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Objective@#To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair(EVAR).@*Methods@#From Jan 2014 to Jan 2018, one hundred and twelve consecutive patients with infra-renal AAA were enrolled for this study, There were 76 patients undergoing standard EVAR (standard-group)and 36 patients doing aneurysmal sac coiling embolization (embo-group). Baseline characteristics, aneurysmal sac parameters, radiological intervention details and follow up results were recorded.@*Results@#Mean follow-up time was 25.9 m for embo-group. During follow-up period, no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported. A mean of (2.72±1.16) coils (range 1-7) was used in the embo-group. The incidence of type Ⅱ endoleak was 30.3%(23/76) in standard-group and 11.1%(4/36) in embo-group(χ2=4.90, P=0.027). Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume≥128 cm3. In the subgroup analysis (sac volume≥128 cm3), the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (χ2=6.07, P=0.014).@*Conclusion@#Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak. This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.
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Objective To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair (EVAR).Methods From Jan 2014 to Jan 2018,one hundred and twelve consecutive patients with infrarenal AAA were enrolled for this study,There were 76 patients undergoing standard EVAR (standard-group) and 36 patients doing aneurysmal sac coiling embolization (embo-group).Baseline characteristics,aneurysmal sac parameters,radiological intervention details and follow up results were recorded.Results Mean follow-up time was 25.9 m for embo-group.During follow-up period,no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported.A mean of (2.72 ± 1.16) coils (range 1-7) was used in the embo-group.The incidence of type Ⅱ endoleak was 30.3％ (23/76) in standard-group and 11.1％ (4/36) in embo-group(x2 =4.90,P =0.027).Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume ≥ 128 cm3.In the subgroup analysis (sac volume≥ 128 cm3),the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (x2 =6.07,P =0.014).Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak.This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.
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Objective To observe the effect of GLP-1 on HSP70 expression of rabbit thoracic aortic endothelial cells at high glucose level.Methods Rabbit thoracic aortic endothelial cells were isolated and cultured.Tunnel was used to assay endothelial cells apoptosis.Cell proliferation was analyzed with BUDR.The protein level of HSP70 were detected by Western blot.Results The proliferation of rabbit thoracic aortic endothelial cells cultured under high glucose (33 mmol/L) decreased,(0.54 ±0.06 vs 0.78 ±0.04,P ＜ 0.01).The apoptosis and the protein level of HSP70 increased,(36.43％ ± 6.85％ vs 5.25％ ±0.73％) and (0.94 ± 0.11 vs 0.29 ± 0.03,all P ＜ 0.01).The proliferation of rabbit thoracic aortic endothelial cells (0.62 ± 0.06)in the GLP-1 group increased,the apoptosis ratio (10.13％ ± 1.19％) and HSP70 expression (0.76 ± 0.05) decreased significantly (P ＜ 0.05) compared with high glucose group.Conclusion GLP-1 can ameliorate high-glucose-induced rabbit thoracic aortic endothelial cells apoptosis and promote cell proliferation,attenuating high-glucose-induced level of HSP70 expression through the GLP-1 R-dependent pathways.
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OBJECTIVE@#To explore the relationship between activity of plasma heparin cofactor II (HC II) and the incidence of in-stent restenosis aft er the intervention of arteriosclerosis obliterans in lower extremity.@*METHODS@#A total of 62 patients with arteriosclerosis obliterans in lower extremity underwent femoropopliteal stent implantation. They were divided into 2 groups: A high HC II activity group (≥100%, n=40) and a low HC II activity group (<100%, n=22). All patients filled in follow up tables and conducted body examination. Possible risk factors resulting in restenosis were collected. Patients were followed up for 6 months after femoropopliteal stent implantation.@*RESULTS@#Baseline clinical characteristics were not significantly different between the 2 groups. The degree and incidence of angiographic restenosis at the end of the 6th month after the implantation in the high HC II activity group were all significantly lower than those in the low HC II activity group (P<0.05). Multivariate analysis demonstrated that high plasma HC II activity was an independent factor in reducing the incidence of angiographic restenosis (OR=0.982, P=0.048, 95%CI, 0.966, 0.998).@*CONCLUSION@#High plasma HC II activity is an independent factor in reducing the degree of in-stent restenosis. The lower the plasma HC II activity, the severer the degree of in-stent restenosis.
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Humans , Arteriosclerosis Obliterans , General Surgery , Constriction, Pathologic , Heparin Cofactor II , Metabolism , Incidence , Lower Extremity , Risk Factors , StentsABSTRACT
Objective To investigate the method and effect of endovascular treatment for ilio-femoral venous post-thrombotic syndrome.Methods We retrospectively analyzed the clinical data of 47 patients,who underwent endovascular treatment for ilio-femoral venous post-thrombotic syndrome from January 2010 to December 2013.Patients received transjugular iliofemoral venous thrombectomy,percutaneous angioplasty (PTA) and/or endovascular stent placement after inferior vena cava filter was implanted.Results All patients were successfully treated with angioplasty and stent placement.The ilio-femoral venous were patent after the placement of the stent.Chronic ulcer in 7 patients healed within one month.The patency rate of the affected limb at 6 months was 88.9％,occlusion rate was 11.1％.No reblocked cases were found during venous ultrasound follow-up.After treatment,the circumference difference of low limb between affected and normal limb decreased from (2.46 ± 0.98) cm to (0.70 ± 0.19) cm (P ＜0.05) at the level of 15 cm above knee,and from (3.28 ±0.85) cm to (0.83 ±0.26) cm (P＜0.05) at the level of 15 cm below knee.Villalta score decreased from (12.0 ± 1.9) to (6.9 ±2.2,P ＜ 0.05) and symptoms were significantly improved.Conclusions Ilio-femoral venous stenting provides a safe,effective and minimal invasive approach for the treatment of post-thrombotic syndrome.Acceptable patency rates can be expected through short-term follow-up.
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Objective To explore the clinical significance of retrograde access for the interventional treatment of lower extremity arterial occlusive diseases when the occluded segment of lower extremity artery could not be reached through antegrade access.Methods Twenty-seven cases (male 17,female 10; age range 32-89 years ) were retrospectively investigated, including 18 with lower limb arteriosclerosis obliterans,7 with diabetic foot and 2 with thromboangiitis obliterans.According to the Fontaine staging,6 cases were classified as Fontaine Ⅱ,11were classified as Fontaine Ⅲ and 10 were classified as Fontaine Ⅳ.All cases underwent endovascular operation through antegrade access first with an attempt to cross the occlusive segment,but in vain.So retrograde access was tried via puncture of pedis dorsalis or posterior tibial artery or exposure of lateral branches of posterior tibial artery,peroneal artery or dorsal artery by open surgery,which followed by Percutaneous transluminal angiography and (or) stenting.Results The operation through retrograde access was successful in all cases with obvious improvement of ischemic symptoms.Hematoma at the puncture site occurred in 3 patients,and paresthesia of toes occurred in 1after dorsalis pedis arteriotomy.No severe perioperative complication occurred.The average ankle brachial index increased from 0.37 ± 0.11preoperatively to 0.85 ± 0.12 postoperatively.Conclusions Retrograde access could be used as an alternative strategy in lower extremity arterial occlusive diseases when the occluded segment could not reach through antegrade access.
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Objective To investigate the protective effects of ulinastatin(UTI)on ischemia-reperfusion(I/R)injury(SMIRI)of skeletal muscle in rats.Method Twenty-four male SD rats randomly were divided into three groups in equal number:control group(Group C)rats underwent anesthetization without ischemia;the ischemia-reperfusion injury group(Group I/R)rats underwent ischemia and reperfusion,0.5 ml normal saline (N.S)was infused upon extermal jngular vein prior to reperfusion;ulinstatin group(Group U)underwent ischemia and reperfusion,and 0.5 ml UTI(5×104 U/kg)Was infused at the same time.The skeletal muscle injury model was induced by a rubber band tourniquet applied to the left root of the hind limb for 4 hours and reperfusion for 4 hours.At the end of study,the expression of TNF-α mRNA of skeletal muscle was determined by reverse transcription-polymerase chain reaction(RT-PCR);enzyme-linked immun-osorbent assay(ELISA)were performed for plasma level of TNF-α;the plasma concentrations of lactate dehydrogenase(LDH),creatine kinase (CK),malondialdehyde(MDA),myeloperoxidase(MPO)activity and MDA in skeletal muscle were measured by colorimetry respectively.The oedema degree was quantified by calculating the wet/dry weight ratio of skeletal muscle.Structural changes of skeletal muscle were also observed histologically and ultrastructurally.The statistical difference was analyzed with One-way ANOVA by SPSS version 10.0 Software for windows.Results The level of plasma TNF-α,TNF-α mRNA expression in skeletal muscle in group I/R were significantly higher than those in Group C(P＜0.01),while those in Group U were significantly lower than those in Group I/R(P＜O.01).The plasma concentrations of LDH,CK,MDA and the MPO activity,W/D of skeletal muscle varied in those groups were likewise in comparinson between groups(P＜0.05).The histologic changes of skeletal muscle tissue under light and electronic microscopy were slingter in Group U than in group I/R.Conclusions UTI can inhibit the production of inflammatory factors and MDA,and suppress the MPO activity,showing protective effects against ischemia-reperfusion injury of skeletal muscle of rats.
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Objectives To investigate the effect of tumor necrosis factor ? on skeletal muscle ischemia reperfusion injury (SMIR). Methods Twenty four healthy male Sprague Dawley rats were divided into three groups. Group A underwent anesthesia and external jugular vein cannulation only. Group B underwent 4 hours of left hind limb ischemia followed by 4 hour reperfusion. Group C ischemia and reperfusion were treated with anti TNF ? monoclonal antibody (2?mg/kg). ResultsSMIR significantly increased the transcription of TNF ? mRNA in monocyte. The increased TNF ? raised significantly the level of MDA(9 9?1 8 vs. 5 5?0 4)?CK(122?24 vs. 49?11)?NO(270?98 vs. 128?46) in plasma and MPO(skeletal muscle 4 27?0 53 vs. 1 28?0 19, lung 2 61? 0 12 vs. 0 57?0 02) in tissues respectively( P
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Objective To evaluate the early clinical efficacy of subfascial endoscopic perforator vein surgery (SEPS) in the treatment of chronic venous insufficiency (CVI) of lower limbs. Methods A retrospective study was carried out in 26 patients (34 legs) with CVI treated by SEPS. Results The number of incompetent perforating veins ligated per limb ranged 1～5 (mean, 3 5). The postoperative clinical score (2.48?0.25) was significantly lower than the preoperative score (6.54?0.93) ( t =21.497, P
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Objective:To evaluate the efficacy of dual intervention for the treatment of acute pulmonary embolism(PE) in patients with deep venous thrombosis(DVT) of lower limbs.Methods:Twenty five patients of DVT with PE were treated with combination of transcatheter thrombolysis and inferior vena cava filter placement.Results:All the filter procedures and catheter were successfully performed,without any complication.The clinical symptoms were markedly improved in all patients.Twenty three cases were followed up for 3-36 months after dual intervention,and no complications of interventional treatment or recurrent PE was found.Conclusion:The inferior vena cava filter placement is an effect method in preventing PE.Dual interventional procedures is a superior and effective method for managing the patients with PE.
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Objective:To investigate the mechanism of Salvia Miltiorrhizae(SM) on protecting the renal injury of rats with obstructive jaundice.Methods:The 36 rats were randomly divided into control group,obstructive jaundice group and SM treated group.The renal injury of rats model with obstructive jaundice was established by ligating common bile duct.In the SM treated group,SM (2.0g/ d) was given through abdominal cavity.Animals were killed at the 7th,14th,21st and 28th day after operation respectively.The malondialdehyde (MDA) and superoxide dismutase (SOD) activity content of serum and renal tissue were determined,and the changes of renal function and histopathology were observed.Results:Comparing with non treated group,the serum and renal tissue SOD activity were markedly increased,and the MDA were obviously decreased(P