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Objective To evaluate the application value of ultrasound-guided suprainguinal iliaca fascia block combined with general anesthesia with laryngeal mask in elderly patients undergoing surgery for the great saphenous varicose veins. Methods Sixty elderly patients scheduled for unilateral high ligation and stripping of the great saphenous veins combined with endovenous laser ablation were randomly divided into Group A (general anesthesia with laryngeal mask alone, n = 30) and Group B (ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask, n = 30) . Intraoperative anesthetic consumption, hemodynamic fluctuations, and laryngeal mask removal time were recorded. Postoperative changes in static and dynamic Visual Analogue Scale (VAS) pain scores, 15-item Quality of Recovery (QoR-15) scores, Mini-Mental State Examination (MMSE) scores, and adverse events were also evaluated. Results The QoR-15 and MMSE scores at postoperative 24 h in Group B were significantly higher than those in Group A (both P < 0.05) . The mean arterial pressure (MAP) and heart rate (HR) during skin incision in Group A were significantly higher than those in Group B (both P < 0.05) . The static and dynamic VAS pain scores at postoperative 5 min, 30 min, 6 h, and 12 h in Group B were significantly lower compared to those in Group A (all P < 0.05) . In Group B, the consumption of propofol and remifentanil was significantly less, and the laryngeal mask removal time was significantly shorter than those in Group A, with statistically significant differences (both P < 0.05) . Conclusion Ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask improves postoperative quality of recovery and cognitive function, reduces anesthetic consumption, shortens extubation time, enhances hemodynamic stability and alleviates postoperative pain, thereby promoting rapid recovery. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy and advantages of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms. Methods A total of 9 patients with complex intracranial aneurysms who underwent intracranial-intracranial bypass in Xiangya Hospital of Central South University from February 2014 to May 2020 were included, and were treated with grafts bypass or reimplantation of recipient arteries. All cases underwent CTA or DSA to detect the patent of grafts, whether aneurysms were completely clipped or resected and aneurysms recurrence occurred during the follow-up. Modified Rankin Scale (mRS) was used to evaluate the neurological prognosis at discharge and during the follow - up. Results Radial artery (RA) or great saphenous vein (GSV) was used for interposition in 4 cases, and recipient arteries were used for reimplantation in 5 cases. Of 4 cases of interposition, the cavernous sinus seoment of internal carotid artery (ICA)-GSV-ICA bypass was adopted in one case, middle cerebral artery (MCA) M2-RA-M2 bypass in one case, anterior cerebral artery (ACA) A3-GSV-A3 bypass in one case, posterior cerebral artery (PCA) P2 -RA -P2 bypass in one case. Of 5 cases of reimplantation, MCA M2 inferior trunk was reimplanted to M2 superior trunk in one case, ACA A3 was reimplanted to contralateral A3 in 2 cases, the posterior inferior cerebellar artery (PICA) was reimplanted to the anterior inferior cerebellar artery (AICA) in 2 cases. CTA in 3 d postoperatively showed all cases grafts were patent and aneurysms disappeared. After 3 months of discharge, 2 were lost to follow-up. The other 7 cases kept the patency of grafts and no new aneurysms, and were constantly followed up, with an average follow-up time of 30.71 months, and mRS score was 1 or lower. Conclusions Intracranial - intracranial bypass can be applied for complex intracranial aneurysms that are difficult for conventional surgical treatment to solve. Compared with extracranial - intracranial bypass, its grafts are shorter and its hemodynamics features are more in line with physiological conditions.

Objective To explore the efficacy and advantages of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms. Methods A total of 9 patients with complex intracranial aneurysms who underwent intracranial-intracranial bypass in Xiangya Hospital of Central South University from February 2014 to May 2020 were included, and were treated with grafts bypass or reimplantation of recipient arteries. All cases underwent CTA or DSA to detect the patent of grafts, whether aneurysms were completely clipped or resected and aneurysms recurrence occurred during the follow-up. Modified Rankin Scale (mRS) was used to evaluate the neurological prognosis at discharge and during the follow - up. Results Radial artery (RA) or great saphenous vein (GSV) was used for interposition in 4 cases, and recipient arteries were used for reimplantation in 5 cases. Of 4 cases of interposition, the cavernous sinus seoment of internal carotid artery (ICA)-GSV-ICA bypass was adopted in one case, middle cerebral artery (MCA) M2-RA-M2 bypass in one case, anterior cerebral artery (ACA) A3-GSV-A3 bypass in one case, posterior cerebral artery (PCA) P2 - RA - P2 bypass in one case. Of 5 cases of reimplantation, MCA M2 inferior trunk was reimplanted to M2 superior trunk in one case, ACA A3 was reimplanted to contralateral A3 in 2 cases, the posterior inferior cerebellar artery (PICA) was reimplanted to the anterior inferior cerebellar artery (AICA) in 2 cases. CTA in 3 d postoperatively showed all cases grafts were patent and aneurysms disappeared. After 3 months of discharge, 2 were lost to follow-up. The other 7 cases kept the patency of grafts and no new aneurysms, and were constantly followed up, with an average follow-up time of 30.71 months, and mRS score was 1 or lower. Conclusions Intracranial-intracranial bypass can be applied for complex intracranial aneurysms that are difficult for conventional surgical treatment to solve. Compared with extracranial - intracranial bypass, its grafts are shorter and its hemodynamics features are more in line with physiological conditions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the early clinical outcomes of no-touch harvesting technique and conventional harvesting technique applied to off⁃pump coronary artery bypass grafting. Methods: The clinical data of 120 patients who underwent off ⁃pump coronary artery bypass grafting from July 2020 to July 2022 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed, of which 50 cases used no⁃touch harvesting technique (No⁃touch group) and 70 cases used conventional harvesting technique (CVH group). Observation indexes included operation time, number of vein graft, average flow rate of vein graft, ventilation time, ICU stay, postoperative complications such as poor healing of leg wound and postoperative acute kidney injury, as well as echocardiographic indexes and coronary CT angiography results after 1 year of follow⁃up. Results: There was no statistically significant difference in operation time, number of vein graft, average flow rate of vein graft, ventilation time and ICU stay between the two groups (P > 0.05). In the No⁃touch group, there were 5 cases of intra⁃aortic balloon pump (IABP) support, 2 cases of poor healing of leg wound, and 1 case of postoperative cardiac event. In the CVH group, there were 2 cases of postoperative IABP support and 1 case of postoperative acute kidney injury. There were no cases of reoperation and reintubation in the two groups, and the difference in the incidence of postoperative complications was not statistically significant (P > 0.05). There was no statistically significant difference in the postoperative echocardiographic indexes between the two groups at 1 year after surgery (P > 0.05). The rate of vein graft occlusion in the No⁃touch group was lower than that in the CVH group at 1 year after surgery, and the difference between the two groups was statistically significant (P < 0.05). Conclusion: Compcued with conventional harvesting technique, the use of no-touch harvesting technique for saphenous vein harvesting in off-pump coronary artery bypass grafting does not increase the surgical risk, and the patency rate of vein graft is high at 1 year after surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect and safety of ultrasonic endovascular laser ablation combined with spot stripping in the treatment of great saphenous vein varicose. Methods: A total of 140 patients with saphenous varicose veins admitted to the Department of Vascular Surgery of our hospital from January 2019 to December 2021 were selected as the research objects. All patients were grouped according to the odd and even numbers of hospitalization numbers, and divided into a combination group and a control group, with 70 cases in each group. The control group was treated with conventional high ligation combined with stripping, and the combined group was treated with ultrasonic intracavitary laser ablation combined with point stripping. The surgical indicators, clinical curative effect, preoperative and postoperative changes of lower extremity deep venous valve function and the incidence of postoperative complications were compared between the two groups. Results: The operation time in the combined group was higher than that in the control group, and the amount of intraoperative blood loss, number of incisions and hospital stay were lower than those in the control group (P<0.05); there was a significant difference in the distribution of clinical efficacy between the two groups, and the combination group had a significant effect. Compared with the control group (P<0.05); 3 months after operation, the VCT of both groups was shortened, and Vmax was increased, and the VCT of the combination group was shorter than that of the control group 3 months after operation, and the Vmax was higher than that of the control group (P<0.05 ); postoperative complications in the combination group were lower than those in the control group (P<0.05). Conclusion: Ultrasonic intracavitary laser ablation combined with spot stripping for patients with varicose veins has better curative effect than conventional surgery, and can significantly improve the venous valve function of the lower extremities, with high safety. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the correlation between optimal placement depth (OPD) and physical measurement parameters in preterm infants receiving placement of peripherally inserted central catheter (PICC) through the great saphenous vein (GSV), and to establish a predictive formula for OPD during the placement of PICC through the GSV., Methods: A retrospective analysis was performed for the preterm infants who received the placement of PICC through the GSV in the Neonatal Intensive Care Unit of the Third Xiangya Hospital of Central South University from December 2022 to February 2024. According to the site of puncture [GSV of the knee joint (KJ) or the ankle joint (AJ)], they were divided into a GSV-KJ placement group ( n =38) and a GSV-AJ placement group ( n =33). The infants were measured in terms of body weight (BW), body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference at the time of placement. The Pearson correlation analysis was used to investigate the correlation between the above variables and OPD. A predictive formula was established for OPD in the placement of PICC via the GSV in preterm infants, and the predicted residual between the predicted depth and the ideal OPD was compared between the conventional predictive formula and the new predictive formula., Results: The Pearson correlation analysis showed that PICC OPD was significantly positively correlated with BW, body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference in both the GSV-KJ placement group and GSV-AJ placement group ( P <0.05), with the highest degree of correlation between OPD and BW. The univariate linear regression analysis showed a linear relationship between PICC OPD and BW in both groups. The predictive formulas for OPD were as follows: GSV-KJ PICC OPD (cm) = 13.1 + 2.7 × BW (kg) and GSV-AJ PICC OPD (cm) = 13.4 + 6.0 × BW (kg), and the new predictive formulas had a significantly lower predicted residual than the conventional predictive formula ( P <0.05)., Conclusions: OPD for PICC through the GSV is positively correlated with BW, and the prediction results of the new predictive formula based on BW are closer to the ideal OPD.

Objective: To investigate the clinical efficacy and safety of ultrasound-guided radiofrequency endovenous obliteration (RFO) combined with point-type stripping in the treatment of varicose veins of lower extremity. Methods: 320 patients (320 limbs) with varicose veins of lower extremities treated in the First Affiliated Hospital of Harbin Medical University from October 2017 to October 2018 were randomly divided into the observation group (200 patients) and the control group (120 patients). 200 patients(200 limbs) from the observation group were treated by ultrasound-guided radiofrequency endovenous obliteration combined with point-type stripping, while 120 patients (120 limbs) from the control group were treated by traditional methods of high ligation stripping saphenous vein combined with point-type stripping. Several clinical features were compared between the two groups, including average hospitalization time, postoperative complications and follow-up of ultrasound of lower extremity veins after a year. Results: The observation group showed shorter hospital stay, less postoperative skin ecchymosis, less subcutaneous hematoma, less damage to the saphenous nerve and less incision infection compared with the control group(P<0.05). However, there was no statistically significant difference (P＞0.05) in the recurrence rate and occlusion of main saphenous vein after 1 year during the follow-up between the two groups. Conclusion: Compared with the traditional methods of high ligation stripping saphenous vein combined with point-type stripping, ultrasound-guided radiofrequency endovenous obliteration combined with point-type stripping is more effective and safer in the treatment of varicose veins of lower extremity, which is beneficial to the postoperative rehabilitation of patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical effect of high ligation of great saphenous vein combined with point stripping in the treatment of varicose great saphenous vein, and to explore its influence on the recurrence and stress response of patients after operation. Methods: A total of 200 patients with varicose great saphenous vein, who were admitted to the First Affiliated Hospital of Xinjiang Medical University from September 2014 to June 2017, were selected and were randomly divided into control group (100 cases) and study group (100 cases). The control group was treated with high ligation of great saphenous vein combined with traditional stripping. The study group was treated with high ligation of great saphenous vein combined with point stripping. The clinical efficacy of the two groups was compared 4 weeks after operation. The operation time, hospitalization time, time to get out of bed and amount of bleeding during the operation were recorded and compared between the two groups. The changes of stress response indexes before operation and 3 days after operation were compared between the two groups. Complications and recurrence were observed in the two groups. Results: The total effective rate of the study group was 97.00% 4 weeks after operation, which was significantly higher than that(76.00%) of the control group (P<0.05). The operation time, hospitalization time and out of bed activity time in the study group were shorter than those in the control group, and the amount of bleeding during the operation was less than that in the control group(P<0.05). The levels of interleukin-6 (IL-6), tumor necrosis factor-琢(TNF-琢) and nitric oxide (NO) in the two groups increased 3 days after operation, but the above indexes in the study group were lower than those in the control group (P<0.05). The total incidence and recurrence rate of complications in the study group were lower than those in the control group (P<0.05). Conclusion: High ligation of great saphenous vein combined with point stripping is effective in the treatment of varicose great saphenous vein. It can promote the recovery of patients, reduce the recurrence rate of patients, with small stress response of the body, good safety, and certain clinical application value. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of Catheter-Directed Thrombolysis (CDT) in the treatment of mixed deep venous thrombosis(DVT) via the Below the Knee(BTK) access. Methods: The clinical data of patients with acute mixed DVT treated with CDT by the BTK access in the department of interventional radiology, Xuzhou Cancer Hospital from January 2013 to October 2017 were retrospectively analyzed. The patients included 26 males and 12 females with an average age of 54± 11 years old. Results: The technical success rate was 100%. Interventional procedures were performed through small saphenous vein puncture (28 cases), small saphenous vein incision(4 cases), posterior tibial vein incision (4 cases), and posterior tibial vein puncture (2 cases). All CDTs were implanted with a temporarily recyclable filter preoperatively and removed within 2 weeks after surgery. Thirty-six patients achieved successful thrombolysis(Grades II and III). Two patients who did not gain thrombolytic success had a time of more than 10 days from symptom onset to CDT. 13 patients (10 cases on the left and 3 cases on the right) underwent balloon dilatation and stent implantation. During perioperative period, there were 4 cases of incision bleeding, 5 cases of numbness at the incision site, and no major complications such as new pulmonary embolism and major hemorrhage. The average follow-up time was 2 years (1 month to 4years) and 28 patients exceeded 1.5 years. Two patients had repeated patellae DVT due to not taking warfarin. The patency rate and PTS rate during follow-up were 81.6%(31/38) and 31.6%(12/38), respectively. Conclusion: The use of CDT via BTK approach in DVT is feasible and safe and may be considered an alternative to traditional CDT approach. [ABSTRACT FROM AUTHOR]

Objective To establish a sensitive method for determination of concentration of lamotrigine (LTG) in rat plasma and to study the pharmacokinetics by LC-MS/MS. Methods 12 rats were divided evenly into model group and shame-operated group. LTG was given as single dose of 10 mg/kg via intragastrical administration. Blood samples were collected from orbital saphenous venous plexus at 5 min,0.25,0.5,1,2,4,6,8,12,24 and 36 h after dosing. The LTG concentrations in rat plasma were assayed by LC-MS/MS. The pharmacokinetic parameters were calculated by DAS software. Results In shame-operated group,cmax (1 382.87±61.17) μg/L,t1/2 (40.43±6.77) h; AUC0-∞(123.45±70.70) mg·h/L. In model group, cmax(1 713.50±65.11) μg/L, t1/2(73.72±17.46) h, AUC0-∞(188.15±76.37) mg·h/L. Conclusion The method is proved to be suitable for the determination of LTG in rat plasma. LTG concentration reached peak value at 2 h in both groups. However, model group had a longer t1/2 and higher concentration than that in shame-operated group, which is a valuable information for further pharmacodynamics study. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical efficacy and advantages of laparoscopic inguinal lymphadenectomy (IL) with preservation of the great saphenous vein through subcutaneous approach via umbilical cord for the treatment of penile carcinoma patients., Methods: The data of 27 patients with penile cancer underwent the laparoscopic inguinal lymph adenectomy with preservation of the great saphenous vein through subcutaneous via umbilical cord approach in the General Hospital of Eastern Theater Command from 2014 May to 2022 May were analyzed retrospectively.All patients underwent partial penile resection, with a pathological diagnosis of squamous cell carcinoma and 20 cases were highly differentiated, 7 cases were moderately differentiated, with the average age was 54 ± 7.5 years old. All patients were in supine position, and a subcutaneous space was established under visualization to establish a laparoscopic operation channel. The scope of cleaning included the superficial and deep inguinal lymph nodes, while the key aspects of the procedure was the preservation of the main trunk of the great saphenous vein. The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20cm lower, the inner boundary was pubic tubercle and its 15cm medical lower measurement, and the line between the inner boundary and the external lower edge was the lower boundary., Result: All the 27 patients were successfully completed without transfer to open surgery. The average operation time was (115 ± 26) minutes, the average blood loss during operation was (40 ± 8) ml, postoperative hospital stays was (6.8 ± 1.5) days, and postoperative drainage tube removal time was (6.4 ± 1.2) days. The average number of lymph nodes was 12.5 (5-21) on the left side, and 11.4 (2-19) on the right side. No skin necrosis and subcutaneous hematoma was occurred in all patients. Three patients had postoperative lymphatic leakage and two patients had lymphatic cysts. All patients were cured by conservation treatment. No recurrence and metastasis were occurred during 14-28 months follow up postoperatively. Conclusion： Laparoscopic inguinal lymphadenectomy with preservation of the great saphenous vein through subcutaneous approach via umbilical cord can achieve the expected surgical outcome. It has some advantages of shorter operation time, less blood loss，low incidence of complication ,especially avoid skin flap necrosis and subcutaneous hematoma．.

Objective To summarize the clinical experience, operation indicators and curative effect of 142 cases of coronary artery bypass grafting (CABG) surgery. Methods We retrospectively analyzed the clinical data of 142 cases of CABG from January 2012 to July 2013 in the Department of Cardiovascular Surgery of Affiliated Yan 'an Hospital of Kunming Medical University. The patients included 92 cases of male, 50 cases of female, aged 24 to 78 years old, average (59.5 ± 5.8) gears. Surgery was performed within the thoracic artery on the left of the left anterior descending branch and right coronary artery and convolution using great saphenous vein arterial anastomosis, treatment of valvular disease and aneurysm at same period, the average bypass 3.89/person. Results Two patients died after the operation, the motality rate was 1.41%. Postoperative complications included low cardiac arrhythmia, cardiac, renal insufficiency, respiratory failure, cerebral infarction/cerebral hemorrhage, open chest again stop bleeding, poor healing of incision, the incidence was 11.2%. The hospital total cost was (68.9 ± 23.4) thousand yuan per patient, the postoperative follow-up time was (8.9 ± 8.9) months, the follow-up rate was 96%, the postoperative patients were reviewed by echocardiography, suggesting left ventricular end-diastolic diameter and left ventricular ejection fraction were improved by different degrees. Conclusion Application of the mulitivessel transplantation methods can reduce the surgical mortality improve the cardiac function and decrease the hospital costs of patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities. Methods: A total of 214 patients with primary varicose veins of the lower extremities in the First Affiliated Hospital of Sun Yat-sen University from January 2017 to November 2019 were included and divided into microwave ablation group ( n =128) and high ligation with microwave ablation group ( n =86) according to surgical approach. Further subgroups including subgroup S (diameter<10 mm) and subgroup L (diameter≥10 mm) were established. The surgical success rate, postoperative incidence and recovery of local skin numbness and ecchymosis, and the postoperative recovery of active skin ulcer were compared between the two groups and subgroups. Results: The surgical success rate was 96% (136/141) in microwave ablation group, 100% in subgroup S (116/116), and 80% in subgroup L (20/25), respectively. In addition, the surgical success rate in high ligation with microwave ablation group, subgroup S, and subgroup L was all 100% (90/90, 73/73, and 17/17). In subgroup L of microwave ablation group, the diameter of 5 great saphenous veins in patients who failed the microwave ablation was 13.0-17.1 mm. The mean follow-up time was (24±4) months in microwave ablation group and (36±6) months in high ligation with microwave ablation group, respectively. In the microwave ablation group and high ligation with microwave ablation group, the incidence of postoperative skin numbness was 15.6% and 14.4%, respectively, and the incidence of skin ecchymosis was 5.7% and 3.3%, respectively, with no statistically significant difference between the two groups (both P >0.05). The rate of active skin ulcer in the two groups was 6.4% and 15.6%, respectively, and the difference was statistically significant ( P =0.020). Local skin ecchymosis in the two groups recovered within 1 month after operation. Local skin numbness in both groups recovered within the maximum 2 years of follow-up, and active skin ulcer in both groups recovered within the maximum 1 years of follow-up. Conclusion: The endovenous microwave ablation is safe and effective, especially combining with high ligation of great saphenous vein. Good follow-up results can be achieved for great saphenous vein with diameter smaller than 10 mm. However, for those with diameter greater than 10 mm, the surgical success rate of endovenous microwave ablation decreases.

Objective: To compare clinical efficacy of interventional treatment with graft vessel and native coronary artery for patients with late saphenous vein grafts disease(SVGD) after coronary artery bypass grafting (CABG). Methods: A total of 1 608 patients underwent CABG in Tianjin Chest from March 2014 to December 2017 were screened. During the follow-up period, 165 hospitalized patients with recurrence of angina pectoris within one year after CABG, who had at least one narrow vein graft(≥50%) confirmed by the coronary angiography were enrolled. According to the results of angiography and surgeon's clinical experiences, the patients received interventional treatment to vein grafts(grafts group, n= 53) or native coronary vessels(native group, n= 112). The operation success rate, mortality and incidence of serious complications after interventional treatment in two groups at the time of hospitalization were compared.And the incidence of major adverse cardiovascular events(MACE) in two groups at one year after discharge were also compared. Kaplan-Meier survival curve was used to compare the cumulative event-free survival rates. The risk factors for the MACE in the patients with late SVGD and treated by interventional therapy were analyzed by Cox regression analysis. Results: A total of 165 patients were included for analysis, including 98 males(59.4%). The age was (64.2±7.1) years old. The follow-up time was 12 (8, 12) months. In the grafts group, operation success rate was 90.57%(48/53), and 3 cases(5.66%) suffered from serious complications after interventional treatment, 2 cases(3.77%) died. For native group the operation success rate was 88.39%(99/112), and 7(6.25%) cases suffered from serious complications after interventional treatment, and no deaths. The operation success rate and the incidences of serious complications after interventional treatment in two groups had no statistically significant difference(both P> 0.05). The mortality in hospital of native group was lower than that in grafts group( P< 0.05). Within 12 months after discharge, there was no statistically significant difference in incidence of MACE of two groups (11.32%(6/53) vs. 10.71%(12/112), P> 0.05). Survival analysis showed that the cumulative event-free survival rates in two groups were 73.58% (39/53) and 66.13%(74/112), and there was no statistically significant difference ( P> 0.05). Cox regression analysis showed acute coronary syndrome ( HR =41.203, 95 %CI 4.859-349.361, P< 0.01), and peripheral vascular diseases ( HR =2.808, 95 %CI 1.067-7.393, P< 0.05) were the risk factors of the MACE for the patients treated by interventional therapy with late SVGD. Conclusion: For the patients with late SVGD after CABG, the success rate of intervention with vein grafts and own coronary vessels are both high with satisfactory safety.The in-hospital mortality of interventional therapy in own coronary vessels is lower than in graft vessel. Patients with acute coronary syndrome and peripheral vascular disease have a poor prognosis.

Objective: To summarize the application of radial artery (RA) as the second arterial graft in coronary artery bypass grafting (CABG). Methods: From January 1, 2015 to June 11, 2019, the clinical data of all patients undergoing CABG in TEDA International Cardiovascular Hospital was retrospectively reviewed. The patients who underwent RA grafting were included. The application of RA, internal mammary artery (IMA) and the saphenous vein, their target vessels, and the operative results were analyzed. Results: A total of 2 901 patients underwent CABG. Of those, 208 patients (7.2%) had RA grafting, with 197 males and 11 females. The average age was (53±8) years old and the average grafts per patient was 3.79. The target vessel for RA was first obtuse marginal (OM, 102 cases), first diagonal (50 cases), right coronary artery (RCA) or posterior descending artery (PDA) (40 cases), intermediate (22 cases), respectively. Among those, 172 were single distal anastomosis with the proximal end anastomosed to the ascending aorta (168 cases), saphenous vein (SV) graft (3 cases) and IMA (1 case). Seventy-two patients accept sequential grafting with the proximal to the ascending aorta (58 cases), SV graft (13 cases) and IMA (1 case). The left IMA was mainly anastomosed to left descending artery (LAD) (188 cases) and diagonal (10 cases). The target vessels for SV were remaining coronary arteries when the IMA and RA were used. The operative time was (5.0±1.5) h. The hospital stay was (17.4±6.4) d. There were 6 cases undergoing exploratory thoracotomy for bleeding (5 cases) or hemodynamic instability due to ventricular arrhythmia (1 case). There was no death. All patients were successfully discharged. Conclusions: Use of the RA and IMA with additional SV for CABG exhibits good results in the Chinese patients. Currently available clinical protocols are effective and safe.

Objective: To investigate the features of plaques of saphenous venous graft (SVG) with virtual histology intravascular ultrasound (VH-IVUS) in patients underwent coronary artery bypass graft surgery. Methods: From March 2016 to March 2018, a total of 45 patients ((64.4±7.9) years old, 88.9% male (40 cases)) with ischemic symptoms after coronary artery bypass graft surgery and with coronary artery angiography evidenced SVG stenosis greater than or equal to 50%, who received percutaneous coronary intervention in Tianjin chest hospital were continuously included in this study, and the clinical data were retrospectively analyzed. VH-IVUS was performed before PCI to analyze plaque composition. The patients were divided into no smoking group (21 cases) and smoking group (24 cases), no diabetes group (30 cases) and diabetes group (15 cases), normal very low density lipoprotein cholesterin (VLDL-C) group (24 cases) and elevated VLDL-C group (21 cases), stable angina pectoris group (5 cases) and acute coronary syndrome group (40 cases), plaque burden (PB) < 70% group (11 cases) and PB ≥ 70% group (34 cases), without thin-cap fibroatheroma group (35 cases) and thin-cap fibroatheroma group (10 cases), and plaque features were compared between different groups. Results: The graft age was (8.9±3.7) years.The stenosis degree of SVG lesions was 90 (90, 98) %. The minimum lumen diameter was 1.6 (1.5, 1.8) mm. The vessel cross-sectional area was (12.1±4.0) mm(2). The plaque area was 8.6 (5.7,12.0) mm(2). The minimum lumen area was 2.5 (2.1,3.3) mm(2). The plaque burden was (75.3±8.3)%. The fibrotic tissue (FI) ratio was (65.1±10.1)%, fibrofatty plaque (FF) ratio was 13.8 (5.4,25.3) %, necrotic core tissue (NC) ratio was 12.0 (5.4,24.0)%, and dense calcium tissue (DC) ratio was1.0 (0.2,3.8)% in SVG lesions. There were no significant differences in SVG plaque area, FI area,FF area,NC area,and DC area between no smoking group and smoking group, no diabetes group and diabetes group, and normal VLDL-C group and elevated VLDL-C group. SVG plaque volume was significantly higher in acute coronary syndrome group than in stable angina pectoris group (262.2 (148.5,401.2) mm(3) vs. 93.1 (50.6,155.9) mm(3), P= 0.006), and plaque area (10.1 (6.6,13.3) mm(2) vs. 5.0 (3.6,6.9) mm(2), P< 0.001), FI area(4.8 (3.2,6.8) mm(2) vs. 2.8 (1.9,3.0) mm(2), P< 0.001),and FF area (1.15 (0.60, 2.07) mm(2) vs. 0.30 (0.10,0.90) mm(2), P= 0.009) were significantly larger in PB ≥ 70% group than in PB < 70% group.The NC area (1.75(0.40,2.78) mm(2) vs. 0.60 (0.20,1.30) mm(2), P= 0.030) and DC area (0.35 (0.10,0.50) mm(2) vs. 0.00 (0.00,0.10) mm(2), P= 0.006) were significantly larger in thin-cap fibroatheroma group than that in without thin-cap fibroatheroma group. Spearman correlation analysis showed that the plaque area of SVG lesion was positively correlated with FF area ( r =0.64, P< 0.001) and NC area ( r =0.43, P= 0.003). PB was positively correlated with FF area ( r =0.50, P< 0.001) and NC area ( r =0.33, P =0.028). Graft age was positively correlated with FF area ( r =0.30, P =0.047). Conclusions: The main components of SVG plaque are fibrotic tissue, conversely, calcified tissue is rare in patients with SVG stenosis after coronary artery bypass graft surgery. Fibrofatty tissue is increased in the plaque in patients with PB ≥ 70%. The necrotic component is also increased in patients with thin-cap fibroatheroma. The fibrofatty component increases and the plaque tends to be unstable in proportion with increaing age of the graft in this patient cohort.

Objective: To evaluated early clinical outcomes of saphenous vein grafts harvested with a No-touch technique in off-pump coronary artery bypass graft (OPCABG) surgery. Methods: A total of 124 patients with three-vessel disease undergoing OPCABG by No-touch technique between June and November 2017 in Beijing An Zhen Hospital were respectively reviewed. Results: The average age of patients was (60.7±10.3) years, and 80 cases (64.5%) were male, with the average body mass index (BMI)of (25.4±2.5) kg/m(2,) the mean preoperative left ventricular ejection fraction (LVEF) of (58.0±7.0%). The operative time was (4.0±0.4) hours, and 16 cases (12.9%) were harvested for whole vein grafts. The number of vein grafts and venous anastomoses was 144 and 284, respectively. There were 16 cases of single bridge NTSVG-LAD, 4 cases of single bridge NTSVG-D, 99 cases of sequential bridge NTSVG-OM-PDA, 5 cases of sequential bridge NTSVG-OM-PLV, 4 cases of sequential bridge NTSVG-OM-RCA, 16 cases of sequential bridge NTSVG-D-OM-PDA. The mean flow volume of No-touch vein grafts was (51.9±2.4) ml/min. There was no death case in hospital. Postoperative re-exploration for hemorrhage of anastomosis happened in 1 case (0.8%), which was caused by pericardial tamponade due to insufficiency of hemostasis in internal mammary bed. There were 1 case of bad wound healing of lower extremity incision (0.8%). A total of 124 cases were followed up after operation, and the follow-up rate was 100%. There was one all-cause death (0.8%) 27 days after the operation. Conclusion: The short-term clinical observation of the application of No-touch great saphenous vein harvesting technique for OPCABG is safe and effective.

Objective: To investigate whether endoscopic saphenous vein harvesting (EVH )reduces leg wound morbidity and improves rehabilitation of lower extremity as compared to open vein harvesting (OVH) in patients with coronary artery disease., Methods: The clinical data of 333 patients who underwent isolated coronary artery bypass graft surgery (CABG) between January 2007 and December 2011 were retrospectively analyzed.These patients were divided into EVH group (n=210) and OVH group (n=123). Parameters including age,sex,with/without diabetes mellitus,leg wound complications rate,postoperative hospital stay,hospitalization expense,and vein graft patency were analyzed., Results: The age,sex,with/without diabetes mellitus were not significantly different between two groups (P>0.05). However,the incidences of leg wound complications, poor wound healing, wound infections, wound pain,wound numbness, and edema of lower extremity were significantly lower in the EVH group than the OVH group (P<0.05). The ecchymoma and deep vein thrombosis incidences were not significantly different between these two groups (P>0.05). The postoperative hospital stay showed no significant difference (P>0.05), while the hospitalization expense was significantly higher in the EVH group than in the OVH group (P<0.05). There was no statistical difference of vein graft patency (P>0.05)., Conclusion: The EVH system is a safe and effective alternative to OVH because it can markedly reduce postoperative leg wound morbidity and the EVH vein graft has good patency.

Objective: To compare the efficacies of endoscopic harvesting saphenous vein as sequential graft by pedicled and scheltoned technique., Methods: From June 2013 to December 2013, a total of 93 patients undergoing coronary artery bypass with endoscopic vein harvesting in shank were recruited. Saphenous veins were harvested by pedicled method in group A (n =46) and scheltoned method in group B (n =47). Harvesting method was decided by a random number for each patient. Saphenous veins were used as sequential grafts during off-pump coronary artery bypass. Inter-group comparisons were made in time for harvesting, time for repairing, venous injuries and perioperative effect of saphenous vein. The postoperative follow-up period was 30 days. Early failure of saphenous vein graft was evaluated with coronary computed tomography (CT) angiography., Results: All saphenous veins in shank were harvested successfully. No significant difference existed in vein length. In groups A and B, average time for harvesting was (21. 7 ± 5. 6) and (27. 4 ± 6. 4) min (P < 0. 05) and time for repairing (7. 2 ± 2. 7) and (10. 6± 4. 4) min respectively (P <0. 05). No severe injury resulted in non-using of saphenous in both groups. The repair rates of saphenous vein were 10. 9% and 38. 3% respectively (P < 0. 05). For each repaired saphenous vein, the average number of locations was (1. 6 ± 0. 5) and (3. 1 ± 1. 0) sites respectively (P < 0. 05). All patients were discharged uneventfully. There was no perioperative onset of myocardial infarction or malignant arrhythmia. For groups A and B, 89. 1% and 93. 6% were followed up for 1 month post-operation. No angina, myocardial infarction or heart failure occurred. For groups A and B, 32 and 37 cases were re-examined on CT coronary angiography and all saphenous vein grafts maintained patency., Conclusions: Pedicled method is more safe and reliable for endoscopic saphenous vein harvesting. It can ensure the quality of sequential graft, shorten harvesting time and reduce the risks of vein injury.

Objective: To explore the effectiveness of a new method to repair severe soft tissue defects of the leg, foot, and ankle with contralateral saphenous neurocutaneous vascular flaps combined with assembly external frisket for fixation in parallel-leg position., Methods: Between August 2009 and August 2013, 29 cases with leg, foot, or ankle wound were treated. There were 18 males and 11 females, with an average age of 37.6 years (range, 11-65 years). The interval of injury and operation was 14-36 days (mean, 22.3 days). The locations were the planta pedis and heel in 5 cases, the dorsal foot in 2 cases, the ankle in 4 cases, middle and lower leg in 14 cases, and upper leg in 4 cases. The area of trauma ranged from 5 cm x 3 cm to 19 cm x 9 cm. The assembly external frisket was used for fixation in parallel-leg position; a bridge flap was transplanted to repair defects, and the area of flap ranged from 6 cm x 4 cm to 22 cm x 11 cm. The donor sites were directly sutured or repaired with skin graft. The pedicle of the bridge flap was cut off and the assembly external frisket was removed after 3-4 weeks., Results: The flaps in all patients survived completely; primary healing of wound and incision at donor site was obtained. The patients were followed up 6-18 months (mean, 13.2 months). The appearance of flaps was satisfactory, and the sensation of the heel recovered. Moreover, the patients had a comfortable feeling, and the ankle and knee joints can move freely, and had good function., Conclusion: The assembly external frisket in parallel-leg position instead of cross-leg can make patients comfortable position, and achieve reliable fixation. The saphenous neurocutaneous vascular flap has the advantages of no need for anastomosis vein and for sacrifice of the main vein. Contralateral saphenous neurocutaneous vascular flap combined with assembly external frisket for fixation in parallel-leg position is a favorite method to repair severe soft tissue defects of the leg, foot, and ankle.

Objective: To review the available data of randomized controlled clinical trials (RCT) to compare endovenous laser therapy (EVLT) with conventional surgery of high ligation and stripping (HL/S) for the treatment of great saphenous varicose veins., Methods: A systematic review of Pubmed, Cochrane Library, Embase, Web of Science, Ovid database, China National Knowledge Infrastructure (CNKI) database and Wanfang database was performed to retrieve RCT studies on the effectiveness of EVLT versus HL/S up to January 1999. The rates of postoperative recurrence at 1 year, 2 years and major complications were analyzed by Review Manager 5.1 software., Results: Eight retrieved RCT studies and 1743 limps were evaluated. The ratios of recurrence were the same for EVLT and HL/S at 1 and 2 years post-operation. For the ratios of major postoperative complications, there was no statistical difference between EVLT and HL/S in thrombosis, wound infection and phlebitis. But EVLT could reduce the ratio of paresthesia., Conclusions: Compared with HL/S, EVLT shows no significant difference in the 1/2-year recurrence rate or the rates of thrombosis, wound infection and phlebitis. However, it can decrease the rate of paresthesia.

Objective: To investigate the clinical value of local regional administration of urokinase and argatroban through small saphenous vein (SSV) catheter in the treatment of acute deep venous thrombosis in the lower limb (LDVT)., Methods: Fifty-six patients with acute LDVT were prospectively randomized into the study group (21 cases, 24 limbs) and control group (35 cases, 36 limbs) for treatment with urokinase and argatroban regionally administered via the SSV catheter and with the same agents given via the peripheral vein, respectively. The patients were examined for changes in serum fibrinogen (FBG) and D-dimer and the perimeter of the affected limbs, and the complications in relation to the agents were observed., Results: By corrected Chi-square test, the incidence of complications was significantly lower in the study group than in the control group (1/21 vs 4/36, χ(2)=1.92, P≤0.05). Wilcoxon's sign rank test suggested no statistically significant difference between the two groups in the total effective rate (95.8% vs 94.4%, V=0.52, P>0.05), but the total excellent rate differed significantly between them (83.3% vs 55.6%, V=2.36, P≤0.05). Serum FBG underwent no significant variations in the study group during thrombolysis (P>0.05), but decreased significantly in the control group (P≤0.05). The decreases in serum D-dimer and perimeter of the affected limbs occurred earlier in the study group than in the control group (P≤0.05)., Conclusion: Regional administration of urokinase and argatroban via small saphenous vein catheter can promote the thrombolytic effect and reduce the risk of hemorrhage in the treatment of LDVT.

Objective: To describe observation of availability of catheter-directed foam sclerotherapy for the great saphenous vein varicosis., Methods: A selective series of 30 patients of vein varicosis were treated with foam sclerotherapy using a standard technique for foam delivery from April 2008 to August 2008. Patients were treated with 1% polidocanol foam through a catheter, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV). All successfully treated patients were examined by colour duplex two weeks after the procedure., Results: Thirty patients with an insufficiency reflux of the GSV were treated with the catheter-directed foam sclerotherapy. Primary technical success was achieved in all the patients. The concentrations (1.0%) and doses (6 to 8 ml) of polidocanol was mainly we used. Five patients experienced transient scotomas and developed segmental phlebitis of a collateral vein. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), a closure of the GSV was found at control visits 2 weeks, 3 months after treatment., Conclusion: The use of an endovascular catheter inserted percutaneously over a guidewire is feasible in most patients and has resulted in high primary occlusion rates.

Objective: To summarize the effectiveness of the improved surgical techniques in fasciocutaneous flaps of the limbs., Methods: From February 1999 to December 2005, 58 patients (39 males, 19 females, aged 10-68 years) underwent repairs of the skin defects with improved fasciaocutaneous flaps of the limbs. Twenty-one patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defects in the heels, 16 patients had the skin defects in the ankles, 3 patients had the skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm x 3 cm to 18 cm x 12 cm. According to the wound locations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenous vein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm x 4 cm to 18 cm x 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin-grafting (6 cm x 3 cm to 13 cmX 6 cm) was performed on 19 patients after the donor wounds were closed., Results: The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The follow-up for 1-20 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory., Conclusion: A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.

Objective: To explore the clinical effect of the lower rotating point super sural neurocutaneous vascular flap on the repair of the soft tissue defects in the ankle and foot., Methods: From May 2001 to February 2006, 24 patients with the soft tissue defects in the ankle and foot were treated with the lower rotating point super sural neurocutaneous vascular flaps. Among the patients, 15 had an injury in a traffic accident, 6 were wringed and rolled by a machine, 1 was frostbited in both feet, 2 were burned, 25 had an exposure of the bone and joint. The disease course varied from 3 days to 22 months; 19 patients began their treatment 3-7 days after the injury and 5 patients were treated by an elective operation. The soft tissue defects ranged in area from 22 cm x 12 cm to 28 cm x 12 cm. The flaps ranged in size from 24 cm x 14 cm to 30 cm x 14 cm, with a range up to the lower region of the popliteal fossa. The rotating point of the flap could be taken in the region 1-5 cm above the lateral malleolar. The donor site was covered by an intermediate thickness skin graft., Results: All the 25 flaps in 24 patients survived with a satisfactory appearance and a good function. The distal skin necrosis occurred in 1 flap, but healing occurred after debridement and intermediate thickness skin grafting. The follow-up for 3 months to 5 years revealed that the patients had a normal gait, the flaps had a good sense and a resistance to wearing, and no ulcer occurred. The two point discrimination of the flap was 5-10 mm., Conclusion: The lower rotating point super sural neurocutaneous vascular flap has a good skin quality, a high survival rate, and a large donor skin area. The grafting is easy, without any sacrifice of the major blood vessel; therefore, it is a good donor flap in repairing a large soft tissue defect in the ankle and foot.

Objective: To investigate the distribution of the perforating branches artery of distally-based flap of sural nerve nutrient vessels and its clinical application., Methods: The origins and distribution of perforating branches artery of distally-based flap were observed on specimens of 30 adult cadaveric low limbs by perfusing red gelatin to dissect the artery. Among the 36 cases, there were 21 males, 15 females. Their ages ranged from 6 to 66, 35. 2 in average. The defect area was 3.5 cm x 2.5 cm to 17.0 cm x 11.0 cm. The flap taken ranged from 4 cm x 3 cm to 18 cm x 12 cm., Results: The perforating branches artery of distally-based flap had 2 to 5 branches and originated from the heel lateral artery, the terminal perforating branches of peroneal artery (diameters were 0.6+/-0.2 mm and 0.8+/-0.2 mm, 1.0 +/- 1.3 cm and 2.8 +/- 1.0 cm to the level of cusp lateral malleolus cusp). The intermuscular septum perforating branches of peroneal artery had 0 to 3 branches. Their rate of presence was 96.7%, 66.7% and 20.0% respectively (the diameters were 0.9 +/- 0.3, 1.0 +/- 0.2 and 0.8 +/- 0.4 mm, and their distances to the level of cusp of lateral malleolus were 5.3 +/- 2.1, 6.8 +/- 2.8 and 7.0 +/- 4.0 cm). Those perforating branches included fascia branches, cutaneous branches, nerve and vein nutrient branches. Those nutrient vessels formed longitudinal vessel chain of sural nerve shaft, vessel chain of vein side and vessel network of deep superficial fascia. The distally-based superficial sural artery island flap was used in 18 cases, all flaps survived., Conclusion: Distally-based sural nerve, small saphenous vein, and nutrient vessels of fascia skin have the same origin. Rotation point of flap is 3.0 cm to the cusp of lateral malleolus, when the distally-based flap is pedicled with the terminal branch of peroneal artery. Rotation point of flap is close to the cusp of lateral malleolus, when the distally-based flap is pedicled with the heel lateral artery.

Objective: To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency., Methods: Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins., Results: Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene)., Conclusion: C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.

Objective: To investigate a new operative method for repairing nonunion and defect of tibia., Methods: First, observe the relation between the joint branches of descending genicular artery and the saphenous branch of descending genicular artery in 10 cadevers. Then the medial femoral condylar bone flap pedicled with the saphenous vessels was prepared in 4 cadavers for simulated purpose. Clinically, two patients with tibial nonunion were treated by transplantation of this pedicled bone flap., Results: In the 4 simulated operations, the ink which was injected into the femoral artery could be released from the joint branches. And in the clinical operation, the area of the pedicled bone flaps were 5.0 cm x 2.0 cm x 1.5 cm and 4.5 cm x 1.5 cm x 1.5 cm respectively. Followed up for 8 to 12 weeks, the fracture unioned well., Conclusion: This operation is simple and reliable, it is characterised by 1. unnecessary to anastomosis the vessels 2. reliable blood supply 3. high quality of bone flap 4. either bone flap or bone-skin flap can be chosen 5. long vessel pedicle.