RESUMEN
OBJECTIVE: To investigate the etiology of Budd-Chiari syndrome (BCS) preliminarily. METHODS: The clinical findings of radical surgery of 109 cases with BCS from March 2001 to May 2009 were analyzed. The pathological components of membranous tissue (MT) from inferior vena cava (IVC) or hepatic vein (HV) of BCS patients were compared with that of thrombus from deep venous thrombosis (DVT), as well as the expression of transforming growth factor beta receptor (TGF-beta R), platelet derived growth factor receptor (PDGFR), endothelin (ET-1), factor VIII related antigen (FVIII-rAg), ferritin and alpha1-antitrypsin in MTs and thrombus through immunohistochemical method. RESULTS: One hundred and four cases of BCS were due to IVC and/or HV membrane or thrombosis except that 4 cases due to IVC tumor or 1 case due to compression of fiber. The new-formed IVC membrane was found in 2 recurred cases whose IVC thrombus was excised before 1 year and 7 years. The development from organized thrombus to MT was found in 3 cases of segmental obstruction of IVC. The IVC membrane located below HV outlet was in 8 cases. Both MTs and thrombus had the pathological components such as fibroblast, neutrophil, granulation tissue, newly-formed blood vessels and so on under the light microscope. The expressions of TGF-beta R, PDGFR, ET-1, FVIII-rAg, and ferritin in MTs and thrombus were as follows: MT 72.3%, thrombus 50.0% (P > 0.05); MT 45.5%, thrombus 100% (P < 0.05); MT 100%, thrombus 0 (P < 0.05); MT 90.9%, thrombus 12.5% (P < 0.05); MT 72.3%, thrombus 100% (P > 0.05). CONCLUSIONS: The membranous tissues and thrombus have the similar homogeneity and cytokines expression. The membrane and thrombus may be different pathological phases.
Asunto(s)
Síndrome de Budd-Chiari/etiología , Adolescente , Adulto , Anciano , Síndrome de Budd-Chiari/patología , Niño , Citocinas/metabolismo , Femenino , Venas Hepáticas/patología , Humanos , Masculino , Persona de Mediana Edad , Trombosis/complicaciones , Vena Cava Inferior/patología , Adulto JovenRESUMEN
OBJECTIVE: To analyze the relative factors of early-term restenosis after artificially grafting bypasses on chronic ischemia of lower extremities. METHODS: From January 2006 to September 2007, 40 cases suffered from chronic ischemia of lower extremities were treated by single side femoropopliteal bypass were followed up during 6 months after operation. There were 36 male and 4 case female with a mean age of (66 +/- 9) years old. Lipid, fibrinogen (FIB) and hypersensitive C reactive protein (hsCRP) were chemical examined during peri-operation. Basing on the degree of restenosis in vascular anastomosis by Color Doppler graft scan, all the patients were divided into light, moderate and severe groups, respectively. Biochemical indicators and cytokines were investigated such as lipid, FIB, hsCRP, IL-6, transforming growing factor beta1 (TGF-beta1). Possible risk factors resulting in restenosis were compared statistically among three groups with SPSS 15.0. RESULTS: Restenosis were more severe among the patients with concomitance disease such as diabetes mellitus and smoking after operation. Relative risk were 6.47 and 7.92, respectively. There are significant difference in total cholesterin, low density lipoprotein, FIB, hsCRP, IL-6 and TGF-beta1 among three groups during six months after operation (P < 0.05). Multiple linear regression showed that FIB and TGF-beta1 may be the risk factors to intimal hyperplasia. CONCLUSION: Diabetes mellitus, smoking and higher levels of FIB may be the major high risk factors resulting in neointima hyperplasia and anastomosis restenosis.
Asunto(s)
Complicaciones de la Diabetes , Fibrinógeno/análisis , Oclusión de Injerto Vascular/etiología , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Fumar , Anciano , Implantación de Prótesis Vascular , Proteína C-Reactiva/análisis , Enfermedad Crónica , Femenino , Humanos , Interleucina-6/sangre , Isquemia/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factor de Crecimiento Transformador beta1/sangreRESUMEN
OBJECTIVE: To report the mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities. METHODS: The clinical data of 212 patients treated with bypass operation from January 2002 to April 2007 were retrospectively reviewed. Femoropopliteal artery bypass to above-knee popliteal (FP-ak) was carried out in 111 cases, femoropopliteal artery bypass to below-knee popliteal (FP-bk) in 59 cases, aortoiliac bypass in 25 cases and femorofemoral bypass in 17 cases. RESULTS: One hundred and eighty-six patients (87.7%) were followed up for 6 to 68 months (median, 18 months). One-year primary patency rate of FP-ak and FP-bk was 69.7% and 53.5%, respectively. After graft revision, 1-year secondary patency rate of FP-ak and FP-bk were 81.6% and 60.5%, respectively. The 3-year patency with FP-ak (56.3%) was significantly higher than that in FP-bk (23.8%) (P < 0.05). Fifty-two cases were reoperated on during the follow-up period. Crural or femoral amputation could not avoid in 23 cases (limb salvage rate 89.2%). Ten cases died in 1 to 30 days after the operation, 20 cases died later during followup, and most of them died of cardio-cerebrovascular diseases. Artificial vessel infection occurred in 6 cases. CONCLUSIONS: The selection of surgical treatment for chronic ischemia of lower extremities should based on the ischemic state of the limb. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Extremidad Inferior/irrigación sanguínea , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To develop a new way to prevent restenosis in the anastomotic site due to intimal hyperplasia after vascular graft bypass (VGB) in peripheral arteries. METHODS: Five mongrel dogs received bilateral iliac-femoral VGB and their arteries between the graft were ligated and cut off under general anaesthesia. The mixture of the paclitaxel and fibrin gel (FG) were randomly sprayed onto one side of grafts including distal and proximal anastomotic site, and the fibrin gel served as control were sprayed onto the other one. The bilateral grafts including distal and proximal anastomotic site were harvested four weeks postoperationally and the anastomotic sites were observed grossly, pathologically and by electron microscopy. The intimal thickness and area of each anastomotic site were measured, then the data were analysed statistically. RESULTS: The bilateral grafts of all dogs were patent and the neointima of all anastomotic sites have been seen grossly. The neointimal thickness and area of the experimental side were significantly reduced compared with the control side (P < 0.05). Scanning electron microscopy showed that the anastomotic intima of the experimental side was covered with one layer of intact and regular endothelium cells with deposition of little blood components, but the anastomotic intima of the control side was covered with irregular endothelium cells and deposited with a lot of blood cells and fibrins. Transmission electron microscopy showed the anastomotic intima of the control side that rich in vascular smooth muscle cells and the matrix of the intima was composed of regular collagenous fibers, and that of the experimental side consisted of several types of cells with a lot of foreign particles in the matrix. CONCLUSION: It is safe and effective to locally use low dose of paclitaxel carried by FG in the prevention of vascular anastomotic site intimal hyperplasia. Paclitaxel molecules can penetrate the graft wall and stay in the anastomotic intima more than four weeks postoperationally.