Development of Endovascular Surgery in China
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SUMMARY
Development of Endovascular Surgery in China
Zhonggao Wang*
Before seeing any angiographic machines and devices, the author spent several years and had a review written on "Selective visceral arterial selective angiogragphy" in 1977 in which the Seldinger technique was introduced and how to prepare the angiographic guidewires and catheters, how to perform the selective arterial catheterization to different arteries and what was the proper dosage of control media that should be used in various arteries were described in detail [1]. Even now that review should still have its reference value. In addition, how to use the mentioned method to identify the bleed point(s) in the gastrointestinal (GI) tract for those with GI bleeding caused by unknown reason was also described. [2] Then at an occasional chance when I worked at the PUMC Hospital, in Beijing (Peking) in 1983, during the cavography carried out for a female 18-year-old patient with intractable ascites (her height was 152 cm, the abdominal girth was 92 cm), Dr. Yang Ning, a radiologist, and I found out that the patient had a web in the inferior vena cava (IVC), and it was penetrated casually by a heavy stiff angiographic catheter with exertion, afterwards, a continuous leak of ascites occurred at the femoral puncture point for a few days requiring local compression with bandage to reduce the leaking. At less than 10 days, however, to our surprise, suddenly not only no more leaks could be seen at the puncture point, but also the ascites disappeared completely [3, 4]. Since then, a new concept of applying special but simple device to treat complicated lesion, such as the mention above, was emerged.
In 1984, with YAG laser fiber, Dr. Li Zhunheng, a specialist of Laser, and I carried out animal studies and treated patients with arterial occlusive disorders and web-type Budd-Chiari syndrome (BCS) at the Beijing An Zhen Hospital [5-7]. Though YAG laser fiber was once employed in clinic, after the occurrence of the incidence that a laser fibroptic fiber was broken during the web penetration process, the Laser method was abandoned. In 1992, on the basis of animal studies, we first made and applied our indigenous stent to treat patients with BCS caused by the IVC web successfully [8, 9].
Having finished abundant animal studies, in 1995, we successfully used the silk-covering stent-graft to treat traumatic femoral arteiovenous fistula first in China, and the stent-graft was also made by ourselves [10]. In 1996, we treated a patient with descending aortic aneurysm and two cases with aortic dissection via semi-open method, which is called "hybrid method" nowadays. We combined the stent with the prosthesis, used invagination and loop method to replace the suture method, and thus simplified the anastomtic technique, shorten the operative time and reduced the operative bleeding [11]. In the same year, we successfully treated a case with a left traumatic internal carotid to internal jugular venous fistula caused by a tremendous cerebral stealing which resulted in hemiplagia and the fistula deeply located close to the cranial base, surgical means was failed to reach the fistula and the fistula was successfully sealed by the endograft [10] ......
SUMMARY
Development of Endovascular Surgery in China
Zhonggao Wang*
Before seeing any angiographic machines and devices, the author spent several years and had a review written on "Selective visceral arterial selective angiogragphy" in 1977 in which the Seldinger technique was introduced and how to prepare the angiographic guidewires and catheters, how to perform the selective arterial catheterization to different arteries and what was the proper dosage of control media that should be used in various arteries were described in detail [1]. Even now that review should still have its reference value. In addition, how to use the mentioned method to identify the bleed point(s) in the gastrointestinal (GI) tract for those with GI bleeding caused by unknown reason was also described. [2] Then at an occasional chance when I worked at the PUMC Hospital, in Beijing (Peking) in 1983, during the cavography carried out for a female 18-year-old patient with intractable ascites (her height was 152 cm, the abdominal girth was 92 cm), Dr. Yang Ning, a radiologist, and I found out that the patient had a web in the inferior vena cava (IVC), and it was penetrated casually by a heavy stiff angiographic catheter with exertion, afterwards, a continuous leak of ascites occurred at the femoral puncture point for a few days requiring local compression with bandage to reduce the leaking. At less than 10 days, however, to our surprise, suddenly not only no more leaks could be seen at the puncture point, but also the ascites disappeared completely [3, 4]. Since then, a new concept of applying special but simple device to treat complicated lesion, such as the mention above, was emerged.
In 1984, with YAG laser fiber, Dr. Li Zhunheng, a specialist of Laser, and I carried out animal studies and treated patients with arterial occlusive disorders and web-type Budd-Chiari syndrome (BCS) at the Beijing An Zhen Hospital [5-7]. Though YAG laser fiber was once employed in clinic, after the occurrence of the incidence that a laser fibroptic fiber was broken during the web penetration process, the Laser method was abandoned. In 1992, on the basis of animal studies, we first made and applied our indigenous stent to treat patients with BCS caused by the IVC web successfully [8, 9].
Having finished abundant animal studies, in 1995, we successfully used the silk-covering stent-graft to treat traumatic femoral arteiovenous fistula first in China, and the stent-graft was also made by ourselves [10]. In 1996, we treated a patient with descending aortic aneurysm and two cases with aortic dissection via semi-open method, which is called "hybrid method" nowadays. We combined the stent with the prosthesis, used invagination and loop method to replace the suture method, and thus simplified the anastomtic technique, shorten the operative time and reduced the operative bleeding [11]. In the same year, we successfully treated a case with a left traumatic internal carotid to internal jugular venous fistula caused by a tremendous cerebral stealing which resulted in hemiplagia and the fistula deeply located close to the cranial base, surgical means was failed to reach the fistula and the fistula was successfully sealed by the endograft [10] ......
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