BACKGROUND Conventional recanalization techniques may fail in patients with completely occluded superior vena cava(SVC).AIM To analyze the effectiveness and complications of sharp recanalization for completely occlude...BACKGROUND Conventional recanalization techniques may fail in patients with completely occluded superior vena cava(SVC).AIM To analyze the effectiveness and complications of sharp recanalization for completely occluded SVC.METHODS This was a retrospective study of patients that underwent puncture and recanalization of the SVC between January 2016 and December 2017 at our hospital.Sharp recanalization was performed using the RUPS-100 system.The patients were followed for 12 mo.The main outcomes were the patency rate of SVC and arteriovenous fistula flow during dialysis.RESULTS The procedure was successful in all 14 patients(100%).Blood pressure in the distal SVC decreased in all 14 cases(100%)from 26.4±2.7 cmH2O to 14.7±1.3 cmH2O(P<0.05).The first patency rates of the SVC at 24 h and at 3,6,9 and 12 mo after sharp recanalization were 100%,92.9%,85.7%,78.6%and 71.4%,respectively.There were two(14.3%)severe,one(7.1%)moderate and one(7.1%)minor complication.The severe complications included one case of pericardial tamponade and one case of hemothorax.CONCLUSION The results suggest that sharp recanalization can be an additional tool to extend or renew the use of an occluded upper extremity access for hemodialysis.This could be of use in patients with long-term maintenance hemodialysis in whom the maintenance of central venous access is often a challenge.展开更多
Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continual...Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional （3D） media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope （arterial microscope group） were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system （arterial 3D group）.For the other 20 rats,10 femoral vein anastomoses using a conventional microscope （venous microscope group） were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system （venous 3D group）.The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows：anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively （P ＞0.05）.The average venous anastomotic time of the venous microscope group and venous 3D group was 29.95 and 31.50 minutes,respectively （P ＞0.05）.Conclusions A small vessel anastomosis can be performed successfully with the help of a 3D display system.Although the vascular anastomotic time did not demonstrate a significant difference between the groups,the 3D microsurgical video system offers another option to improve the working environment for surgeons.Further development of our 3D monitoring system should focus on a higher resolution and better flexibility.展开更多
文摘BACKGROUND Conventional recanalization techniques may fail in patients with completely occluded superior vena cava(SVC).AIM To analyze the effectiveness and complications of sharp recanalization for completely occluded SVC.METHODS This was a retrospective study of patients that underwent puncture and recanalization of the SVC between January 2016 and December 2017 at our hospital.Sharp recanalization was performed using the RUPS-100 system.The patients were followed for 12 mo.The main outcomes were the patency rate of SVC and arteriovenous fistula flow during dialysis.RESULTS The procedure was successful in all 14 patients(100%).Blood pressure in the distal SVC decreased in all 14 cases(100%)from 26.4±2.7 cmH2O to 14.7±1.3 cmH2O(P<0.05).The first patency rates of the SVC at 24 h and at 3,6,9 and 12 mo after sharp recanalization were 100%,92.9%,85.7%,78.6%and 71.4%,respectively.There were two(14.3%)severe,one(7.1%)moderate and one(7.1%)minor complication.The severe complications included one case of pericardial tamponade and one case of hemothorax.CONCLUSION The results suggest that sharp recanalization can be an additional tool to extend or renew the use of an occluded upper extremity access for hemodialysis.This could be of use in patients with long-term maintenance hemodialysis in whom the maintenance of central venous access is often a challenge.
文摘Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional （3D） media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope （arterial microscope group） were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system （arterial 3D group）.For the other 20 rats,10 femoral vein anastomoses using a conventional microscope （venous microscope group） were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system （venous 3D group）.The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows：anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively （P ＞0.05）.The average venous anastomotic time of the venous microscope group and venous 3D group was 29.95 and 31.50 minutes,respectively （P ＞0.05）.Conclusions A small vessel anastomosis can be performed successfully with the help of a 3D display system.Although the vascular anastomotic time did not demonstrate a significant difference between the groups,the 3D microsurgical video system offers another option to improve the working environment for surgeons.Further development of our 3D monitoring system should focus on a higher resolution and better flexibility.
