatment is recommended for patients with PA because PA may go rupture or induce dital limb ischemia and these patients may have good outcome after surgical treatment.Long-term follow-up is warranted to detect the new aneurysm formation.