In order to develope a new method to overcome the difficulties in anastomosis of blood vessels with different diameter, phleboplasty was utilized at the join-point to expand the diameter of branched vein graft, with a funnel-shaped stoma formed consequently. After successfully experimented in fresh blood vessels in vitro, the method was practised clinically to repair injured arteries in extremities, with the outcome that phleboplasty of branched vein graft could enlarge the diameter by 1-1.25 times, and with satisfied effects in 3 clinic cases. So, the conclusion was that: phleboplasty of branched vein graft was a new effective and convinient method to repair injured arteries with different diameters
Objective To study the mechanism of restenosis of the vein graft and the effect of the grafting injury to the vein graft. Methods One side of the 36 healthy rabbits was randomly chosen as the V-A group, and on the side a 1.5cmlong femoral vein was obtained, and an 0.5-cm-long segment of the obtained femoral vein was separated as the control group. The remaining 1-cm-long femoral vein was inverted and was autogenously implanted into the femoral artery on the same side of the rabbit. The other side of the rabbits was chosen as the V-V group, and on this side a 1-cm-long femoral vein was obtained ex vivo and then was sutured in situ. The vein grafts on both sides were harvested 4 weeks after operation. The specimens from the harvested vein grafts were stained with HE and theelastic fiber Victoria blue for an observation on the histological changes in the walls of the vein grafts, and the specimens were also stained by the immunohistochemistry of the proliferating cell nuclear antigen (PCNA) for an observation on the wall cell proliferation of the vein grafts. The changes in the ultrastructure of the proliferated wall cells of the vein grafts were observed under electron microscope. The two sides of the rabbits were compared. Results The smooth muscle cells of the media developed hyperplasia, but theintima and the media remained unchanged in their thickness (3.50±0.41 μm, 12.23±1.59 μm) in the V-V group, with no difference when compared with the control group (3.40±0.37 μm, 12.14±1.62 μm); however, when compared with the V-A group (25.60±3.21 μm, 21.30±2.47 μm),there was a significant difference in the thickness (Plt;0.01). There were no cells positive for PCNA by the immunohistochemistry examination in the control group. The cells positive for PCNA were found in the intima and the media in both the V-V group and the V-A group; however, the percentageof the cells positive for PCNA in the intima and the media was significantly greater in the V-A group than in the V-V group (16.4%±1.9% and 36.5%±3.7% vs 5.9%±1.3% and 23.4%±3.4%, Plt;0.01). In the V-V group, the endothelial cell could be observed under transmis-sion electron microscope, which was flat and had a processlike villus at its free end, and the endothelial cells were closely arranged andhad hyperplasia of the smooth muscle cells in the media. But in the V-A group,the endothelial cells had an obvious hyperplasia with an irregular shape and a widened space between the cells, and in the intima a great amount of the smooth muscle cells could be observed, which had a broken basement membrane. The smooth muscle cells also had an obvious hyperplasia in the media. The shape and alignment of the endothelial cells in the control group were similar to those in the V-V group, but the hyperplasia of the smooth muscle cells was not observed in the media. Conclusion The grafting injury can cause hyperplasia ofthe vascular wall cells, and if the hemodynamics is changed simultaneously, more serious hyperplasia and cell migration can be observed from the media to the intima, resultingin restenosis of the blood vessels. So, if we can reduce the grafting injury and improve the microcirculation of the vein graft, we may find out the methods ofpreventing restenosis of the vein graft. The animal model of the V-V graftcan help to understand the mechanism of restenosis of the vein graft.
OBJECTIVE: To investigate the relationship between the different defect length of vessels and the options of vascular repair, and to compare the different options of repair because of the longitudinal biomechanical effect. METHODS: A clinical analysis was undertaken to evaluate the major arterial and venous injuries in human extremities repaired by end-to-end anastomoses or venous autograft(177 cases, 185 vessels). Compared the defect length of the same kind of vessels repaired by different options (Student-t test). Evaluated the defect length to repair arterial injuries between by end-to-end anastomoses and by vein graft by means of 95% confidence interval. RESULTS: There was significant difference between the defect length of brachial artery repaired by end-to-end anastomosis and femoral artery and popliteal artery repaired by autogenous vein graft (P lt; 0.01). The upper limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 3.17 cm, 2.81 cm and 2.44 cm respectively by end-to-end anastomosis by means of 95% confidence interval. The lower limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 2.82 cm, 2.41 cm and 2.17 cm respectively by vein graft by means of 95% confidence interval. The defect length of brachial artery, femoral artery and popliteal artery repaired by vein graft was linear correlation with the length of graft. CONCLUSION: Because of the longitudinal biomechanical difference of arteries and veins in human extremities, different options of repair are necessary to different arterial injuries.
The femoral veins were excised from 28 dogs and distended with pressure of 40, 80 and 120 kPa, respectively before grafted to femoral arteries. The veins were harvested at different times and Pollak sections were prepared which revealed different stains of elastin, collagen and smooth muscle in each section. The sections were led to image analysis system to computerize the relative contents of theabove components. The results were as follows: Elastin decreased significantly at 4 weeks (P lt;0.01), and was constant between 4 and 16 weeks. No statistical difference was found in 40, 80 kPa and the control group (P gt;0.05), but the elastin of 120 kPa group by the 16th week was still decreasing. Collagen of each group had no difference, but C/E increased significantly with time. Smooth muscle contents were correlated positively with time, and negatively with the pressure at 1 week, then positively with the pressure at 16th week. The changes of the above trends were the same as development of intimal hyperplasia. The contentions were the value of C/E was determined by the arterial pressure but that of 120 kPa pressure was more higher. The preimplant pressure distension was a possible significantfactor leading to excessive intimal hyperplasia of early and middle stage of autogenous vein grafts.
Objective To investigate the results and applicationvalue of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter.Methods From June 1998 to October 2003, 35 cases of vesseldefects with a large diameter were repaired with crotch-shaped vein graft (29 males and 6 females,aged 18 to 45 years with an average of 25.7 years ). The locations of defects were femoral artery in 25 cases, popliteal artery in 2 cases, femoral vein in 7 cases, and subclavian vein in 1 case. The interval between injure and operatioinwas 1-8.5 hours (4.1 hours on average).The blood flows of trouble and healthy vascular were determined with Doppler detector and compared preoperatively andpostoperatively. Results All the anastomotic stomas were patent in 35 cases. Thirty-one cases were followed up 6 weeks to 24 months (9.5 months on average), the patent rate was 100%, no case occurred vasospasm or tromboembolism; 2 cases occurred stomal leak and became hematoma, 3 cases occurred muscular necrosis, and the 5 cases achieved primary healing after secondary operation. The Doppler results showed that there was statistically significant difference in the blood flow betweenpostoperation and preoperation (Plt;0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular (Pgt;0.05). Conclusion The methodof crotch-shaped vein grafts is safe and effective in repairing defects of vessels with a large diameter,which is easy to draw materials and handy to operate. It has a promising value in clinical application.
Objective To construct vectors that express phosphatidylinositol-3-kinase, catalytic, beta polypeptide （PIK3cb） shRNA in eukaryon plasmid catalyzed by PI3K in rat, then test their effects on intimal hyperplasia in transplanted vein graft. Methods One hundred and fifty SD rats were randomly divided into six groups （n=25, in each group）: blank (25% Pluronic F-127), shRNA-1, shRNA-2, 1/2 （shRNA-1+shRNA-2）, negative control (pGenesil-1 scramble shRNA) and positive control （wortmannin） group. The jugular vein in rats were interpositioned autologously into the common carotid artery. shRNA and 25% Pluronic F-127 were mixed and coated around the transplanted vein in three PIK3cb shRNA groups. Every 5 samples were removed according to the time point (1, 3, 7, 14 and 28 days after operation), respectively. The thickness of intima and neointima area were calculated and analyzed by computer system. The PCNA expression was detected by Western blot and SP immunohistochemistry. Results The intimal thickness of three PIK3cb shRNA groups were lower than those in the blank group and negative control group on day 3, 7, 14, 28 after operation (P＜0.05); The neointima area in three PIK3cb shRNA groups (except shRNA-2 group on day 3, 7) began to decrease significantly from day one (P＜0.05). The protein expression of PCNA in three PIK3cb shRNA groups on day 3 after operation were decreased compared with blank group and negative group (P＜0.05). The percentage of the PCNA positive cells area in three PIK3cb shRNA groups were significantly lower than those in blank group and negative control group in each time point (Plt;0.05). There were no significant differences between blank and negative control group in different time points (Pgt;0.05). Conclusion The PIK3cb shRNA can effectively inhibit the proliferation of vascular smooth muscle cell, which may provide a new gene therapy for the prevention of vein graft restenosis after bypass grafting.
ObjectiveTo investigate the application value of the intravenous indwelling needle in radionuclide imaging examination. MethodsA total of 120 patients underwent single photon emission computed tomography for bone and kidney dynamic imaging between October 2012 and April 2013 were randomly divided into group injected by venous indwelling needle (observagtion group) and group injected by traditional steel needle (control group), with 60 cases in each. We calculated the one-time success rate of venipuncture, the leakage rate of intravenous injection, residual radioactive dosage within the syringe and average exposure time of medical staff to radionuclide in the two groups of patients. ResultsThe one-time success rate of venipuncture in observation group was similar to that in the control group (P > 0.05). During the injection, no leakage was found in observation group, while 4 leakage in 37 patients underwent bone imaging and 3 leakage in 23 patients underwent kidney dynamic imaging in the control group were found; there was no significant difference between the two groups (P > 0.05). The residual radioactive dosage within the syringe in observation group was lower than that in the control group, and the exposure time of medical staff to radionuclide in observation group was also lower than that in the control group (P < 0.01). ConclusionsIntravenous indwelling needle for venous puncture can avoid leakage of radioactive imaging agent, reduce the residual radiological dosage within the syrings, increase the one-time puncture success rate and imaging resolution of dynamic scan, and improve the diagnostic accuracy and work efficiency effectively. Besides, the intravenous indwelling needle technique can reduce average exposure time of medical staff to radionuclide, acheaving the goal of optimized protection.
Coronary artery bypass grafting (CABG) is an effective method for the treatment of coronary heart disease at present. However, there is still a high rate of vein graft occlusion after CABG, which has a serious impact on the short and long-term clinical results. Venous access technique has been considered as an important factor on affecting the long-term patency rate. Compared with harvesting technology of the open saphenous vein harvesting, no-touch technology retained the surrounding tissue and vascular adventitia of great saphenous vein, and it avoided the high pressure of expansion vein. After CABG was performed by using the no-touch technique, the vein grafts obtained a better short and long-term patency rate, but the effect still needs further clinical verification.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.