Jiang Shao

Surgical Resection of the Inferior Vena Cava for Leiomyosarcoma

Our case of primary leiomyosarcomas involved retrohepatic, suprarenal, and infrarenal inferior vena cava (IVC). Preoperative phlebography proved that there was adequate collateral circulation formed, which allowed us to achieve en bloc resection including segment I and II IVC without either extracorporeal circulation or prosthetic revascularization of the IVC and renal vessels. Our choice of en bloc resection including segment I and II IVC without extracorporeal circulation or prosthetic replacement of the vessels was justified as the patient had normal liver and kidney function after the operation.

Surgical Management of a Primary Retroperitoneal Venous Aneurysm Originating from the Presacral Venous Plexus

Venous aneurysms are rare vascular abnormalities, and primary venous aneurysm originating from sacral venous plexus is exceedingly rare. In this article, we report a 28-year-old man with a large venous aneurysm (∼15 × 10 cm in size) originating from presacral venous plexus. The patient complained of 1 year of constant back pain associated with frequent defecation and urination, caused by the compression from the aneurysm. Exploratory laparotomy was performed for diagnosis, with successful aneurysmectomy to relieve the compression. The patient recovered uneventfully with complete relief of symptoms. Postoperative histopathologic examination manifested classic venous aneurysm. During follow-up 6 months after surgery, all symptoms were resolved without significant postoperative complications.

Radical correction for Budd-Chiari syndrome through a transabdominal approach.

BACKGROUND To describe radical correction for Budd-Chiari syndrome through a unique transabdominal approach. METHOD After the liver was turned leftward through a transabdominal approach, segments II and III of the inferior vena cava (IVC), the second porta hepatis, and third porta hepatis were visualized. Then, radical correction and angioplasty of the IVC were performed. Three patients operated through this approach recovered well. RESULT All procedures were performed successfully, without any perioperative mortality. There were two cases of postoperative ascites. The elevated venous pressure and the liver function returned to normal at follow-up. CONCLUSION Radical correction for Budd-Chiari syndrome through a transabdominal approach without extracorporeal circulation minimizes the surgical injury and has a good curative effect.

Combination of Octopus and Periscope Techniques for the Management of Visceral Branches From Type V Thoracoabdominal Aortic Aneurysm: A Case Report

Purpose: To describe an endovascular technique combining the octopus and periscope techniques for the treatment of a patient with type V thoracoabdominal aortic aneurysm in order to protect the patient’s visceral circulation. Case Report: An 84-year-old male patient was hospitalized for type V thoracoabdominal aortic aneurysm involving celiac axis, superior mesenteric artery, and both renal arteries. The patient’s aneurysm was successfully treated by combining the octopus technique and periscope techniques. The 1-year follow-up computed tomography angiography showed that the endograft and the branches were patent. The gutters had thrombosed with no signs of endoleak. No spinal cord ischemia or impairment of the renal function was observed during the follow-up. Conclusions: This case is an example of the successful usage of the combined octopus and periscope techniques in protecting the renovisceral arteries arising from a type V thoracoabdominal aortic aneurysm; this combined technique might be applicable in carefully selected patients.

Orthotopic renal autotransplantation for young-onset and medical treatment-requiring complex renovascular hypertension

Objective: In this article, we aim to prove the safety and effectiveness of orthotopic renal autotransplantation using ex vivo repair for the treatment of complex renovascular hypertension (RVH). Methods: We retrospectively reviewed five consecutive patients (three women, two men) with young-onset RVH from January 2009 to August 2014. Orthotopic renal autotransplantation using ex vivo repair was performed and perioperative data were collected for statistical analysis. Results: The median age at diagnosis was 20 years (range, 11 to 27 years). Technique success was achieved in all the patients with no in-hospital or late deaths. During a median follow-up of 3.4 years (range, 1.5 to 6 years), the postoperative blood pressure was decreased compared with preoperative level (204 ± 8/133 ± 8 mm Hg vs 129 ± 3/78 ± 5 mm Hg; p < 0.0001). The postoperative anti-hypertensive medications number was reduced (3.4 ± 0.4 vs 0.2 ± 0.2; p < 0.0001). Early and late renal functions were both well preserved as measured by no changes in serum creatinine level (p > 0.05). The primary patent rate was 100% (5/5) at one-year follow-up. Conclusion: In our small series, orthotopic renal autotransplantation using ex vivo repair was safe and effective for the resolution of complex young-onset RVH.

An evaluation on novel application of cone-beam CT imaging with multi-volume technique in carotid body tumor

Due to the high risk of vascular and nerve damage during surgery, precise pre-operative evaluation of carotid body tumor (CBT) is important. We aim to apply intra-operative contrast-enhanced cone-beam CT (CBCT) with multi-volume technique in CBT evaluation, where the tumor, patent carotid arteries, and skull are demonstrated in three different colors, and to compare this novel technique with traditional computed tomography angiography (CTA). Seven CBT patients scheduled for traditional surgical removal were enrolled in this study between October 2013 and March 2016. For each patient, two CBCT scans were performed on the carotid region both pre- and post-operatively, with contrast injected into the common carotid artery directly. CT-like cross-sectional slices were then reconstructed with a dedicated workstation, and a novel multi-volume technique was further applied for advanced image post-processing. For all seven patients, the anatomic relationship between tumor and surrounding vessels was clearly demonstrated by reconstructed CBCT images with multiple fused volumes. Carotid was either completely or partially incarcerated by tumors. Interestingly, two sets of draining vein systems of CBT were found feeding into the internal jugular vein and the anterior vertebral venous plexus, respectively, which have not been revealed in pre-operative CTA. Post-operative CBCT confirmed the thorough removal of the tumor with an intact preservation of the internal carotid artery. CBCT with multi-volume technique outperforms CTA in discovering fine structures and revealing tumor–vessel relationship for CBT. This emerging imaging technique would offer more accurate diagnosis of CBT and assist in the decision of surgical plan.