Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted.Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fistula occlusion were carried out from Aug.2007 to Mar.2011,comparing the success rate and long-term patency rate.Results Two hundred and fourteen cases of initial autologous arteriovenous fistula,in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox,46 cases were cephalic vein-radial artery end-toside anastomosis at proximal wrist,the success cases were 203 (94.8％),the failed cases were 11 (5.2％),limb edema in 82 cases and there was no steal syndrome and heart failure.The primary patency rate was 95.2％ at 1 year and 91.3％ at 2 years.There were 22 patients accepted treatment of arteriovenous fistula occlusion,in which,8 cases were embolectomy due to acute occlusion,8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed,5 cases were proximal anastomosis again after chronic occlusion.Conclusions Autologous arteriovenous fistula of the distal upper limb,especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula.And deal with arteriovenous fistula occlusion actively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.

Objective To evaluate thoracic endovascular aortic repair for type B aortic dissection.Methods Chnical data were reviewed on 126 cases with type B aortic dissection undergoing endovascular aortic repair in our hospital from January 2006 to April 2011.There were 86 male patients and 40 female patients,age from 32 to 82 years.The stent- grafts were introduced via femoral arteriotomy.Stent-grafts were implanted to blockade tears of aortic dissection under the guidance of DSA.Postoperatively patients were followed-up by angiography and imiging for endoleak,stent migration,and fracture of stent-graft.Results In all cases,the aortic dissection tears were closed,true lumens were opened,and organ function was restored.There were not complications such as internal hemorrhage due to trauma or stent displacement on CTA from 3 to 63 months after endovascular therapy.Procedure was successful in all 126 cases,157 stents were released,2 cases died in the perioperative period,1 case died during the followed-up.A breach was found at the end of the stent in 12 cases,endovascular aortic repair redone successfully with a retrograde type A dissection found during follow-up.Conclusions Endovascular aortic repair is safe and effective for patients with Stanford type B aortic dissection with a favorable outcomes.

Objective To explore the misunderstanding and comprehension of hybrid operation for treating aortic dissection involving aortic arch.Methods From March 2009 to November 2013,13 patients received hybrid operation for aortic dissection involving aortic arch in the People's Hospital of Xinjiang Urgur Autonomous Region were enrolled,including male 11 and female 2,and aged 36 ～ 60 years old with a mean age (44 ± 6.8) years old.All patients were type-B aortic dissection.All of them were not suitable to be treated with endovascular exclusion monotherapy.The ascending aorta-brachiocephalic artery bypass and left carotid artery bypass was established with median sternotomy approach and neck incision in 13 patients,and 2 patients did left subclavian artery bypass additionally,then retrograde endovascular stent graft implantation was used.Computed tomography angiography (CTA) scanning at 3-month,9-month,1-year and every-year after operation showed no stent grafts translocation and bypass graft obstruction.Results The surgical operation and stent grafts implantation were completely successful.Angiography showed 1 case had end leakage and other cases no obvious displacement or end leakage of stent grafts in operation.Blood flow in true lumen of aortic dissection was recovered and all of bypass grafts were unobstructed.No death and severe complications occurred.All patients were followed-up with 3 to 56 months [(29.0 ± 10.2) months],and all patients resumed normal life.Enhanced CT scanning after operation showed 1 case had endoleak and other cases no endoleak,stent grafts translocation and bypass graft obstmction.No signs of brain and limb ischemia were observed.Conclusions To summarize misunderstanding and experience by continuous explore feature of hybrid operation for treating disease involving aortic arch,we developed a more reasonable surgical treatment options that can improve the success rate of complex aortic dissection surgery,and ultimately achieve better surgical results.

Objective To observe the function improvement of deep venous valve after superficial vein surgery of lower extremity by ultrasound.Methods Sixty patients(70 lower limbs)with primary deep venous insufficiency were enrolled tO accept surgical management of vein systems.All Datients were detected with color Doppler ultrasonography,their deep venous hemodynamics indices were measured and recorded before operation and 6 months after operation. Results The total improvement rate of the deep venous hemodynamics after superficial vein surgery was 65.7%.The valve function of suPerficial femoral vein and popliteal vein were improved after operation,and there was no significant difference between the two veins in effectiveness.The improvement for deep venous reflux had no significant difference between two surgical methods. Conclusions The superficial vein surgery of lower extremity can improve deep vein valve function in some extent.

Objective To discuss the necessity and rationality of regional pancreatoduodenectomy combined vas-cular reconstruction in the treatment of chronic pancreatitis with lump in the head. Methods Thirteen patients who suffered from pancreas with lump in the head, were operated in our department from January 2000 to March 2006. The clinical data were analyzed retrospectively,there were 10 men and 3 women with an age ranging from 37 to 71 (mean = 51 ), all the patients underwent pancreatoduodenectomy combined PV and SMV reconstruction. Results All thirteen patients were pathologically confirmed chronic pancreatitis without postoperative deaths, in which stom-ach empty disorder and pancreatic fistula occurred and were cured conservatively in one case. All the 13 patients who were followed up 19～86 months had no pain and jaundice at all after the operation. Conclusion Combined vascular reconstruction to treat the lump in the head of the pancreas that packages blood vessel and hard to separa-tion is proved to be a safe and reliable method, being capable of raising lump resection rate, which can improve quality of life of patients remarkably to avoid omit minimum cancer in lump to result in lose the curative opportunity.

Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage.Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006.All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography.Results Thirty-nine patients’ deep venous valve function kept well up to now,and there was no significant difference between the two results.Four patients without proximal saphenous vein ligation recurred,and there was reflux in deep venous.Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively.Proximal great saphenous vein ligation is important for successful operation.

Objective To explore the treatment principle of distal crevasses in aortic dissection.Methods According to the different treatment principles of distal crevasses in aortic dissection to divide the patients into two groups:following the treatment principle group:take the principle of from near to far,endovascular repair of distal crevasses,if not deal with the crevasses involving visceral arteries,do not handle the distal crevasses; unfollowing the treatment principle group:do not deal with the crevasses involving visceral arteries,endovascular repair of it's distal crevasses).Analyze the postoperative discomfort (chest and back pain,lower back pain) incidence,postoperative distal crevasses happening again and false lumen changes respectively.Results Fifty-three patients were included in the standard,in which follow the treatment principle group has 37 cases,and do not follow the treatment principle group has 16 patients.There were no significance statistically in complained of postoperative discomfort and postoperative distal crevasses happening again(P ＞ 0.05).And there was statistically significant in the false lumen (P ＜ 0.05).Conclusions The prognosis of patients in the following the principle treatment is better than that of unfollowing the principle group.To treat the distal crevasses in aortic dissection should be took the principle of from near to far,if not deal with the crevasses involving visceral arteries,don't handle the distal crevasses also.

Objective To explore the distribution characteristics and clinical typing methods in distal crevasses of Stanford B aortic dissection.Methods Review of the cases in the People's Hospital of Xinjiang Urgur Autonomous Region from 2010 January to 2013 June were diagnosis of Stanford type B aortic dissection with computed tomographic angiography data,Observed its distal crevasses distribution and statistical its number,then summarizes the distribution characteristics of the distal crevasses and further put forward a method of clinical typing.Results Refer to 115 cases with Stanford type B aortic dissection computed tomographic angiography data,including 101 cases with distal crevasses (87.83％) and a total of 240 distal crevasses,an average of 2.37 per case.Conclusions The distal crevasses more often appear in the area involving visceral artery,combined with its different in distribution characteristics and processing methods,we put forward the classification method,namely:Type Ⅰ:the distal crevasses are located in the zone of the thoracic artery; Type Ⅱ:the distal crevasses are close to the visceral artery or involvement it; Type Ⅲ:the distal crevasses are lower than the renal artery,not involving the visceral artery; Type Ⅳ:the distal crevasses are located in the zone of the iliac artery.

Objective To evaluate the impact of splenic vein-left adrenal vein shunting on prehepatic portal hypertension caused by cavernous transformation of portal vein in young patients.Methods From June 2004 to February 2012,9 patients with prehepatic portal hypertension due to cavernous transformation of portal vein received splenic vein-left adrenal venous shunting.The clinical data were reviewed.Results The procedure was uneventful in all the patients.There was no mortality,recurrent hemorrhage or hepatic encephalopathy on follow-up.The patients were discharged home on the 7th postoperative day.Conclusions In young patients with prehepatic portal hypertension secondary to cavernous transformation of portal vein,the left adrenal vein was often found to be large.Spleno-adrenal shunting,utilizing the left adrenal vein as a conduit,represents an excellent option in selected cases.

Aorta ; abnormalities ; Child ; Heart Defects, Congenital ; diagnosis ; Heart Ventricles ; abnormalities ; Humans ; Male