A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the cont...A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.展开更多
Objective: To investigate the changes of the plasma level of MMP-9 (Matrix Metalloproteinase-9, MMP-9) in the patients with abdominal aortic aneurysms (AAAs) before and after the treatment, and evaluate the significan...Objective: To investigate the changes of the plasma level of MMP-9 (Matrix Metalloproteinase-9, MMP-9) in the patients with abdominal aortic aneurysms (AAAs) before and after the treatment, and evaluate the significance of MMP-9 in the pathogenesis of AAAs. Methods: Blood samples of 35 patients with AAAs and 10 patients with the arterial occlusive diseases (AODs) , which enrolled into the Vascular Surgery Center of Colonge University Hospital from February to August of 2002, were collected before and one month after surgical repair or less-invasive endovascular exclusion. The plasma concentrations of MMP-9 of all the collected samples were measured by means of enzyme-linked immunosorbent assay(ELISA), and compared between the two groups patients at different time point. Results: The mean plasma concentration of MMP-9 of AAAs was significantly higher than that of AODs prior to treatment [(90.3±9.1) ng/ml vs (23.6±7.3) ng/ml, P<0.05], and no apparent difference was showed in the patients with AODs [(23.6±7.3) ng/ml vs (25.3±5.8) ng/ml, P>0.05)] before and after the surgical bypass operation. However, in the patients with AAAs the plasma concentration of MMP-9 was apparently decreased one month after the surgical repair or endovascular exclusion compared with before [(28.6±8.4) ng/ml vs (90.3±9.1) ng/ml, P<0.05)]. No meaningful difference of the mean plasma MMP-9 concentration was seen between two groups after the both being successfully treated [(28.6±8.4) ng/ml vs (25.3±5.8) ng/ml, P>0.05]. Conclusion: Apparent elevation of plasma concentration of MMP-9 in the AAAs and its dramatic decrease after being treated implicated that MMP-9 might play an important role in the formation and development of AAAs. Meanwhile, to investigate the changes of MMP-9 level of AAAs could provide an practical way to facilitate the earlier diagnosis and long term surveillance for AAAs. More importantly, pharmacologic prevention and treatment of AAAs, in which the MMP-9 serves as effective target, might be possible in the future.展开更多
Objective： To explore the efficacy of interventional therapy for chronic atherosclerotic occlusive disease of the lower extremity. Methods： Fifty-six cases of simple atherosclerotic occlusive disease of lower extrem...Objective： To explore the efficacy of interventional therapy for chronic atherosclerotic occlusive disease of the lower extremity. Methods： Fifty-six cases of simple atherosclerotic occlusive disease of lower extremity were divided into 3 types according to the location of occhision, including 17 cases of abdominal aorta-iliac artery, 18 cases of iliac-femoral artery, and 21 cases of inferior popliteal artery. Catheter and guide wire combined with blunt dissection and subtle banding were used to dredge the occluded vessels, and stents were implanted when interlayer appeared. Results： After the treatment, 46 cases of occlusion were dredged （82.1%）, 6 cases remained occluded with the same symptoms （10.7%）, and 4 cases had severer symptoms （7.1%）. Among the 46 successful cases, there were 16 cases of abdominal aorta-iliac artery （94.1%）, 16 cases of iliac-femoral artery （88.9%） and 14 cases of inferior popliteal artery, artery （66.6%）. There was no statistical difference between the abdominal aorta-iliac artery cases and iliac-femoral artery cases （P〉0.05）, but there was statistical difference between these two types and the inferior popliteal artery cases （P〈0.05）. In the successful cases, 9 cases of abdominal aorta-iliac artery （52.9%）, 10 cases of iliac-femoral artery （55.5%） and 10 cases of inferior popliteal artery （33.3%） had 5-10 cm of occlusion, with no statistical difference between the first two types （P〉0.05）, but with statistical difference between the first two types and the third type （P〈0.05）. Compared with the 14 dredged cases （71.4%）, the 7 cases （33.3%） of inferior popliteal artery cases had richer compensatory circulation （P〈0.05）. Conclusion： It＇s safe and effective to treat simple atherosclerotic occlusive disease of the lower extremity with interventional therapy. The location and length of occlusion and the abundance of compensatory circulation had effect on the therapy.展开更多
文摘A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.
文摘Objective: To investigate the changes of the plasma level of MMP-9 (Matrix Metalloproteinase-9, MMP-9) in the patients with abdominal aortic aneurysms (AAAs) before and after the treatment, and evaluate the significance of MMP-9 in the pathogenesis of AAAs. Methods: Blood samples of 35 patients with AAAs and 10 patients with the arterial occlusive diseases (AODs) , which enrolled into the Vascular Surgery Center of Colonge University Hospital from February to August of 2002, were collected before and one month after surgical repair or less-invasive endovascular exclusion. The plasma concentrations of MMP-9 of all the collected samples were measured by means of enzyme-linked immunosorbent assay(ELISA), and compared between the two groups patients at different time point. Results: The mean plasma concentration of MMP-9 of AAAs was significantly higher than that of AODs prior to treatment [(90.3±9.1) ng/ml vs (23.6±7.3) ng/ml, P<0.05], and no apparent difference was showed in the patients with AODs [(23.6±7.3) ng/ml vs (25.3±5.8) ng/ml, P>0.05)] before and after the surgical bypass operation. However, in the patients with AAAs the plasma concentration of MMP-9 was apparently decreased one month after the surgical repair or endovascular exclusion compared with before [(28.6±8.4) ng/ml vs (90.3±9.1) ng/ml, P<0.05)]. No meaningful difference of the mean plasma MMP-9 concentration was seen between two groups after the both being successfully treated [(28.6±8.4) ng/ml vs (25.3±5.8) ng/ml, P>0.05]. Conclusion: Apparent elevation of plasma concentration of MMP-9 in the AAAs and its dramatic decrease after being treated implicated that MMP-9 might play an important role in the formation and development of AAAs. Meanwhile, to investigate the changes of MMP-9 level of AAAs could provide an practical way to facilitate the earlier diagnosis and long term surveillance for AAAs. More importantly, pharmacologic prevention and treatment of AAAs, in which the MMP-9 serves as effective target, might be possible in the future.
基金Supported by the Natural Science Foundation of Shaanxi,China(No.2004C2_51)
文摘Objective： To explore the efficacy of interventional therapy for chronic atherosclerotic occlusive disease of the lower extremity. Methods： Fifty-six cases of simple atherosclerotic occlusive disease of lower extremity were divided into 3 types according to the location of occhision, including 17 cases of abdominal aorta-iliac artery, 18 cases of iliac-femoral artery, and 21 cases of inferior popliteal artery. Catheter and guide wire combined with blunt dissection and subtle banding were used to dredge the occluded vessels, and stents were implanted when interlayer appeared. Results： After the treatment, 46 cases of occlusion were dredged （82.1%）, 6 cases remained occluded with the same symptoms （10.7%）, and 4 cases had severer symptoms （7.1%）. Among the 46 successful cases, there were 16 cases of abdominal aorta-iliac artery （94.1%）, 16 cases of iliac-femoral artery （88.9%） and 14 cases of inferior popliteal artery, artery （66.6%）. There was no statistical difference between the abdominal aorta-iliac artery cases and iliac-femoral artery cases （P〉0.05）, but there was statistical difference between these two types and the inferior popliteal artery cases （P〈0.05）. In the successful cases, 9 cases of abdominal aorta-iliac artery （52.9%）, 10 cases of iliac-femoral artery （55.5%） and 10 cases of inferior popliteal artery （33.3%） had 5-10 cm of occlusion, with no statistical difference between the first two types （P〉0.05）, but with statistical difference between the first two types and the third type （P〈0.05）. Compared with the 14 dredged cases （71.4%）, the 7 cases （33.3%） of inferior popliteal artery cases had richer compensatory circulation （P〈0.05）. Conclusion： It＇s safe and effective to treat simple atherosclerotic occlusive disease of the lower extremity with interventional therapy. The location and length of occlusion and the abundance of compensatory circulation had effect on the therapy.
