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Limb Pseudoaneurysms Clinical Diagnosis and Treatment(Report of 30 Cases)

目的　探讨肢体假性动脉瘤的病因、发病机理以及手术方式的选择，评价各种手术的治疗效果，以提高对假性动脉瘤的诊治水平。方法　30例假性动脉瘤患者（股动脉18例，腘动脉7例，肱动脉2例，桡动脉3例），其中8例为感染或破裂性假性动脉瘤，1例肢体坏死。30例患者均行外科手术治疗,其中11例行假性动脉瘤破口修补术，2例行股动脉结扎术，2例行血管端端吻合术，8例行自体大隐静脉移植术，6例行人工血管移植术，1例行截肢术。结果　30例患者术后恢复顺利，除1例行下肢截肢术外，其余29例术后效果良好。随访7个月～8年,平均(4.4±2.3）年； 行人工血管移植术者4例移植段发生血栓，经溶栓治疗后好转，其余血供状况良好。结论　外科手术治疗肢体假性动脉瘤是一种有效的方法。

ANALYSIS OF THE MISTAKES IN THE MANAGEMENT OF INJURIES OF FEMORAL ARTERY

The injuries of the femoral arteries were mistreated in 5 cases. The causes of the mistakes were resulted from: the initial cause of the injury was not carefully analyzed; the arterial injury was overlooked by the concomitant injuries, and the improper method of management was selected, as a result, 2 patients died from acute renal failure and the other 3 patients developed the complications of secondary thrombosis of the artery or rupture of the artery at the anastomotic site following repair. Of the 3 patients, 2 patients had recovered following reoperation and the other 1 patient had lost his limb from amputation. It should be emphasized that all of the following key points might avoid the mistakes occurred in the management of the injury of the femoral artery: (1) early diagnosis; (2) debredment of arteral end; (3) in infections wounds, insted of vein transplantation bypass technique should be done.

RECONSTRUCTION OF FEMORAL ARTERY WITH EXTERNAL JUGULAR VEIN GRAFT

Objective To introduce the treatment and clinical result of reconstructing femoral artery with external jugular vein graft. Methods From June 2002 to April 2006, 22 cases of femoral artery defects caused by pseudoaneurysm resection, were reconstructed withexternal jugular vein graft by microsurgical technique. There were 20 males and2 females, aging 25-46 years (mean 31.2 years). The length of femoral artery defects was 5-9 cm, with an average of 6.8 cm. The location was left in 14 cases and right in 8 cases.Results Ten cases achieved healing by the first intention, and 4 cases by the second intention. The other 8 cases need the regional flap repair because the wound splited open and became ulcer. Femoral artery defects were reconstructed successfully and the pulse of dorsal arteries of foot could be felt except 1 case of bleeding of anastomotic rupture. Eighteen patients were followed up 1-30 months, and no pseudoaneurysm recurred. Color ultrasound Doppler detection showed that the external jugular veins took place of the femoral artery defects in 12 cases. Conclusion External jugular vein is stable at anatomy and easy-to-obtain. Its calibre is close to that of the femoral artery. It can be used for reconstructing femoral artery defects as the vein material. The operation is easy and the clinical result is sure. 

Application of The Femoral Vesseles Catheterization in Extracorporeal Membrane Oxygenation for Salvage Treatment （Report of 47 Cases）

目的　分析股动静脉插管在体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）抢救治疗中的临床应用。方法　回顾性分析笔者所在医院2002 年6 月至2010年7 月期间因重症心肺功能衰竭而施行股动静脉插管并进行静脉-动脉转流体外膜肺氧合（VA-ECMO）抢救的47例患者的临床资料。结果　本组47例患者均顺利施行ECMO支持，37例患者经过治疗后治愈出院，10例死亡。插管并发症有出血、肢体缺血等，均经相应处理后治愈。结论　ECMO对急性心肺衰竭是理想的支持方法，股动静脉为急救插管的首选通道。

The Value of Ultrasonic Examination in Evaluating the Relativity of Hypertension with Intimamedia Thickness of the Carotid and Femoral Arteries and the Blood Flow Parameters

目的:探讨颈动脉(CA)、股动脉(FA)的内—中膜厚度(IMT)及其血流参数对高血压病的诊断价值。方法:对52例原发性高血压病患者利用高频超声进行CA、FA的IMT检查,并与45例正常对照组结果进行对比研究。结果:高血压组的受检者CA、FA的内中膜厚度较正常对照组的明显增厚,差异有统计学意义(Plt;0.01)。高血压组的受检者CA、FA内径较正常对照组增宽,有显著性差异(Plt;0.01)。高血压组与正常对照组的血流速度测量:高血压组CA、FA平均流速(MV)、加速度时间(AT)明显低于正常对照组,差异有统计学意义(Plt;0.01)。高血压组的CA收缩/舒张期血流速度比值(S/D),搏动指数(PI)、阻力指数(RI),均高于正常对照组,差异有统计学意义(Plt;0.01〉。高血压组的FA收缩/舒张期血流速度比值(S/D)、搏动指数(PI)、阻力指数(RI)与正常对照组比较差异无统计学意义。高血压组与正常对照组钙斑形成比较差异有统计学意义(Plt;0.01)。结论:高血压病的CA、FA内—中膜及血流参数均有不同程度改变,超声检查对临床预警和防治具有重要意义。

股动脉穿刺后假性动脉瘤的超声诊断与治疗

目的评价彩色多普勒超声在股动脉穿刺后股动脉假性动脉瘤形成的诊断及治疗中的临床应用价值。 方法回顾性分析2011年1月－2013年11月10例股动脉穿刺后假性动脉瘤形成的彩色多普勒超声声像图表现，总结在超声引导下对假性动脉瘤进行压迫治疗的操作方法，并对治疗结果追踪复查。 结果10例患者超声均查见股动脉周围无回声团块或混合回声团，并在瘤体内查见涡流血流信号及破口处出现“双期双向”血流频谱。10例假性动脉瘤患者行超声引导下压迫治疗，7例1次按压成功，3例重复多次按压成功。 结论彩色多普勒超声诊断假性动脉瘤准确率高，是首选的检查方法。超声引导下压迫治疗股动脉穿刺后假性动脉瘤，是一种有效的治疗方法，可以作为首选。

Efficacy and safety of ultrasound-guided percutaneous retrograde closure of patent ductus arteriosus

ObjectiveTo evaluate the efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with transthoracic echocardiography (TTE).MethodsFrom February 2016 to November 2018, 98 patients of pure PDA were selected, including 43 patients of funnel type and 55 patients of tube type. There were 38 males and 60 females at age of 2-48 (9.8±10.4) years. All patients underwent TTE-guided retrograde closure of the PDA through the femoral artery to establish a femoral-abdominal aorta-thoracic aorta-ductus arteriosus-aorta-right ventricle trajectory.Under the guidance of TTE, a suitable closure umbrella was placed through the femoral artery. One month, 3 months, 6 months, 12 months after the surgery, the patients received out-patient clinical follow-up.ResultsNinety eight patients were successfully occluded by TTE. The occluder was replaced many times in an adult PDA patient, but finally it was successfully plugged. The operation time was 33.2±5.8 min. The lumbar diameter was 12±6 mm. And the postoperative murmur disappeared. Ultrasound showed no shunt between the aorta and the pulmonary artery, and the postoperative hospital stay was 3-4 days. No shunt signal was found in 1, 3, 6, 12 months follow-up. Left atrial anteroposterior diameter (25.8±6.1 mm vs. 30.6±8.4 mm) and left ventricular end diastolic diameter (38.5±9.1 mm vs. 45.2±11.5 mm) were significantly smaller (P < 0.05).ConclusionTTE-guided transcatheter closure of PDA via femoral artery is a safe and effective method to avoid the damage of X-ray and contrast medium. The prospect of clinical application is good.

感染性股动脉损伤的救治

【摘 要】 目的 总结感染性股动脉损伤的救治方法。 方法 1999 年1 月－ 2006 年10 月，收治14 例感染性股动脉损伤患者。其中男12 例，女2 例；年龄18 ～ 45 岁。致伤原因：吸毒注射性损伤7 例，刀刺伤2 例，压砸伤2 例，火器伤2 例，医源性穿刺伤1 例。致伤部位：均为股动脉近端。对感染区彻底清创引流后，采用自体静脉或人造血管移植旁路血管重建11 例，血管修补1 例，单纯血管结扎2 例。创面封闭：1 例直接对位缝合，2 例行皮瓣错位缝合，8 例以局部肌皮瓣修复，3 例采用威克伤封闭负压引流后二期植皮。 结果 14 例手术均顺利，无下肢严重缺血，保肢成功。创面切口均Ⅰ期愈合。8 例获随访3 ～ 28 个月，无吻合口漏和血栓形成。其中7 例肢体远端肌肉未见明显萎缩，足背动脉均能触及，感觉运动功能恢复良好；1 例患肢肌力下降，轻度跛行。 结论 正确诊断、积极手术、术中彻底清创是关键，旁路血供重建和肌皮瓣移位修复是治疗感染性股动脉损伤的一种有效方法。

主动脉-股动脉分流用于合并心力衰竭的主动脉缩窄矫正术一例

REPAIR AND RECONSTRUCTION OF INFECTIVE FEMORAL FALSE ANEURYSM CAUSED BY DRUG INJECTION

Objective To summarize the revascularization method of infective femoral false aneurysm caused by drug injection. Methods Between November 2003 and May 2009, 84 patients with infective femoral false aneurysm caused by drug injection were treated, and the cl inical data were analysed retrospectively. There were 67 males and 17 females with anaverage age of 34.6 years (range, 19-51 years). The average duration of drug injection was 2.7 years (range, 1-11 years). In 13 cases, the defect of femoral artery was 3-10 cm; defect ranged from 1.0 cm × 0.3 cm to 3.0 cm × 0.7 cm in the others. The surgical treatment included bypass using synthetic grafts in 5 cases, great saphenous veins transplantation in 29 cases, repair of femoral artery in 24 cases, and l igation of femoral artery in 26 cases. Results Two cases died of intraoperative pulmonary embol ism. Eight cases had postoperative wound infection, which was cured after changing dressings. Incisions healed by first intention in the other paitents. A total of 82 cases were followed up 12-36 months (mean, 17.3 months). In 56 patients undergoing artery reconstruction or repair, dorsal pedis artery pulse was significantly improved, and no distal osteofascial compartment syndrome occurred. In 26 patients undergoing femoral artery l igation, angiography at 1 week after operation showed abundant collateral circulation from ipsilateral internal il iac artery, superior gluteal artery or contralateral internal il iac artery. Three cases had postoperative intermittent claudication which was improved after symptomatic treatment. Conclusion Infective femoral false aneurysm caused by drug injection should be treated surgerically as early as possible, and effective treatments include debridement, drainage, defect repair or bypass with synthetic graft or great saphenous vein from homonymy external il iac artery to superficial femoral artery. Ligation of femoral artery is an option in patients with serious infection when revascularization is impossible.