The optimal dose of oral tranexamic acid in melasma: A network meta-analysis

Background: Melasma is a chronic skin condition that adversely impacts quality of life. Although many therapeutic modalities are available there is no single best treatment for melasma. Oral tranexamic acid has been used for the treatment of this condition but its optimal dose is yet to be established. Objectives: We used network meta-analysis to determine the optimal dose of oral tranexamic acid for the treatment of melasma. Methods: We conducted a comprehensive search of all studies of oral tranexamic acid for the treatment of melasma up to September 2020 using PubMed, EMBASE and the Cochrane Library database. The quality of the studies was evaluated using the Jadad score and the Cochrane’s risk of bias assessment tool. Only high quality randomised controlled trials were selected. Some studies lacked standard deviation of changes from baseline and these were estimated using the correlation coefficient obtained from another similar study. Results: A total of 92 studies were identified of which 6 randomized controlled trials comprising 599 patients were included to form 3 pair-wise network comparisons. The mean age of the patients in these studies ranged from 30.3 to 46.5 years and the treatment duration ranged from 8 to 12 weeks. The Jadad scores ranged from 5 to 8. The optimal dose and duration of oral tranexamic acid was estimated to be 750 mg per day for 12 consecutive weeks. Limitations: Some confounding factors might not have been described in the original studies. Although clear rules were followed, the Melasma Area and Severity Index and the modified Melasma Area and Severity Index were scored by independent physicians and hence inter-observer bias could not be excluded. Conclusion: Oral tranexamic acid is a promising drug for the treatment of melasma. This is the first network meta-analysis to determine the optimal dose of this drug and to report the effects of different dosages. The optimal dose is 250 mg three times per day for 12 weeks, but 250 mg twice daily may be an acceptable option in poorly adherent patients. Our findings will allow physicians to balance drug effects and medication adherence. Personalized treatment plans are warranted.

Association of the serum calcium level with metabolic syndrome and its components among adults in Taiwan

ABSTRACT Objective: An increasing amount of literature indicates that the serum calcium level may be related to metabolic syndrome (MetS) and obesity. This study aimed to examine the relationship between the serum calcium level and MetS in adults in Taiwan. Subjects and methods: We conducted a cross-sectional study and enrolled 1,580 participants (54.4% women; mean age, 33.28 ± 12.21 years) who underwent health examinations in northern Taiwan between 2012 and 2016. Logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of MetS and its components in groups of patients in the tertiles of the serum calcium level. Results: In total, 167 participants (10.6%) had MetS. The odds of high systolic blood pressure (BP), blood glucose, and triglyceride (TG) levels significantly increased as the serum calcium level increased. Compared with the participants in the lowest tertile of the serum calcium level (tertile 1), those in the second tertile (OR = 1.47, 95% CI: 0.97-2.23) and third tertile (OR = 1.63, 95% CI: 1.06-2.53) had a significantly higher risk of MetS. Further analyses revealed a significant association between MetS and an increased serum calcium level in those in the overweight and obese groups. However, there was no association between the serum calcium levels and MetS in those in the normal weight group. Conclusion: This study demonstrated that a higher serum calcium level is associated with an increased risk of MetS and its components in adults with overweight and obesity.

Factors associated with falls among community-dwelling older people in Taiwan

<p><b>INTRODUCTION</b>Falls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people.</p><p><b>MATERIALS AND METHODS</b>We conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications.</p><p><b>RESULTS</b>The mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study.</p><p><b>CONCLUSION</b>Among community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls.</p>

Recanalization of superficial femoral artery occlusions with Outback LTD catheter / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate immediate- and median-term outcomes from subintimal recanalization of superficial femoral arteries (SFA) chronic total occlusions (CTO) with the Outback LTD catheter.</p><p><b>METHODS</b>From January 2010 to May 2011, 35 legs in 30 patients with CTO of the SFA and proximal popliteal artery were treated by Outback LTD catheter. There were 20 male and 10 female patients. The mean age of the patients was 68 years. Clinical presentation was severe intermittent claudication (Rutherford category 3, 10/35, 28.6%), rest pain (Rutherford category 4, 13/35, 37.1%), and minor ulceration (Rutherford category 5, 12/35, 34.3%). In all cases, the true lumen could not be entered by using standard antegrade catheter and guide wire techniques. Technical success, complications, procedure times, clinical outcomes and cumulative patency rates in follow-up were evaluated.</p><p><b>RESULTS</b>Median lesion length was (210 ± 15) mm. Recanalization of the arterial occlusion was successful in 34 of 35 treated lesions (97.1%). None of the 30 patients showed any procedure-related complications during or after treatment. The mean follow-up was (7.2 ± 0.3) months. Cumulative primary patency rates after 3, 6, and 12 months were 90.9%, 84.8% and 50.6%. Three minor toe amputations and one major below-the-knee amputation were observed in patients with critical limb ischemia.</p><p><b>CONCLUSIONS</b>The Outback LTD catheter is a safe and effective device to recanalize challenging superficial femoral arteries CTO. The technique could reduce radiation exposure time and raise the technique success rate.</p>

The dilatation of the proximal neck after endovascular repair of abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVES</b>To review the dilatation of the proximal neck in abdominal aortic aneurysm (AAA) after endovascular repair (EVR), and to analyze the factors contributed to these changes.</p><p><b>METHODS</b>From January 1997 to January 2007, a total of 45 patients treated by EVR met the inclusion criteria. There were 44 male and 1 female patients, with an average age of (69 ± 17) years. The patients were all asymptomatic abdominal aortic aneurysm, combined hypertension in 37 cases, coronary heart disease in 40 cases. All the patients had the complete preoperative enhanced CT information, and accepted more than 6 months of regular enhanced CT follow-up (1, 3, 6, 12 months after surgery and annually thereafter). The proximal aneurysm neck diameter increase was determined by CT, increase over 2 mm as having change, less than 2 mm as no change.</p><p><b>RESULTS</b>The average follow-up interval was (34 ± 25) months (ranging from 9 to 100 months). The mean preoperative proximal neck diameter was (21.5 ± 2.3) mm, and (22.4 ± 2.4) mm one month after operation and (24.0 ± 2.8) mm at the latest follow-up. The increase of proximal neck diameter was detected in 71.1%. The oversizing percentage was 19% ± 6%. The incidence of proximal neck over-sizing stent-graft in diameter was 6.7%. The incidence of no dilation at proximal neck diameter was 97.4%, 68.6%, 39.3% and 3.3% at 16, 24, 36 and 96 months postoperatively respectively. The stent-graft migration was detected in 22.2% patients, and the migration distance was (7.0 ± 1.3) mm (ranging from 0 to 9.5 mm). There were no case which the migration oversized 10 mm or need to reintervention.</p><p><b>CONCLUSIONS</b>The more oversizing percentage, the more dilatation in the proximal neck. The stent-graft migration and the dilatation of the proximal neck might have effect on each other.</p>

Endovascular aneurysm repair in high-surgical-risk abdominal aortic aneurysm patients: initial and long-term results / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients.</p><p><b>METHODS</b>From July 1997 to July 2011, 120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry. There were 96 male and 24 female patients, aged from 52 to 95 years with a mean of 74 years. Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3, 6, 9, 12 months, and annually thereafter. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement.</p><p><b>RESULTS</b>Mean aneurysm diameter was (57 ± 8) mm. Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five type I endoleaks, twenty-five type II endoleaks and one type III endoleak occurred during the perioperative period. The technical success rate was 95%. Operative mortality was 2.5%. The survival rates at 1-, 3- and 5-year were 92%, 75% and 43% respectively. The mean follow up was (36 ± 3) months. Primary and secondary patency rates at 3 year were respectively 97% and 100%. Secondary intervention rate was 10% (12/120) at 5 year. The reasons included endoleaks for 7 patients, stent-grafts fracture for 2 patients, stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients.</p><p><b>CONCLUSIONS</b>Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.</p>

Endovascular repair of type B acute aortic dissection / 中华普通外科杂志

Objective To evaluate the safety and efficacy of endovascular repair(EVR)for type B acute aortic dissection(AAD). Methods Between Feb 2002 and May 2008.39 consecutively admitted patients with the confirmed diagnosis of acute type B aortic dissection were studied.All patients were treated bv EVR.Left comnlon carotid artery were covered after bypass in 2 cases.of which fenestrated stent graft (SG)at innominate artery was used in one;1 case underwent left lower extrernity amputation:13 left subclavian artery(LSA)and 1 aberrant risht subclavian artery were completely covered without bypass.5 LSA were pattially covered.All cases were followed by CTA after EVR.the porfusion status of the false lumen were monitored in the aorta at the level of the stented segment(L1)and distal to the stent graft (L2).Results The procedure Was technically successful in all cases;30-day mortality rate was 10.3%.At the 1-month follow-up,false lumen in L1 thrombosed in 100%,a complete thrombosis of the false lumen Was observed in 21 patients(77.8%).partial thrombosis in 6(22.2%).with complete reabsorption of the thrombus and remodelling of the true lumen in 5(18.5%);False lumen in L2 thrombosed only in 7 patients(28%),complete thrombosis in 2(8%)and partial thrombosis in 5(20%).Conclusions The results of endovascular repair of acute type B dissection Was satisfactory.30-day mortalitv rate was related to severe complications before EVR.

The application of chimney technique in TEVAR of aortic arch lesions / 中华普通外科杂志

Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair(TEVAR) in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% (5/27) of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.

Total percutaneous endovascular abdominal aortic aneurysm repair / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the safety and efficacy of total percutaneous endovascular abdominal aortic aneurysm repair using the Perclose ProGlide suture-mediated closure system.</p><p><b>METHODS</b>From May 2008 to April 2010, 36 abdominal aortic aneurysm patients were undergone total percutaneous endovascular repair. There were 30 male and 6 female patients with a mean age of 68 years. Endografts used included 3 Endurant endografts, 13 Talent endografts, and 20 Zenith endografts. Prior to insertion of the introducer sheath, two ProGlides were pre-set to 18 to 24 F access sites and one to 14 to 16 F access sites. At last, suture the arteriotomy by tying down knots of the ProGlide following removal of the sheath. Technical success, complications, and procedure and access closure times were evaluated. Follow-up protocol consisted of computed tomography angiograms performed at 3, 6, 9, 12 months, and annually thereafter.</p><p><b>RESULTS</b>Twenty patients were operated under local anesthesia and 16 patients under general anesthesia. A total of 68 femoral arteries were closed with 128 devices. Thirty-eight vessels were with 2 devices, while 8 arteries required 3 devices and 2 arteries required 4 devices for hemostasis and an additional 20 vessels only required a single device. Sixty-three (63/68, 92.6%) vessels were closed successfully. Two vessels converted to open closure. Three vessels complicated with hematomas without surgical procedure. The mean follow-up was (12±3) months. There was one asymptomatic femoral artery dissection 3 months after operation.</p><p><b>CONCLUSIONS</b>Total percutaneous endovascular abdominal aortic aneurysm repair is safe and effective. But it should be performed at hybrid operating room where can convert to open procedure if necessary.</p>

Surgical treatment of peripheral arterial aneurysms: a report of 35 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment strategies of peripheral arterial aneurysms.</p><p><b>METHODS</b>Thirty-five cases were reviewed from July 1998 to December 2007, and 28 cases were male, 7 cases were female. Eleven cases were popliteal artery aneurysms, 15 cases were femoral artery aneurysms, 4 cases were extracranial carotid aneurysms and 5 cases were subclavian artery aneurysms. All cases had either open procedures or endovascular procedures.</p><p><b>RESULTS</b>Surgical open procedures were performed on 24 cases, and endovascular procedures were performed on 11 cases. The perioperative complication rate were 16.7% (4/24) and 0% for open and endovascular groups respectively. The average follow-up time was 41 months (7 months to 8 years). The accumulative five year patency were 61% and 48% for surgical grafts and stent grafts respectively. Two cases died of diseases and one had stroke during follow-up.</p><p><b>CONCLUSIONS</b>Surgical open repair is still standard procedure for most peripheral arterial aneurysms and endovascular repair may have its own advantage for high risk patients.</p>

CT-research about how to design the diameter and length of the modular branched stent-graft / 中华外科杂志

<p><b>OBJECTIVE</b>To study the anatomical characteristics about ascending aortic and aortic arch in Chinese population by CT.</p><p><b>METHODS</b>From September 2006 to September 2007, 388 patients free of current known aortic pathology undergone thoracic aorta CTA. The diameter of ascending aorta, aortic arch, and branch vessels of aortic arch were measured respectively by AW4.2 work station. The data base about all the measurements was set up. The CHISS statistical software was used to analysis data.</p><p><b>RESULTS</b>The aortic diameter above coronary artery (CA), the level at origin of and brachiocephalic trunk (BCT), the halfway of the ascending aorta, the level at origin of left common carotid artery (LCCA), the level at origin of left subclavian artery (LSA) and the level at distal of origin of LSA respectively were (34 +/- 5) mm, (34 +/- 5) mm, (33 +/- 4) mm, (30 +/- 4) mm, (28 +/- 3) mm and (26 +/- 3) mm. The diameters of two level between the origin of BCT and right subclavian artery (RSA) were (13.1 +/- 1.9) mm and (12.8 +/- 2.3) mm. Diameters of two level at LCCA were (8.7 +/- 1.5) mm and (7.9 +/- 1.0) mm. The diameters of two level between the origin of LSA and left vertebral artery were (10.7 +/- 1.7) mm and (9.3 +/- 1.3) mm. The aortic lumina length between the origin of CA and BCT was (5.3 +/- 1.2) cm, the aortic lumina length between the origin of BCT and LCCA was (1.3 +/- 0.4) cm, the lumen length between origin of BCT and RSA was (4.1 +/- 0.8) cm, the lumen length between origin of LSA and left vertebral artery was (3.8 +/- 0.8) cm. The distance between the wall of BCT and LCCA was (0.4 +/- 0.2) cm, the distance between the wall of LCCA and LSA was (0.7 +/- 0.6) cm.</p><p><b>CONCLUSIONS</b>Modular branched stent-graft system is fit for most part of the Chinese. The size fit for human could be got on this basic.</p>

Catheter-directed foam sclerotherapy of incompetent saphenous reflux: early results / 中华外科杂志

<p><b>OBJECTIVE</b>To describe observation of availability of catheter-directed foam sclerotherapy for the great saphenous vein varicosis.</p><p><b>METHODS</b>A selective series of 30 patients of vein varicosis were treated with foam sclerotherapy using a standard technique for foam delivery from April 2008 to August 2008. Patients were treated with 1% polidocanol foam through a catheter, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV). All successfully treated patients were examined by colour duplex two weeks after the procedure.</p><p><b>RESULTS</b>Thirty patients with an insufficiency reflux of the GSV were treated with the catheter-directed foam sclerotherapy. Primary technical success was achieved in all the patients. The concentrations (1.0%) and doses (6 to 8 ml) of polidocanol was mainly we used. Five patients experienced transient scotomas and developed segmental phlebitis of a collateral vein. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), a closure of the GSV was found at control visits 2 weeks, 3 months after treatment.</p><p><b>CONCLUSION</b>The use of an endovascular catheter inserted percutaneously over a guidewire is feasible in most patients and has resulted in high primary occlusion rates.</p>

CT topography of asending aorta and aortic arch in adult Chinese / 中华普通外科杂志

Objective To study the anatomical characteristics of ascending aortic and aortic arch in adult Chinese. Methods From Sep 2006 to Sep 2007, we retrospectivly reviewed 388 volunteers undergoing thoracic aorta CTA in our institution. We measured the diameter of ascending aorta, aortic arch, and branch vessels of aortic arch respectively in AW4.2 work station. CHESS statistical software was used to analyze data. Results The aortic diameter above coronary artery (CA) (D1), the level at origin of brachiocephalie trunk (BCT) ( D3 ), the halfway of the AA( D2 ), the level at origin of LCCA( D4 ) , the level at origin of LSA ( D5 ) and the level at distal origin of LSA ( D6 ) respectively are: ( 34 ± 5 ) mm; ( 33 ± 4) mm; ( 34 ± 5 ) mm; ( 30 ± 4) mm; ( 28 ± 3 ) mm; ( 26 ± 3 ) mm. The diameters of two level between the origin of BCT and RSA are ( 13. 1 ± 1.9) mm, ( 12. 8±2. 3) mm, respectively. The diameter of two level at LCCA is ( 8. 7 ± 1.5 )mm and ( 7. 9 ± 1. 0) mm respectively. The diameter of two level between the origin of LSA and L-vertebral arteryis (10.7±1.7) mm,(9.3±1.3) mm, respectively. Conclusion The data of the diameter and length of ascending aort and vasculature arising from the arch abtained by CT topography in Chinese volunteers are very useful for clinical practice.

The endovascular repair or open surgery for abdominal aortic aneurysm / 中华普通外科杂志

Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.

Hybrid treatment for thoracoabdominal aortic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of hybrid conventional open and endovascular treatment of thoracoabdominal aortic aneurysm (TAAA), and evaluate the immediate and long term outcomes.</p><p><b>METHODS</b>From September 1998 to October 2008, 15 TAAA patients were treated by hybrid-procedures. The mean patient age was 58.7 years (ranged from 44 to 72 years). The aneurysms were Crawford type I in 2, type II in 8, type III in 2, type IV in 3. The median aneurysms diameter was (67.5 +/- 7.5) mm (ranged from 55 to 82 mm). Patients were followed up before dismissal, 3, 6, 12 months later, and annually thereafter.</p><p><b>RESULTS</b>Two patients were antegrade revascularization, the others were retrograde revascularization. Mean operation time was (8.1 +/- 1.4) h (ranged from 6.8 to 12.7 h), mean blood loss was (956.7 +/- 80.1) ml (ranged from 750 to 3,000 ml). Two patients died during perioperative time, no paraplegia. During follow up revealed shrinkage of aneurysm, no graft migration and paraplegia, but 1 died for acute myocardial infarct.</p><p><b>CONCLUSIONS</b>Hybrid treatment is a safe and effective option for treatment of TAAA. Immediate and mid-term outcomes are favorable, but long-term surveillance is indefinite.</p>

Endovascular repair: alternative treatment of ruptured abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As an alternative to open aneurysm repair, endovascular aortic repair (EVAR) has been applied to ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.</p><p><b>METHODS</b>From July 1997 to September 2007, 20 men and six women with rAAA (median age, 68 years) were treated with EVAR. Most patients with suspected rAAA underwent emergency computed tomographic angiography (CTA). The procedure was performed under general or local anesthesia. Endovascular clamping was attempted in hemodynamically unstable patients. Bifurcated endografts and aorto-uni-iliac (AUI) endografts with crossover bypass were used. Patients had CT scan prior to discharge, 3, 6, 12 months after discharge, and annually thereafter.</p><p><b>RESULTS</b>Time between diagnosis and EVAR ranged from 1 hour to 5 days. EVAR was performed under general anesthesia in 21 patients, and under local anesthesia in five patients. Endovascular aortic clamping was performed in four patients. There was no conversion to open surgery during EVAR. Stent-graft insertion was successful in all patients. One patient died during EVAR from acute myocardial infarction. Ten patients had systolic blood pressure < 80 mm Hg. Eleven patients received a blood transfusion. Mean aneurysm size was (47 +/- 12) mm. Mean ICU stay was (8 +/- 3) days, mean hospital stay (18+/- 6) days, and mean procedure time (120 +/- 32) minutes. The 30-day mortality was 23% (6/26 patients), and major morbidity 35% (9/26 patients). Early endoleak occurred in 8/26 patients (31%). The mean follow-up was (18 +/- 7) months. No patient demonstrated migration of the stent-graft.</p><p><b>CONCLUSIONS</b>EVAR is a safe and effective option for treatment of acute rAAA, independent of the patient's general condition. Immediate and mid-term outcomes are favorable, but long-term outcome is unknown. Multi-center studies are necessary to establish the role of EVAR for rAAA.</p>

The significance of aneurysm sac pressure monitoring during the endovascular repair of abdominal aortic aneurysm / 中华普通外科杂志

Objective To evaluate aneurysm sac pressure monitoring during endovascular repair (EVAR)of abdominal aortic aneurysm. Methods From April 2006 to May 2007,12 patients with abdominal aorta aneurysm underwent endovascular aneurysm repair.The average max-diameter of the aneurysm WR8(5.83±0.95)cm.The sac pressure was monitored during the whole process of the operation.The correlation between the pressure and endoleaks and long-term outcomes was observed during follow-up.Results Before the stentgraft was delivered.sac pressure was equal to the systemic blood pressure in all the 12 cases.After the EVAR wag finished,the sac systolic pressure dropped by＞40% in 11 cases,among which sac blood pressure bropped by ≥50% in 7 cases.sac pressure did not change in 1 case.In all the 12 cases,pulse pressure diminished by＞30%,and＞75%in 6 cages.During the follow-up,there were no endoleaks and death.In 5 Cases.with sac systolic pressure drop＞50%,the max-diameter of the aneurysm decreased by 1.6～3.1 mm,while in one c88e,in which sac pressure had no change the postoperative maxdiameter of the aneurysm has increased by 3.2 nma. Conclusion Abdominal aorta aneurysm sac pressure monitoring during EVAR helps to predict the change of the sac pressure after EVAR,and to detect the endoleaks.

The feasibility study of endovascular reconstruction of aortic arch with modular branched stent-graft system in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair.</p><p><b>METHODS</b>After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed.</p><p><b>RESULTS</b>Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and artery rupture of left subclavian respectively during operation. In the eight successful cases, two proximal type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed.</p><p><b>CONCLUSION</b>It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.</p>

Mid-long term complications of endovascular repair in aortic diseases and its secondary interventional strategies / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and effects of secondary intervention for mid-long term complications of endovascular repair (EVR) in aortic diseases.</p><p><b>METHODS</b>From May 1999 to Jun 2007, 21 patients with mid-long term complications after EVR were treated in our center. Of these cases, 15 cases received first EVR for abdominal aortic aneurysm (AAA), 3 cases for thoracic aortic aneurysm (TAA) and 3 cases for aortic dissection (TAD). The mid-long term complications included 11 cases of type I endoleak, 4 cases of type II endoleak, 2 cases of type III endoleak and 4 cases of migration of stent grafts. Proximal or distal extensions were used for type I and III endoleak in 9 cases. Fenestrated, scallop and bifurcated stent grafts were used to reconstruct the aortic arch in 3 cases. Emboli technique was used in treating type II endoleak. Thrombectomy and bypass technique were used in 4 cases with stent graft limb occlusion. One ruptured AAA accepted open surgery.</p><p><b>RESULTS</b>Secondary endovascular technique were undergone in 20 (95.2%) cases. One case died in 30 days after the secondary intervention and endoleak remained after the secondary operation in 5 cases. Three cases died of the secondary intervention.</p><p><b>CONCLUSIONS</b>Endoleak and limb occlusion were the chief mid-long complications after EVR. Secondary endovascular technique can be used in most cases and carries great challenges in aortic arch lesions.</p>

Treatment of left subclavian artery in endovascular repair of thoracic aortic aneurysm and thoracic aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD).</p><p><b>METHODS</b>In 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover.</p><p><b>RESULTS</b>DSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg.</p><p><b>CONCLUSIONS</b>EVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.</p>