0.05). ConclusionsWhen varicose veins of the lower extremity with deep vein insufficiency exists, patients should undergo high ligation and stripping of the great saphenous vein, additional correction of the deep vein reflux provides no further effect.

Objective To investigate the value of the pre-occusion and stump pressure(SP)of the internal carotid artery in carotid endarterectomy(CEA).Methods During Januray 2007 to January 2009,12 patients with carotid arterial stenosis underwent CEA in our deparment.With cervical plexus block,we performed pre-occlusion test and measured the stump pressure(SP)by using vascular shunt selectively.The patients were monitored with clear consciousness during the whole procedure of CEA.The data of postoperative complications and results of pre-occlusion and SP as well as the follow-up were analyzed afterwards.Results During the operaion,three patients had transient increase of heart rate and blood pressure.The lowest SP was detected in two patients,who had moderate or severe stenosis of the contralateral carotid artery complicated with lesions in the vertebral basilar artery.Two patients showed positive results in pre-occusion test,and vascular shunt was used in four cases.After the operaion,one patients developed hyperperfusion syndrome.Nine patients showed improvement of symptoms of dizziness and decreased eyesight.This series were followed up for a mean of 11 months(ranged from 1 to 26 months).During the period,two of the patients showed re-stenosis of the carotid artery;none of them had cerebral infarction.Conclusions Cervical plexus block combined with pre-occusion test ensures the safty and effectiveness of minimally invasive carotid endarterectomy.We recommend selective vascular shunt according to the results of pre-occlusion test,SP,and the severity of the lesions in the contralateral carotid artery and vertebral basilar artery.

Objective To assess long-term outcomes of electrocoagulation for treating varicose veins of the lower extremities. Methods A retrospective review was made on clinical data of 426 cases of varicose veins of the lower extremities treatd by electrocoagulation from October 1996 to October 2001.Postoperative follow-ups were carried out with clinic checkups or questionnaires.Results Of the 426 cases,follow-ups for 4~9 years(mean,5.8 years) were completed in 364 cases(500 limbs) and a loss to follow-up was encountered in 62 cases,the follow-up rate being 85.4%.The cumulative rate of recurrent varicose veins was 10.4%(52/500),in which the recurrent varicose veins were cured with sclerosing agents in 50 limbs and with re-operations in 2 limbs.The relief rate of sensation of heaviness and tension was 95.1%(309/325).Accompanying venous ulcers in 20 limbs healed up within 2~8 weeks.The incidences of subcutaneous hematoma and saphenous nerve injury were 0.8%(5/594) and 1.2%((7/594),) respectively.Skin burns happened in 5 limbs(0.8%,5/594). Conclusions Electrocoagulation for varicose veins of the lower extremities is proved to be a novel minimally invasive method,with advantages of safety,effectiveness,low costs,and short hospital stay.

Objective To summarize the experience of fluoroscopy-guided chemical thoracic sympathectomy(CTS) for the treatment of Raynaud's phenomenon.Methods A series of 73 cases of Raynaud's phenomenon(141 upper limbs) treated with CTS from March 2001 to September 2005 in this hospital was chronologically divided into two groups: the Group A between March 2001 and December 2002 and the Group B between January 2003 and September 2005.In the Group A,under the guidance of X-ray fluoroscopy,a needle was punctured through the back skin to the second or the third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected.In the Group B,when the needlepoint reached the rear edge of target thoracic vertebra,2~3 ml of anesthetic was injected.Then the needle was advanced sequentially untill the needlepoint reached the sympathetic ganglion.Other manipulation was the same with the Group A. Results The incidence of pneumothorax in the Group A(28.4%,19/67) exceeded greatly that in the Group B(4.1%,3/74)(?~2=15.773,P=0.000).The effective rate in the Group A(77.6%,52/67) was much lower than that in the Group B(97.3%,72/74)(?~2=12.851,P=0.000).Between the two groups,differences of the incidence of axilla pain(Group A,2 limbs;Group B,5 limbs)(?~2=0.411,P=0.521),bradycardia(Group A,1 case;Group B,nil)(?~2=0.002,P=0.967),and Horner's syndrome(Group A,1 case;Group B,1 case)(?~2=0.000,P=1.000) were not statistically significant.Conclusions Pneumothorax is a common complication of chemical thoracic sympathectomy.Improvement of procedure can reduce the incidence of pneumothorax and increase the effective rate.

Objective To compare electrocoagulation effects of three types of electrodes for varicose veins.Methods Twelve dogs(24 veins in hind limbs)were randomly divided into 3 groups with 4 dogs in each group:columnar electrode group,circular electrode group,and radial electrode group.Each dog's long saphenous veins were high ligated and electrocoagulated.The activated partial thromboplastin time(APTT)was measured and pathological examinations(HE and Weigert)were performed immediately following operation and on the 7th and the 14th postoperative day,respectively.The destruction depth and extent,residual vessels,and skin burn after electrocoagulation were compared among the three groups.Results One case of skin burn on the left hind limb occurred in the columnar electrode group.Immediately following the operation,the number of vessels that were destroyed beyond 50% of perimeter in the radial electrode group was 8,which was significantly higher than that in the columnar electrode group(3 vessels)and the circular electrode group(4 vessels)(Fisher's exact test,P=0.013 and 0.038),and the number of vessels that were destroyed deep to the meddle membrane in the radial electrode group was 1,which was significantly lower than that in the columnar electrode group(7 vessels)and the circular electrode group(6 vessels)(Fisher's exact test,P=0.005 and 0.020).On the 7th day after operation,there was no statistical difference among the 3 groups in the number of vessels with remnant area above 50% of the perimeter(?2=5.371,P=0.068).On the 14th day after operation,the number of vessels with remnant area above 50% of the perimeter in the radial electrode group(1 vessel)was significantly lower than that in the columnar electrode group(7 vessels)and the circular electrode group(6 vessels)(Fisher's exact test,P=0.005 and 0.020).There was no statistical difference among 3 groups in APTT immediately following operation and on the 7th and the 14th postoperative day(P=0.905,0.871,and 0.865).Conclusions Compared with the other two catheters,radial electrode has the largest destroyed area,the smallest remnant area of the vessel,and the lowest risk of skin burn.

Objective To summarize the clinical application of the Tempofilter Ⅱ temporary caval filter.Methods The Tempofilter Ⅱ temporary caval filter was employed in 24 patients from April 2002 to August 2006.Before the implantation,we performed color ultrasonography to detect the extent of thrombus and the situation of inferior vena cava,renal vein,and access vein(right internal jugular vein).Under the guidance of color ultrasonography and X-ray fluoroscopy(free of contrast agent),the temporary filter was placed in the inferior vena cava distal of the renal vein orifice through a guide wire by using the Seldinger technique.Results The filter was successfully implanted and removed in all the 24 patients.The duration of placement was 5 days～6 weeks(mean,16.8 days).Filter thrombosis occurred in 4 patients at 3 days ～ 2 weeks after operation.The thrombi(

Objective　This study was To investigate the incidence rate of Cockett syndrome and relationship between Cockett syndrome and varicose veins and deep venous incompetence of the left lower extremities.Methods　73 patients(100 legs) with varicose veins of the lower extremities were investigated by descending deep venography and iliography preoperatively.Results　There were 35(47.9%) cases with abnormalities of the left common iliac vein (ALCIV)in all the cases.There were 31 cases with this conditions in the patients with varicose veins of the left or both lower extremity.While in the patients with varicose veins of the only right lower extremity,there were only 4 cases with ALCIV.In contrast,there was a significant difference between groups(χ2=9.8641,P=0.0017).In the patients with ALCIV,14 cases with Ⅲ or Ⅳ grade of deep venous incomptence were found, and only 6 cases with deep venous incompetence in the patients without ALCIV.There was a significant difference(χ2=5.3688,P=0.0205).Conclusion　Cockett's syndrome frequently occurs in varicose veins of the left lower extremity.There is a relationship between them.Cockett's syndrome might be one of the causes for the deep venous incompetence of the left leg.

Objective To study the long-term result of thrombectomy and thrombolysis for acute mixed deep vein thrombosis(DVT)of the lower extremity. Methods Clinical data of 142 patients treated for acute mixed DVT from September,1991 to June,2005 were reviewed.There were 77 patients treated by thrombectomy.Among these 77 patients there were 49 patients whose common iliac vein was occluded or stenosis.All the 77 patients received territorial transfusion with urokinase and hepafin after operation.The other 65 cases were treated by systemic thrombolysis with urokinase and heparin. Results Two weeks after thrombectomy or thrombolysis,the circumference difference between bilateral limbs was occlusive from (4.3±2.2)cm to(0.6±0.5)cm in thrombectomy group,and from(3.9±2.5)cm to(1.6±0.9)cmin thrombolysis group(t=-8.346,P=0.000).Patients were followed up for an average of(49±42)months.The circumference difference between bilateral limbs was reduced to(0.5±0.4)cm in thrombectomy group and(1.4±1.3)cm in thrombolysis group respectively(t=-5.764,P=0.000).The sequela morbidity in thrombectomy group was less than that in thrombolysis group(P＜0.05).The morbidity of edema,pigmentation,and ulcer was 29.9%,15.6%,0%in thrombectomy group and 50.8%,84.6%,6.2%in thrombolysis group.In thrombectomy group,89.6%veins regained patency and 72.7%valves had normal function compared with that in thrombolysis group 30.8%and 9.2%(Z=-8.502.P=0.000).The cure rate was 70.1%in thrombectomy group and 30.8%in thrombolysis group (Z=-4.740.P=0.000).Mortality rate was 3.9%in thrombectomy group,while there was no inhospital death in thrombolysis group. Conclusions For the treatment of acute mixed DVT.especially in protecting the normal valve function,thrombectomy was significantly superior to that of thrombolysis except for causing some mortality.

Objective To evaluate the complicatio ns after thrombectomy for deep vein thrombosis (DVT) of the lower extremity. Methods Thrombectomy was under taken for 143 patients using Fogarty catheter, then local thrombolysis and antic oagulation was undertaken by a indwelling catheter in the great saphenous vein. Results The total recurren ce rate of DVT was 12.6%(18/143), whereas the early recurrence rate without loc al thrombolysis and anticoagulation was 29.8%(14/47). The recurrence rate was 1 8.9%(14/74) against the background of Cockett syndrome, and 5.8%(4/69) withou t Cockett syndrome. Other complications included lymphatic fistula in 4 cases (2 .8%), pulmonary embolism, vena cava thrombosis, massive haemorrhage, and incisi onal infection in one each, death ensued in 3 (2.1%). ConclusionsThe recurrence rate of DVT could be low ered by management of the stenosis or occlusion of common iliac vein and local thrombolysis and anticoagulation. Thrombectomy should be the first choice of the rapy for DVT.

0.05). Neuralgia of the lower limb was complicated in 3 (8%)cases. 31 cases were followed up from 3 months to 9 years. 24 out of the 26 patients experincing immediate post-CLS relief remained asymptomatic, and 2 suffered symptom deterioration necessitating major amputation. ConclusionsCLS is a simple procedure with less complication offering an alternative for the treatment of lower limb ischemia.