One hundred and twenty-eight cases of peripheral aneurysm were reported.Traumatic prsucdoaneursyms(87cases)dominated and aneurysm in lower extremities(68 cases)consisted of most the cases.Rupture of aneurysm and massive kaemomhage is the most serious complications(22 cases in the report).Therefore,operative treatment should be performed soon after the diagnosis is ascertained.Resteration of normal blood flow should be the aim.Intracystic repairation is indicated in pseudoaneurysm with part of the vascular wall invaded.Artificial graft may be indicated for aneurysm of the middle and large artery,and autovenous graft for the smaler arteries.Aneurysm may be resected if the procedure is easy to perform or there is severe inflammation around the aneurysm.Proper postoperative drainage is important.General heparinization during blockade of local circulation is also important in case of vascular grafting. We concluded that proper selection of operative procedure is essential for better prognosis.
Objective To identify an evidence-based treatment for a patient with aneurysmal subarachnoid hemorrhage (aSAH). Methods We first put forward clinical problems about how to prevent complications and how to treat ruptured aneurysm of aSAH, then searched The Cochrane Library (Issue 4, 2006), Ovid ACP Journal Club (1991 to 2006), Ovid MEDLINE (1966 to 2006), NGC (1998 to 2006) and CBM (1978 to 2006) to identify systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines. Results Eleven studies and five guidelines were included. Current evidence indicated that nimodipine was effective for prophylaxis of poor outcome after vasospasm, while tirilazad was not effective in female patients with good grades. The effectiveness of other treatments to prevent complications was not clear. Evidence on the use of antifibrinolytics for the prevention of re-bleeding was inconsistent. If a ruptured aneurysm was considered suitable for both surgical clipping and endovascular coiling, coiling was associated with a better outcome. According to the available evidence and guidelines, considering the patient’s conditions and preferences, nimodipine and antifibrinolytics were administered to prevent complications and her aneurysm was treated by early endovascular embolization. She did not experience vasospasm or re-bleeding during her hospital stay. Short-term follow-up showed a good outcome. Long-term prognostic benefits after endovascular therapy need to be confirmed by prolonged follow-up. Conclusions Therapies based on the best clinical evidence and guidelines should be given to prevent complications and improve outcome for patients after an aSAH.
The hemodynamic parameters in arteries are difficult to measure non-invasively, and the analysis and prediction of hemodynamic parameters based on computational fluid dynamics (CFD) has become one of the important research hotspots in biomechanics. This article establishes 15 idealized left coronary artery bifurcation models with concomitant stenosis and aneurysm lesions, and uses CFD method to numerically simulate them, exploring the effects of left anterior descending branch (LAD) stenosis rate and curvature radius on the hemodynamics inside the aneurysm. This study compared models with different stenosis rates and curvature radii and found that as the stenosis rate increased, the oscillatory shear index (OSI) and relative residence time (RRT) showed a trend of increase; In addition, the decrease in curvature radius led to an increase in the degree of vascular curvature and an increased risk of vascular aneurysm rupture. Among them, when the stenosis rate was less than 60%, the impact of stenosis rate on aneurysm rupture was greater, and when the stenosis rate was greater than 60%, the impact of curvature radius was more significant. Based on the research results of this article, it can be concluded that by comprehensively considering the effects of stenosis rate and curvature radius on hemodynamic parameters, the risk of aneurysm rupture can be analyzed and predicted. This article uses CFD methods to deeply explore the effects of stenosis rate and curvature radius on the hemodynamics of aneurysms, providing new theoretical basis and prediction methods for the assessment of aneurysm rupture risk, which has important academic value and practical guidance significance.
Objective To investigate the characteristics of fundus photography and fundus fluorescein angiography (FFA) of IRVAN (idiopathic retinal vasculitis, aneurysms, and neuroretinitis) syndrome and Eales disease. Methods The fundus photography and FFA data of 4 cases (8 eyes) with IRVAN syndrome and 43 cases (68 eyes) with Eales disease were retrospectively analyzed. All patients received ophthalmic routine examinations, including visual acuity, intraocular pressure, slit-lamp microscope and indirect ophthalmoscope. All patients had taken fundus photography and FFA for both eyes, except 4 patients of Eales disease who had vitreous hemorrhage in one eye. All 4 cases(1 male/3 female )with IRVAN syndrome were bilateral and aged 1643 years old( mean age 2700plusmn;1293 years old). 43 cases (32 male/11 female) of Eales disease aged 6-59 years old( mean 30.79plusmn;11.46 years old), 29 cases were bilateral and 14 cases were unilateral. Both diseases had retinal vascular whitesheath or white threadlike changes, exudative retinal hemorrhage and vitreous hemorrhage. Results Both arteries and veins of posterior pole of all eyes with IRVAN syndrome were involved and shown multiple retinal macroaneurysms. Other signs of IRVAN syndrome included capillary occlusion and nonperfusion (7/8 eyes, 87.5%),fluorescein leakage and edema of optic disc (5/8 eyes,62.5%), optic atrophy(2/8 eyes,25%), vitreous hemorrhage(1/8 eyes,12.5%), neovascularization of optic disc(2/8 eyes,25%), retinal neovascularization(4/8 eyes,50%) and macular edema(4/8 eyes,50%). The signs of Eales disease included fluorescein leakage of peripheral retinal vein (68/68 eyes, 100%), fluorescein leakage of posterior retinal vein (32/68 eyes, 47.06%), artery involvement (5/68 eyes, 7.35%), peripheral capillary occlusion and nonperfusion (38/68 eyes, 55.88%), fluorescein leakage of optic disc(29/68 eyes, 42.65%), neovascularization of optic disc(4/68 eyes,5.88%), retinal neovascularization(26/68 eyes,38.2%) and macular edema(15/68 eyes,22.06%). Compared IRVAN syndrome with Eales disease, the difference of artery inflammation, vein inflammation, retinal macroaneurysms in posterior area had statistics significance(all P=000,Plt;005), and that of edema of optic disc, retinal vascular nonperfusion area, neovascularization of optic disc, neovascularization elsewhere, and macular edema had no statistics significance(chi;2=0.479，P＞0.05；P=0.131，P＞0.05；chi;2=1.449，P＞0.05；chi;2=0.068，P＞0.05；chi;2=1.676，P＞0.05). Conclusions Both IRVAN syndrome and Eales disease may have vein and artery inflammation in posterior pole of the eye, and may result in neuroretinitis. IRVAN syndrome has much more vein and artery inflammation in posterior pole than Eales disease. Posterior retinal macroaneurysms is the most important sign for the diagnosis and differential diagnosis of IRVAN syndrome and Eales disease.
Objective To summarize the diagnosis and endovascular treatment of middle cerebral artery (MCA) bifurcation aneurysm. Methods Between January 2010 and June 2011, 32 patients with MCA bifurcation aneurysm underwent endovascular treatment. There were 12 males and 20 females, aged 49.5 years on average (range, 35-81 years). All patients had sudden headache, 2 cases had disturbance of consciousness and hemi plegia, and 22 cases had a history ofhypertension. Before operation, 10 cases were classified as Hunt-Hess level I, 15 cases as level II, and 7 cases as level III; 24 cases were classified as Fisher level II and 8 cases as level III. The patients underwent coil embolization using single microcatheter in 16 cases, using double microcatheter in 7 cases, using balloon-assisted in 4 cases, using single stent in 4 cases, and using double stent in 1 case. Results The results of postoperative immediate digital subtraction angiography showed that 30 patients achieved dense embolization, and 2 patients using single microcatheter achieved approximated dense embolization. Among them, 18 cases suffered extensive subarachnoid hemorrhage, thus lumbar puncture continued drainage was performed for 3-7 days; the other 14 cases had l ittle subarachnoid hemorrhage, lumbar puncture released hemorrhagic cerebrospinal fluid discontinuously, and after1 week, head CT demonstrated that subarachnoid hemorrhage was significantly decreased. At 1 day after surgery, 2 patients had local cerebral ischemia; after Nimotop and other drugs were used for 1 week, the symptom was alleviative. All 32 patients were followed up 4 to 17 months. No aneurysm rupture and bleed occurred during follow-up; no other complications or sequelae was observed except for 3 cases of hemiparesis and 1 case of aphasia. The computed tomographic angiography examination showed no re-open of dense embolized aneurysm at 3, 6 months, and 1 year after surgery. Conclusion As long as appropriate intervention treatment method is chosen, endovascular treatment of MCA bifurcation aneurysm is safe and effective.
ObjectiveTo investigate the value and clinical significance of multi-slice spiral computed tomography angiography (MSCTA) in diagnosing true splenic artery aneurysm. MethodsSeven patients with splenic artery aneurysm diagnosed by MSCTA between October 2010 and July 2014 were included in this study. Image post-processing technologies such as multi-planar reformation, curved planar reformation, maximum intensity projection and volume rendering technology were introduced. ResultsAll the artery aneurysms were found through image post-processing technologies. There were 9 tumors in the 7 patients with splenic artery aneurysm, among which 1 was at the upper segment of pancreas, 2 at the segment of pancreas, 3 at the anterior segment of pancreas, and 1 (multiple) at the anterior segment of pancreas and anterior of hilus of spleen. The maximum volume of tumor was 60 mm×57 mm×54 mm. One tumor wall had calcification and other 6 cases only displayed tumor wall had varying degrees of "egg-shell" calcification, and mural thrombosis was detected in 3 cases. ConclusionsMSCTA is a reliable method to display splenic artery aneurysm. The combination of multiple image post-processing technologies is more helpful in observing the features of tumor body and the internal and external conditions of tumor cavity, which has guiding significance for further clinical treatment.
Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
Objective To review the strategies on repairing elastic fibers in aorta. Methods Literature concerningelastic fiber as well as its repairment was consulted and summarized from three aspects: enhancement of the expressions ofits components, improvement of the condition of its assembly, and reduction of the destructive effects. Results Elastinis concerned as the main protein to be enhanced with three different methods including gene transfection, stimulationwith ectogenesis factors, and induction of phenotype transition of smooth muscle cell. Fibul in and lysyl oxidases show theabil ity to improve the assembly of the elastic fiber, while the related mechanisms are not clear. Matrix metalloproteinasesare regarded as the main destructive factors, and researches focus on reducing their expression as well as their destructiveeffects. Conclusion To assure a high-qual ity repair of elastic fibers in aorta, their components should be sufficientlyexpressed and effectively assemblyed, and the destructive effects caused by dangerous factors should also be reduced.
ObjectiveTo evaluate clinical outcomes of thoracic endovascular aortic repair (TEVAR)for the treatment of Stanford type B aortic dissection (AD)and descending aortic aneurysm. MethodsClinical data of 20 patients with Stanford type B AD or descending aortic aneurysm who underwent TEVAR in West China Hospital from March to June 2013 were retrospectively analyzed. There were 19 male and 1 female patients with their age of 41-76 (58.3±10.2)years. Clinical outcomes were analyzed. ResultsAmong the 20 patients, 18 patients were successfully discharged, 1 patient refused further postoperative treatment and was discharged, and 1 patient died postoperatively. Sixteen patients (88.9%)were followed up for over 3 months. In all the patients during follow-up, true lumen diameter recovered within the scope of intravascular stents, and there was thrombosis in false lumen or aneurysm lumen. ConclusionTEVAR provides a new choice with significant advantages for the treatment of Stanford type B AD, especially for the elderly and patients with concomitant serious diseases, so it is worthy of clinical application.
【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.