Significantly reduced function of T cells in patients with acute arterial thrombosis

Objectives To explore the intrinsic factors related to the pathogenesis of acute arterial thrombosis （AAT） and to elucidate the patho- genesis of AAT on the basis of differentially expressed genes. Methods Patients with acute myocardial infarction （AMI）, stable angina （SA） and healthy controls （n = 20 per group） were recruited, and the whole human genome microarray analysis was performed to detect the differentially expressed genes among these subjects. Results Patients with AMI had disease-specific gene expression pattern. Biological functional analysis showed the function of T cells was significantly reduced, the mitochondrial metabolism significantly decreased, the ion metabolism was abnormal, the cell apoptosis and inflammatory reaction increased, the phagocytosis elevated, the neutrophil-mediated immunity increased and the post-traumatic repair of cells and tissues increased in AMI patients. The biological function in SA group and healthy controis remained stable and was comparable. Conclusions The reduced function ofT cell gene models in AAT showed the dysfunction of the immune system. The pathogenesis of AAT may be related to the inflammatory reaction after arterial intima infection caused by potential pathogenic microorganisms.

Meta-analysis of the impact of hyperuricemia on contrast agent-related acute kidney injury after percutaneous coronary intervention

Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases,and publish articles on the correlation between hyperuricemia and contrast agent-related acute kidney damage after percutaneous coronary intervention from the establishment of the database to August 162023.Two researchers independently conducted literature screening and data extraction to evaluate the bias risk of inclusion in the study,and conducted metaanalysis using Review Manager 5.4 software.Results:A total of 12 articles were included,including 11676 patients.The meta-analysis results showed that compared with patients without hyperuricemia,patients with hyperuricemia had a higher risk of developing PC-AKI,with an incidence rate of 22.3%.Hyperuricemia was a risk factor for the occurrence of PCAKI(OR=2.03,95%CI:1.58-2.61);Patients with hyperuricemia have a higher risk of death after PC-AKI,with a mortality rate of 7.5%.Hyperuricemia is a risk factor for early death in PC-AKI patients(OR=2.33,95%CI:1.81-3.00);The probability of CRRT treatment after PCAKI in patients with hyperuricemia is higher,at 3.14%.Hyperuricemia is an influencing factor for CRRT treatment in PC-AKI patients(OR=7,95%CI:2.83-17.30).Conclusion:Existing research evidence suggests that the presence of hyperuricemia is an independent risk factor for the occurrence of PC-AKI,and it significantly increases the hospital mortality rate and the risk of renal replacement therapy in PC-AKI patients.

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Multidisciplinary management of acute mesenteric ischemia:Surgery and endovascular intervention

Acute mesenteric ischemia(AMI)is a rare cause of the“acute abdomen”,characterized by impaired blood flow to the intestine.The principle of treatment is restoration of perfusion to ischemic bowel and resection of any necrotic intestine.Surgery and endovascular intervention are two complementary approaches to mesenteric ischemia.Endovascular intervention is not an alternative to the surgical approach,but it has the potential to improve the prognosis of patients with AMI when judiciously combined with a surgical approach.Due to the need for emergent treatment of patients with acute mesenteric ischemia,the treatment strategy needs to be modified for each facility.This review aims to highlight cutting-edge studies and provide reasonable treatment strategies for patients with acute mesenteric ischemia based on available evidence.

Coronary Artery Perforation Complicated With Acute Aortic Valve Regurgitation During Percutaneous Coronary Intervention:Report of Two Cases

CORONARY artery perforation catastrophic complication （CAP） is a rare, of percutaneous coronary intervention （PCI）. CAP during PCI procedure is invariably associated with high riskpatients with complex coronary artery disease such as coronary calcified lesions, multi-vessel lesions, coronary chronic total occlusion and so on,

Relationship between interleukin-18 levels and characterization of atherosclerotic plaque and percutaneous coronary intervention

Background lnterleuldn-18(IL-18)plays a key role in the development,progression and outcome of coronary artery disease and its complications.However,its variability relation to the characterization of atherosclerotic plaque and percutaneous coronary intervention are still unknown.Methods Fifty four patients with coronary artery disease[22 patients with stable angina(SA)and 32 patients with acute coronary syndrome(ACS)]were enrolled in this study.All patients underwent percutaneous coronary intervention(PCI).The stability of the plaques at the criminal vessels was assessed with analogical IVUS.Serum IL-18 levels were measured at the time points of 5 rain before PCI,and Oh,6h,24h and lmonth after PCI in all patients.Results ACS group consisted mainly of lipidic unstable plaques while SA group of fibrous stable plaques.Moreover,compared with those in SA group,eccentricity index(EI)and remodeling index(RI)were significantly higher in ACS group.Positive remodeling was seen in ACS group while negative or no remodeling in SA group.Further,serum IL-18 levels were significantly elevated in patients with ACS than those in SA group before PCI,increased at Oh,6h,24h after PCI(P<0.05)and were not significant different at 1 month after PCI from those before PCI.Conclusions There is significant difference in the composition and structural characteristics of atherosclerotic plaques between ACS and UA groups.PCI triggersd and enhances the inflammatory response in a short time.Serum levels of IL-18 are the predictors of progression of unstable plaque in atherosclerosis.Post-operative complications of PCI might be reduced by inhibiting IL-18.

Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy(DAPT)to reduce stent thrombosis and avoid target lesion failure.The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome,and 6 mo for patients with chronic coronary syndrome or high bleeding risk.The new generation of drug-eluting stents have metallic platforms with thinner struts,associated with significantly less stent thrombosis.Shortened DAPT has been investigated with these stents,with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes.This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations.This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

Novel Biomarkers of Contrast-Induced Kidney Injury after Endovascular Procedures: An Interventional Cardiologists Notion

Modern achievements of interventional cardiology in treatment of coronary heart disease (CHD) have significantly increased frequency of interventions and volume of contrast media (CM). Contrast-induced acute kidney injury (CIAKI) associated with CM administration is determined by 26.5 μmol/l increase in serum creatinine (SCr) within 48 - 72 hours or >?1.5-fold SCr increase versus its known or estimated level in the previous 7 days. Without effective disease management, prevention with early CIAKI risk stratification and cessation of nephrotoxic medications taken by patients are important. Given significant complexity in existing CIAKI treatment, modern therapeutic options are limited only to adequate renal injury prevention. The problem’s significance and diagnostic limitations associated with SCr definition require search for clinically and diagnostically significant AKI biomarkers. In terms of coronarography and percutaneous coronary interventions, several studies have been conducted on clinical and diagnostic significance of some biomarkers. This article characterizes and discloses prospective practical use of neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), cystatin C (CysC) and interleukins-6,8,18 (IL-6,8,18) in interventional cardiology.

Commentary on a case report and literature review of acute carotid stent thrombosis

In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of carotid artery stenting(CAS)represents a rare but potentially catastrophic event.There is a wide range of treatment options available,including carotid endarterectomy,which is generally recommended for cases of refractory ACST.While there is no standard treatment regimen,dual antiplatelet therapy is typically recommended both before and after CAS to reduce risk of ACST.

Mesenteric venous thrombosis in a young adult:A case report and review of the literature

BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infarction cases and is seen predominantly in older adults.In younger individuals,MVT is uncommon,with 36%of cases having unidentified mechanisms and causes.CASE SUMMARY A 27-year-old man presented to the emergency department on February 29,2024,with a chief complaint of intermittent abdominal pain for 3 day.He was previously in good health.As the abdominal pain was not alleviated by conventional treatment,an abdominal computed tomography(CT)scan was performed,which showed increased density in the portal and mesenteric veins.Further imaging,including portal vein ultrasound,mesenteric CT angiography,and enhanced abdominal CT,revealed widespread thrombosis of the portal vein system(including the main portal vein,left and right branches,proximal mesenteric vein,and splenic vein).After 10 day of thrombectomy and anticoagulation therapy,the patient’s abdominal pain had improved significantly.Follow-up assessments indicated that portal venous blood flow had largely returned to normal.He was discharged on March 9,2024.During a follow-up exam 2 months later,repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain,to prevent misdiagnosis of this fatal condition.

Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A Case Report of Acute Arterial Embolization of Right Lower Extremity As the Initial Presentation of Nephrotic Syndrome with Minimal Changes

THROMBOEMBOLISM is a well-known complicationof nephrotic syndrome. Deep vein thrombosis,pulmonary embolism and renal vein thrombosisare the most common venous thromboembolicdiseases in patients with nephrotic syndrome, while arterialthromboembolic complications are observed less frequently,and rarely when it occurs before the diagnosis of nephroticsyndrome.1 Here we report a case with minimal change ofnephrotic syndrome who presented initially as external iliacartery thrombosis, which may be associated with longsitting while playing Mah-Jong.

Acute carotid stent thrombosis:A case report and literature review

BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the literature,and investigate risk factors and management strategies for ACST.CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS.Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020.The demographic data,risk factors,treatment strategies,and prognosis were extracted and analyzed.CONCLUSION The reason for ACST is multifactorial.Proper patient selection,normative antiplatelet treatment,and perfect technical detail may decrease the incidence of ACST.Several treatment strategies such as thrombolysis,mechanical thrombectomy,and open surgery may be options for the treatment of ACST.Limited data have shown that carotid endarterectomy is effective with favorable results.

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

BACKGROUND Gastric submucosal arterial collaterals(GSAC)secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach.CASE SUMMARY A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis.Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels.In order to characterize the fundic lesion,pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis(SAT)and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus.GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization(TAE).CONCLUSION This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.

急性肠系膜缺血血管内治疗的研究进展

虽然急性肠系膜缺血(AMI)的发生率较低,但其致死率较高。AMI的常见分型包括急性肠系膜上动脉栓塞、急性肠系膜上动脉血栓形成和急性肠系膜静脉血栓形成。目前,血管内治疗是AMI的有效治疗策略之一,针对不同类型的AMI可选择不同的血管内治疗方式,包括血管内机械取栓、动脉内置管溶栓及联合策略。本文针对近些年AMI血管内治疗的相关进展进行综述,并分析存在的问题。

急性心肌梗死冠脉介入治疗前TyG及心率变异性的监测价值及预后影响因素分析

目的 探讨急性心肌梗死(AMI)冠脉介入治疗前后甘油三酯葡萄糖指数(TyG)及心率变异性的监测价值及预后影响因素。方法 选取2020年3月到2023年3月佳木斯市中心医院收治的90例AMI患者进行回顾性分析,所有患者均采取冠脉介入治疗,对所有患者进行1年门诊复查随访,分析其治疗情况及预后,并对比其治疗前后TyG及心率变异性变化,建立受试者操作特征(ROC)曲线,分析治疗后TyG及心率变异性指标对AMI后不良心血管事件的诊断价值。随后将术后1年发生心血管不良事件的20例患者分为预后不良组,其余为预后良好组。多因素Logistics回归分析影响AMI介入治疗预后的因素。结果 90例AMI患者27例行急诊PCI,63例行择期PCI,单支血管病变患者42例,2支及以上48例,通过对患者进行1年随访,20例患者发生不良心血管事件。治疗后TyG为7.28±1.49,低于治疗前,治疗后全程相邻R-R间期差值均方根值(rMSSD)、全部正常窦性心搏R-R间期标准差(SDNN)及5 min心搏间期均值标准差(SDANN)分别为(37.62±6.24) ms、(120.51±12.37) ms、(126.62±16.66) ms,均高于治疗前,差异均有统计学意义(P<0.05)。TyG联合心率变异性指标的诊断敏感度为71.57%,特异度为83.56%,联合诊断明显高于单一指标诊断;预后良好组与预后不良组患者性别、体重指数、饮酒史、PCI治疗时机、左心室射血分数、预后危险(TIMI)评分比较,差异均无统计学意义(P>0.05),预后良好组与预后不良组患者年龄、发病到PCI时间、合并基础疾病、Killip心功能分级、吸烟史、冠脉病变支数、TIMI评分、TyG、rMSSD、SDNN、SDANN比较,差异均有统计学意义(P<0.05)。结果显示,年龄、发病到PCI时间、Killip心功能分级、TyG、rMSSD、SDNN、SDANN是影响AMI介入治疗预后的独立危险因素(P<0.05)。结论 AMI采取冠脉介入治疗术后1年不良心血管事件发生率达22.22%,通过冠脉介入治疗可降低患者机体TyG水平,改善心率变异性;治疗后采用TyG联合心率变异性指标和提升对不良心血管事件的诊断价值;进一步分析发现,年龄、发病到PCI时间、Killip心功能分级、TyG及心率变异性为其预后不良的影响因素。

人文关怀在急性心肌梗死经鼻烟壶动脉途径行PCI术患者不良情绪及睡眠质量的影响

目的:分析人文关怀在急性心肌梗死经鼻烟壶动脉途径行经皮冠状动脉介入治疗(PCI)术患者不良情绪及睡眠质量的影响。方法:选取厦门大学附属第一医院经鼻烟壶动脉途径行PCI术治疗的急性心肌梗死患者96例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组48例。对照组采用常规护理,观察组配合人文关怀护理,比较2组心肌梗死患者的恢复结果。结果:护理后,观察组心肌梗死患者焦虑、抑郁情绪程度较对照组明显更低,睡眠状况则较对照组更佳,且观察组严重心律失常、心绞痛、非致死性心肌梗死等心脏不良事件也较对照组更少(P<0.05)。结论:人文关怀在急性心肌梗死患者经鼻烟壶动脉途径行PCI术可显著提高睡眠质量。

冠心病进展相关基因筛选及冠心Ⅱ号方干预靶点的预测

目的:探索冠心病疾病进展相关基因,并预测冠心Ⅱ号方防治冠心病的作用靶点。方法:从基因表达综合数据库(GEO)下载急性心肌梗死(AMI)与稳定型冠心病(SCAD)病人转录组表达谱,通过差异表达分析和加权基因共表达网络分析(WGCNA),筛选冠心病疾病进展相关基因,并针对冠心病进展相关基因进行基因本体(GO)功能分析与京都基因与基因组百科全书(KEGG)通路富集分析。从中药系统药理学数据库与分析平台(TCMSP)数据库下载冠心Ⅱ号方的有效成分及药效靶点,与冠心病疾病进展相关基因进行交集分析,获得冠心Ⅱ号方防治冠心病的潜在靶点。结果:通过差异表达分析比较AMI和SCAD转录组表达谱,共获得166个差异表达基因(DEGs)。通过WGCNA获得与AMI相关的基因模块Black。取DEGs与Black模块的交集,获得64个冠心病疾病进展相关基因。从TCMSP数据库共获得224个冠心Ⅱ号方的药效靶点,将药效靶点与冠心病疾病进展相关基因取交集,得到冠心Ⅱ号方防治冠心病的潜在作用靶点,即过氧化物酶体增殖物激活受体(PPARG)、单核细胞分化抗原CD14(CD14)和细胞色素P4501b1(CYP1B1)。结论:细胞因子信号转导抑制因子3(SOCS3)、嗜酸性粒细胞阳离子相关蛋白(ECRP)、肿瘤坏死因子受体超家族成员10D(TNFRSF10D)、S100钙结蛋白A9(S100A9)等64个基因可能与冠心病疾病进展相关,其中,PPARG、CD14、CYP1B1是冠心Ⅱ号方防治冠心病的潜在作用靶点。

Hepatic artery complications after orthotopic liver transplantation： interventional treatment or retransplantation？

Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation （OLT） include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT. Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis （HAT） and hepatic artery stenosis （HAS） between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement. Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion. Conclusions Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.

两种经皮机械血栓清除方式对急性下肢缺血的疗效与安全性研究

目的比较两种经皮机械血栓清除方式(Rotarex机械血栓切除和Angiojet机械血栓抽吸)对急性下肢缺血的临床疗效及安全性差异。方法回顾性选取2020年2月至2023年2月浙江省台州医院血管外科收治并行机械血栓清除治疗的急性下肢缺血患者98例,其中采用机械血栓切除术38例(Rotarex组),机械血栓抽吸术60例(Angiojet组)。收集两组患者基线资料,比较两组手术技术成功率等临床疗效指标、并发症情况等安全性评估指标。结果两组患者缺血原因、缺血程度、发病时间等基线资料比较差异均无统计学意义(均P>0.05)。Rotarex组患者手术技术成功率为100.00%,Angiojet组为98.33%。Rotarex组血栓清除后残存狭窄[(46.18±12.97)%比(54.25±14.67)%]、支架置入率(47.37%比73.33%)、踝肱指数改善值[(0.67±0.10)比(0.63±0.11)]、术后住院天数[5(3,6)d比7(5.5,8.5)d]均优于Angiojet组(均P<0.05)。两组患者缺血症状改善情况、30 d内截肢率、30 d内再次手术率比较差异均无统计学意义(均P>0.05)。与术前比较,Angiojet组患者术后WBC、中性粒细胞/淋巴细胞计数比值、CRP升高(均P<0.05),而Hb下降(P<0.05)。两组患者围术期肝肾功能、Fib、D-二聚体指标和并发症发生情况比较差异均无统计学意义(均P>0.05)。结论Rotarex机械血栓切除和Angiojet机械血栓抽吸这两种方式对急性下肢缺血均有良好的疗效及安全性,但Rotarex系统相对更具疗效优势,血栓清除效率更佳,且对内环境影响更小,安全性更高。