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.

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.

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.

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 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

A total of 33 patients with isolated lilac artery aneurysms, 19 males and 14 females, who received treatment between January 1997 and June 2007, were retrospectively analyzed. Among these patients, 29 suffered from unilateral iliac artery aneurysm and 4 from bilateral iliac artery aneurysm. Under general anesthesia, all patients were subjected to aneurysmectomy, followed by vascular prosthesis implantation for vascular reconstruction. Results revealed that among 4 cases of bilateral iliac artery aneurysm, there was 1 case who was subjected to aorta-bilateral femoral artery vascular prosthesis implantation, and there were 3 cases who underwent aorta-bilateral lilac artery vascular prosthesis implantation; among 29 cases of unilateral lilac artery aneurysm, there was 1 case receiving aorta-common lilac artery vascular prosthesis implantation, 3 cases undergoing iliac-femoral artery vascular prosthesis implantation, 21 cases subjected to common-external iliac artery vascular prosthesis implantation, and 4 cases undertaking common -common lilac artery bypass. Color Doppler ultrasonic examination, spiral CT angiography, or digital subtraction arteriography was performed 3, 6 months, 1, 3, 5, 8, and 10 years after surgery. The mean follow-up time was 5 years. Three cases died of acute cerebral infarction, myocardial infarction, and traffic accident 3, 6, and 2 years after surgery, respectively. The remaining cases well survived as determined by no recurred Uiac artery aneurysm, anastomotic stoma stenosis or lower limb ischemia found. These results indicated that aneurysmectomy and subsequent vascular prosthesis implantation remained a good and primary means for treatment of isolated iliac artery aneurysm under the present medical condition.

OBJECTIVE: The intimal hyperplasia caused by mig ration and proliferation of the smooth muscle cells play a most important role in the stenosis of the vein grafts. This study is to explore how the C-myc onc ogene and its protein contribute to the intimal hyperplasia after the jugular ve in is transplanted to the abdominal aorta and to assess the effect of Mithramyci n on the intimal hyperplasia. METHODS: In 60 Wistar rats, a 0.8 cm segment of the right j ugular vein graft was interposed at the level of the abdominal aorta. The experi ment group received Mithramycin (150 mug/kg IP) 1 h before and after the operat ion. The control group received normal saline, specimens of vein graft at 2 and 6 h postoperatively were subjected respectively to in situ hybridization. The ve in grafts 4 weeks after operation were perfusion fixed. The specimens were stain ed with hemotoxylin-eosin and the computer morphologic analysis system was used to evaluate the degree of intimal thickening. Immunohistochemistry studies of m uscle-specific &amg;-actin, C-myc protein and 5'-Bromodeoxyuridine were perfor med. RESULTS: The areas of neointimal and the ratios of neointimal t o medial area were significantly smaller and lower in the Mithramycin-treated t han in the control rats (P<0.05). The 5'-Brdu labeli ng rate between the two groups were also different significantly (P<0.05). Muscl-specific alpha-actin showed that the smooth muscle ce lls formed the most area of myointimal hyperplasia. Steady-state C-myc mRNA le vel was incre ased from 2 h to 6 h postoperatively. The positive rate of the placebo-treated group was higher significantly than that of the Mithramycin-treated group (P<0.05). CONCLUSIONS: Mithramycin may effectively inhibits transcription of C-myc in proliferating vascular smooth muscle cells and could be useful in the prevention of restenosis after vascularization. These results support the hy pothesis that systemic administration of Mithramycin might immediately prevent i ntimal proliferation.

Objective To sum up our experience in the diagnosis and management of acute superior mesenteric venous thrombosis (SMVT). Methods We retrospectively reviewed 41 patients treated for acute SMVT admitted in our hospital from Jan 1978 to Aug 2003. Before 1995 (group Ⅰ), a surgery was preformed in patients with suspected acute SMVT. Since Jan 1995 (Group Ⅱ), aggressive medical therapy was immediately delivered, and the patients were subjected to laparatomy with suspected peritonity. Results There were 13 cases in group Ⅰ, and 28 in group Ⅱ. Mortality in group Ⅰ was 38.5%, and that in group Ⅱ was 10.7% (P