Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with...Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly hig展开更多
May-Thurner syndrome(MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrom...May-Thurner syndrome(MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures.展开更多
Background Iliac vein compression syndrome （IVCS）, the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this res...Background Iliac vein compression syndrome （IVCS）, the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS. Methods Between January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months （average 46 months） and evaluated for symptom improvement with color ultrasound and ascending venography. Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography. Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.展开更多
Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fractur...Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.展开更多
Background： Deep vein thrombosis （DVT） may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression...Background： Deep vein thrombosis （DVT） may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression. This prospective study was to detemline the incidence of DVT in individuals with iliac vein compression and identify risk factors predictive of DVT. Methods： A total of 500 volunteers without symptoms of venous diseases of lower extremities and overt risk factors of deep venous thrombosis between October 2011 and September 2012 in Shijitan Hospital were enrolled in this cohort study. All the participants underwent contrast-enhanced abdominal computed tomography （CT） to evaluate lilac vein compression. Baseline demographic information and degree of iliac vein compression were collected. They were categorized into ≥50% or 〈50% iliac vein compression group. Ultrasound examination was pertbrmed to screen DVT at the time of CT examination and 3, 6, 9, and 12 months alter the examination. Primary event was DVT of ipsilateral lower extremity. Correlation between DVT and iliac vein compression was estimated by multivariate Logistic regression alter adjusting for age, gender, malignancy, surgery/immobilization, chemotherapy/hormonal therapy, and pregnancy. Results： In 500 volunteers, 8.8% （44） had 〉50% iliac vein compression and 91.2% （456） had 〈50% lilac vein compression, lpsilateral DVT occurred in six volunteers including two in iliofemoral vein, two in popliteal vein, and two in calf vein within 1 year. Univariate analysis showed that the incidence of DVT was 6.8% in 〉_50% compression group, significantly higher than that in 〈50% compression group （0.7%） （Х^2= - 12.84, P 0.01）. Patients with malignancy had significantly higher incidence of DVT than those without malignancy （Х^2 = 69.60, P〈 0.01 ）. Multivariate Logistic regression indicated that iliac vein compression and malignancy were independent risk factors of DVT. Alter adjustment for malignancy, patie展开更多
Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful...Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200e10,000 mL, with an average volume of 2850 mL. Postoperative followup ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral ar展开更多
Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which m...Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal lilac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods： Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results： The obturator artery arising from the external lilac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory （aberrant） artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion： A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.展开更多
Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the app...Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.展开更多
Background At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation （OLT）. Hepatic artery （HA） variations occur frequently in both donors and recipients. Mor...Background At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation （OLT）. Hepatic artery （HA） variations occur frequently in both donors and recipients. Moreover, there are always some pathological changes in the recipient hepatic artery. If handled improperly, it may cause complications after anastomosis.Therefore, arterial conduit could be used in primary OLT, re-OLT and multiple-OLT. This study aimed to investigate the indications, methods and techniques with usage of arterial conduit for HA revascularization during adult OLT.Methods We reviewed 1200 patients of consecutive OLTs performed during 2000-2009 in the First Affiliated Hospital of Sun Yat-sen University. Of these patients, 48 recipients with artery variations received HA revascularization with usage of arterial conduit and special postoperative managements. The indications, methods, techniques, and the managements of postoperative complications in adult OLT with usage of arterial conduit for HA revascularization were analyzed.Results In 48 cases with artery bypass, the arterial conduit were anastomosed between donor hepatic artery and recipient infrarenal aorta （n=32）, between donor hepatic artery and recipient suprarenal aorta （n=10）, and between donor upper abdominal organ cluster artery and recipient suprarenal aorta （n=6）. The technique was applied in 4% （48/1200 cases） of the whole OLTs performed in the same period, and the patency rate of the conduits was 100%. Forty patients （83.3%） survived, and the average survival time was 3.9 years. Eight patients （16.7%） died （all due to tumor recurrence）,while the average survival time was 1.2 years. All these patients have not experienced artery-related complications in their survival time.Conclusions When recipient HA has variations or pathological changes in OLT, the donor artery should be anastomosed to recipient abdominal aorta with an arterial conduit to achieve satisfactory outcomes. For arterial anastomos展开更多
Endovascular aneurysm repair （EVAR） has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm. However, for aneurysms extending to both iliac bifurcations, routine EVAR will occlud...Endovascular aneurysm repair （EVAR） has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm. However, for aneurysms extending to both iliac bifurcations, routine EVAR will occlude both internal iliac arteries （llAs）, which may increase the risk for pelvic ischemia. New endovascular techniques have been developed to preserve the pelvic perfusion in EVAR for such situation. This article reports an endovascular repair of an aortoiliac aneurysm with an external iliac artery （EIA） to the IIA endograft to preserve the pelvic perfusion. First, an endograft was advanced into the left IIA under the help of an inflated aortic balloon. Coils were deployed to embolize the distal type-1 endoleak from the tunnel around the endograft, and an aortouniiliac endograft and an iliac extension were deployed below the renal arteries extending to the right EIA. Finally, a right-to-left femoro-femoral artery bypass was constructed. Angiography at completion and computed tomography after 6 months demonstrated patency of all grafts and complete exclusion of the aneurysm without any endoleak. Endovascular repair with an EIA-to-IIA endograft to preserve the pelvic inflow is a feasible and effective technique for aortoiliac aneurysms. Coil embolization might be an option to repair the distal type of endoleak. The balloon assisted U-turn technique may help advance the endovascular device over a sharp-angled vessel bifurcation.展开更多
Aim:To evaluate the diagnosis and treatment strategies for the iliac vein compression syndrome(IVCS) and the factors that affect the treatment outcome.Methods:In total,69 patients with IVCS were enrolled in the study....Aim:To evaluate the diagnosis and treatment strategies for the iliac vein compression syndrome(IVCS) and the factors that affect the treatment outcome.Methods:In total,69 patients with IVCS were enrolled in the study.The patients underwent computed tomography(CT) venography before treatment.CT observations included assessment of the iliac venous channel sagittal diameter(IVCD) before the lower lumbar vertebra,causes of oppression,thrombus density,and embolization range.The patients with IVCS were divided into the simple IVCS(s IVCS,n=22),lumbar degeneration-related type IVCS(d IVCS,n=33),and IVCS of other causes(o IVCS,n=14) including lumbar fracture,hematoma of infection,and abscess wraping around and compressing the iliac vein,groups.The treatment methods included target venous catheter-directed thrombolysis(CDT),a mechanical breaking and sucking treatment for the thrombi,followed by balloon dilatation and iliac vein stent implantation.The factors that may possibly affect the treatment outcomes included IVCS type,duration of disease,thrombus hardness,embolization length,and treatment regimen.Logistic regression was used to analyze the factors that affected the therapeutic efficacy.Results:At the first stage,CDT was only effective in 15 cases(5 d IVCSs and 10 o IVCSs) and was ineffective in the remaining 54 cases,which required further mechanical breaking and sucking of the thrombi and intravenous balloon dilatation.In the second stage,combination of thrombi breaking and suction and balloon dilatation was preliminarily effective in 26 cases(6 s IVCSs,16 d IVCSs and 4 o IVCSs),but during follow-up from 1 to 6 months,treatment was considered futile for 9 recurrent cases(3 s IVCSs and 6 d IVCSs).So,28 cases of preliminary ineffective treatment and 9 relapse in the second stage were arranged to the third stage of treatment by iliac vein stent implantation.All 37 cases were treated effectively and achieved a satisfactory iliac vein patency,and were followed-up for 24 months without recurrence.Logistic regression anal展开更多
BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding...BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.展开更多
Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a terti...Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.展开更多
BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of v...BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of various factors,including the bleeding risk,dosage,specific anticoagulant medications,and duration of therapy.Herein,a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d.Considering her medical history and relevant post-admission investigations,it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors,including multiple primary malignant tumors,iliac venous compression syndrome,previous novel coronavirus infection,and inadequate treatment for prior thrombotic events.However,the selection of appropriate anticoagulant medications,determination of optimal drug dosages,and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia,decreased quantitative fibrinogen levels,and renal insufficiency.CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis.Individualized anticoagulation therapy is required for complex thrombosis.展开更多
OBJECTIVE: To investigate the occurrence and extent of apoptosis in the course of restenosis. METHODS: The experimental models of vessel narrowness and intima thickness were established in minipigs' iliac arteries...OBJECTIVE: To investigate the occurrence and extent of apoptosis in the course of restenosis. METHODS: The experimental models of vessel narrowness and intima thickness were established in minipigs' iliac arteries by balloon injury and specimens were retrieved on the 1st, 3rd, 6th, 12th and 30th days for dynamic observation. Apoptotic smooth muscle cells (SMCs) were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). RESULTS: Apoptotic SMCs occurred only in the thickened intima 12 days after injury accompanied with the proliferative SMCs, the percentage of apoptosis was 1.94% +/- 0.42% on the 12th day and 1.36% +/- 0.31% on the 30th day respectively. The low frequency of apoptosis compared with the proliferative SMCs was a feature in the restenotic pathology. CONCLUSIONS: Apoptosis participates in the pathogenetic process of intimal thickening and its level was low compared with proliferation. The findings suggest that attempts to modulate apoptosis after vessel injury constitute a theoretical approach to the prevention of restenosis.展开更多
文摘Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly hig
文摘May-Thurner syndrome(MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures.
文摘Background Iliac vein compression syndrome （IVCS）, the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS. Methods Between January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months （average 46 months） and evaluated for symptom improvement with color ultrasound and ascending venography. Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography. Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.
文摘Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.
文摘Background： Deep vein thrombosis （DVT） may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression. This prospective study was to detemline the incidence of DVT in individuals with iliac vein compression and identify risk factors predictive of DVT. Methods： A total of 500 volunteers without symptoms of venous diseases of lower extremities and overt risk factors of deep venous thrombosis between October 2011 and September 2012 in Shijitan Hospital were enrolled in this cohort study. All the participants underwent contrast-enhanced abdominal computed tomography （CT） to evaluate lilac vein compression. Baseline demographic information and degree of iliac vein compression were collected. They were categorized into ≥50% or 〈50% iliac vein compression group. Ultrasound examination was pertbrmed to screen DVT at the time of CT examination and 3, 6, 9, and 12 months alter the examination. Primary event was DVT of ipsilateral lower extremity. Correlation between DVT and iliac vein compression was estimated by multivariate Logistic regression alter adjusting for age, gender, malignancy, surgery/immobilization, chemotherapy/hormonal therapy, and pregnancy. Results： In 500 volunteers, 8.8% （44） had 〉50% iliac vein compression and 91.2% （456） had 〈50% lilac vein compression, lpsilateral DVT occurred in six volunteers including two in iliofemoral vein, two in popliteal vein, and two in calf vein within 1 year. Univariate analysis showed that the incidence of DVT was 6.8% in 〉_50% compression group, significantly higher than that in 〈50% compression group （0.7%） （Х^2= - 12.84, P 0.01）. Patients with malignancy had significantly higher incidence of DVT than those without malignancy （Х^2 = 69.60, P〈 0.01 ）. Multivariate Logistic regression indicated that iliac vein compression and malignancy were independent risk factors of DVT. Alter adjustment for malignancy, patie
文摘Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200e10,000 mL, with an average volume of 2850 mL. Postoperative followup ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral ar
文摘Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal lilac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods： Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results： The obturator artery arising from the external lilac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory （aberrant） artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion： A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.
文摘Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.
基金This study was supported by a grant from the Guangdong Natural Science Foundation （No. 9151008901000052）.
文摘Background At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation （OLT）. Hepatic artery （HA） variations occur frequently in both donors and recipients. Moreover, there are always some pathological changes in the recipient hepatic artery. If handled improperly, it may cause complications after anastomosis.Therefore, arterial conduit could be used in primary OLT, re-OLT and multiple-OLT. This study aimed to investigate the indications, methods and techniques with usage of arterial conduit for HA revascularization during adult OLT.Methods We reviewed 1200 patients of consecutive OLTs performed during 2000-2009 in the First Affiliated Hospital of Sun Yat-sen University. Of these patients, 48 recipients with artery variations received HA revascularization with usage of arterial conduit and special postoperative managements. The indications, methods, techniques, and the managements of postoperative complications in adult OLT with usage of arterial conduit for HA revascularization were analyzed.Results In 48 cases with artery bypass, the arterial conduit were anastomosed between donor hepatic artery and recipient infrarenal aorta （n=32）, between donor hepatic artery and recipient suprarenal aorta （n=10）, and between donor upper abdominal organ cluster artery and recipient suprarenal aorta （n=6）. The technique was applied in 4% （48/1200 cases） of the whole OLTs performed in the same period, and the patency rate of the conduits was 100%. Forty patients （83.3%） survived, and the average survival time was 3.9 years. Eight patients （16.7%） died （all due to tumor recurrence）,while the average survival time was 1.2 years. All these patients have not experienced artery-related complications in their survival time.Conclusions When recipient HA has variations or pathological changes in OLT, the donor artery should be anastomosed to recipient abdominal aorta with an arterial conduit to achieve satisfactory outcomes. For arterial anastomos
文摘Endovascular aneurysm repair （EVAR） has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm. However, for aneurysms extending to both iliac bifurcations, routine EVAR will occlude both internal iliac arteries （llAs）, which may increase the risk for pelvic ischemia. New endovascular techniques have been developed to preserve the pelvic perfusion in EVAR for such situation. This article reports an endovascular repair of an aortoiliac aneurysm with an external iliac artery （EIA） to the IIA endograft to preserve the pelvic perfusion. First, an endograft was advanced into the left IIA under the help of an inflated aortic balloon. Coils were deployed to embolize the distal type-1 endoleak from the tunnel around the endograft, and an aortouniiliac endograft and an iliac extension were deployed below the renal arteries extending to the right EIA. Finally, a right-to-left femoro-femoral artery bypass was constructed. Angiography at completion and computed tomography after 6 months demonstrated patency of all grafts and complete exclusion of the aneurysm without any endoleak. Endovascular repair with an EIA-to-IIA endograft to preserve the pelvic inflow is a feasible and effective technique for aortoiliac aneurysms. Coil embolization might be an option to repair the distal type of endoleak. The balloon assisted U-turn technique may help advance the endovascular device over a sharp-angled vessel bifurcation.
基金Regional Development Project of Fujian Province(2019Y3007)Military Logistics Research Projects(CLB18J060)Supporting Army Project of Zhangzhou City Government(ZZ2018KD01).
文摘Aim:To evaluate the diagnosis and treatment strategies for the iliac vein compression syndrome(IVCS) and the factors that affect the treatment outcome.Methods:In total,69 patients with IVCS were enrolled in the study.The patients underwent computed tomography(CT) venography before treatment.CT observations included assessment of the iliac venous channel sagittal diameter(IVCD) before the lower lumbar vertebra,causes of oppression,thrombus density,and embolization range.The patients with IVCS were divided into the simple IVCS(s IVCS,n=22),lumbar degeneration-related type IVCS(d IVCS,n=33),and IVCS of other causes(o IVCS,n=14) including lumbar fracture,hematoma of infection,and abscess wraping around and compressing the iliac vein,groups.The treatment methods included target venous catheter-directed thrombolysis(CDT),a mechanical breaking and sucking treatment for the thrombi,followed by balloon dilatation and iliac vein stent implantation.The factors that may possibly affect the treatment outcomes included IVCS type,duration of disease,thrombus hardness,embolization length,and treatment regimen.Logistic regression was used to analyze the factors that affected the therapeutic efficacy.Results:At the first stage,CDT was only effective in 15 cases(5 d IVCSs and 10 o IVCSs) and was ineffective in the remaining 54 cases,which required further mechanical breaking and sucking of the thrombi and intravenous balloon dilatation.In the second stage,combination of thrombi breaking and suction and balloon dilatation was preliminarily effective in 26 cases(6 s IVCSs,16 d IVCSs and 4 o IVCSs),but during follow-up from 1 to 6 months,treatment was considered futile for 9 recurrent cases(3 s IVCSs and 6 d IVCSs).So,28 cases of preliminary ineffective treatment and 9 relapse in the second stage were arranged to the third stage of treatment by iliac vein stent implantation.All 37 cases were treated effectively and achieved a satisfactory iliac vein patency,and were followed-up for 24 months without recurrence.Logistic regression anal
文摘BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.
文摘Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.
文摘BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of various factors,including the bleeding risk,dosage,specific anticoagulant medications,and duration of therapy.Herein,a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d.Considering her medical history and relevant post-admission investigations,it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors,including multiple primary malignant tumors,iliac venous compression syndrome,previous novel coronavirus infection,and inadequate treatment for prior thrombotic events.However,the selection of appropriate anticoagulant medications,determination of optimal drug dosages,and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia,decreased quantitative fibrinogen levels,and renal insufficiency.CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis.Individualized anticoagulation therapy is required for complex thrombosis.
文摘OBJECTIVE: To investigate the occurrence and extent of apoptosis in the course of restenosis. METHODS: The experimental models of vessel narrowness and intima thickness were established in minipigs' iliac arteries by balloon injury and specimens were retrieved on the 1st, 3rd, 6th, 12th and 30th days for dynamic observation. Apoptotic smooth muscle cells (SMCs) were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). RESULTS: Apoptotic SMCs occurred only in the thickened intima 12 days after injury accompanied with the proliferative SMCs, the percentage of apoptosis was 1.94% +/- 0.42% on the 12th day and 1.36% +/- 0.31% on the 30th day respectively. The low frequency of apoptosis compared with the proliferative SMCs was a feature in the restenotic pathology. CONCLUSIONS: Apoptosis participates in the pathogenetic process of intimal thickening and its level was low compared with proliferation. The findings suggest that attempts to modulate apoptosis after vessel injury constitute a theoretical approach to the prevention of restenosis.
