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World Journal of Clinical Cases 2021年第7期9卷 1755-1760页

作者： Tie-Hao Wang ji-chun zhao Fei Xiong Yi Yang Department of Vascular Surgery Sichuan University West China HospitalChengdu 610000Sichuan ProvinceChina

BACKGROUND Floating thrombus within the thoracic aorta is a rare entity but may cause systemic *** pathogenesis of floating aortic thrombi is not yet fully *** definitive guidelines are available for the management of floating aortic *** SUMMARY We report a 48-year-old patient,without a history of trauma and infection,who presented with sudden severe back pain.A floating thrombus within the aortic arch was found by computed tomography angiography(CTA).No evidence of coagulopathies was ***,with the assistance of a three dimensionalprinted model,this floating thrombus was identified to be caused by occult aortic dissection(AD).Subsequently,an emergency thoracic endovascular repair was *** patient’s back pain was rapidly alleviated *** at 1 year showed no filling defect in the stent-graft and *** Occult AD is a potential factor causing floating aortic thrombi,endovascular stent-graft exclusion may be an optimal therapeutic choice with promising ***,the combination of CTA and three dimensional-printed models can contribute to the diagnosis and treatment of floating aortic thrombi due to occult AD.

关键词： Floating thrombus Thoracic aorta Occult aortic dissection Three dimensional printing Endovascular treatment Case report

Successful endovascular treatment with long-term antibiotic therapy for infectious pseudoaneurysm due to Klebsiella pneumoniae:A case report

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World Journal of Clinical Cases 2020年第24期8卷 6529-6536页

作者： Tie-Hao Wang ji-chun zhao Bin Huang jia-Rong Wang Ding Yuan Department of Vascular Surgery West China HospitalSichuan UniversityChengdu 610000Sichuan ProvinceChina

BACKGROUND Infectious common femoral artery pseudoaneurysm caused by Klebsiellapulmonary infection is a relatively infrequent entity but is potentially life andlimb threatening. The management of infectious pseudoaneurysm *** SUMMARY We reported a 79-year-old man with previous Klebsiella pneumoniae pulmonaryinfection and multiple comorbidities who presented with a progressive pulsatemass at the right groin and with right lower limb pain. Computed tomographyangiography showed a 6 cm × 6 cm × 9 cm pseudoaneurysm of the right commonfemoral artery accompanied by occlusion of the right superficial femoral arteryand deep femoral artery. He underwent endovascular treatment (EVT) withstent–graft, and etiology of infectious pseudoaneurysm was confirmed. Then, 3-mo antibiotic therapy was given. One-year follow-up showed the stent–graft waspatent and complete removal of surrounding *** The femoral artery pseudoaneurysm can be caused by Klebsiella pneumoniaederiving from the pulmonary infection. Moreover, this unusual case highlights theuse of EVT and prolonged antibiotic therapy for infectious pseudoaneurysm.

关键词： Infectious pseudoaneurysm Common femoral artery Klebsiella pneumoniae Antibiotic therapy Endovascular treatment Case report

Ex vivo revascularization of renal artery aneurysms in a patient with solitary kidney: A case report

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World Journal of Clinical Cases 2019年第16期7卷 2401-2405页

作者： Xi-Yang Chen ji-chun zhao Bin Huang Ding Yuan Yi Yang Department of Vascular Surgery West China Hospital of Sichuan University

BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to *** vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular *** choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous *** SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 *** tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal *** patient met the criteria for surgical repair due to symptoms of threatened *** to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was *** the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped *** patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG *** SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.

关键词： Renal artery aneurysm Bypass Ex vivo repair Aneurysmal degeneration Case report

Successful management of infected right iliac pseudoaneurysm caused by penetration of migrated inferior vena cava filter:A case report

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World Journal of Clinical Cases 2021年第30期9卷 9211-9217页

作者： Cheng-Xin Weng Shu-Min Wang Tie-Hao Wang ji-chun zhao Ding Yuan Department of Vascular Surgery West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Indwelling inferior vena cava(IVC)filters might cause various complications,including filter penetration,filter fracture,filter migration,and thrombosis of the *** and migration complications are common,while a caudal migrated double-basket filter with associated infected iliac pseudoaneurysm has seldom been *** SUMMARY We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 *** patient had a history of failed endovascular IVC filter *** tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein,leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis,and bilateral iliac veins were *** open repair was performed to remove the IVC filter,the right iliac pseudoaneurysm,and the compromised segments of the iliac veins and IVC with right common iliac artery *** aureus was isolated from the tissue *** patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after ***-month follow-up computed tomography revealed that the right common iliac artery was patent,and only mild hydronephrosis was *** An indwelling IVC filter,even‘embedded’within organized thrombus,could still cause life-threatening *** procedures remain the last resort for IVC filters with severe complications.

关键词： Inferior vena cava filter Infected pseudoaneurysm Hydronephrosis Filter migration Open repair Antibiotic therapy Case report

Unusual case of digestive hemorrhage: Celiac axis-portal vein arteriovenous fistula

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World Journal of Gastroenterology 2015年第4期21卷 1362-1364页

作者： Yi-Ren Liu Bin Huang Ding Yuan Zhou-Peng Wu ji-chun zhao Department of vascular surgery West China HospitalSichuan University

A case of intractable upper gastrointestinal-hemorrhage was reported in a patient with portal hypertension caused by an arterioportal fistula(APF), namely, celiac axis-portal vein arteriovenous fistula. Portal hypertension caused by extrahepatic-APFs is extremely rare. Trauma, malignancy, and hereditary causes are the common etiology of APFs; but were absent in our patient. Our patient represents an unusualcase of unexplained APF who presented with portal hypertension and was successfully managed through endovascular aortic repair.

关键词： Arterioportal fistula Portal hypertension Endovasc

The pre-Kasai procedure in living donor liver transplantation for children with biliary atresia

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Hepatobiliary & Pancreatic Diseases International 2013年第1期12卷 47-53页

作者： Qiao Wang Lu-Nan Yan Ming-Man Zhang Wen-Tao Wang ji-chun zhao Cong-Lun Pu Ying-Cun Li Quan Kang Liver Transplantation Division Department of SurgeryWest China HospitalSichuan University Department of Hepatobiliary Surgery Children's HospitalChongqing Medical University

BACKGROUND:Biliary atresia(BA) is a major cause of chronic cholestasis,a fatal disorder in *** study was undertaken to evaluate the safety and effectiveness of primary living donor liver transplantation(LDLT) in comparison with the traditional first-line treatment,the Kasai ***:We assessed 28 children with BA at age of less than two years(3-21.3 months) who had undergone LDLT in two hospitals in Southwest China during the period of *** children who had had primary LDLT were included in a primary LDLT group,and ten children who had undergone the Kasai operation in a pre-Kasai *** patients were followed up after discharge from the *** records of the BA patients and donors were ***:The time of follow-up ranged 12-44.5 months with a median of 31 *** 30-day and 1-year survival rates were 85.7% and 78.6%,*** was no significant difference in the 30-day or 1-year survival between the two groups(83.3% vs 90% and 77.8% vs 80%,P>0.05).The main cause of death was hepatic artery *** were more patients with complications who required intensive medical care or re-operation in the pre-Kasai group(8,80%) than in the primary LDLT group(9,50%)(P=0.226).But no significant differences were observed in operating time(9.3 vs 8.9 hours,P=0.77),intraoperative blood loss(208.6 vs 197.0 mL,P=0.84) and blood transfusion(105.6 vs 100.0 mL,P=0.91) between the two *** durations of ICU and hospital stay in the primary LDLT group and pre-Kasai group were 180.4 vs 157.7 hours(P=0.18) and 27 vs 29 days(P=0.29),***:Primary LDLT is a safe and efficient management for young pediatric patients with *** with the outcome of LDLT for patients receiving a previous Kasai operation,a similar survival rate and a low rate of re-operation and intensive medical care for patients with BA can be obtained.

关键词： biliary atresia living donor liver transplantation pediatric Kasai operation

Effect of low-dose tacrolimus with mycophenolate mofetil on renal function following liver transplantation

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World Journal of Gastroenterology 2014年第32期20卷 11356-11362页

作者： jing-Cheng Hao Wen-Tao Wang Lu-Nan Yan Bo Li Tian-Fu Wen jia-Yin Yang Ming-Qing Xu ji-chun zhao Yong-Gang Wei Department of Liver Surgery West China Hospital of Sichuan University

AIM: To determine whether low-dose tacrolimus (TAC) combined with mycophenolate mofetil (MMF) is a safe approach to decrease the incidence of chronic kidney disease (CKD) in liver transplantation (LT) recipients. METHODS: We analyzed the medical records of 689 patients who underwent LT between March 1999 and December 2012 in a single Chinese center. Immunosuppression was initiated with a calcineurin inhibitor (TAC or CSA) and prednisone with or without MMF. CKD is defined by the glomerular filtration rate (GFR), estimated by an abbreviated Modification of Diet in Renal Disease formula, < 60 mL/min per 1.73 m(2) for at least 3 consecutive months after LT. Individuals with TAC trough concentrations <= 8 ng/mL at 3 mo after LT were defined as the low-dose group. The incidence of CKD within 5 years was compared between the TAC group and the CSA group, as well as between four subgroups (low-dose and high-dose TAC groups with or without MMF). RESULTS: No difference regarding the occurrence of pre-LT renal dysfunction or that of post-LT rejection was found between the TAC and CSA groups or between the four subgroups. With a definition of GFR < 60 mL/min per 1.73 m(2), the overall incidence of CKD was significantly higher in the CSA group than in the TAC group. The incidence of CKD in the low-dose TAC + MMF group (7.7%) was significantly lower than that observed in the low-dose TAC group (15.9%), high-dose TAC group (24.6%) and high-dose TAC + MMF group (18.5%). The cumulative 1-, 3- and 5-year incidence rates of CKD were 12.7%, 14.5% and 16.7%, respectively. The cumulative 5-year survival rates were 61.7% and 82.2% in patients with or without CKD, respectively. CONCLUSION: In LT patients, the choice of immunosuppressive therapy appears to affect renal function and patient survival. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Liver transplantation Chronic kidney disease Calcineurin inhibitor Mycophenolate mofetil

Risk factors associated with early and late HAT after adult liver transplantation

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World Journal of Gastroenterology 2014年第30期20卷 10545-10552页

作者： Yi Yang ji-chun zhao Lu-Nan Yan Yu-Kui Ma Bin Huang Ding Yuan Bo Li Tian-Fu Wen Wen-Tao Wang Ming-Qing Xu jia-Yin Yang Department of Vascular Surgery Liver Transplantation CenterWest China HospitalSichuan University Liver Transplantation Center Department of Liver SurgeryWest China HospitalSichuan University

AIM: To identify risk factors that might contribute to hepatic artery thrombosis (HAT) after liver transplantation (LT). METHODS: The perioperative and follow-up data of a total of 744 liver transplants, performed from February 1999 to July 2010, were retrospectively reviewed. HAT developed in 20 patients (2.7%). HAT was classified as early (occurring in fewer than 30 d post LT) or late (occurring more than 30 d post LT). Early HAT devel-oped in 14 patients (1.9%). Late HAT developed in 6 patients (0.8%). Risk factors associated with HAT were analysed using the chi(2) test for univariate analysis and logistic regression for multivariate analysis. RESULTS: Lack of ABO compatibility, recipient/donor weight ratio >= 1.15, complex arterial reconstruction, duration time of hepatic artery anastomosis > 80 min, duration time of operation > 10 h, dual grafts, number of units of blood received intraoperatively >= 7, number of units of fresh frozen plasma (FFP) received intraoperatively >= 6, postoperative blood transfusion and postoperative FFP use were significantly associated with early HAT in the univariate analysis (P = 1.15 (OR = 4.499), duration of hepatic artery anastomosis > 80 min (OR = 5.429), number of units of blood received intraoperatively >= 7 (OR = 4.059) and postoperative blood transfusion (OR = 6.898). Graft type (whole/living-donor/split), duration of operation > 10 h, retransplantation, rejection reaction, recipients with diabetes preoperatively and recipients with a high level of blood glucose or diabetes postoperatively were significantly associated with late HAT in the univariate analysis (P 10 h (OR = 6.394), retransplantation (OR = 21.793) and rejection reactions (OR = 16.936). CONCLUSION: Early detection of these

关键词： Liver transplantation Hepatic artery thrombosis Risk factors Complication Blood transfusion

Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

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World Journal of Gastroenterology 2009年第33期15卷 4170-4176页

作者： jin Li Lu-Nan Yan Jan Yang Zhe-Yu Chen Bo Li Yong Zeng Tian-Fu Wen ji-chun zhao Wen-Tao Wang jia-Yin Yang Ming-Qing Xu Yu-Kui Ma Division of Liver Transplantation West-China Hospital West China Medical School of Sichuan University Chengdu 610041 Sichuan Province China

AIM： To identify prognostic factors of patients with hepatocellular carcinoma （HCC）, who were treated by orthotopic liver transplantation （OLT）. METHODS： From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS： The median follow-up was 13.0 mo （2.8-69.5 too）. Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria （97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively） compared with that of patients who met the Milan or University of California, San Francisco （UCSF） criteria. CONCLUSION： Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely aff

关键词： Hepatocellular carcinoma Prognosis Liver transplantation Outcome assessment Survival

Risk Factors for Preoperative Anxiety and Depression in Patients Scheduled for Abdominal Aortic Aneurysm Repair

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Chinese Medical Journal 2018年第16期131卷 1951-1957页

作者： Xiao-Yan Liu Yu-Kui Ma ji-chun zhao Zhou-Peng Wu Lin Zhang Li-Hui Liu Department of Vascular Surgery West China Hospital Chengdu Sichuan 610041 China

Background： Perioperative emotional disorders of patients underwent abdominal aortic aneurysm （AAA） repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair. Methods： A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale （HADS）. Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression. Results： A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients （29.3%） had borderline anxiety or clinical anxiety, and 42 patients （28.0%） were found to have borderline or clinical depression. Female （odds ratio [OR]： 2.81, 95% confidence interval [C1]： 1.08-7.26）, the American Society of Anesthesiologists （ASA） Grade 3/4 （OR： 4.34, 95% CI： 1. 13-16.68）, higher education （OR： 1.44, 95% CI： 1.02-2.04）, and abdominal or back pain （OR： 3.08, 95% CI： 1.20-7.87） were identified as significant independent risk factors of abnormal HA DS-anxiety in overall patients; and higher level of education （OR： 1.87, 95% CI： 1.16-3.01） was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index （BMI）（OR： 1.18, 95% CI： 1.04-1.33） and abdominal or back pain （OR： 3.93, 95% CI： 1.70-9.11） were predictive of abnormal preoperative HADS-depression in overall patients. Conclusion： As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression.

关键词： Abdominal Aortic Aneurysm Anxiety Depression Preoperative Care Risk Factors