ObjectiveTo observe the effects of endovascular radiation (ER) on the proliferation and apoptosis of medial smooth muscle cells (SMC) and to discuss the possible mechanisms of radiation in the prevention of vascular restenosis (RS) in rabbits after carotid endarterectomy (CEA).MethodsForty rabbits undergoing CEA were randomly divided into four groups (each group=10) and given a radiation dose of 0, 10, 20 and 40 Gy 32P respectively. Rabbits were killed on the 3rd, 7th, 14th, 28th and 56th day after operation. The specimens were collected and histopathologic examinations were done.ResultsProliferation apparently occurred in the intima and media of carotid the lumen became narrow in the control group on the 14 th, 28 th and 56 th day after operation. While in the radiation groups, proliferation was apparently suppressed and the lumen was much less narrowed (P＜0.05). The apoptosis rate of SMCs and PCNA positive cells increased on the 3rd day after operation and reached the peak on the 7th day. There was statistical difference between the ER groups and control group (P＜0.01). The effects were much more evident in 20 Gy and 40 Gy groups compared with 10 Gy group (P＜0.01).ConclusionER may prevent RS by suppressing SMC proliferation and migration as well as inducing SMC apoptosis. The effects are positively correlated with radiation doses. SMC proliferation and apoptosis occur in the early period after balloon injury, while hyperplasia of intima and medial happens later.
Objective To discuss the safety and validity of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) patients with severe right heart failure (RHF). Methods PEA procedures were performed on 36 patients in Fu Wai Hospital from January 2015 to April 2016. There were 28 males and 8 females, with a mean age of 46.56±11.85 years. According to the New York Heart Association (NYHA) cardiac function classification, 36 patients were divided into preoperative severe RHF group (grade Ⅲ-Ⅳ,n=28) and preoperative without severe RHF group (grade Ⅱ,n=8). Hemodynamic parameters before and after PEA were recorded and 3-18 months' follow-up was done. Results All the patients having PEA surgeries had an obvious decrease of mean pulmonary arterial pressure (from 49.53±13.14 mm Hg to 23.58±10.79 mm Hg) and pulmonary vascular resistance (from 788.46±354.60 dyn·s/cm5 to 352.89±363.49 dyn·s/cm5, bothP<0.001). There was no in-hospital mortality among all the patients. Persistent pulmonary hypertension occurred in 2 patients, perfused lung in 2 patients, pericardial effusion in 2 patients. No mortality was found during the follow-up period. All patients improved to NYHA grade Ⅰ-Ⅱ (WHO grade Ⅰ-Ⅱ), and only 2 patients remained in the NYHA grade Ⅲ (P<0.01). Conclusion The CTEPH patients having PEA surgeries had an obvious improvement in both their hemodynamics results and postoperative heart function, which in return could improve their quality of life.
ObjectiveTo analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. MethodsThe clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. ResultsA total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. ConclusionOne-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.
Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.
Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.
Objective To investigate the influencing factors for restenosis after femoral endarterectomy in treatment of arteriosclerosis obliterans at femoral artery . Methods A total of 103 patients with arteriosclerosis obliterans at femoral artery who underwent femoral endarterectomy from Jan. 2012 to Jan. 2017 in our hospital were retrospectively selected as subjects of this study, to compare the clinical feathers between restenosis group and patent group, and then exploring the influencing factors for restenosis after femoral endarterectomy. Results Thirty-six patients (35.0%) suffered from restenosis after femoral endarterectomy. Patients in the restenosis group had a high proportion of high smoking and diabetes mellitus, and high level of low density lipoprotein than those corresponding indexes of the patent group (P<0.05). Results of Cox proportional hazard model showed that, diabetes mellitus 〔RR=3.338, 95% CI was (1.003, 11.113), P=0.049〕 and high level of low density lipoprotein 〔RR=3.311, 95% CI was (1.166, 9.397), P=0.024〕 were independent risk factors for restenosis after femoral endarterectomy. Conclusions Monitoring of high-risk factors like controlling blood glucose strictly and strengthening statin treatment should be done to reduce the risk of restenosis after femoral endarterectomy for patients with arteriosclerosis obliterans at femoral artery.
Objective To summarize cl inical experience of carotid endarterectomy (CEA) in treating severe carotid stenosis. Methods Between October 1998 and January 2010, 215 patients with carotid stenosis were treated with CEA. There were 140 males and 75 females with an average age of 66 years (range, 51-88 years). Transient ischemic attack (TIA) occurred in127 cases, and 31 cases had history of cerebral infarction. All cases were diagnosed definitely by selective angiography and/or CT angiography, and stenosis degree was more than 80%; contralateral carotid artery was also involved in 45 cases. Ninty-six cases were found to have coronary artery stenosis by coronary angiography. CEA and coronary artery bypass grafting were performed simultaneously in 25 cases. Peripheral arterial disease was found in 43 cases and treated at the same time. Results A total of 155 patients were followed up 6-72 months. The cl inical symptom significantly alleviated in 148 cases postoperatively. Two cases had compl ication of cerebral hemorrhage within 1 week postoperatively; one died and the other was resumed after the conservative treatment. One case had hypoglossal nerve injury. Four cases had injuring marginal mandibular branch of the facial nerve, and no special treatment was given. Restenosis was found in 25 patients, and the stenosis degree was less than 25%; moreover, the patients had no TIA. One case died of heart attack at 3 years of follow-up period. Conclusion CEA is an effective and safe method for treating severe carotid stenosis.
ObjectiveTo summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.MethodsWe retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.ResultsThe mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.ConclusionCTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.
Abstract: Objective To invest igate the early and m iddle2long term clinical outcome of surgical t reatment for pulmonary th romboembo lism (PTE). Methods The data of 57 cases of surgical t reatment fo r pulmonary embolism from O ctober 1994 to O ctober 2007 in A nzhen Ho sp italw ere analyzed ret ro spect ively, of w h ich 47 casesw ere ch ronic PTE done w ith pulmonary th romboendarterectomy, and 10 w ere acute PTE done w ith pulmonary embo lectomy. Results There w ere 6 (12. 8%) perioperat ive death s in ch ronic PTE and 4 (40. 0%) death s in acute PTE (P =0.030). F ifteen cases suffered w ith residual pulmonary hypertension and 25 casesw ith severe pulmonary reperfusion injury. The pulmonary artery systo lic p ressure (PA SP) and the pulmonary vascular resistance (PVR ) of 41 cases with ch ronic PTE at 72 hours after surgery w ere low ered significant ly than tho se befo re surgery (52. 9±26. 1 mmHg vs. 91. 2±37. 4 mmHg; 410. 3±345. 6 dyn?s/ cm5 vs. 921. 3±497. 8 dyn?s/ cm5). The arterial oxygen saturat ion (SaO 2) and the arterial part ial p ressure of oxygen (PaO 2 ) at 72 hours after surgery w ere h igher significant ly than tho se befo re surgery (94.8% ±2.7% vs. 86.7% ±4.3%; 84. 4±5. 4 mmHg vs. 51. 8±6. 4 mmHg, P lt; 0. 05). With the fo llow -up of 44. 6±39. 3 month s (cumulat ive fo llow -up w as 160. 1 pat ient-years) of the 47 perioperative survivo rs, there w ere 5 late death s, of w h ich 4 ch ronic PTE and 1 acute PTE. A cco rding to Kap lan-Meier survival curve, the 5 years survival rate w as 89. 43%±5. 80% fo r ch ronic PTE and 83. 33%±15. 21% fo r acute PTE (Log rank test= 1.57, P = 0. 2103). The lineal bleeding rate related to ant icoagulat ion w as 1. 25% pat ient-years, and the lineal th romboembo lic rate related to ant icoagulat ion w as 0. 62% pat ient-years. A nd of the 42 mid-long term survivo r, the heart funct ion in 29 cases w as N ew Yo rk Heart A ssociat ion (NYHA ) class I , 10 cases NYHA class II , 3 cases N YHA class III. A cco rding to logist ic regression, the risk facto rs fo r the early death w ere acute PTE (OR = 3.28, peripheral type of PTE (OR = 2. 45) , unadop t ive of deep hypertherm ia and circulato ry arrest (OR = 2.86) ; and the risk facto rs fo r late death w ere peripheral type of PTE (OR = 2. 69) , lower limb edema p rep rocedure (OR = 2.79). Conclus ion The operat ive mo rtality in acute PTE is significant ly h igher than that in ch ronic PTE, and the mid-long term survival rate is agreeable in bo th acute and ch ronic PTE, and the comp licat ions rate related to ant icoagulat ion is relat ively accep table.
ObjectiveTo explore the short-term and long-term efficacy of carotid endarterectomy (CEA) in patients with carotid artery stenosis, and analyze the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after operation.MethodsThe clinical data of 326 patients with carotid artery stenosis who underwent CEA in the Second Department of General Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from January 2012 to December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to screen the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum homocysteine (Hcy) and modified Rankin scale (mRS) score.ResultsAll patients underwent successful surgery. Follow-up results showed that the incidence rate of cardiovascular and cerebrovascular events within 30 days after surgery was 6.7% (22/326), and the incidence rate of cardiovascular and cerebrovascular events within one year after surgery was 11.8% (38/323). Multivariate logistic regression analysis showed that smoking history (OR=2.373), contralateral carotid artery stenosis (OR=4.669), preoperative mRS score≥3 (OR=2.550), and preoperative serum Hcy≥20 μmmol/L (OR=1.335) were independent risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA (P<0.05). ROC curve analysis showed that the area under the curve of serum Hcy level was 0.834 in predicting cardiovascular and cerebrovascular events within 30 days after CEA [95%CI was (0.769, 0.899), P=0.003]. The area under the ROC curve of mRS score for predicting cardiovascular and cerebrovascular events within 30 days after CEA was 0.697 [95%CI was (0.552, 0.842), P=0.009].ConclusionsCEA is a safe and effective procedure for the treatment of carotid artery stenosis. The smoking history, contralateral carotid artery stenosis, preoperative severe neurological deficit, and elevated serum Hcy are independent risk factors for occurrence of cardiovascular and cerebrovascular events after CEA.