Actins ; metabolism ; Female ; Heart Atria ; pathology ; Heart Neoplasms ; secondary ; surgery ; Humans ; Iliac Vein ; pathology ; surgery ; Leiomyomatosis ; metabolism ; pathology ; surgery ; Middle Aged ; Uterine Neoplasms ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; metabolism ; pathology ; surgery ; Veins ; pathology ; surgery ; Vena Cava, Inferior ; pathology

OBJECTIVE: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. METHODS: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. RESULTS: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, <0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×10 U vs. (26.5±7.5)×10 U, <0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (<0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all >0.05). CONCLUSIONS Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.
Catheterization, Peripheral ; Fibrinolytic Agents ; therapeutic use ; Humans ; Iliac Vein ; pathology ; surgery ; Retrospective Studies ; Thrombectomy ; Thrombolytic Therapy ; Treatment Outcome ; Venous Thrombosis ; surgery ; therapy

OBJECTIVETo investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.

METHODSTwenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.

RESULTSThe surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.

CONCLUSIONSThe use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; pathology ; surgery ; Humans ; Iliac Artery ; pathology ; surgery ; Male ; Middle Aged ; Neovascularization, Physiologic ; Saphenous Vein ; surgery ; Substance Abuse, Intravenous ; complications ; Vascular Surgical Procedures ; methods ; Young Adult

OBJECTIVESTo confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment.

METHODSIFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS).

RESULTSThe positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05).

CONCLUSIONSThe present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

Adult ; Aged ; Animals ; Disease Models, Animal ; Female ; Femoral Vein ; Humans ; Iliac Vein ; Male ; Middle Aged ; Postthrombotic Syndrome ; metabolism ; pathology ; surgery ; Rats ; Rats, Sprague-Dawley ; Retrospective Studies ; Tissue Plasminogen Activator ; metabolism ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; metabolism

BACKGROUND AND OBJECTIVEPelvic lymph node metastasis is an important prognostic factor of cervical cancer. The prognosis of cervical cancer patients with common iliac lymph node metastasis is poor, but few systematic studies have been reported . This study was to investigate the characteristics, risk, treatment and prognosis of stage IB-IIB cervical carcinoma patients with common iliac lymph node metastasis.

METHODSA total of 960 patients with cervical cancer receiving radical hysterectomy and bilateral pelvic lymphadenectomy were selected from the hospitalized patients in the Cancer Center of Sun Yat-sen University between January 1995 and December 2005, and analyzed retrospectively.

RESULTSOf the 960 patients, 288 (30.0%) had pelvic lymph node metastasis, and 45 (4.7%) had positive common iliac lymph node. The 5-year overall survival rate (OS) of patients with common iliac lymph node metastasis was 46.1%, and 67.5% in patients with other pelvic lymph node metastasis (P < 0.05). Univariate analysis showed that clinical stage, serum level of squamous cell carcinoma antigen (SCC-Ag) > 4 microg/L before treatment, depth of cervical invasion > or =2/3 and positive parametrial margin were associated with common iliac lymph node metastasis (P < 0.05). Patients with > or =3 pelvic lymph node metastasis (excluding common iliac lymph node) or recurrence had poor prognosis (P < 0.05). Factors predictive of common iliac lymph node metastasis on Logistic forward regression were SCC-Ag > 4 microg/L (P = 0.026, OR = 2.303) before treatment and positive parametrial margin (P = 0.045, OR = 2.634).

CONCLUSIONSCervical cancer patients with common iliac lymph node metastasis had poorer prognosis compared with patients with other pelvic lymph node metastasis. SCC-Ag >4 microg/L before treatment and positive parametrial margin were the independent predictive factors for common iliac lymph node metastasis of cervical carcinoma. Pelvic lymph node metastasis (excluding common iliac lymph node) > or = 3 or recurrence was prognostic factors for patients with common iliac lymph node metastasis.

Adenocarcinoma ; blood ; pathology ; surgery ; Adult ; Antigens, Neoplasm ; blood ; Carcinoma, Squamous Cell ; blood ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Iliac Artery ; Iliac Vein ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pelvis ; Retrospective Studies ; Risk Factors ; Serpins ; blood ; Survival Rate ; Uterine Cervical Neoplasms ; blood ; pathology ; surgery

OBJECTIVETo explore the surgical treatment of Cockett's syndrome in patients with deep vein thrombosis of lower extremity (DVT).

METHODSNinety-five patients were diagnosed as Cockett's syndrome among 160 patients with DVT who received surgeries in our hospital from February 1991 to September 2005. Among these 95 patients, pathological changes included left common iliac vein (LCIV) occlusion (n = 20), > 50% stenosis of the LCIV (n = 53), < 50% stenosis (n = 22). All patients received thrombectomy. In patients with LCIV occlusion, resection and reconstruction were performed in 10 patients, iliocaval bypass for 3 patients, and Palma procedures for 3 patients. In patients with > 50% stenosis of LCIV, 5 patients received stent placement, 8 patients received percutaneous transluminal angioplasty (PTA) by dilation balloon catheter, 4 patients received iliac angioplasty, and the other 36 patients received PTA by F8-10 Fogarty thrombectomy catheter. Territorial anticoagulant and lytic therapy were performed through the catheter inserted into the great saphenous vein intraoperatively for 3 days and then venography was performed for all the patients postoperatively. Warfarin was administered for more than 6 months.

RESULTSEighty-two patients (86.3%) were cured. One patient died of myocardial infarction, and the others were improved.

CONCLUSIONSManagement of Cockett's syndrome is essential to increase the cure rate of DVT. Resection and reconstruction is useful for occlusive LCIV, while PTA or stent placement if preferred for severely stenotic vessels.

Adult ; Aged ; Constriction, Pathologic ; complications ; surgery ; Female ; Humans ; Iliac Vein ; pathology ; surgery ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Retrospective Studies ; Thrombectomy ; Treatment Outcome ; Venous Thrombosis ; complications ; surgery ; Young Adult

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

OBJECTIVE: To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). MATERIALS AND METHODS: Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. RESULTS: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. CONCLUSION: From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective.
Adolescent ; Adult ; Aged ; *Angioplasty, Balloon ; *Balloon Dilatation ; Constriction, Pathologic/therapy ; Diagnostic Imaging ; Female ; Humans ; Iliac Vein/*pathology/surgery ; Male ; Middle Aged ; Peripheral Vascular Diseases/complications/diagnosis/*therapy ; Retrospective Studies ; *Stents ; Thrombectomy ; Vascular Patency ; Vena Cava Filters ; Venous Thrombosis/complications/diagnosis/*therapy