Liu B

Research advances in endotension after endovascular abdominal aneurysm repair

When more abdominal aortic aneurysms are repaired by endovascular approaches, the post-operative endotension without endoleak increase along with the extended follow-up. An early detection of such endotension and a proper differentiation from endoleaks are particularly important for the treatment decision-making. This article reviews the mechanism, diagnosis, and management of endotension.

Open construction of experimental abdominal aortic aneurysm swine models with Dacron patch for evaluating endovascular aneurysm repair techniques

OBJECTIVE To construct an experimental abdominal aortic aneurysm (AAA) swine model with Dacron patch for evaluating endovascular aneurysm repair (EVAR) technique. METHODS The experimental pigs were generally anesthetized for the open procedure of an aneurysm model creation with Dacron and subsequent arteriography and EVAR with stent graft. Repeat arteriography was performed after 3-month follow-up. RESULTS AAA models were successfully constructed in all 10 experimental pigs. The average aneurysm diameter was (26.3±3.1)mm, increasing by (15.7±3.1)mm comparing to the primary aorta diameter (10.5±0.4)mm. The aorta diameter before and after the experiment showed significant difference (P<0.001). All the animals were survived after the procedure. One swine died 24 hours after the subsequent EVAR because the covering of both renal arteries by the stent graft. The rest 9 animals survived well after the whole operation and 3-month follow-up. The surviving rates at 1 month and 3 months after the operation were both 90%. One type 2 endoleak (10%) was observed after the EVAR, which disappeared at 3-month follow-up. CONCLUSIONS Open construction of experimental AAA swine models with Dacron patch is safe and feasible. The model can be used in the developing new EVAR techniques and implant training.

Clinical analysis of two carotid endarterectomy procedures in treating carotid artery stenosis

OBJECTIVE To analyze the effectiveness and costs of the eversion carotid endarterectomy (eCEA) and the carotid endarterectomy with patch angioplasty (pCEA) in treating carotid artery stenosis. METHODS Patients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study. According to the two different surgical procedures, the patients were divided into eCEA group and pCEA group. RESULTS The two groups were not significantly different in terms of gender ,age ,risk factors, stenosis degree of carotid artery, and the ratio of bilateral lesions (all P>0.05).The ratio of shunt and antibiotics application, operative time, hospitalization cost, and length of hospital stay in the eCEA group were significantly lower than those in pCEA group (P<0.05).The therapeutic effectiveness, complications, surgery-related death, restenosis, and ipsilateral stroke were not significantly different between these two groups (P>0.05). CONCLUSION Both surgical procedures are safe and effective in treating the carotid artery stenosis;however, eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.

Effectiveness of polytetrafluoroethylene graft for hemodialysis access and treatment of graft occlusion

OBJECTIVE To assess the patency and complications of the polytetrafluoroethylene (PTFE) graft for hemodialysis access and to summarize the experiences in the treatment of graft occlusions. METHODS The clinical data of 30 patients who underwent forearm PTFE graft for hemodialysis access from March 2003 to December 2008 in our hospital were retrospectively analyzed. RESULTS Patients were followed up for (28.7+/-17.6) months (range: 8-78 months).The peri-operative mortality was zero. Primary patency rate was 70.0% at Year 1 and 56.7% at Year 2. Accumulative secondary patency rate was 90.0% and 80.0%, respectively at Year 1 and Year 2. Postoperative complications included graft thrombosis (n=13, 43.3%), venous anastomosis stenosis (n=1, 3.3%), graft infection (n=2, 6.7%), and edema of the forearm (n=10, 33.3%). Totally 24 graft revisions were performed, including thrombectomy (12 times), thrombectomy and venous anastomosis plasty with artificial patch (4 times), arterial and venous anastomosis plasty with patch (2 times), venous anastomosis angioplasty with a balloon (2 times), new graft hemodialysis access construction in the contralateral arm (1 case), and graft removal (3 cases). CONCLUSIONS PTFE graft is an important backup hemodialysis access in uremic patients. Proper revision according to different cause of graft occlusions can prolong the service time of the graft.