Mid- and long-term outcomes and prognostic factors of drug-coated balloon angioplasty for treatment of femoropopliteal long lesions / 中华外科杂志

Objective: To examine the effective and safe outcomes of drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal long lesions in mid-term and long-term follow-up. Methods: The clinical data of 114 patients with symptomatic (Rutherford 2 to 6) femoropopliteal long lesions who underwent angioplasty with DCB between June 2016 and May 2021 at Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital were retrospectively analyzed. A total of 75 males and 39 females were enrolled, aged (71.9±8.4)years (range: 49 to 89 years). Among 138 lesions in 114 patients, there were 111 de nove lesions (80.4%, 111/138). Total occlusions were recanalized in 116 limbs (84.1%, 116/138). The lesion length was (280.9±78.7)mm (range: 150 to 520 mm). DCB angioplasty combined with debulking devices was used in 59 lesions (42.8%, 59/138).The bail-out stent implantation was performed in 27 limbs (19.6%, 27/138). The Kaplan-Meier method was used to evaluate cumulative primary patency rate, freedom from the clinically driven target lesion revascularization (CD-TLR) rate and accumulate survival rate. Univariate and multivariate analyses with Cox proportional hazards models were performed to determine the significant prognostic factors for primary patency. Results: DCB angioplasty was completed in 114 patients. The technical success rate was 98.2%(112/114). The mean follow-up time was 18 months (range: 3 to 54 months).The results showed that primary patency rates at 12, 24 and 36 months postoperatively were 87.5%, 75.2% and 55.1%, respectively. Freedom from CD-TLR rate at 12, 24 and 36 months postoperatively were 92.4%, 81.8% and 68.7%, respectively. Accumulate survival rate at 12, 24 and 36 months postoperatively were 96.2%, 94.0% and 80.2%. Multivariate Cox's regression analyses showed that chronic limb-threatening ischemia(CLTI) (HR=2.629, 95%CI:1.519 to 4.547, P<0.01) and hyperlipidemia (HR=2.228, 95%CI: 1.004 to 4.948, P=0.026) were independent prognosis factors for primary patency in DCB treatment of femoropopliteal long lesions. Conclusions: DCB provided favorable outcomes for the treatment of femoropopliteal long lesions. CLTI and hyperlipidemia are independent prognosis factors for restenosis after DCB angioplasty.

Preliminary study on etiology of Budd-Chiari syndrome through clinic and experiment / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the etiology of Budd-Chiari syndrome (BCS) preliminarily.</p><p><b>METHODS</b>The clinical findings of radical surgery of 109 cases with BCS from March 2001 to May 2009 were analyzed. The pathological components of membranous tissue (MT) from inferior vena cava (IVC) or hepatic vein (HV) of BCS patients were compared with that of thrombus from deep venous thrombosis (DVT), as well as the expression of transforming growth factor beta receptor (TGF-beta R), platelet derived growth factor receptor (PDGFR), endothelin (ET-1), factor VIII related antigen (FVIII-rAg), ferritin and alpha1-antitrypsin in MTs and thrombus through immunohistochemical method.</p><p><b>RESULTS</b>One hundred and four cases of BCS were due to IVC and/or HV membrane or thrombosis except that 4 cases due to IVC tumor or 1 case due to compression of fiber. The new-formed IVC membrane was found in 2 recurred cases whose IVC thrombus was excised before 1 year and 7 years. The development from organized thrombus to MT was found in 3 cases of segmental obstruction of IVC. The IVC membrane located below HV outlet was in 8 cases. Both MTs and thrombus had the pathological components such as fibroblast, neutrophil, granulation tissue, newly-formed blood vessels and so on under the light microscope. The expressions of TGF-beta R, PDGFR, ET-1, FVIII-rAg, and ferritin in MTs and thrombus were as follows: MT 72.3%, thrombus 50.0% (P > 0.05); MT 45.5%, thrombus 100% (P < 0.05); MT 100%, thrombus 0 (P < 0.05); MT 90.9%, thrombus 12.5% (P < 0.05); MT 72.3%, thrombus 100% (P > 0.05).</p><p><b>CONCLUSIONS</b>The membranous tissues and thrombus have the similar homogeneity and cytokines expression. The membrane and thrombus may be different pathological phases.</p>

Analysis of relative factors of restenosis after artificially grafting bypasses on chronic ischemia of lower extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the relative factors of early-term restenosis after artificially grafting bypasses on chronic ischemia of lower extremities.</p><p><b>METHODS</b>From January 2006 to September 2007, 40 cases suffered from chronic ischemia of lower extremities were treated by single side femoropopliteal bypass were followed up during 6 months after operation. There were 36 male and 4 case female with a mean age of (66 +/- 9) years old. Lipid, fibrinogen (FIB) and hypersensitive C reactive protein (hsCRP) were chemical examined during peri-operation. Basing on the degree of restenosis in vascular anastomosis by Color Doppler graft scan, all the patients were divided into light, moderate and severe groups, respectively. Biochemical indicators and cytokines were investigated such as lipid, FIB, hsCRP, IL-6, transforming growing factor beta1 (TGF-beta1). Possible risk factors resulting in restenosis were compared statistically among three groups with SPSS 15.0.</p><p><b>RESULTS</b>Restenosis were more severe among the patients with concomitance disease such as diabetes mellitus and smoking after operation. Relative risk were 6.47 and 7.92, respectively. There are significant difference in total cholesterin, low density lipoprotein, FIB, hsCRP, IL-6 and TGF-beta1 among three groups during six months after operation (P < 0.05). Multiple linear regression showed that FIB and TGF-beta1 may be the risk factors to intimal hyperplasia.</p><p><b>CONCLUSION</b>Diabetes mellitus, smoking and higher levels of FIB may be the major high risk factors resulting in neointima hyperplasia and anastomosis restenosis.</p>

Mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To report the mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities.</p><p><b>METHODS</b>The clinical data of 212 patients treated with bypass operation from January 2002 to April 2007 were retrospectively reviewed. Femoropopliteal artery bypass to above-knee popliteal (FP-ak) was carried out in 111 cases, femoropopliteal artery bypass to below-knee popliteal (FP-bk) in 59 cases, aortoiliac bypass in 25 cases and femorofemoral bypass in 17 cases.</p><p><b>RESULTS</b>One hundred and eighty-six patients (87.7%) were followed up for 6 to 68 months (median, 18 months). One-year primary patency rate of FP-ak and FP-bk was 69.7% and 53.5%, respectively. After graft revision, 1-year secondary patency rate of FP-ak and FP-bk were 81.6% and 60.5%, respectively. The 3-year patency with FP-ak (56.3%) was significantly higher than that in FP-bk (23.8%) (P < 0.05). Fifty-two cases were reoperated on during the follow-up period. Crural or femoral amputation could not avoid in 23 cases (limb salvage rate 89.2%). Ten cases died in 1 to 30 days after the operation, 20 cases died later during followup, and most of them died of cardio-cerebrovascular diseases. Artificial vessel infection occurred in 6 cases.</p><p><b>CONCLUSIONS</b>The selection of surgical treatment for chronic ischemia of lower extremities should based on the ischemic state of the limb. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.</p>