Efficacy and anatomical factors of Endurant stent graft in endovascular aortic repair of abdominal aortic aneurysm with hostile neck / 中国实用外科杂志

OBJECTIVE: To observe the safety and efficacy of Endurant stent-graft in abdominal aortic aneurysm with hostile neck,and detect the anatomic factors of hostile neck-related adverse events.METHODS: The clinical data of 144 consecutive patients of abdominal aortic aneurysm with hostile proximal neck who underwent endovascular aortic repair with Endurant stentgraft from January 2010 to January 2016 in Department of Vascular Surgery,Zhongshan Hospital,Fudan University were analyzed retrospectively.The perioperative clinical and the technical success rate as well as adverse event during follow up were observed.The anatomical factors correlated with proximal neck related adverse events were analyzed.RESULTS: The median length of follow-up was 36(1-73) months,and there were 26 cases of adverse events,with 18.1% incidence rate of adverse events.The clinical success rate was 98.6% and technical success rate 96.5%.Nineteen patients experienced proximal neck related adverse events.Univariate analysis demonstrated proximal neck length,neck angle,short neck,twist neck were anatomical factors that influenced the proximal neck related adverse events(All P<0,05).Multifactor logistic regression analysis identified that proximal neck length,neck angle,taper neck were anatomical factors significantly correlated with proximal neck related adverse events(All P<0.05).CONCLUSION: The Endurant stent graft generally presents safe and effective for the treatment of abdominal aortic aneurysm with hostile proximal neck,while patients with short,angulated and taper proximal neck warranted enhanced follow up.

Curative effect of the rivaroxaban and the low-molecular weight heparin anticoagulation in patients with active malignant tumors combined with venous thromboembolism / 复旦学报（医学版）

Objective To investigate the efficacy and safety of rivaroxaban in contrast with lowmolecular weight heparin (LMWH) in patients with active malignant tumor combined with venous thromboembolism (VTE).Methods This study was a prospective case-control study.All cases were from Zhongshan Hospital,Fudan University between Jan.,2015 and Aug.,2016.They were treated with either rivaroxaban or LMWH for anticoagulation.Patients were followed up for 90 days to observe the treatment efficacy,recurrence and bleeding events.The total efficiency,recurrence events,bleeding events and adverse events were statistically analyzed.Results A total of 67 patients were enrolled in this study.Among them,37 cases aged 38-84 years old were assigned to LMWH group,of which 16 cases (43.2％) were male.Another 30 cases aged 45-88 years old were assigned to rivaroxaban group and 12 cases (40.0％) were male.There was no statistically significant difference between the two groups.The total effective rate (P =0.699),recurrence events (P =0.774),bleeding events (P =0.490) and adverse events (P =0.448) between the LMWH group and the rivaroxaban group had no significant difference.Conclusions Rivaroxaban and LMWH anticoagulation had similar safety and efficacy in patients with active malignant tumor combined with VTE.

Identification of human serum protein targets of Qianggu Decoction () in primary type I osteoporosis based on tandem mass tag labeling and liquid chromatography-tandem mass spectrometry technology / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the serum protein targets of Qianggu Decoction (, QGD) on treating osteoporosis by the proteomics analysis using tandem mass tag (TMT) and liquid chromatographytandem mass spectrometry (LC-MS/MS).</p><p><b>METHODS</b>Twenty serum protein samples were recruited (10 patients with primary type I osteoporosis before and after QGD treatment) and the high abundance ratios protein was removed, two serum samples were extracted and labeled with TMT reagent. Then, mass spectrometric detection, identification of differentially expressed proteins and bioinformatics analysis of differentially expressed proteins were carried out.</p><p><b>RESULTS</b>A total of 60 proteins were identified, within a 99% confidence interval, to be differentially regulated of which, 34 proteins were up-regulated and 26 proteins were down-regulated. Differentially expressed proteins analyzed by Gene Ontology (GO) annotation mainly get involved in 12 different biological processes, 7 types of cellular components, and 6 kinds of molecular functions. Angiotensinogen (AGT), stromelysin-1 (MMP3), heparanase (HPSE) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were screened as candidate protein targets of QGD treatment, which were related to metabolic mechanism of bone remodeling and/or bone collagen of osteoporosis. By the utilization of the protein-protein interaction network analysis tool named STRING10.0, it showed that AGT, MMP3, HPSE and GAPDH were located in the key node of the protein-protein interactions network. Furthermore, AGT, MMP3, HPSE and GAPDH were found to be directly related to BMP, MAPK, Wnt, SMAD and tumor necrosis factor ligand superfamily member 11 (TNFSF11) families.</p><p><b>CONCLUSIONS</b>The proteomics analysis by using TMT combined with LC-MS/MS was a feasible method for screening the potential therapeutic targets associated with QGD treatment. It suggests that AGT, MMP3, HPSE and GAPDH may be candidate protein targets of QGD treatment which can be used as therapeutic effect monitor and early diagnosis of primary type I osteoporosis.</p>

Effect and mechanism of total flavone of epimedium on primary callus formation in ovariectomized rats with fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effects and related mechanisms of total flavone of epimedium treatment(TFE)on primary callus for mation in ovariectomized rats.</p><p><b>METHODS</b>Forty male SD rats weighted from 209 to 246 g and aged 6 to 8 weeks were selected. Six weeks after ovariectomy a femur fracture model with middiaphyseal segment fracture was established, estimated and randomly divided into TFE group (150 mg·kg⁻¹·d⁻¹) and control group(received saline). HE staining was used to evaluate the morphologic difference of primary callus during the bone callus healing between these two groups. The relative expression of Runt-related transcription factor 2(Runx2) mRNA in the callus was identified by real-time polymerase chain reaction. Immunohistochemical technique was used to observe the Casein kinase 2-interacting protein 1(CKIP-1) protein level in the callus of the two groups. Maximum fracture load was tested by three point bend test.</p><p><b>RESULTS</b>The BMD, primary callus volume, trabecular member(Tb.N) and trabecular thickness(Tb.Th) were higher in TFE group than that in control group(<0.001). The Tb.N and Tb.Th of primary callus were higher in TFE group than control group (=0.001). The volume and bone volume/tissue volume of primary callus were in TFE group than control group(<0.01). The trabecular separation(Tb.Sp) of primary callus were in control group higher than TFE group(<0.01). The HE staining of the 6 week slices showed that the degree of cartilage ossification in callus of the TFE group was significantly higher than that in control group under high magnification. Real-time PCR revealed that the comparative expression of Runx2 mRNA in control group was higher than that in TFE group(<0.001); the positive number of CKIP-1 was less in TFE group than that in control group (<0.001). TFE could increase the maximum load of the primary callus (<0.001).</p><p><b>CONCLUSIONS</b>TFE can promote the cartiage ossification of callus in ovariectomized rats, enhancing the bone strength and bone quality in the process of fracture healing via the CKIP-1/Runx2 pathway.</p>

Autophagy and hypoxic ischemic brain injuries / 生理学报

Autophagy is a highly evolutionarily conserved physiological mechanism of organism, including several stages such as autophagosomes formation, the fusion of lysosomes and autophagosomes, and autophagosomes degradation. In physiological conditions, autophagy is responsible for clearing the spoiled organelles and long-lived proteins to maintain the homeostasis of cells and organism. Meanwhile, autophagy is also involved in the formation and development of diseases, but the mechanism has not been confirmed yet. The relationship between autophagy and hypoxic ischemic brain injuries represented by stroke is a research hotpot in recent years, but there is no clear conclusion about autophagy's role and mechanism in hypoxic ischemic brain injuries. We reviewed the activation, function and mechanism of autophagy in hypoxic ischemic brain injuries, in order to provide some perspectives on these researches.

Antitumor effect of allicin on esophageal cancer EC109 cells compared with chemotherapeutics in vitro / 中国病理生理杂志

AIM:To investigate the inhibitory effect of allicin on human esophageal cancer cell line EC 109 and its possible mechanism by comparison with chemotherapeutic drugs .METHODS:The EC109 cells were treated with different concentrations of allicin , 5-fluorouracil and cisplatin .The cell viability was detected by CCK 8 assay and the activ-ity of lactic dehydrogenase (LDH) was analyzed at 6 h, 12 h, 24 h, 48 h and 72 h.The apoptosis of the EC109 cells in-duced by Z-VAD-FMK, allicin, allicin+Z-VAD-FMK, 5-fluorouracil and cisplatin was analyzed by flow cytometry with Annexin V-FITC and PI double staining .The enzyme activity changes of caspase-3, caspase-8 and caspase-9 were detected by spectrophotometry .RESULTS:Allicin had inhibitory effect on the growth of the EC 109 cells and killed them in con-centration-dependent and time-dependent manners .LDH activity was decreased compared with 5-fluorouracil and cisplatin . The increased activity of caspase-3 and caspase-8 in allicin-treated cells was statistically significant , but caspase-9 activity changed without statistical significance .CONCLUSION:Allicin inhibits the growth of EC109 cells in concentration-and time-dependent manners through extrinsic apoptosis pathways activated by caspase -8, and the side effects are weaker com-pared with 5-fluorouracil and cisplatin .

Antitumor effect of allicin on esophageal cancer EC109 cells compared with chemotherapeutics in vitro / 中国病理生理杂志

AIM:To investigate the inhibitory effect of allicin on human esophageal cancer cell line EC 109 and its possible mechanism by comparison with chemotherapeutic drugs .METHODS:The EC109 cells were treated with different concentrations of allicin , 5-fluorouracil and cisplatin .The cell viability was detected by CCK 8 assay and the activ-ity of lactic dehydrogenase (LDH) was analyzed at 6 h, 12 h, 24 h, 48 h and 72 h.The apoptosis of the EC109 cells in-duced by Z-VAD-FMK, allicin, allicin+Z-VAD-FMK, 5-fluorouracil and cisplatin was analyzed by flow cytometry with Annexin V-FITC and PI double staining .The enzyme activity changes of caspase-3, caspase-8 and caspase-9 were detected by spectrophotometry .RESULTS:Allicin had inhibitory effect on the growth of the EC 109 cells and killed them in con-centration-dependent and time-dependent manners .LDH activity was decreased compared with 5-fluorouracil and cisplatin . The increased activity of caspase-3 and caspase-8 in allicin-treated cells was statistically significant , but caspase-9 activity changed without statistical significance .CONCLUSION:Allicin inhibits the growth of EC109 cells in concentration-and time-dependent manners through extrinsic apoptosis pathways activated by caspase -8, and the side effects are weaker com-pared with 5-fluorouracil and cisplatin .

Microenvironments induce iPSCs and BMSCs into neuron-like cells--Reelin's regulative role in cell differentiation and polarization / 生理学报

The present study was aimed to investigate how the induced pluripotent stem cells (iPSCs) and bone marrow mesenchymal stem cells (BMSCs) differentiate into neuron-like cells under the induction of hippocampal microenvironments and Reelin's regulation. iPSCs or BMSCs were co-cultured with WT (wild type) or genotypic hippocampal slice and cerebral homogenate supernatant, then the stem cells' differentiation under the induction of hippocampal environment was observed by using immunofluorescence technique. In the meantime, stem cells were co-cultured with hippocampal slice and cerebral conditioned medium of reeler (Reelin deletion) mouse respectively. The results showed that both adhesive iPSCs and BMSCs on WT hippocampal slice exhibited lamination of double "C" shape with high density on granular and pyramidal layers. The stem cells could differentiate into neuron-like cells with obvious polarization on WT hippocampal slice. In pyramidal cell layer, the differentiated neuron-like cells were oriented vertically with similar shapes of pyramidal cell in vivo, and the cells within molecule layer were arranged horizontally. In addition, adhesive iPSCs and BMSCs could differentiate into Nestin positive neural stem cells and NeuN positive neurons, respectively, under WT hippocampal microenvironment. On the other hand, under induction of hippocampal microenvironment of reeler mouse, iPSCs and BMSCs differentiation could also be seen, but their lamination was in disorder, and cell polarization was irregular. Moreover, differentiation and polarization of the iPSCs and BMSCs were delayed. These results suggest both iPSCs and BMSCs can differentiate into neuron-like cells under the induction of hippocampal microenvironments. Reelin is involved in the regulation of neuronal differentiation and cell polarization. Without Reelin, the cellular lamination and polarization appear irregular, and the stem cells' differentiation is delayed.

Evaluation of acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.</p><p><b>METHODS</b>We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage (RIFLE) kidney disease criteria. The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.</p><p><b>RESULTS</b>Of the 71 patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU). Risk factors for AKI were ruptured AAA (odds ratio (OR) = 5.846, 95% confidence interval (CI): 1.346 - 25.390), intraoperative hypotension (OR = 6.008, 95%CI: 1.176 to 30.683), and perioperative blood transfusion (OR = 4.611, 95%CI: 1.307 - 16.276). Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in Surgical Intensive Care Unit.</p><p><b>CONCLUSIONS</b>Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.</p>

Management of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair / 中华医学杂志(英文版)

We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery.

The development of a type II endoleak domesticated pig model with continuous pressure monitor / 中华外科杂志

<p><b>OBJECTIVE</b>To develop a type II endoleak porcine model with continuous pressure monitor by the strain-gauge pressure transducer and the patch.</p><p><b>METHODS</b>Nine tamed porcine was randomized as the experiment group of 6 domesticated pigs and the control group of 3 domesticated pigs. When the abdominal aortic aneurysm (AAA) was created, the 2(nd) and 3(rd) pair of infrarenal lumber arteries were preserved in the experiment group, while ligated in the control group. The stent-graft was implanted in the endovascular repair. CT angiography was performed to seek endoleak, and the angiography was performed to excluded the type I and type III endoleak. The pressure in the excluded AAA monitored by the strain-gauge pressure transducer was recorded and compared in both groups to evaluated the effect of type II endoleak in the experiment group.</p><p><b>RESULTS</b>The AAA porcine model with pressure monitor were successfully developed in all 9 porcine. The endoleak and the retrograde flow of the lumber arteries were confirmed by CT angiography in the experiment group. The ratio of the average pressure after the procedure to before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). The ratio of the pulse pressure after the procedure to the average pressure before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020).</p><p><b>CONCLUSION</b>It is feasible to develop type II endoleak domesticated pig model by preserving the lumber arteries for the retrograde flow, and the AAA model with pressure monitor by the strain-gauge pressure transducer and the patch.</p>

Complications in endovascular repair of abdominal aortic aneurysms: treatment and prevention / 中华外科杂志

<p><b>OBJECTIVE</b>To review the prevention and treatment strategies in the complications after endovascular repair (EVAR) of abdominal aortic aneurysms, retrospectively in a single medical center.</p><p><b>METHODS</b>From January 2003 to December 2010, clinical data of 344 EVAR cases were analyzed retrospectively, including postoperative period and long-term results. There were 302 male and 42 female patients, with a mean age of (69 ± 8) years. Patients were followed up at 3 months, 6 months, and then every year with abdominal x-ray and spiral CT angiography.</p><p><b>RESULTS</b>The surgical success rate was 99.7% (343/344). The mortality with elective and emergency surgery was 0.30% (1/334) and 1/10 respectively. The average follow-up time was 3 to 84 months with a mean of 32.9 months. The follow-up rate was 81.8% (279/341). The mortality was 1.1% (3/279), the re-intervention rate was 10.4% (29/279) and the overall complication rate was 12.9% (36/279), including endoleak 5.7% (16/279), stent-graft migration 1.1% (3/279), aneurysm expansion or rupture 5.4% (15/279), limb occlusion 2.5% (7/279) and stent-graft infection 1.4% (4/279).</p><p><b>CONCLUSION</b>EVAR has allowed a minimally invasive approach to aortic pathology. A careful preoperative assessment is the key for EVAR. Endoleak continues to be the major long-term complication of the endoluminal grafting technique, and the major cause for re-intervention. Life-long follow-up is an integral part of EVAR.</p>

Sodium nitrite preconditioning protects against ethanol-induced damage in human hepatoma SMMC-7721 cells / 药学学报

This study is to investigate the cytoprotective role of NaNO2 preconditioning against ethanol induced damage in human hepatoma SMMC-7721 cells. The cells were preconditioned with NaNO2 (0.25 mmol x L(-1)) for 24 hours or 4 weeks, and then exposed to ethanol (200 mmol x L(-1)) for additional 12 h and untreated cells served as control. Both temporal and chronic NaNO2 preconditioning could prevent ethanol elicited cytotoxicity as evidenced by thiazolyl blue (MTT). NaNO2 preconditioning also could inhibit ethanol-induced apoptosis, which was confirmed by FITC-Annexin V/PI flow cytometer and Hoechst 33258 and PI staining. Further, simultaneous NaNO2 preconditioning treatment along with ethanol showed protection against ethanol mediated cellular damage as indicated by significantly decreased levels of malondialdehyde (MDA) and elevated activities of superoxide dismutase (SOD) and catalase (CAT). Western blotting analysis revealed that in ethanol treated cells preconditioned with NaNO2, the HIF-1alpha and Bcl-2 increased obviously, while the expression of pro-apoptotic proteins, including Bax, Caspase-9, Caspase-3 decreased. The results showed that low doses of NaNO2 preconditioning resistant to ethanol-induced human hepatoma SMMC-7721 cells apoptosis, which mechanism may be related to increased expression of HIF-1alpha in the cells.

Cinnamaldehyde ofloxacin-3-ylhydrazone induces apoptosis of human hepatocarcinoma SMMC-7721 cells / 药学学报

This study is to observe the effect of N-(3-phenylallylidene)-6-fluoro-1, 8-(2, 1-propoxy)-7-(4-methylpiperazin-1-yl)-quinolin-4(1H)-one-3-carbonyl hyarazine (FQ16) on apoptosis of hepatocarcinoma SMMC-7721 cells in vitro. With different concentrations of FQ16 at different times used to treat SMMC-7721 cells in vitro, the proliferation of the cells and the inhibition effect of FQ16 on the cell proliferation were examined by MTT assay. Cell apoptosis was determined by Hoechst 33258/PI fluorescence staining, TUNEL and agarose gel electrophoresis method. The effect of FQ16 on topoisomerase II activity was measured by agarose gel electrophoresis using Plasmid pBR322 DNA as the substrate. Mitochondrial membrane potential (MMP, delta psi m) was measured by high content screening image system. The reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the expression changes of Bcl-2 mRNA and Bax mRNA. The caspase-9, caspase-8, caspase-3, p53, Bcl-2 and Bax protein expressions were detected by Western blotting analysis. The results showed that the cell proliferation was inhibited by FQ16 at 0.625 - 10 micromol L(-1) in a time-dose dependent manner. Treatment of SMMC-7721 cells with different concentrations of FQ16 for 24 h increased the percentage of the apoptosis cells obviously (P<0.05), the typical ladder DNA in apoptotic cells and a concomitant dissipation of the mitochondrial membrane potential. Compared with control group, FQ16 influenced obviously DNA topoisomerase II activity, stimulated DNA cleavage and inhibited DNA reunion mediated by topoisomerase II. In addition, FQ16 (3 - 7.39 micromol L(-1)) increased mRNA expression of Bax and protein expression of p53, Bax, caspase-9, caspase-3, separately, and induced cytosolic accumulation of activities caspase-9 and caspase-3, whereas the mRNA and protein expression of Bcl-2 decreased with no change of caspase-8. Therefore it can be concluded that the effects of inhibited topoisomerase II and mitochondrial-dependent pathways were involved in FQ16 induction of apoptosis of SMMC-7721 cells.

Surgical treatment of renal stenosis: a report of 80 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of surgical treatment for renal stenosis.</p><p><b>METHODS</b>Eighty cases from November 1997 to August 2008 were reviewed, including 53 males and 27 females, aged from 9 to 80 years old. There are 42 atherosclerosis, 23 Takayasu arteritis and 11 fibrodysplasia patients. Surgical procedures included aorto-renal bypass for 13 cases, autogenous renal transplantation for 5 cases, nephrectomy for 1 case, renal endarterectomy for 1 case, lesion resection and reconstruction for 1 case, balloon angioplasty for 14 cases, and stent implantation 48 cases.</p><p><b>RESULTS</b>There were 1 mortality peri-operation. During follow-up (1 to 129 months), 2 among 63 patients died. Significant decline of blood pressure [(135.7 +/- 15.8)/(80.1 +/- 8.5) mm Hg (1 mm Hg = 0.133 kPa) vs. (149.8 +/- 18.3)/(88 +/- 13.6) mm Hg, P < 0.01] and totally 65.6% effective rate were observed. Atherosclerosis, Takayasu arteritis and fibrodysplasia group all presented positive anti-hypertension results with 50%, 73.3% and 100% effective rate respectively (P < 0.05). The creatine level also underwent significant decrease [(112.7 +/- 53.6) micromol/L vs. (131.7 +/- 91.7) micromol/L, P < 0.05], mainly in atherosclerosis group [(127.2 +/- 56.6) micromol/L vs. (138.0 +/- 87.0) micromol/L, P < 0.05].</p><p><b>CONCLUSIONS</b>Surgical treatment of renal stenosis can achieve improvement in hypertension and renal function. Endovascular stent and angioplasty are the first choices for atherosclerotic and fibrodysplasia patients respectively, while open surgery is better for Takayasu arteritis ones.</p>

Prospective study of coverage of left subclavian artery during thoracic endovascular aortic repair in a single center / 中华外科杂志

<p><b>OBJECTIVE</b>To describe observation of security and availability of covering left subclavian artery during thoracic endovascular aortic repair (TEVAR) in follow-up.</p><p><b>METHODS</b>From December 2007 to December 2008, 111 consecutive patients received stent grafts to treat lesions involving thoracic aorta. According to the covering of left subclavian artery, four groups including total covering (TC), less-than 50% covering (LTC), more-than 50% covering (MTC) and non-covering (NC) were formed. Difference of blood pressure between two upper extremities was required before TEVAR and 1st, 3rd, 5th, 30th day after TEVAR. Patients were evaluated postoperatively and at follow-up for stroke as well as symptoms of paraplegia, hemiparalysis or left upper extremity claudication.</p><p><b>RESULTS</b>Fifty-five (49.6%), 18 (16.2%), 7 (6.3%) and 31 (27.9%) cases were divided into TC, LTC, MTC and NC groups, respectively. Difference of blood pressure between TC and the 3 latter groups were significantly different (P<0.01). Complications appeared as followed during one week after TEVAR: 13 patients in dizziness, among which 5 patients suffered from amaurosis and spotted vision, and 7 patients in left upper extremity claudication. No stroke, paraplegia or hemiparalysis in TC. Thoracic aortic lesions were successfully excluded in all patients.</p><p><b>CONCLUSIONS</b>Intentional coverage of left subclavian artery to obtain an adequate proximal landing zone during TEVAR is safe and well-tolerated. But it may be managed expectantly with some exceptions for further lasting efficacy.</p>

Influence of gender on development and prognosis of atherosclerosis obliterans / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the influence of gender on the development and prognosis of atherosclerosis obliterans (ASO).</p><p><b>METHODS</b>Eight hundred and forty-two patients with ASO were treated from January 2000 to February 2007. The clinical data were retrospectively collected. And the influence of gender on the development and prognosis of ASO was investigated.</p><p><b>RESULTS</b>Among the 842 patients, 661 were male and 181 were female. The ratio of male to female was 3.65 : 1.00, and the ratio decreased with increasing age. The mean age of male and female patients were (71.7 +/- 9.0) years and (75.7 +/- 6.8) years, respectively. Significantly more iliac lesions occurred in male patients than in female, while female patients experienced more infrainguinal lesions. The coexistence rate of diabetes and amputation rate were significantly higher in female patients than in male (46.4%/24.7% and 16.0%/9.1%, respectively).</p><p><b>CONCLUSION</b>The female patients with ASO appear to have poorer prognosis than the male, despite their lower incidence of ASO.</p>

Short to midterm results of endovascular for 105 case of infrarenal abdominal aortic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To assess short to midterm outcome of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA) in 105 cases.</p><p><b>METHODS</b>Stent-grafts were placed into 105 patients with infrarenal AAA between January 2001 and February 2007. The clinical data of those cases were retrospectively analyzed.</p><p><b>RESULTS</b>Primary technical success rate was 100%. Eighty-two cases (78.09%) were followed-up for 1 to 73 months (mean, 8.9 +/- 5.8 months). Three cases (2.86%) died during peri-operative period, from acute cardiac infarction, multi-organ failure and significant upper gastrointestinal bleeding, respectively. Another one died from hepatic cancer 30 months after EVAR. Twenty-one cases experienced primary endoleak. Eighteen were type I, among which 10 underwent secondary intervention in the form of balloon dilatation (n = 9) and stent-graft placement (n = 1), 8 sealed spontaneously. Two cases were type II and sealed spontaneously. One type III was treated by placing a stent-graft. An emergent femorofemoral crossover was performed for one graft limb thrombosis 2 weeks after EVAR. Four late type I endoleaks occurred. One stent-graft migration without endoleak was cured conservatively. Two stent-graft infections occurred 1 month and 3 months after EVAR respectively, and were cured with debridement, drainage and antibiotics. Nine femorofemoral or iliofemoral bypass and three internal iliac bypasses were all patent during the follow-up period.</p><p><b>CONCLUSION</b>Endovascular repair is a safe and effective method for infrarenal AAA with perfect short to midterm outcomes.</p>

Endovascular repair of descending thoracic aortic aneurysm: preliminary experience / 中华外科杂志

<p><b>OBJECTIVE</b>To report an initial experience with the endovascular repair of descending thoracic aortic aneurysm (DTAA).</p><p><b>METHODS</b>Endoprostheses were placed into 41 patients with DTAA between January 2001 and July 2007 which were retrospectively analyzed. The preliminary right-left carotid and left carotid-subclavian bypass was performed in 4 cases in which the distances from the proximal aneurysm to the origin of the left common carotid artery were no longer than 15 mm. EVAR was conducted 1 week after the bypass or immediately.</p><p><b>RESULTS</b>All stent grafts were deployed in proper position. There were two deaths (4.9%) during perioperative period, resulting from multiorgan failure and acute cardiac infarction, respectively. Eighteen endoleaks occurred immediately after EVAR (43.9%), four disappeared after balloon dilatation. There were two acute renal insufficiencies (4.9%), one requiring hemodialysis for more than 30 days. Follow-up, which ranged from 1 to 60 months [median, (18.6 +/- 4.2) months] was carried out in 26 patients (63.4%). Type-I endoleak and type-III endoleak were detected in two patients in 4 years and 2 years after EVAR, might because of migration, and were corrected using another stent-graft each. Two patients died of other diseases during follow-up. Complete thrombosis of the thoracic aneurysm sac with no late migration or endoleaks was revealed on CT at 3 months postoperatively in the remaining patients. The decrease in maximal aneurysm diameter was 0-22 mm [median, (8.3 +/- 4.5) mm] and the prosthetic vascular grafts in four patients with preliminary carotid subclavian bypass surgery were patent during the follow-up period.</p><p><b>CONCLUSIONS</b>The treatment of descending thoracic aortic aneurysm with an endovascular approach is feasible with less trauma, quick recovery and less complications. It may offer the best means of therapy for high risk patients.</p>

Endovascular stent-grafts for the treatment of isolated iliac artery aneurysms: a report of 14 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endovascular repair (EVR) for isolated iliac artery aneurysms (II AA).</p><p><b>METHODS</b>Fourteen patients were treated with transluminally placed endovascular stent-grafts from October 2004 to May 2006. In eight patients, the aneurysms involved the right common iliac arteries. In five cases, left common iliac arteries were involved. The aneurysm involved the left internal iliac artery and ruptured in the other case. Criteria for repair were a diameter over 3.0 cm for true aneurysms.</p><p><b>RESULTS</b>Technical success was achieved in all cases. Eight cases with right common iliac artery aneurysms were treated with bifurcated aorto-iliac stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with right common iliac artery aneurysm involved the bottom of abdominal aorta was treated with AUI stent-graft and femorofemoral bypass. Five cases involved left common iliac arteries were treated with tubular stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with ruptured left internal iliac artery aneurysm was treated emergent with tubular stent-graft after ipsilateral internal iliac artery embolization with coils. Aortography carried out immediately after the procedure showed the II AA were completely excluded by stent-grafts and no serious endoleaks both on the proximal or distal connections. One case with acute left ventricular dysfunction and alveolar edema postoperatively recovered after emergent treatment No complications in thirteen cases. All patients were followed up for a mean of 10.2 months (3 to 19 months) by CTA, no aneurysms enlargement, no stent-grafts migration, no endoleak, femorofemoral bypass was patent.</p><p><b>CONCLUSIONS</b>Endovascular repair of isolated iliac artery aneurysms is a minimally invasive,safe and feasible technique and provides good short-term patency. Long-term patency is followed.</p>