CEREBRAL ARTERY RECONSTRUCTION IN THE TREATMENT OF LARGE AND GIANT INTRACRANIAL ANEURYSMS

From 1978 to 1988, 14 giant intracranial aneurysms(more than 2.4 cm in diameter) and one large aneurysm (1.5cm in diameter) were treated by extracranial/intracranial(EC/IC) bypass or cerebral artery reconstruction. Of theaneurysms, 10 were located at the intracavernous carotid ar-tery (CCA). One of the 10 anourysms was posttraumatic andlocated at both the carotid-ophthalmic artery segment and thebifurcation of the internal carotid artery (ICA). Three wereseen at the middle cerebral artery (MCA) trunk.Theaneurysms were demonstrated by angiography and CTscanning. They were treated with trapping of the aneurysm andsuperficial temporal artery (STA)/middle cerebral artery(STA-MCA) bypass with/without a graft (6 cases), cervicalICA ligation and STA-MCA bypass with / without a graft (6)aneurysm excision with an end-to-end anastomosis of theMCA and a STA-MCA bypass with a graft (1), proximal

Aneurysm Resection and Vascular Reconstruction for True Aneurysm at the Initial Segment of Splenic Artery

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography（CT） and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10–14 days after operation. A 1–14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

Reconstruction of pulmonary artery by autologous pericardium or azygous venae for non-small cell lung cancer

Objective To review the clinical experience of reconstruction of pulmonary artery(PA) by a patch of autologus pericardium or azygous venae for non-small cell lung cancer. Methods Between March 1992 and August 2009,62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA.

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery （VATS） currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery （VATS） procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer （NSCLC） received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Clinical significance of variant hepatic artery in pancreatic resection:A comprehensive review

The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels.A variant of the hepatic artery,which is not a rare finding during pancreatic surgery,is prone to intraoperative injury.Inadvertent injury to the hepatic artery may affect liver perfusion,resulting in necrosis,liver abscess,and even liver failure.The preoperative identification of hepatic artery variations,detailed planning of the surgical approach,careful intraoperative dissection,and proper management of the damaged artery are important for preventing hepatic hypoperfusion.Nevertheless,despite the potential risks,planned artery resection has become acceptable in carefully selected patients.Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods.The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery.Here,we comprehensively reviewed the anatomical basis of hepatic artery variation,its incidence,and its effect on the surgical and oncological outcomes after pancreatic resection.In addition,we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion.Overall,the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.

A liver donor with double hepatic artery aneurysm: a saved graft

The shortage of organs and the increasing median age of deceased donors for orthotropic liver transplantation stimulate transplant centres to accept grafts that otherwise would have been discarded due to severe vascular abnormali- ties. We encountered a donor with two arterial aneurysms and a left accessory hepatic artery： an arterial aneurysm of the common hepatic artery and a left accessory hepatic artery arising from a second aneurysm of the left gastric artery （Mi- chels type V）. A complex reconstruction was created to trans- plant the liver. Multiple arterial anastomosis was made and the hepatic inflow of the transplanted liver restored. Although the procedure increased the risk of hepatic artery thrombosis, one more organ supposed to be discarded was saved.

Retroperitoneal teratoma resection assisted by 3-dimensional visualization and virtual reality:A case report

BACKGROUND Primary retroperitoneal tumor is a rare type of tumor with insidious onset,large tumor size at the time of diagnosis,and often extensive involvement of surrounding tissues and blood vessels in the retroperitoneum.Surgery for primary retroperitoneal tumors is technically challenging.Preoperative imaging evaluation is critical for the selection of the optimal surgical approach and can influence complete resection and recurrence rates.Three-dimensional model reconstruction combined with virtual reality is useful for preoperative assessment.CASE SUMMARY A 17-year-old female patient was admitted for abdominal pain lasting for half a year that had been worsening for half a month.Abdominopelvic enhanced helical computed tomography revealed a retroperitoneal space-occupying lesion about 11.3 cm×9.1 cm in size,with well-defined borders in the upper left quadrant of the abdomen.The lesion compressed the left renal artery and vein resulting in vascular displacement and deformation.A multidisciplinary team decided on the optimal treatment approach.Preoperative three-dimensional visualization and virtual reality technology were used to assess and simulate the surgical procedure.Then,retroperitoneal tumor resection along with renal artery reconstruction was decided as the treatment.Complete resection of the retroperitoneal tumor was performed.Stable blood flow was established after renal artery reconstruction.The tumor was diagnosed as mature cystic teratoma(retroperitoneal tumor)by postoperative pathologic analysis.The patient,who recovered well,was discharged after 2 wk and maintains regular follow-ups.CONCLUSION A combination of three-dimensional reconstruction and virtual reality technology before surgery improves the rate of complete resection of retroperitoneal teratoma.

Reconstruction of a new pulmonary artery in arterial switch operation

Background:This study was undertaken to evaluate the new method for the reconstruction of the pulmonary artery in arterial switch operation(ASO).Methods:A total of 108 consecutive infants with congenital heart disease were treated with ASO in our department between January 2004 and June 2012.The new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which was clipped pants­like with continuous mattress suture of 6-0 Prolene thread.Patients were reexamined consecutively at 3 and 6 months and 1,2 and 6 years after discharge.The pulmonary arterial blood velocity was measured by continuous Doppler during systole.The pulmonary flow of healthy children of same age was also measured in the control group.Simplified Bernoulli formula was used to calculate the pressure gradient via the pulmonary artery for determining whether there was pulmonary stenosis.Results:In this series,96 infants survived after the surgery and 88 were followed up with a mean peirod of(22±4)months.No pulmonary stenosis was detected with the simplified Bernoulli formula.Conclusion:No pulmonary stenosis was detected with the simplified Bernoulli formula.

Back-table surgery pancreas allograft for transplantation:Implications in complications

To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique.Back-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the success of implant surgery and perioperative results depends.The technique can be described in the following steps:Preparation of the sterile table,ex-situ inspection of the pancreasspleen block,management of the duodenum,identification of the bile duct,preparation of the portal vein,preparation of the own graft arteries and anastomosis to the arterial graft,spleen management and graft preservation prior to implantation in the recipient.A careful inspection of the pancreas-spleen block should be performed.It is important to identify the stump of the main bile duct,the portal vein cuff,and the arrangement of the superior mesenteric artery and splenic artery.The redundant duodenum must be removed.The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft,two key points to prevent thrombosis.The section line of the arteries must be clean,without atherosclerosis,to prevent arterial thrombosis.The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue.The artery can be reconstructed by interposing a"Y"graft from the donor iliac artery;or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery.An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation:Thrombosis and graft pancreatitis.