Lianrui Guo

Xuanwu hospital, Peping, Beijing, China

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Publications (9)9.45 Total impact

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    ABSTRACT: Totally laparoscopic aortoiliac surgery has been newly developed in China. It is known as the most complex laparoscopic technique to learn because of its high-risk procedures. Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique. Twelve male patients (56-70 years old) with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery (TLABS) in our institute. Clinical data and operation-related complications were retrospectively analyzed. Of the 12 patients, TLABS succeeded in nine and conversion to open surgery occurred in three. One of the converted patients finally died of pulmonary infection. Operation-related complications included bleeding from arterial injury, perforation from colonic injury, graft embolism, residual aortic stenosis, and hydronephrosis. Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery. Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications. Left hydronephrosis, which was thought to result from intraoperative injury and treated with ureteric intubation drainage, recovered 6 months after TLABS. Good understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS. Immediate conversion to open surgery is necessary for saving the patient's life in case of life-threatening complications.
    Chinese medical journal 04/2014; 127(7):1218-21. · 0.90 Impact Factor
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    ABSTRACT: To evaluate the immediate and long-term outcomes of drug-eluting stent (DES) vs. bare metal stent (BMS) for symptomatic vertebral artery stenosis (VAS). From 2003 to 2010, 206 consecutive patients (158 men; mean age 66.8 years) underwent DES (sirolimus-eluting or paclitaxel-eluting) or BMS placement for symptomatic extracranial and intracranial stenoses in 219 vertebral arteries. The technical success, clinical success, periprocedural complications, target vessel revascularization (TVR), and overall survival were compared between the DES and BMS groups. The technical success rate was 98.3% (119/121) for the DES group vs. 100% for the BMS group (p = 0.503). The clinical success rate was 95.5% (107/112) for the DES group vs. 97.9% (92/94) for the BMS group (p = 0.592). No periprocedural death or stroke occurred. The overall periprocedural complication rate was 2.7% (3/112) in the DES group vs. 4.3% (4/94) in BMS group (p = 0.813). The median follow-up was 43 months (range 3-95) for the DES group and 46 months (range 6-89) for BMS. At last follow-up, the TVR rate was 6.3% (7/112) for the DES group vs. 20.2% (19/94) for the BMS group (p = 0.003); 4 (3.6%) patients in the DES group and 8 (8.5%) patients in the BMS group experienced a VBS stroke (p = 0.132). By life-table analysis, the 5-year TVR rate was 4.5% (5/112) for the DES group vs. 19.1% (18/94) for the BMS group (p = 0.001). No difference was detected in the overall survival curves between the groups (p = 0.500). Both DES and BMS are feasible, safe, and effective for symptomatic VAS. However, DES can significantly decrease the TVR rate in the long term compared with BMS.
    Journal of Endovascular Therapy 04/2012; 19(2):231-8. · 2.70 Impact Factor
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    ABSTRACT: To analyze the immediate and long-term outcomes of endovascular stenting vs. extrathoracic surgical bypass for subclavian steal syndrome. From 1989 to 2010, 252 consecutive patients (173 men; mean age 62 years) with vertebrobasilar and upper extremity symptoms of subclavian steal were treated with balloon-expandable stents (n=148) or extrathoracic surgical bypasses (n=104: 71 axilloaxillary and 33 carotid-subclavian) using polytetrafluoroethylene grafts. The technical success rate was 97.3% in the stent group vs. 99.0% for the bypass group (p=0.605). There was no perioperative mortality or any permanent neurological deficit in either group. The overall perioperative complication rate was 6.1% in the stent group vs. 9.6% in the bypass group (p=0.295). The 10-year target vessel revascularization rate was 46.6% for stenting vs. 5.8% for bypass (p<0.001). The cumulative primary patency rates at 1, 3, 5, and 10 years were 91%, 78%, 67%, and 49% for the stent group vs. 99%, 97%, 95%, and 89% for the bypass group (p<0.001). The cumulative secondary patency rates were 95%, 91%, 86%, and 64%, respectively, for the stent group vs. 99%, 99%, 98%, and 94% for the bypass group (p=0.001). No difference was detected in overall survival curves between the groups (p=0.527). Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian steal syndrome in the short and medium term; however, extrathoracic surgical bypasses are more durable in the long term.
    Journal of Endovascular Therapy 02/2012; 19(1):44-51. · 2.70 Impact Factor
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    ABSTRACT: The purpose of the present phase I clinical trial was to evaluate the safety, tolerability, and preliminary efficacy of naked DNA therapy expressing two isoforms of hepatocyte growth factor (pCK-HGF-X7) in critical limb ischemia (CLI) patients. Twenty-one patients with CLI were consecutively assigned to receive increasing doses (cohort I: 4  mg; cohort II: 8  mg; cohort III: 12  mg; and cohort IV: 16  mg) of pCK-HGF-X7, which was administered into the ischemic calf and/or thigh muscle at days 1 and 15. A safety and tolerability evaluation and measurement of pain severity score using a visual analog scale (VAS), ulcer status, transcutaneous oxygen (TcPO(2) ) and ankle-brachial index (ABI) were performed throughout a 3-month follow-up period. No serious adverse events were observed in any of the 21 patients for the 3-month follow-up period. A significant reduction in pain was observed in the treated patients, with the mean VAS decreasing from 5.95-1.64 (p  <  0.001). The mean ABI value increased from 0.49-0.63 (p  =  0.026) at 3-month follow-up. The mean TcPO(2) value on the dorsum of the foot, the anterior calf and posterior calf significantly increased from 28.25-39.28  mmHg (p  =  0.012), from 22.00-30.63  mmHg (p  =  0.046) and 32.05-47.19  mmHg (p  =  0.001) at 3-month follow-up, respectively. Wound healing improvement was observed in the six of nine patients that had an ulcer at baseline. These results support the performance of a phase II randomized controlled trial with pCK-HGF-X7.
    The Journal of Gene Medicine 11/2011; 13(11):602-10. · 2.16 Impact Factor
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    ABSTRACT: To investigate the effectiveness of percutaneous transluminal renal artery stenting (PTRAS) in treating atherosclerotic renal artery stenosis (ARAS). A total of 69 patients with severe ARAS were treated with PTRAS between January 2002 and December 2008. There were 47 males and 22 females with an average age of 66.2 years (range, 42-88 years), including 66 cases of unilateral ARAS (single functional kidney, 1 case) and 3 cases of bilateral ARAS. Renal angiography revealed that the degree of renal artery stenosis was 70%-99%. Concomitant diseases included hypertension (67 cases), atherosclerosis obliterans (69 cases), coronary heart disease (34 cases), diabetes (44 cases), and hyperlipidemia (36 cases). Blood pressure, serum creatinine (sCr), and patency of the renal artery were measured to assess the effectiveness of PTRAS after 12 months. The renal artery stent was successfully implanted in 68 patients and the technical success rate was 98.6%. One patient was converted to ilio-renal bypass because of intra-operative acute renal artery occlusion. One patient died of heart failure at 6 months after PTRAS, and 1 patient was lost at 3 months after PTRAS. The other 66 patients were followed up 32 months on average (range, 13-60 months). The blood pressure decreased significantly at 1 month and gained a further decrease at 12 months after PTRAS when compared with the preoperative ones [systolic blood pressure: (132 +/- 24) mm Hg vs (163 +/- 34) mm Hg, P < 0.05; diastolic blood pressure: (78 +/- 11) mm Hg vs. (89 +/- 17) mm Hg, P < 0.05; 1 mm Hg = 0.133 kPa]. Hypertension was cured in 4 cases (6.3%), improved in 52 cases (81.2%), failure in 8 cases (12.5%), and the overall benefit rate was 87.5%. The sCr level was stable after 12 months of PTRAS, showing no significant difference when compared with preoperative baseline [(107.8 +/- 35.4) micromol/L vs (104.1 +/- 33.8) micromol/L, P > 0.05]. Renal function was improved in 9 cases (13.6%), stable in 48 cases (72.8%), deterioration in 9 cases (13.6%), and the overall benefit rate was 86.4%. Instant restenosis found in 2 patients (3.0%) at 12 months after operation. PTRAS is a safe and effective method to treat ARAS. It can control the blood pressure and stabilize the renal function in most ARAS patients. Long-term efficacy needs further investigation.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 09/2010; 24(9):1037-40.
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    ABSTRACT: To explore the effective surgical approaches in treating subclavian artery occlusion. Between December 2005 and February 2010, 53 patients with subclavian artery occlusion were treated, including left subclavian artery occlusion (35 cases) and stenosis (5 cases), right subclavian artery occlusion (5 cases) and stenosis (4 cases), and bilateral subclavian artery occlusion (4 cases). There were 40 males and 13 females with an average age of 64 years (range, 22-77 years), including 49 cases of arteriosclerosis obliterans and 4 cases of aortic arteritis. The disease duration was 15 days to 20 months (6.5 months on average). In 49 patients with unilateral subclavian artery occlusion, 39 cases complicated by carotid or/ and cerebral artery lesion underwent axillo-axillary bypass grafting, and 10 cases without carotid or/and cerebral artery lesion underwent carotid-subclavian bypass grafting. Ascending aorta to bi-subclavian bypass grafting were performed on 4 cases with bilateral subclavian artery occlusion. After operation, patients received routine treatment with anticoagulant and antiplatelet agents. The operations were successfully performed in 52 cases with a successful rate of 98.11%. Thrombogenesis at anastomotic site occurred in 1 case of aortic arteritis after 48 hours. Two cases had brachial plexus crush injury and 4 had hematoma around the bilateral anastomosis after axillo-axillary bypass grafting, and all recovered with nonoperative therapy. A total of 52 patients were followed up 1-52 months (24.5 months on average). All patients survived and the symptoms of basilar and upper limb artery ischemia disappeared. Doppler ultrasonography showed that the blood flow was patent through anastomosis and polytetrafluoroethylene graft, and the vertebral artery flow was normal. Pseudoaneurysm at anastomosis was found in 1 case after 18 months and treated by interventional embolization. The postoperative graft patency rate was 100% at 1 year and at 2 years. Both thoracic and extrathoracic surgical approaches are effective for treating subclavian artery occlusion. The reasonable surgical approach should be selected according to the arteriopathy and the patient's condition. Perioperative treatment and strict intraoperative manipulation are important to guarantee the success of surgery.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 09/2010; 24(9):1030-2.
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    ABSTRACT: To explore the middle-term outcome of autologous bone marrow mononuclear cells transplantation in the treatment of lower limb ischemia. From March 2003 to June 2005, 65 patients with lower limb ischemia were treated by autologous bone marrow mononuclear cells transplantation. Of the patients, there were 50 males and 15 females, with a mean age of 66.5 years (range 36-89 years), including 4 cases of simple arteriosclerotic occlusion, 5 cases of thromboangiitis obliterans and 56 cases diabetic lower limb ischemia. A total of 400 mL bone-marrow blood were extracted from the posterior superior iliac crest. And then the mononuclear cells were isolated from the bone-marrow blood in the laboratory. The amount of transplantation bone marrow mononuclear cells was (0.60-1.80) x 10(9) (mean 1.05 x 10(9)). Twelve patients received cell transplantation from two to four times and the other patients one time. According to the improvement of clinical finding, the outcome was evaluated. All the patients were followed up for 8-56 months (mean 21.5 months). There were 8 deaths, and the mortality was 12.3%; 5 were due to myocardial infarction and heart failure and 3 were due to cerebral infarction. The general effective rate was 70.8% (46/65) and the recurrent rate was 10.7% (7/65). Of them, the response to treatment lasted over 12 months in 42 cases, accounting for 91.3% (42/46); over 24 months in 24 cases, accounting for 52.2% (24/46); and over 37 months in 12 cases, accounting for 26.1% (12/46). The effective rates were 100% in 12 patients who received 2-4 times transplantation and 64.2% in 53 patients who received 1 time transplantation, showing statistically significant difference between them (P < 0.001). The middle-term outcome of autologous bone marrow mononuclear cells transplantation show that it is a feasible and simple method for treatment of lower limb ischemia.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 03/2009; 23(3):341-4.
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    ABSTRACT: To discuss the safety and feasibility of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm x 4.3 cm x 4.5 cm) located in the main renal artery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal iliac artery. The reconstructed left kidney was re-implanted into the right iliac fossa. The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right iliac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2008; 22(9):1085-8.
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    ABSTRACT: We cultured bone marrow-derived endothelial progenitor cells by a simple ex vivo expansion method and observed the expansion efficacy. Bone marrow mononuclear cells from five mongrel adult dogs were cultured with EGM-2MV medium in culture flasks coated with fibronectin. Morphology was observed with phase contrast microscopy, and a growth curve was constructed to evaluate the efficacy of expansion. Incorporation of Dil-ac-LDL was tested to evaluate the function. At different time points, immunocytochemical staining for flk-1, CD133, and factor VIII-related antigens was done and compared to staining of endothelial cells and mesenchymal stem cells and percentages of CD133, vascular endothelial growth factor receptor 2 (VEGFR-2), and the double-positive cells measured with flow cytometry to identify the quality and efficacy of expansion. Cluster-like attached cells grew to confluence at an average time of 10 days, and the mean number of cells harvested from 1 mL of bone marrow was (1.3 +/- 0.3) x 10(6). The cells presented a cobblestone-like appearance and took up Dil-ac-LDL. Immunocytochemistry showed that flk-1, CD133, and factor VIII-related antigens were positive. Flow cytometry showed that VEGFR-2 and CD133 double-positive cells augmented 242-fold at the tenth day. Ex vivo expansion can effectively proliferate endothelial progenitor cells from bone marrow; the expansion efficacy could meet the requirements for tissue engineering of blood vessels.
    Annals of Vascular Surgery 06/2006; 20(3):387-94. · 0.99 Impact Factor