OBJECTIVETo explore the management of cerebral ischemia caused by Takayasu's arteritis.

METHODSOne hundred and three cases treated from 1984 to 2003 were reviewed including 92 females. Seven cases underwent ascending aorta to bilateral internal carotid artery (ICA) bypass, 38 cases to the axillary artery with graft to single ICA bypass. Six cases underwent ascending aorta to axillary bypass with 3 graft to single ICA bypasses as the second stage surgery. Three cases underwent ascending aorta to right ICA bypass with 2 graft to left ICA bypasses as well as 6 subclavian to carotid bypass, PTA in 5 and stenting in 3 cases, etc.

RESULTSTwenty-seven patients with less clinical severity received conservative therapy, 9 of them had mostly temporarily improvement, 15 had slight improvement or basically no change, 1 had hemiplegia and 2 died of stroke and myocardial infarction respectively. Surgically, the short-term effective rate was 87% and operative death 7.8%. Fifty-five patients were followed up, a mean follow-up time was 48 months, and the follow-up rate was 80.9%. The excellently, good, fair, no change and death rate were 36.4%, 38.2%, 20.0%, 3.6% and 1.8% respectively. All patients with PTA or stent had an immediate good response and all recurred within 3 to 5 months.

CONCLUSIONSFor treating severe cerebral ischemia caused by Takayasu's arteritis, the ascending aorta to axillary and single ICA reconstruction or the ascending aorta-bilateral axillary bypass for patients with subclavian steal syndrome is advocated; second stage operation from graft to contralateral ICA can be carried out if necessary.

Adolescent ; Adult ; Angioplasty, Balloon ; Brain Ischemia ; etiology ; therapy ; Carotid Artery, Internal ; surgery ; Cerebral Revascularization ; methods ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Takayasu Arteritis ; complications ; Treatment Outcome ; Vascular Surgical Procedures

Endovascular technologies have intrinsic appeal to patients and physicians, they may, if proved safe and effective, replace a substantial proportion of current vascular surgical procedures. Because the developement and the use of these technologies require the skills and the talents of the vascular surgeons and interventional radiologists, a collaborative, multispecialty approach to the use of endovascular technologies is recommended as the most reasonable and optimal treatment for patient care. The purpose of this article is to review our experiences with cooperative endovascular treatments in vascular disease and to stress the key role of vascular surgeon on these technologies. From July, 1995 to March, 1998, 7 cooperative endovascular treatments were done in six patients. Male to female ratio was 4:2 and median age was 58.0 yrs (40~71 yrs). All procedures were done in angiography suite under the local anesthesia. Indications for treatments were 3 pseudoaneurysms in Behcet's disease, 2 abdominal aortic aneurysms (AAAs), 2 acute arterial occlusions with ASO. Six stent graftings were done for aneurysmal diseases. Recurred pseudoaneurysm was occurred in one patient with Behcet's disease, and stent graft was reinserted. Postoperative leak was seen in one patient with AAA, but sealed up spontaneously on following angiography. Simultaneous endovascular balloon angioplasty with open thrombectomy were done in 2 acute arterial occlusions with ASO. Vascular surgeons and interventional radiologists executed cooperative, team approaches in all procedures with success. Although this approach may not be applicable for every vascular disease, vascular surgeons must represent the leadership of the this cooperative treatment. For this, sufficient knowledge and training program with active participation in these technologies are necessary.
Anesthesia, Local ; Aneurysm ; Aneurysm, False ; Angiography ; Angioplasty, Balloon ; Aortic Aneurysm, Abdominal ; Aptitude ; Blood Vessel Prosthesis ; Education ; Female ; Humans ; Leadership ; Male ; Patient Care ; Thrombectomy ; Vascular Diseases ; Vascular Surgical Procedures

OBJECTIVE: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND METHODS: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. RESULTS: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. CONCLUSION: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.
Aged ; Aged, 80 and over ; Aneurysm/complications/*surgery ; Angioplasty, Balloon ; Arteriovenous Fistula/*surgery ; Arteriovenous Shunt, Surgical/adverse effects ; Constriction, Pathologic/complications ; Endovascular Procedures ; Equipment Failure ; Female ; Fibrinolytic Agents/therapeutic use ; Heparin/therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents/adverse effects ; Thrombectomy/instrumentation/*methods ; Thrombosis/etiology/*surgery ; Urokinase-Type Plasminogen Activator/therapeutic use ; Vascular Patency ; Veins

OBJECTIVE: To explore the application value of blunt separation method in the modified sytinger technology peripherally inserted central catheter (PICC) catheterization in the hemopathic patients. METHODS: One hundred and twenty cases of the hemopathic diseases used modified sytinger technology PICC catheterization were selected from January 2016 to July 2017 in our Hospital, and randomly divided into blunt and routine group, each with 60 patients. For the routine group, the routine longitudinal method was used to expand the skin, for the blunt group the blunt separation method was used to expand the skin. RESULTS: At the time point of 24 h after the blunt catheterization, the bleeding volume and exudation rate in the blunt group were significantly lower than those in the rouline group (P<0.05). At the 1, 3, 5 d after catheterization, pain visual analogue score (VAS) showed that the scores of blunt group were significantly lower than those of the routine group (P<0.05). in expanding skin, the successful rate of catheterization once in blunt group and routine group were not significantly different (P>0.05). CONCLUSIONS Compared with the longitudinal method, the blunt separation method has considerable skin expansion and sheath feeding effect on the modified sytinger technology PICC catheterization for the hemopathic patients. This method can effectively reduce the patient's catheter trauma and percolation, and is helpful to relieve the patients' pain symptoms, worthing for further clinical promotion.
Catheterization, Central Venous ; Catheterization, Peripheral ; Humans

Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

The addition of femoral-femoral cardiopulmonary bypass in the cardiac catheterization laboratory to support the high risk patient is a challenging new frontier for percutaneous transluminal coronary angioplasty. We report our first experience of successful supported angioplasty in patient presented with exertional angina and orthopnea who had multi-vessel coronary artery disease with depressed left ventricular ejection fraction. Although cardiopulmonary support provides excellent support for high-risk patient, CPS is a technically challenging and expensive procedure associated with significant patient morbidity or complication. Despite its drawbacks, CPS has been shown to help save the lives of selected patients undergoing high-risk procedures.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Coronary Artery Disease ; Humans ; Stroke Volume

Percutaneous transluminal coronary angioplasty (PTCA) is often used in the management of coronary artery disease and the advances in equipment, technichal skill and acquisition of operator experiences have improved initial success rates and reduced the frequency of complications. However, acute coronary occlusion is the most common and serious complication related to angioplasty and its several potential mechanisms are intracoronary thrombus, coronary artery spasm and coronary artery dissection. Accordingly,heparinization, intracoronary thrombolysis, re-PTCA, stent implantation and emergency coronary artery bypass grafting have been previously used for reopening of an occluded coronary artery during angioplasty. In this report we describe our experience in the management of acute coronary occlusion of left anterior descending artery caused by dislodgement of thrombotic material during PTCA by means of aspiration thromboembolectomy instead of medical therapy,re-PTCA and stent implantation.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Occlusion* ; Coronary Vessels ; Emergencies ; Spasm ; Stents ; Thrombosis

Catheterization, Central Venous ; Catheterization, Peripheral ; Humans ; Pleural Effusion

A 47-year-old woman with stage IV chronic kidney disease developed a fistula between common carotid artery (CCA) and internal jugular vein (IJV) during central catheterization of the right IJV. The patient was treated with a self-expandable graft stent, which achieved successful closure of the carotid-jugular fistula. As demonstrated in our case, self-expandable graft stents could be a feasible treatment option for CCA-IJV fistulas without additional interventional procedures such as balloon angioplasty.
Angioplasty, Balloon ; Carotid Artery, Common* ; Catheterization, Central Venous ; Female ; Fistula* ; Humans ; Jugular Veins* ; Middle Aged ; Renal Insufficiency, Chronic ; Stents* ; Transplants*

Percutaneous transluminal coronary angioplasty of chronic total coronary artery occlusions are at a high risk of failure and complication. We report a case of arteriovenous fistula with drainage into the coronary sinus during the percutaneous transluminal coronary angioplasty of the chronic total occlusion of circumflex coronary artery. We think that the arteriovenous fistula of this case was occurred by the guide wire- induced trauma. But after 20-30 minutes later, the injection of contrast no longer detectd arteriovenous fistula. Later we recommended coronary artery bypass graft surgery to the patient, but he refused. Thereafter he received conservative treatment and dyspnea, chest pain were improved.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteriovenous Fistula* ; Chest Pain ; Coronary Artery Bypass ; Coronary Sinus* ; Coronary Vessels* ; Drainage* ; Dyspnea ; Humans ; Transplants