Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage. Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006. All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography. Results Thirty-nine patients’ deep venous valve function kept well up to now, and there was no significant difference between the two results. Four patients without proximal saphenous vein ligation recurred, and there was reflux in deep venous. Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively. Proximal great saphenous vein ligation is important for successful operation.
Abstract： Objective To evaluate clinical outcomes of endoscopic vein harvesting （EVH）for coronary artery bypass grafting（CABG） in diabetic patients. Methods In this prospective non-randomized control study, patients with type 2 diabetes who underwent CABG from December 2010 to Febuary 2012 in West China Hospital were enrolled. Based on different vein graft harvesting technique, these patients were divided into two groups: an EVH group and a conventional vein harvesting（CVH）group. Perioperative complications were compared between the two groups. Interventional or CT coronary angiogram was used to evaluate bypass graft patency during follow-up. Results A total of 51 patients with type 2 diabetes were enrolled in this study with 24 patients in the EVH group and 27 patients in the CVH group. There was no statistical difference in age, weight, and comorbidities between the two groups. There was no statistical difference in cardiopulmonary bypass time and aortic cross-clamping time between the two groups （67.2±9.8 min versus 68.3±14.5 min, P＞0.05; 62.4±11.3 min versus 65.2±10.3 min, P＞ 0.05）. The vein graft harvesting time （35.6±6.4 min versus 45.2±11.4 min, P＜ 0.05）and rate of delayed leg wound healing（0.0% with 0/24 versus 18.5% with 5/27, P＜0.05） of the EVH group were significantly shorter or lower than those of CVH group.There was no statistical difference in major postoperative complications with respect to venous graft failure rate and chest pain during short term follow-up（9.1 months in the CVH group and 9.4 months in the EVH group） between the two groups. Conclusion EVH is a safe, effective, minimally invasive and quick vein graft harvesting technique for CABG in diabetic patients.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
目的 研究地佐辛＋咪达唑仑在大隐静脉射频闭合术中的镇静作用，并观察其对生命体征的影响以及不良反应的发生情况。方法 选取60例行大隐静脉射频闭合术患者，根据麻醉方式分为芬太尼＋咪达唑仑组和地佐辛＋咪达唑仑组２组，每组30例。分别监测心率（HR）、动脉血氧饱和度（SpO2）、平均动脉压（MAP），记录用药后5min和30min的镇静评分、生命体征以及术中不良反应的发生情况。结果 给药后5min和30min的镇静效果评分芬太尼＋咪达唑仑组分别为（2.95±0.14）分和（4.09±0.05）分，地佐辛＋咪达唑仑组分别为（3.16±0.09）分和（4.08±0.08）分，2组比较差异无统计学意义（P＞0.05）。2组给药后5min和30min的HR、SpO2及MAP比较差异均无统计学意义（P＞0.05）；与给药前（0min）比较，差异也无统计学意义（P＞0.05）。2组患者镇静良好，无躁动，均无一例发生呼吸抑制，仅芬太尼＋咪达唑仑组有4例发生呛咳。结论 芬太尼和地佐辛联合咪达唑仑用于大隐静脉射频消融手术患者，镇静效果良好，对生命体征影响小，但地佐辛组无呛咳，不良反应发生率更低。
ObjectiveTo summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome (PAES).MethodThe clinical data of 10 patients (10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed.ResultsAmong 10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and (or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography (DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction (distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to 1-year of following-up. ConclusionSurgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
Objective To compare the patency of the postoperative vessel bridge grafts between the no-touch technique and the conventional technique for saphenous vein harvest in the coronary artery bypass grafting. Methods A total of 70 patients underwent coronary artery bypass grafting from January 2014 to January 2015 in the First Affiliated Hospital of Zhengzhou University. They were randomly divided into a conventional technique group (saphenous vein obtained by traditional technique) and a no-touch technique group (saphenous vein obtained by no-touch technique). There were 34 patients in the conventional technique group, including 16 males and 18 females with an average age of 61.6±6.4 years. There were 36 patients in the no-touch technique group, including 16 males and 20 females with an average age of 62.2±6.6 years. The 1-year postoperative coronary CT angiography (CTA) results were compared. Results Seventy patients underwent coronary CTA examination 1 year postoperatively. The patency rate of the conventional technique group and no-touch technique group were 83/116 (71.6%) and 113/122 (92.6%). Logistic regression analysis showed a statistical difference between the non-touch technique and the conventional technique (P<0.05). Conclusion The short-term patency rate of vessel bridge grafts is higher when the no-touch technique is used.
Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
ObjectiveTo identify the core genes involved in the great saphenous varicose veins (GSVVs) through bioinformatics method. MethodsThe transcriptional data of GSVVs and normal great saphenous vein tissues (control tissues) were downloaded from the gene expression omnibus database. The single sample gene set enrichment analysis (ssGSEA) was used to calculate the Hallmark score. The weighted gene co-expression network analysis (WGCNA) combined with machine learning algorithms was used to screen the key genes relevant GSVVs. The protein-protein interaction (PPI) analysis was performed using the String database, and the receiver operating characteristic (ROC) curve was used to reflect the discrimination ability of the target genes for GSVVs. ResultsCompared with the control tissues, there were 548 up-regulated genes and 706 down-regulated genes in the GSVVs tissues, the Hallmark points of KRAS signaling and apical junction were down-regulated, while which of peroxisomes, coagulation, reactive oxygen species pathways, etc. were up-regulated in the GSVVs tissues. A total of 639 differentially expressed genes relevant GSVVs were obtained and 165 interaction relations between proteins encoded by 372 genes, and the top 10 genes with the highest betweeness values, ADAM10, APP, NCBP2, SP1, ASB6, ADCY4, HP, UBE2C, QSOX1, and CXCL1, were located at the center of the interaction relation. And the core genes were mainly related to copper ion homeostasis, neutrophil degranulation G protein coupled receptor signaling, response to oxidative stress, and regulation of amide metabolism processes. The SP1 and QSOX1 were both Hub genes. The expressions of the SP1 and QSOX1 in the GSVVs tissues were significantly up-regulated as compared with the control tissues. The areas under the ROC curves of SP1 and QSOX1 in distinguishing GSVVs tissues from normal tissues were 0.972 and 1.000, respectively. ConclusionsSP1 and QSOX1 are core genes in the occurrence and development of GSVVs. Regulation of SP1 or QSOX1 gene is expected to achieve precise treatment of GSVVs.
ObjectiveTo explore the mid-term outcomes achieved by using the left internal mammary artery to saphenous vein composite grafts in off-pump coronary artery bypass surgery (OPCAB) for elderly patients. MethodsA total of 59 elderly patients (≥70 years old) underwent OPCAB by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) composite grafts in Xinhua Hospital between March 2006 and October 2012. There was 37 males and 22 females at age of 72.71±1.95 years. Twenty one patients used LIMA-SV composite grafts (LIMA-SV group), and 38 patients used LIMA-RA composite grafts (LIMA-RA group). ResultsAll patients successfully underwent OPCAB with LIMA-SV or LIMA-RA composite grafts. There was one early death in the LIMA-RA group. No statistical differences in early postoperative outcomes were found between the two groups (P > 0.05). During a follow-up of 12 to 91 months, no patient occurred revascularization. There were no statistical differences in overall survival or graft patency rate, and 1 year, 3 years or 5 years survival rates between the two groups (P > 0.05). The patency rate of LIMA in each group was 100% respectively. There was also no statistical difference in overall patency rate of SV and RA between the two groups at the end of 1 year, 3 years or 5 years (P > 0.05). ConclusionAlthough artery grafts are the best choice for OPCAB, LIMA-SV composite grafts can be used as an alternative graft for elderly patients whose RA or right internal mammary artery is not possible or advisable.