The Dacron grafts seeded with autologous venous fragments were implanted into IVC of 13 canines as seeded group and the control grafts (8 cases), which were only preclotted with fresh blood. The amounts of cAMP and cGMP in serum and within platelet were measured. All of the specimens explanted at exsaguination were observed morphologically. The results shown that the total patency rate were 61.5% in seeded group, but 25.0% in control one and new endothelial lining formed at two weeks after implantation of the seeded grafts. The amounts of cAMP in serum and within platelet were higher in seeded group, but the amounts of cGMP were lower in serum and within platelet. These were in accordance with the results that the endothelialization of the grafts were complete in seeded group but not complete in control one. The results indicate that seeding Dacron with autologous venous fragment makes new endothelium formed at two weeks after implantation, increases the amounts of cAMP in serum and within platelet, but reduces the amounts of cGMP and thus improves graft patency rate.
Objective To study the curative effect of operative and interventional treatment in 78 cases of BuddChiari syndrome (BCS). Methods Among these patients, percutaneous transinferior vena cava angioplasty (PTA) was performed in 18 cases, PTA and stent in 10 cases, splenopneumopexy plus pedicled omento-pneumopexy of the left lower lobe in 20 cases, combined transcardiac membranotomy and transfemoral venous ballon dilatation and stent in 15 cases, right atrium-inferior vena cava shunt in 10 cases, and radical operation plus stent in 5 cases. Results After the treatment, the descent of inferior vena cava (IVC) pressure from 2.50～3.95 kPa to 1.41～2.33 kPa, the descent of portal venous pressure from 3.63～5.00 kPa to 2.16～3.23 kPa were observed. Conclusion The authors consider that PTA is the first choice for localized lesions, the following method is the operation combined with interventional treatment.
Objective To evaluate the value of MRI and MDCT in detecting both inferior vena cava tumor thrombus and vena cava wall invasion in renal cell carcinoma. Methods Databases including PubMed, EMbase, The Cochrane Library, MEDLINE (Ovid), CBM, CNKI, VIP and WanFang Data were searched from January 2000 to February 2012. Relevant studies were screened on the basis of the inclusion and exclusion criteria, and then quality assessment and data extraction were conducted. Then heterogeneity test and meta-analysis were conducted using RevMan 5 and Meta-disc 1.4. Results A total of 6 trials involving 244 patients and 246 cases of renal cell carcinoma were included. The results of meta-analysis showed that, for the MRI group and the MDCT group, the sensitivity was 0.963 and 0.952, the specificity was 0.969 and 0.979, the value of +LR was 9.759 and 15.57, the value of −LR was 0.091 and 0.108, and the dOR was 198.71 and 251.54, respectively. There were no significant differences in pooled effect-size among groups (Pgt;0.05). The area under curve (AUC) of summary ROC curve analysis as well as Q index of the MDCT group were 0.981 8 and 0.940 7, respectively. Conclusion There is no significant difference in the value of MRI and MDCT in detecting inferior vena cava tumor thrombus induced by renal cell carcinoma. More original studies on vena cava wall invasion by tumor thrombus should be conducted in the future due to the limitation of current materials.
Objective To analyze the quantitative relationship between respiratory effort and inferior vena cava (IVC) diameter variability in healthy adults, and explore the effects of respiratory effort on the fluid responsiveness with IVC diameter variability. Methods From October 2022 to May 2023, a cross-sectional study was conducted in healthy young subjects who met the criteria. Respiratory effort was evaluated by using portable pulmonary function to measure the subjects’ inspiratory conditions in three states (quiet breathing, moderate inspiration, and maximal inspiration). At the same time, the IVC internal diameter was measured by bedside ultrasound and the IVC diameter variability was calculated. The correlation between inspiratory volume and IVC diameter variation was analyzed, and the receiver operator characteristic (ROC) curve was drawn. The sensitivity and specificity of fluid responsiveness induced by inspiratory effort were predicted according to the area under the ROC curve (AUC). Results A total of 95 subjects were screened, aged 27.13±5.77 years, of whom 30 (32%) subjects were males. During quiet breathing, 41.1% of subjects had IVC inner diameter variation ≥50%. For moderate inspiration, it was 68.4%. At maximum inspiration, this proportion is more than 85%. Inspiratory volume was moderately positively correlated with IVC diameter variation, and the correlation coefficient r=0.45. With the IVC diameter variation ≥50% as the positive criterion for fluid responsiveness, the AUC of fluid responsiveness induced by inspiratory effort was 0.73 (95% confidence interval 0.67 - 0.78, P<0.001), and the inspiratory volume threshold was 13 mL/kg ideal body weight when the maximum Youden index was 0.41. That is, moderate force breathing can induce fluid responsiveness, with sensitivity of 79.57% and specificity of 61.62%. Conclusion The degree of respiratory effort significantly affects the IVC inner diameter variation, and there may be false positives in the evaluation of fluid responsiveness according to IVC inner diameter variation in the case of spontaneous breathing.
【Abstract】ObjectiveTo report the author’s experience with the first case of an adult-to-adult living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) using cryopreserved vena cava graft in postheptic vena cava reconstruction. MethodsA 35-year-old male patient with a diagnosis of BCS complicated with inferior vena cava (IVC) obstruction received medical treatment and radiologic intervention for nine months, no relief of the symptoms could be achieved. Finally, the patient underwent LDLT, which required posthepatic vena cava reconstructed using cryopreserved vena cava graft. ResultsThe patient has had an uneventful course since the LDLT. ConclusionWe believe that LDLT combined with posthepatic IVC reconstruction using cryopreserved vena cava graft is considered to be a sound modality for IVC obstructed BCS.
ObjectiveTo assess the therapeutic effect of catheter thrombolysis combined with inferior vena cava (IVC) filter placement in treatment of deep venous thrombosis (DVT) complicated with floating IVC thrombus. MethodsThe clinical data of 16 patients with DVT complicated with floating IVC thrombus from July 2013 to November 2014 in this hospital were collected. These patients were treated with the catheter thrombolysis combined with IVC filter placement, the IVC filter was placed via jugular vein, the catheter thrombolysis was performed by the side of the small saphenous vein, the amount of urokinase was (60-80) ×104 U/d. Results①The floating IVC thrombi of 13 patients were disappeared following catheter thrombolysis combined with IVC filter placement therapy, a small amount of visible thrombi were adhered on the recycled IVC filter, the lower limb swelling was relieved, the IVC could effectively open.②The IVC filters of 2 patients could not be recycled due to the adhesion of floating IVC thrombus and lumen of IVC resulting in luminal stenosis.③The floating IVC thrombus of 1 patient was disappeared, the IVC filter could not be recy-cled due to a large of thrombi adhered on the IVC filter. The lower limb swelling was slowly relieved. The complications such as severe pulmonary embolism didn't happen in all the patients during treatment and following-up. ConclusionThe limited data preliminarily shows that it is an effective and safe method by catheter thrombolysis combined with IVC filter placement in treatment of DVT complicated with floating IVC thrombus.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo explore the effect of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (ADVT) in lower extremity. MethodsLimb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity. ResultsAll patients were placed catheter successfully, 5 patients were placed catheter by 'contralateral mountain' technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was (4.7±1.8) d (3-12 d). There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above (P=0.028, P=0.017, P=0.031) and below (P=0.035, P=0.038, P=0.047) the knee at affected side, and patency improvement score (P=0.023, P=0.028, P=0.031) in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above (P=0.073, P=0.387, P=0.358) and below (P=0.416, P=0.625, P=0.253) the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients (32.6%), partial blood vessel recanalization occurred in 28 patients (60.9%), but thrombus of 3 patients (6.5%) didn't removed, the total effective rate was 93.5% (43/46). Forty three patients were followed up for 1-24 months, the median is 18-month. During follow-up period, skin color obviously deepened after the activity occurred in 5 patients, obvious limb acid bilges occurred in 19 patients, vein thrombosis (DVT) recurred in 9 patients of 28 patients with partial blood vessel recanalization, in addition, thrombosis syndrome (PTS) occurred in 11 patients. ConclusionCDT is the most direct and effective way to treat ADVT.
Objective To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE). Methods Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups. Results The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05). Conclusions IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
ObjectiveTo investigate the basic operation and treatment experiences of the surgical treatment of Budd-Chiari syndrome (BCS). MethodsClinical data of 1 024 cases of BCS who received surgical treatment in our hospital from April 1994 to December 2013 were collected and analyzed. ResultsThere were 1 024 cases in our study, 116 cases of them underwent surgery, 908 cases of them underwent interventional surgery; 265 cases underwent inferior vena cava (IVC) balloon dilatation, 464 cases underwent IVC balloon dilatation and stenting, 97 cases underwent open surgery of hepatic vein (HV), 52 cases underwent right atrium femoral vein combined membrane rupture balloon dilation stent, 7 cases underwent caval shunt, 20 cases underwent radical surgery, 45 cases underwent IVC-right atrium bypass, 6 cases underwent intestinal cavity-real shunt, 9 cases underwent intestinal cavity-neck combined shunt, 30 cases underwent transjugular intrahepatic portosystemic shunt, 29 cases underwent intestinal-line real shunt. There were 902 cases were followed-up for 1 day-19 years (13 years on average), and the application of many kinds of operation strictly and flexibly brought satisfactory results for cases of BCS. ConclusionsThe diagnosis and classification of BCS will help us to make safe, effective, and appropriate treatment plan. In addition, we must use color Doppler ultrasound to observe the pathological changes of the situation, in this way we can have a clear goal in the treatment process.