Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst form...Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.展开更多
More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America.Necrotizing pancreatitis accounts for 20%-30%of the cases.One-qu...More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America.Necrotizing pancreatitis accounts for 20%-30%of the cases.One-quarter of the patients with pancreatitis develop vascular complications,which carries a high mortality.This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.展开更多
Cardiovascular complications of patients with type 2 diabetes mellitus(T2DM)threaten the health and life of numerous individuals.Recently,growth factor receptor-binding protein 10(GRB10)was found to play a pivotal rol...Cardiovascular complications of patients with type 2 diabetes mellitus(T2DM)threaten the health and life of numerous individuals.Recently,growth factor receptor-binding protein 10(GRB10)was found to play a pivotal role in vascular complications of T2DM,which participates in the regulation of lipid metabolism of T2DM patients.The genetic variation of GRB10 rs1800504 is closely related to the risk of coronary heart disease in patients with T2DM.The development of GRB10 as a key mediator in the association of lipid metabolism with cardiovascular complications in T2DM is detailed in and may provide new potential concerns for the study of cardiovascular complications in T2DM patients.展开更多
Pregnancy requires several changes in the body of the mother to successfully carry and deliver a child.Multiple alterations occur,including changes in cardiovascular system to meet the increased demands of the mother ...Pregnancy requires several changes in the body of the mother to successfully carry and deliver a child.Multiple alterations occur,including changes in cardiovascular system to meet the increased demands of the mother and placenta,the tilting of the hypercoagulable status to a more pro-coagulable state to prevent excessive blood loss post-delivery,and immunologic manipulations to protect the mother and fetus and decreasing the risk of a fatal immunologic response to the allogeneic fetus.These alterations are physiologically normal and expected,but can become pathologic when thresholds are crossed.Pregnancy may cause or exacerbate underlying retinal vascular diseases,a class of disorders compromised predominantly of retinal vein occlusion(RVO),retinal artery occlusion(RAO),central serous retinopathy(CSR),diabetic retinopathy,and hypertensive-related retinopathy,which includes pre-eclampsia,eclampsia,and hemolysis,elevated liver enzymes,and low platelets(HELLP)syndrome.The majority of the literature on retinal changes associated with pregnancy has focused on diabetic retinopathy,while the knowledge regarding the pathogenesis and treatment options of other pregnancy-related vascular diseases remains scarce.Understanding the implications pregnancy has on these rare,but severe,retinal vascular complications can help guide clinical management and potential treatment modalities.This paper aims to serve as a review of the retinal manifestations of diseases outside of diabetic retinopathy.展开更多
Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical ...Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].展开更多
The aim of this study was to investigate the effects of high-advanced glycation end products(AGEs) diet on diabetic vascular complications. The Streptozocin(STZ)-induced diabetic mice were fed with high-AGEs diet. Dia...The aim of this study was to investigate the effects of high-advanced glycation end products(AGEs) diet on diabetic vascular complications. The Streptozocin(STZ)-induced diabetic mice were fed with high-AGEs diet. Diabetic characteristics, indicators of renal and cardiovascular functions, and pathohistology of pancreas, heart and renal were evaluated. AGEs/RAGE/ROS pathway parameters were determined. During the experiments, the diabetic mice exhibited typical characteristics including weight loss, polydipsia,polyphagia, polyuria, high-blood glucose, and low-serum insulin levels. However, high-AGEs diet effectively aggravated these diabetic characteristics. It also increased the 24-h urine protein levels, serum levels of urea nitrogen, creatinine, c-reactive protein(CRP), low density lipoprotein(LDL), tumor necrosis factor-α(TNF-α), and interleukin-6(IL-6) in the diabetic mice. High-AGEs diet deteriorated the histology of pancreas, heart, and kidneys, and caused structural alterations of endothelial cells, mesangial cells and podocytes in renal cortex. Eventually, high-AGEs diet contributed to the high-AGE levels in serum and kidneys, high-levels of reactive oxygen species(ROS) and low-levels of superoxide dismutase(SOD) in serum, heart, and kidneys. It also upregulated RAGE mR NA and protein expression in heart and kidneys. Our results showed that high-AGEs diet deteriorated vascular complications in the diabetic mice. The activation of AGEs/RAGE/ROS pathway may be involved in the pathogenesis of vascular complications in diabetes.展开更多
To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had...To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.展开更多
Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible ...Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single(double)LT(SSLTx).Still,the long-term overall survival is,in general,better for SSLTx.Despite the great success over the years,the early post-SLT period remains a perilous time for these patients.Patients who undergo SLT are predisposed to evolving early or late postoperative complications.This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction,native lung complications,anastomosis complications,infections,cardiovascular,gastrointestinal,renal,and metabolite complications,and their association with morbidity and mortality in these patients.Furthermore,we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.展开更多
Background:The reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation procedure.Hepatic artery thrombosis(HAT)and stenosis are complications which may result in ischemic biliary ...Background:The reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation procedure.Hepatic artery thrombosis(HAT)and stenosis are complications which may result in ischemic biliary injury,causing early graft lost and even death.Methods:Two hundred and fifty-nine patients underwent liver transplantation in 2017 in a single liver transplantation group.Among them,225 patients were living donor liver transplantation(LDLT)and 34 deceased donor liver transplantation(DDLT).Results:In LDLT all reconstructions of hepatic artery were microsurgical,while in DDLT either microsurgical reconstruction or traditional continuous suture technique was done depending on different conditions.There were five(1.9%)HATs:four(4/34,11.8%)in DDLT(all whole liver grafts)and one(1/225,0.4%)in LDLT(P=0.001).Four HATs were managed conservatively using anticoagulation,and 1 accepted salvage surgery with re-anastomosis.Until now,3 HAT patients remain in good condition,whereas two developed biliary complications.One of them needed to be re-transplanted,and the other patient died due to biliary complications.Conclusions:Microsurgical technique significantly improves the reconstruction of hepatic artery in pediatric liver transplantation.The risk for arterial complications is higher in DDLT.Conservative therapy can achieve good outcome in selected HAT cases.展开更多
AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 pati...AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015.RESULTS Thirty-day mortality(3.5% vs 8.7%:OR=0.44,P=0.21) and 1-year mortality(25.7% vs 20.1%,P=0.55) were similar in the S3-THV and the XT-THV groups.The rates of both major vascular complication and paravalvular regurgitation(PVR)>1 were almost 4 times lower in the S3-THV group than the XT-THV group(major vascular complication: 2.8% vs 9.9%,P<0.0001:PVR>1: 2.4% vs 9.7%,P<0.0001).However,the rate of new pacemaker implantation was almost twice as high in the S3-THV group(17.3% vs 9.8%,P=0.03).In the S3 group,independent predictors of new permanent pacemaker were pre-procedural RBBB(OR=4.9:P=0.001),pre-procedural PR duration(OR=1.14,P=0.05) and device lack of coaxiality(OR=1.13:P=0.05) during deployment.CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV.Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.展开更多
BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening a...BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening and usually need open surgical repair.We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis,which was diagnosed in a timely manner and managed by conservative treatments.CASE SUMMARY We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation.The stenosis rate of 90%and the EPSA were verified by computed tomography angiography.The diagnosis was further confirmed with digital subtraction angiography.Percutaneous transluminal angiography was conducted,and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk.No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding;regular ultrasonographic follow-ups were recommended.The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.CONCLUSION Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.展开更多
BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated ...BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated with the risk of a device failure that may result in clinically relevant residual bleeding.Thus,a bailout intervention is needed.So far,the best management of pre-closure device failure has not been recognized.AIM To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of TF-TAVR.METHODS We developed a“pledget-assisted hemostasis”technique to manage residual access-site bleeding.This consists of the insertion of a surgical,non-absorbable,polytetrafluoroethylene pledget over the sutures of the two ProGlide(Abbott Vascular,CA,United States).The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery leak.This technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure technique.Post-procedural access-site angiography was systematically performed.In-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 criteria.RESULTS Out of 136 consecutive patients who underwent TF-TAVR,15 patients(mean age 80.0±7.2 years,66.7%female)with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted hemostasis.In the majority of patients,16F sheath was used(n=12;80%).In 2 cases(13%),a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget preparation.Angiography-confirmed hemostasis(primary efficacy endpoint)was achieved in all patients.After the procedure,1 patient required blood transfusion(2 units),and no other bleeding or major ischemic complication was noticed.CONCLUSION The“pledget assisted hemostasis”might be considered as a possible bailout technique to treat patients with residual access site bleeding.Further studies are needed to compare this approach with other bail-out techniques.展开更多
文摘Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.
文摘More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America.Necrotizing pancreatitis accounts for 20%-30%of the cases.One-quarter of the patients with pancreatitis develop vascular complications,which carries a high mortality.This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.
文摘Cardiovascular complications of patients with type 2 diabetes mellitus(T2DM)threaten the health and life of numerous individuals.Recently,growth factor receptor-binding protein 10(GRB10)was found to play a pivotal role in vascular complications of T2DM,which participates in the regulation of lipid metabolism of T2DM patients.The genetic variation of GRB10 rs1800504 is closely related to the risk of coronary heart disease in patients with T2DM.The development of GRB10 as a key mediator in the association of lipid metabolism with cardiovascular complications in T2DM is detailed in and may provide new potential concerns for the study of cardiovascular complications in T2DM patients.
文摘Pregnancy requires several changes in the body of the mother to successfully carry and deliver a child.Multiple alterations occur,including changes in cardiovascular system to meet the increased demands of the mother and placenta,the tilting of the hypercoagulable status to a more pro-coagulable state to prevent excessive blood loss post-delivery,and immunologic manipulations to protect the mother and fetus and decreasing the risk of a fatal immunologic response to the allogeneic fetus.These alterations are physiologically normal and expected,but can become pathologic when thresholds are crossed.Pregnancy may cause or exacerbate underlying retinal vascular diseases,a class of disorders compromised predominantly of retinal vein occlusion(RVO),retinal artery occlusion(RAO),central serous retinopathy(CSR),diabetic retinopathy,and hypertensive-related retinopathy,which includes pre-eclampsia,eclampsia,and hemolysis,elevated liver enzymes,and low platelets(HELLP)syndrome.The majority of the literature on retinal changes associated with pregnancy has focused on diabetic retinopathy,while the knowledge regarding the pathogenesis and treatment options of other pregnancy-related vascular diseases remains scarce.Understanding the implications pregnancy has on these rare,but severe,retinal vascular complications can help guide clinical management and potential treatment modalities.This paper aims to serve as a review of the retinal manifestations of diseases outside of diabetic retinopathy.
基金Supported by the Shenzhen Science and Technology R&D Fund,No.JCYJ20220530163011026and Shenzhen Third People’s Hospital,No.G2022008 and No.G2021008。
文摘Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].
基金supported by National Nature Science Foundation of China(No.81073111)the Priority Academic Program Development of Jiangsu Higher Education Institutions(No.nzyzyxjp1006)Jiangsu Province graduate student scientific research innovation plan project(No.CXZZ13_0622)
文摘The aim of this study was to investigate the effects of high-advanced glycation end products(AGEs) diet on diabetic vascular complications. The Streptozocin(STZ)-induced diabetic mice were fed with high-AGEs diet. Diabetic characteristics, indicators of renal and cardiovascular functions, and pathohistology of pancreas, heart and renal were evaluated. AGEs/RAGE/ROS pathway parameters were determined. During the experiments, the diabetic mice exhibited typical characteristics including weight loss, polydipsia,polyphagia, polyuria, high-blood glucose, and low-serum insulin levels. However, high-AGEs diet effectively aggravated these diabetic characteristics. It also increased the 24-h urine protein levels, serum levels of urea nitrogen, creatinine, c-reactive protein(CRP), low density lipoprotein(LDL), tumor necrosis factor-α(TNF-α), and interleukin-6(IL-6) in the diabetic mice. High-AGEs diet deteriorated the histology of pancreas, heart, and kidneys, and caused structural alterations of endothelial cells, mesangial cells and podocytes in renal cortex. Eventually, high-AGEs diet contributed to the high-AGE levels in serum and kidneys, high-levels of reactive oxygen species(ROS) and low-levels of superoxide dismutase(SOD) in serum, heart, and kidneys. It also upregulated RAGE mR NA and protein expression in heart and kidneys. Our results showed that high-AGEs diet deteriorated vascular complications in the diabetic mice. The activation of AGEs/RAGE/ROS pathway may be involved in the pathogenesis of vascular complications in diabetes.
文摘To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.
文摘Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single(double)LT(SSLTx).Still,the long-term overall survival is,in general,better for SSLTx.Despite the great success over the years,the early post-SLT period remains a perilous time for these patients.Patients who undergo SLT are predisposed to evolving early or late postoperative complications.This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction,native lung complications,anastomosis complications,infections,cardiovascular,gastrointestinal,renal,and metabolite complications,and their association with morbidity and mortality in these patients.Furthermore,we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.
基金grants from the National Key R&D Program of China(2017YFC0908100)Cohort Study of HCC and Liver Diseases,Double First-Class Foundation,Shanghai Jiao Tong University(W410170015)+2 种基金Overall Leverage Clinical Medicine Center,NHFPC Foundation(2017ZZ01018)Key Clinical Subject Construction Project of Shanghai(shslczdzk05801)Shanghai Shenkang Three-year Program(16CR1003A).
文摘Background:The reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation procedure.Hepatic artery thrombosis(HAT)and stenosis are complications which may result in ischemic biliary injury,causing early graft lost and even death.Methods:Two hundred and fifty-nine patients underwent liver transplantation in 2017 in a single liver transplantation group.Among them,225 patients were living donor liver transplantation(LDLT)and 34 deceased donor liver transplantation(DDLT).Results:In LDLT all reconstructions of hepatic artery were microsurgical,while in DDLT either microsurgical reconstruction or traditional continuous suture technique was done depending on different conditions.There were five(1.9%)HATs:four(4/34,11.8%)in DDLT(all whole liver grafts)and one(1/225,0.4%)in LDLT(P=0.001).Four HATs were managed conservatively using anticoagulation,and 1 accepted salvage surgery with re-anastomosis.Until now,3 HAT patients remain in good condition,whereas two developed biliary complications.One of them needed to be re-transplanted,and the other patient died due to biliary complications.Conclusions:Microsurgical technique significantly improves the reconstruction of hepatic artery in pediatric liver transplantation.The risk for arterial complications is higher in DDLT.Conservative therapy can achieve good outcome in selected HAT cases.
文摘AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015.RESULTS Thirty-day mortality(3.5% vs 8.7%:OR=0.44,P=0.21) and 1-year mortality(25.7% vs 20.1%,P=0.55) were similar in the S3-THV and the XT-THV groups.The rates of both major vascular complication and paravalvular regurgitation(PVR)>1 were almost 4 times lower in the S3-THV group than the XT-THV group(major vascular complication: 2.8% vs 9.9%,P<0.0001:PVR>1: 2.4% vs 9.7%,P<0.0001).However,the rate of new pacemaker implantation was almost twice as high in the S3-THV group(17.3% vs 9.8%,P=0.03).In the S3 group,independent predictors of new permanent pacemaker were pre-procedural RBBB(OR=4.9:P=0.001),pre-procedural PR duration(OR=1.14,P=0.05) and device lack of coaxiality(OR=1.13:P=0.05) during deployment.CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV.Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.
基金the Funding from Beijing Municipal Administration of Hospitals’Ascent Plan,No.DFL 20180102and the Capital's Funds for Health Improvement and Research,No.2020-4-20211.
文摘BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening and usually need open surgical repair.We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis,which was diagnosed in a timely manner and managed by conservative treatments.CASE SUMMARY We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation.The stenosis rate of 90%and the EPSA were verified by computed tomography angiography.The diagnosis was further confirmed with digital subtraction angiography.Percutaneous transluminal angiography was conducted,and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk.No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding;regular ultrasonographic follow-ups were recommended.The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.CONCLUSION Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.
文摘BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated with the risk of a device failure that may result in clinically relevant residual bleeding.Thus,a bailout intervention is needed.So far,the best management of pre-closure device failure has not been recognized.AIM To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of TF-TAVR.METHODS We developed a“pledget-assisted hemostasis”technique to manage residual access-site bleeding.This consists of the insertion of a surgical,non-absorbable,polytetrafluoroethylene pledget over the sutures of the two ProGlide(Abbott Vascular,CA,United States).The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery leak.This technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure technique.Post-procedural access-site angiography was systematically performed.In-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 criteria.RESULTS Out of 136 consecutive patients who underwent TF-TAVR,15 patients(mean age 80.0±7.2 years,66.7%female)with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted hemostasis.In the majority of patients,16F sheath was used(n=12;80%).In 2 cases(13%),a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget preparation.Angiography-confirmed hemostasis(primary efficacy endpoint)was achieved in all patients.After the procedure,1 patient required blood transfusion(2 units),and no other bleeding or major ischemic complication was noticed.CONCLUSION The“pledget assisted hemostasis”might be considered as a possible bailout technique to treat patients with residual access site bleeding.Further studies are needed to compare this approach with other bail-out techniques.
