Application and value of intravascular ultrasound for excimer laser ablation combined with drug-coated balloon in the treatment of lower limb arteriosclerotic obliterans / 中华外科杂志

Objective: To examine the value of intravascular ultrasound (IVUS) for excimer laser ablation (ELA) combined with drug-coated balloon (DCB) in treating lower limb arteriosclerotic obliterans (ASO). Methods: As a prospective case series study, patients who underwent ELA combined with DCB for lower limb ASO with the guidance of IVUS from September 2021 to March 2022 at Department of Vascular Surgery, Zhongshan Hospital, Fudan University were enrolled prospectively. Lesion characteristics, procedure-related outcomes and complications were collected. The therapy outcomes were compared with baseline data by paired t test. Results: There were 8 males and 2 females, aged (72.0±5.9) years (range: 61 to 81 years). Of all the 11 lesions, there were 8 lesions in superficial femoral artery and 3 in popliteal artery. The lesion length was (7.0±2.4) cm (range: 3.2 to 9.8 cm). There were 4 chronic totally occlusion and 7 severe stenosis. All patients underwent the operation successfully. The technical success rate was 10/11. Bailout stenting was performed in one lesion because of flow-limiting dissection. Four lesions were grade 3 to 4 in peripheral artery calcium score system, and 9 lesions with calcification arc≥180°. Larger diameter drug-coated balloons were selected in 5 lesions after measurement of intravascular ultrasound. The follow-up time was (6.0±1.9) months (range: 3 to 9 months). The ankle-brachial index of the patient was significantly improved immediately after surgery (0.97±0.13 vs. 0.48±0.18, t=-7.60, P<0.01) and at 3 months after surgery (0.95±0.12 vs. 0.48±0.18, t=-7.17, P<0.01). The 3-month primary patency rate was 11/11, the target lesion reintervention was 0 and ulcer healing rate was 3/4. Conclusion: IVUS assisted ELA in the treatment of lower limb artery lesions is safe and effective in early stage.

Countermeasures and treatment for aortic acute syndrome with novel coronavirus pneumonia / 中华外科杂志

The novel coronavirus pneumonia (NCP) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant NCP, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. It also hopes to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with NCP, as a final point to limit the severe epidemic situation, and minimize the damage of NCP.

Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency / 中华医学杂志(英文版)

BACKGROUND@#Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.@*METHODS@#Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis.@*RESULTS@#A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency.@*CONCLUSION@#Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.

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.

endovenous laser treatment for patients with varicose veins

Objective: To evaluate the clinical effect of endovenous laser treatment [EVLT] for patients with varicose veins

Methods: Our series included 117 patients who underwent EVLT combined with high ligation and stripping since the introduction of the technique in our institution. All EVLT procedures were performed with local skin cooling to prevent skin burns, as well as stripping after exsanguinations to prevent thrombotic phlebitis

Results: A total of 146 limbs in 117 patients were ablated by EVLT. Bilateral EVLT was performed in 29 patients, with the remaining 88 patients undergoing unilateral EVLT. The mean age of the patients was 57 years +/- 12 years [range: 21 years to 80 years], and 56 were male and 61 were female. Follow-up for all patients lasted three to six months. The most common complication was induration and swelling, which was observed in 64 patients, followed by paraesthesia in 27, and skin burns in 12

Conclusion: The treatment with endovenous laser treatment for patients with varicose veins is safe and effective

Effect of Intravascular Ultrasound-assisted Thoracic Endovascular Aortic Repair for "Complicated" Type B Aortic Dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intravascular ultrasound (IVUS) examination can provide useful information during endovascular stent graft repair. However, its actual clinical utility in thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (type B-AD) remains unclear, especially in complicated aortic dissection. We evaluated the effect of IVUS as a complementary tool during TEVAR.</p><p><b>METHODS</b>From September 2011 to April 2012, we conducted a prospective cohort study of 47 consecutive patients with "complicated" type B-AD diagnosed. We divided the patients into two groups: IVUS-assisted TEVAR group and TEVAR using angiography alone group. The general procedure of TEVAR was performed. We evaluated the perioperative and follow-up events. Patient demographics, comorbidities, preoperative images, dissection morphology, details of operative strategy, intraoperative events, and postoperative course were recorded.</p><p><b>RESULTS</b>A total of 47 patients receiving TEVAR were enrolled. Among them (females, 8.51%; mean age, 57.38 ± 13.02 years), 13 cases (27.66%) were selected in the IVUS-assisted TEVAR group, and 34 were selected in the TEVAR group. All patients were symptomatic. The average diameter values of IVUS measurements in the landing zone were greater than those estimated by computed tomography angiography (31.82 ± 4.21 mm vs. 30.64 ± 4.13 mm, P < 0.001). The technique success rate was 100%. Among the postoperative outcomes, statistical differences were only observed between the IVUS-assisted TEVAR group and TEVAR group for total operative time and the amount of contrast used (P = 0.013 and P < 0.001, respectively). The follow-up ranged from 15 to 36 months for the IVUS-assisted TEVAR group and from 10 to 35 months for the TEVAR group (P = 0.646). The primary endpoints were no statistical difference in the two groups.</p><p><b>CONCLUSIONS</b>Intraoperative IVUS-assisted TEVAR is clinically feasible and safe. For the endovascular repair of "complicated" type B-AD, IVUS may be helpful for understanding dissection morphology and decrease the operative time and the amount of contrast used.</p>

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>

Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases, few people have applied it surgically. In fact, MPR is also very useful to clinical operation, especially for patients with type B aortic dissection. It helps the surgeon to locate accurately with more information about aortic dissection, so that the safety and effectiveness of operation can be improved. This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a cross-section, a spin angle of the coronal plane, and a tilt angle of the sagittal plane in treatment of type B aortic dissection.</p><p><b>METHODS</b>The conventional and the MPR approaches were compared on positioning the aortic arch for surgery. A group of 40 patients (group A) and another group of 42 patients (group B) was sampled. About the comparison of baseline characteristics, a fourfold table χ(2) test was conducted on gender, and two independent samples t-test was applied to age between group A and group B. Spin as well as tilt angles for group A were obtained from the patients using both approaches, and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group. Stent graft placement of group B was based on the conventional approach. Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement. They were also compared with a fourfold table χ(2) test.</p><p><b>RESULTS</b>Gender difference was not found between group A and group B (χ(2)0.80, P > 0.05), and age difference was not statistically significant (F = 2.55, homogeneity of variance, t = -1.46, P > 0.05). A significant difference was found between the conventional and the MPR approaches for spin angle (t = 9.17) as well as tilt angle (t = 2.07), P < 0.05. Percentage of proximal distributed markers (5.0%) of group A was significantly lower than that of group B (42.9%), χ(2) = 15.92, P < 0.05; and incidence of complications (5.0%) of group A was also significant lower than that of group B (21.4%), χ(2) = 4.76, P < 0.05.</p><p><b>CONCLUSIONS</b>Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA. It is feasible in endovascular treatment of type B aortic dissection, and can effectively and safely guide surgical operations.</p>

Progress in genetic study of aortic dissection / 中华医学遗传学杂志

Genetic study can provide important insight into the etiology of aortic dissection. To explore the pathogenesis and natural history of aortic dissection, a number of genes have been identified through microarray chip screening and undergone testing of polymorphisms to find mutations strongly associated with the disease. The results suggested aortic dissection to be a multi-gene disorder. Multiple genes probably work together to promote its development. Several diseases with a genetic predisposition are closely connected with aortic dissection, which also implied a role of genetic changes and malfunction in this disease.

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>

Functional endothelial cells derived from embryonic stem cells labeled with HIV transactivator peptide-conjugated superparamagnetic nanoparticles / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The development of regenerative therapies using derivatives of embryonic stem (ES) cells would be facilitated by a non-invasive method to monitor transplanted cells in vivo, for example, magnetic resonance imaging of cells labeled with superparamagnetic iron oxide (SPIO) nanoparticles. Although ES cells have been labeled with SPIO particles, the potential adverse effects of the label have not been fully examined. The objective of this study was to determine whether SPIO labeling affects murine ES cell viability, proliferation, or ability to differentiate into functional endothelial cells (ECs).</p><p><b>METHODS</b>Cross-linked iron oxide (CLIO, an SPIO) was conjugated with human immunodeficiency virus transactivator of transcription (HIV-Tat) peptides, and murine ES cells were labeled with either CLIO-Tat, CLIO, or HIV-Tat. After labeling, ES cells were cultured for 4 days and Flk-1(+) ES cells identified and sorted by immunocytochemistry and fluorescence activated cell sorting (FACS). Flk-1(+) cells were replated on fibronectin-coated dishes, and ECs were obtained by culturing these for 4 weeks in endothelial cell growth medium supplemented with vascular endothelial growth factor (VEGF). ES cell viability was determined using trypan blue exclusion, and the proportion of SPIO(+) cells was evaluated using Prussian blue staining and transmission electron microscopy. After differentiation, the behavior and phenotype of ECs were analyzed by reverse transcription-polymerase chain reaction, flow cytometry, immunocytochemistry, DiI-labeled acetylated low-density lipoprotein (AcLDL) uptake, and Matrigel tube formation assay.</p><p><b>RESULTS</b>CLIO-Tat was a highly effective label for ES cells, with > 96% of cells incorporating the particles, and it did not alter the viability of the labeled cells. ECs derived from CLIO-Tat(+) ES cells were very similar to murine aortic ECs in their morphology, expression of endothelial cell markers, ability to form vascular-like channels, and scavenging of AcLDL from the culture medium.</p><p><b>CONCLUSIONS</b>CLIO-Tat is a highly effective label for ES cells and does not adversely affect cell viability, differentiation, or behavior. CLIO-Tat could be a useful marker for the non-invasive monitoring of transplanted stem cells.</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>

Effect of suprarenal fixation on renal function in endovascular abdominal aneurysm repair patients / 中华外科杂志

<p><b>OBJECTIVE</b>to assess the the mid-term renal function of abdominal aortic aneurysm (AAA) patients following supra-renal endovascular repair.</p><p><b>METHODS</b>from March 2005 to December 2009, 290 AAA patients were included and grouped depending upon whether they had received infra-renal (IR) or supra-renal (SR) EVAR. SR was performed in 173 patients, with a mean age of (72 ± 8) years and 85.0% for male. IR was performed in 117 patients, with a mean age of (71 ± 9) years and 90.6% for male. Preoperative and 1 week, 1-, 3-, 6-, 12-month postoperative serum creatinine (Cr) and cystatin C (Cys-C) were detected. Estimated glomerular filtration rate (eGFR) were calculated by Cystatin-based formula and Cr-based Cockcroft formula. T test were used to determine statistical difference between or within groups.</p><p><b>RESULTS</b>all Patients received Talent or Zenith endograft. The ratio of device-used were 67/106 in SR group and 25/92 in IR group (P < 0.05). The other characteristics and operative files in two groups were well matched. Preoperative Cr and Cys-C were (82 ± 8) µmol/L and (0.89 ± 0.11) mg/L for SR group, (81 ± 11) µmol/L and (0.87 ± 0.15) mg/L for IR group, no difference between groups. Compared to preoperative renal markers within each group, Cr, Cys-C and eGFR worsening were found at 1 week and 12 months postoperative (P < 0.05). At 1 week postoperative, Cr in SR group and IR group were (98 ± 11) µmol/L and (95 ± 13) µmol/L, Cys-C were (1.01 ± 0.10) mg/L or (0.99 ± 0.10) mg/L. At 12 months postoperative, Cr in SR group and IR group were (91 ± 15) µmol/L or (90 ± 12) µmol/L, Cys-C were (1.03 ± 0.20) or (1.02 ± 0.21) mg/L. Also, Cys-C [SR: (0.93 ± 0.17) mg/L, IR: (0.92 ± 0.31) mg/L] and eGFR by Cys-C worsening were found at 6 months postoperative. There was no difference between groups in patients Cr, Cys-C and eGFR at each follow-up time interval.</p><p><b>CONCLUSION</b>the use of SR fixation was not significantly associated with mid-term postoperative renal injury.</p>

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>

The indication and time of treatment of thoracic endovascular aortic repair in acute Stanford B dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection.</p><p><b>METHODS</b>From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups.</p><p><b>RESULTS</b>The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P<0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P<0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P<0.01). Four out of 24 cases of intramural hematoma had recurrent dissection.</p><p><b>CONCLUSIONS</b>Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.</p>

B16-F10 melanoma cells and cell culture supernatant enhance angiogenesis in mouse ischemic limb / 生理学报

Generation of therapeutic angiogenesis to enhance vascularization in the ischemic tissues is a method for treating ischemic tissues in atherosclerotic cardiovascular artery disease. The chemokine stromal cell-derived factor-1 (SDF-1) and its receptor (CXC chemokine receptor 4, CXCR4) play a critical role in the process of post-natal neovascularization. The SDF-1-CXCR4 axis is a potential mechanism for the treatment of ischemic limb. Here, we investigated the role of CXCR4 in bone marrow cells (BMCs) in neovascularization induced by tumor cells and the supernatant of culture media in a murine hind-limb ischemia model which was made by resecting femoral artery and vein. After the injection of mouse melanoma cells B16-F10 (1x10(6) cells in 0.1 mL at the operation day, s.c.) into the abdomen or the cell culture supernatant (0.1 mL/d for 21 d after operation, i.m.) into the ischemic abductor muscle, the CXCR4 positive BMCs were analyzed by flow cytometry. The perfusion of the ischemic limb was evaluated by laser Doppler perfusion imaging (LDPI) on 7, 14 and 21 d after vascular injury operation. Capillary endothelial alkaline phosphatase (AP) was stained to quantify the presence of capillaries, and histological method was used to evaluate the capillary density as a measure of neovascularization in ischemic tissues. The proportions of CXCR4 positive BMCs were notably higher in ischemic limb injected with tumor cells or the supernatant compared to those in the control group (P<0.05). Injection of tumor cells or the supernatant resulted in significantly improved perfusion as measured by LDPI perfusion ratios on 7, 14 and 21 d after femoral artery and vein resection in mice, compared to the controls (P<0.05). Tissue samples harvested from the lower calf muscle at day 21 demonstrated increased capillary densities in mice receiving tumor cells (0.81+/-0.13) or the supernatant (0.63+/-0.05), compared with those in control group (0.44+/-0.09, P<0.05). In conclusion, the injection of B16-F10 tumor cells or the supernatant induces the increase of CXCR4 positive cells in BMCs and the improvement of in vivo neovasculogenesis in mouse ischemic limb.

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>