A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms.

BACKGROUND: Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR). METHODS: A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. RESULTS: A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period. CONCLUSIONS: On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

[Critical limb ischemia during perioperative period of open surgery for rupture abdominal aortic aneurysm: treatment and prognosis].

OBJECTIVE: To explore the treatment and prognosis of critical limb ischemia during perioperative period of open surgery for ruptured abdominal aortic aneurysm (AAA). METHODS: Retrospective reviews were conducted for the clinical data of unstable ruptured AAA patients with open repair at our hospital from June 2002 to June 2012 to examine the characteristics and treatment regimens for associated critical limb ischemia. RESULTS: A total of 46 unstable AAAs were enrolled. There were 37 males and 9 females with an average age of 69 years. All AAAs were repaired by a bifurcated polytetrafluoroethylene graft via a transperitoneal midline incision. Critical limb ischemia was found in 8 patients during or after the procedure. Treatments included additional graft-distal iliac artery bypass (n = 2), anastomotic stoma stenting (n = 2), Fogarty catheter embolectomy plus local thrombolysis (n = 2), Fogarty catheter embolectomy (n = 1) and venous thrombolysis (n = 1). Lower limb necrosis developed in 5 patients (4 unilateral, 1 bilateral) and all of them died. CONCLUSION: Open repair of ruptured AAA may be associated with a considerate morbidity of critical limb ischemia. Early reconstruction of blood flow improves the prognosis.

[Effects of left renal vein division on postoperative renal function during open repair of abdominal aortic aneurysm].

OBJECTIVE: To explore the effects of left renal vein division (LRVD) on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm (AAA). METHODS: Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011. They were divided into LRVD (n = 35) and non-LRVD (n = 141) groups. The 30-day mortality, cardio-cerebrovascular complications, pulmonary complications, preoperative and postoperative levels of creatinine and glomerular rate filtration (GFR), aortic cross-clamping time, blood loss volume, intensive care duration and dialysis or continuous renal replacement therapy (CRRT) rate were compared between two groups. RESULTS: A total of 189 AAA repair were performed. And 13 patients with suprarenal clamping were excluded. The LRVD group had a significant higher proportion of ruptured AAA (48.6% vs 27.7%, P < 0.01), higher 3-day postoperative creatinine (P < 0.01), longer intensive duration (P < 0.05) and decreased 3-day postoperative GFR (P < 0.01). No significant difference existed in 30-day mortality, incidence of major complications, creatinine or GFR at discharge (P > 0.05). CONCLUSIONS: LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.

[Observation of intraoperative lower limb blood flow of infrarenal aortic occlusion].

OBJECTIVE: To summarize the surgical therapy and profiles of lower limb blood flow during surgery for chronic infrarenal aortic occlusion. METHODS: A total of 36 patients of chronic infrarenal aortic occlusion underwent surgical procedures at our department from 2004 to 2011. Their clinical data were analyzed. Several methods were applied at different time points during surgery to observe the lower limb blood flow. RESULTS: SaO2, waveforms of dorsalis pedis artery and posterior tibial artery changed dramatically at different time points during surgery. Before and after blood occlusion, the SaO2 was 82% ± 6% and 23% ± 4% respectively, 1min after unclamped and after abdomen-closing, the SaO2 increased to 66% ± 5% and 88% ± 8% respectively. CONCLUSION: Doppler blood flow and blood oxygen saturation monitors are simple, non-invasive and objective detection methods for lower limb blood flow. A combination of both methods can improve the safety of surgery. Keeping the limbs warm and uses of spasmolytic drugs can facilitate the recovery of postoperative blood flow of lower limbs.

[Correlation of hemoglobin concentration with the diameter of abdominal aortic aneurysm and long-term patient survival].

OBJECTIVE: To assessed the relationships between hemoglobin concentration from the patients with abdominal aortic aneurysm (AAA) and its diameter as well as patients' long-term survival. METHODS: Between January 2002 to June 2012, 255 AAA patients were reviewed retrospectively. The outcomes were compared between 3 groups of different treatments (excluding 20 cases dead within 30 days). The procedures included open AAA repair (n=76), endovascular (EVAR) (n=62) and non-operated (n=97). The mean follow-up period was 63±42 months. The association of hemoglobin level with AAA diameter was assessed with multiple linear regression. Kaplan-Meier survival curves of anemic and non-anemic patient groups were compared by the log-rank method in 3 groups. Cox's proportional hazard regression mode was used to determine the effects of anemia on vital status after EVAR, open AAA repair or non-operation. RESULTS: A total of 88 (34.5%) of AAA patients had anemia. After adjustment for various risk factors, hemoglobin level was inversely correlated with maximal AAA diameter (ß=-0.152, P=0.017). During a long-term follow-up, the 5-year survival rates were 56%, 51% and 42% in anemic patients versus 94%, 90% and 80% in non-anemic ones. Survival was lower in anemic patients than those without anemia in 3 groups (P=0.005, 0.001, 0.025 by log-rank respectively). In three groups, according to multivariable Cox regression analysis, the hemoglobin levels were independently correlated with long-term mortality respectively after adjusting for various risk factors. The hemoglobin levels were correlated with death (HR: 0.923, 0.963, 0.963; P: 0.001, 0.002, 0.028; 95%CI: 0.8798-0.970, 0.941-0.986, 0.932-0.996). CONCLUSION: Hemoglobin concentration is independently associated with AAA diameter and reduced long-term survival after undergoing EVAR, open AAA repair and non-operation.

[Expression of HIF-1a in acute limb ischemia of rats].

OBJECTIVE: To explore the expression of hypoxia-inducible factor 1 alpha (HIF-1a) in rat lower limb skeletal muscle with acute ischemia. METHODS: Acute lower limb ischemia was established in 25 male or female SD rats of 200-250 g by ligating left iliac artery with microsurgical techniques. Gastrocnemius of lower limb was harvest at the time points of sham (0h), 4, 8, 12 and 24 h respectively. Immunohistochemistry, Western blot and real-time polymerase chain reaction (PCR) were used to detect the expression of HIF-1a in lower limb gastrocnemius. RESULTS: There was a low expression of HIF-1a in normal gastrocnemius, but it was highly expressed in lower limb ischemia. With the elongation of ischemia time, its expression increased (P < 0.05), peaked at 4 h and 8 h (P < 0.05) and then declined gradually. CONCLUSION: With a characteristic trend during acute limb ischemia, HIF-1a may play an important role in the adaptive response to acute limb ischemia.

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta.

Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.

[Evaluation of efficacy of the anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach].

OBJECTIVE: To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. METHODS: There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. RESULTS: Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94.4% vs.69.5%, P < 0.01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85.9% vs. 75.3%, P > 0.05). A mean follow-up period was (43 ± 18) months. There was no significant difference in incidence of complication and recurrence between two groups. CONCLUSIONS: The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.

[Surgical treatment of non-traumatic aneurysm in ilio-femoral arterial region].

OBJECTIVE: To summarize the surgical experiences of treating 61 cases of non-traumatic aneurysms in ilio-femoral arterial region. METHODS: The clinical data of 61 consecutive patients with non-traumatic aneurysms in ilio-femoral arterial region between January 1985 and November 2010 were retrospectively reviewed. RESULTS: There were a total of 76 non-traumatic aneurysms in ilio-femoral arterial region, including solitary iliac aneurysms (n = 29) and femoral aneurysms (n = 32). Seventeen (27.9%) patients had multiple aneurysms, 8 (13.1%) patients ruptured aneurysms and 4 (6.6%) patients coexistent peripheral vascular occlusive disease. Fifty patients underwent electively aneurysm excision and graft (or autogenous vein) replacement. Seven patients with ruptured aneurysms received emergency treatment. And one with multiple aneurysms died intra-operatively from ruptured iliac aneurysm. One patient with common iliac aneurysm underwent endovascular repair without endoleak and 1 with internal iliac aneurysm received embolization. There was no perioperative mortality. But one with femoral aneurysm underwent amputation due to acute thrombosis. Seven patients died during the follow-up period and the survivors remained stable and had a good graft patency without new aneurysm formation. CONCLUSION: Early management of aneurysms in ilio-femoral arterial region is rather important and multiple aneurysms should be considered. Aneurysm excision and arterial reconstruction yield an excellent outcome. Close and long-term follow-up is mandatory for the detection of new aneurysm formation.

[The study about expression of Gli2 in vein grafts].

OBJECTIVE: To study the expression of cell cycle related factor Gli2 in autogenous vein graft and its relation with neointima formation. METHOD: Autogenous vein graft model were established in 36 male wistar rats of 8 weeks old, 140 g, by transplanting the left jugular vein to intra renal abdominal aorta with microsurgical technique. Graft veins were harvest at 14, 28 days after transplantation. The IF and W-B were used to detect the protein expression in the vein graft. At the same time Gli2- mRNA was measured by RT-PCR. RESULTS: Immunofluorescent staining showed that the Gli2+ cells was only 3.2% ± 0.4% in the normal vein, but was much more in the vein graft after surgery, was 41.3% ± 0.6%, 58.3 ± 0.6% respectively; The expression of Gli2 and PCNA were both elevated in the vein graft. There is a positive correlation between them which indicated by W-B, the relation index was 0.826; the Gli2 mRNA content was also increased in vein graft, was 8.9, 13.6 fold compared with normal vein as 1 respectively. CONCLUSION: Gli2 is upregulated in autogenous vein grafts and may correlated with the proliferation of vascular smooth muscle cells.

[The study of different operative style for abdominal aortic aneurysm during surrounding operation].

OBJECTIVE: To compare the the similarities and differences during the surrounding operation of endovascular repair (EVAR) and open surgical repair (OSR) for abdominal aortic aneurysm. METHODS: 112 patients with abdominal aortic aneurysms (AAA) were selected from 2004 to 2009: among them, 66 patients were treated with EVAR, 46 patients with OSR. Data of two groups were collected and analyzed during surrounding operation. RESULTS: Compared to OSR group, the mean blood lost, blood transfusion and intra-operative fluid in EVAR group were significantly less than OSR group (P < 0.05). The mean time of operation, observation period in ICU and being in hospital in EVAR group were shorter than OSR group (P < 0.05). But the cost of hospitalization in EVAR was far higher than that of OSR group (P < 0.05). In short term postoperative complications the OSR group was higher than the EVAR (P < 0.05), however, there was no statistically significant difference in death rate of the two groups during surrounding operation (P > 0.05). CONCLUSION: EVAR has the advantages of mild trauma, less blood loss, quicker recovery after operation, and less disturbance to internal environment. Especially, it is suitable for the patients who can not undergo open surgery repair, but its cost is still higher.

[The expression of sonic hedgehog in rat vein grafts].

OBJECTIVE: To study the expression of cell cycle related factor sonic hedgehog (SHH) in autogenous vein graft and its relation with neointima formation. METHODS: Autogenous vein graft model were established in 24 male Wistar rats of 8 weeks old and 140 g weight, by transplanting the left jugular vein to intra renal abdominal aorta with microsurgical technique. Graft veins were harvested at 14 d and 28 d after transplantation. The immunohistochemistry and Western blot were used to detect the SHH and PCNA expression in the vein graft. At the same time SHH mRNA was measured by quantitative real-time PCR. The opposite normal veins served as control. RESULTS: Histological staining showed that the percent of SHH+ cells was only (2.0 +/- 0.5)% in the normal vein, but was much more in the vein graft after surgery, as (39.4 +/- 0.4)% and (63.0 +/- 0.3)% respectively (P < 0.01). The expression of SHH and PCNA were both elevated in the vein graft. There was a positive correlation between them which indicated by Western blot (r = 0.808, P < 0.01). The SHH mRNA content also increased in vein graft to 9.5 and 23.8 folds of that in control. CONCLUSION: SHH is upregulated in autogenous vein grafts and may correlated with the proliferation of vascular smooth muscle cells.

Inflammatory abdominal aortic aneurysm: clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm.

BACKGROUND: Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs). In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA. METHODS: Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs. The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors. All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared. RESULTS: The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs. 42.4%, P = 0.001) and had larger aneurysms on admission ((7.4 +/- 0.7) cm vs. (6.3 +/- 0.9) cm, P = 0.006). In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5 +/- 9.1) mm/h vs. (11.4 +/- 5.4) mm/h, P < 0.05). Surgical morbidity and mortality rates did not differ between the two groups. The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308 +/- 36) minutes vs. (224 +/- 46) minutes, P < 0.05), but the cross-clamp time was similar in both groups ((41.5 +/- 6.2) minutes vs. (41.8 +/- 6.2) minutes, P = 0.92). A five-year survival rate analysis showed no significant difference between the two groups (P = 0.711). CONCLUSIONS: Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause low morbidity and mortality, similar to patients with aAAA. Long term outcome of IAAA patients is of no difference from aAAA patients.

[Analysis of death-related factors of type B aortic dissection treated medically during the acute phase].

OBJECTIVE: To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection. METHODS: Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase. RESULTS: In univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm. CONCLUSION: Malperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.

[The diagnosis and therapy of acute upper limbs deep venous thrombosis].

OBJECTIVE: To conclude the experience of diagnosis and therapy, the effect analysis and the prognosis factors of acute upper limbs deep venous thrombosis (ULDVT). METHODS: We retrospectively analyzed the etiological factor, clinical manifestation, diagnosis, therapy and prognosis of 28 patients treated for acute ULDVT admitted in our hospital between 1988 and 2009. The patients were divided into two groups according to the time of admission and management in hospital. Group I, from 1988 to 1998, and group II, from 1999 to 2009. RESULTS: There were 28 patients diagnosed as acute ULDVT, which was 8.1% of lower limbs deep venous thrombosis in synchronization. There were 14 men and 14 women, and the mean age was 46.1 years. 17 patients developed in left upper limbs, and 11 patients developed in right upper limbs. There were 9 patients in group I and 19 in group II. A significant difference was observed between two groups in their risk factors, primary and secondary cause. 8 patients (28.6%) were relevant to venepuncture catheterization, and 13 patients (46.4%) have tumors. There is clear difference between the two groups in the way of primary disease and risk Factors, which means that the probability of ULDVT caused by malignant tumors or other factors in group II is apparently higher than group I, and the prognosis of group II is worse compared with group I. All the patients in the group were made a definite diagnosis by ultrasound, after that our policy were thrombolysis and anticoagulation followed by Warfarin oral administration for 6 months. All the conditions of the patients were well improved, and the symptoms were relieved obviously and discharged. The mean follow-up duration was 2.2 years. 2 recurred, 1 was pulmonary infarction, and 6 was died. CONCLUSION: The incidence of ULDVT is much lower than LLDVT. The motivations are blood hypercoagulable state, such as tumor, vein catheterization etc. The final diagnosis is mostly based on clinical manifestation combined with ultrasound. Thrombolysis, anticoagulation in time have an obvious therapy effect. After that the anticoagulation therapy through oral administration can prevent recurrence.

[Expression of proto-oncogene Wip1 in breast cancer and its clinical significance].

OBJECTIVE: To investigate the expression of proto-oncogene Wip1 in breast cancer tissue and its clinical significance. METHODS: Through the uses of semi-RT-PCR, immunohistochemical technique and Western blot, the specimens from 70 patients of breast cancer and 20 normal controls were detected for Wip1 mRNA and protein expression. At the same time, the authors analyzed the relations between the expression of Wip1 in human breast cancer and different clinical pathologic parameters. RESULTS: RT-PCR: The values of gene expression of Wip1 mRNA in breast cancer tissue, pericancerous tissue and normal breast tissue were 0.715 +/- 0.087, 0.175 +/- 0.021 and 0.154 +/- 0.022 respectively. Thus the value of gene expression in breast cancer tissue was significantly higher than that in pericancerous tissue or normal breast tissue (P < 0.01). Immunohistochemistry: The high expression rates of Wip1 protein in breast cancer tissue, pericancerous tissue and normal breast tissue were 62.9% (44/70), 2.9% (2/70) and 0 (0/20) respectively and there was a significant difference among these three different tissues (P < 0.01). Western blot: The relative contents of Wip1 protein in breast cancer tissue, pericancerous tissue and normal breast tissue were 0.688 +/- 0.151, 0.251 +/- 0.043 and 0.234 +/- 0.044 respectively. The relative content of Wip1 protein in breast cancer tissue was significantly higher than that in pericancerous tissue or normal breast tissue (P < 0.01). The high expression of Wip1 protein was negatively correlated with the expression of p53, but it had nothing to do with tumor size, age, tumor staging, axillary lymph node metastasis and expressions of ER and PR. CONCLUSION: The high expression of Wip1 mRNA and its protein in breast cancer tissue may promote the growth of breast cancer. Wip1 may become a new target for therapy of breast cancer.

[The sonic hedgehog induce vascular adventitial fibroblasts phenotypic modulation, proliferation and migration].

OBJECTIVE: To study the effect of shh on the migration, proliferation and phenotypic modulation of vascular adventitial fibroblasts. METHOD: Cultivate the vascular adventitial fibroblast in vitro. Use immunofluorescent, laser confocal microscopy, Western-blot and real-time PCR to detect the expression of mRNA and protein of related index. Estimate cell proliferation according to the expression of Ki67 and cell proliferation curve. Application of wound healing test to estimate migration of fibroblast. The expression of alpha-actin is thought to be marker of phenotypic modulation of fibroblast. RESULT: The expression of shh was detected in vascular adventitial fibroblast in vitro. After addition of exogenous shh (3.5 microg/ml), there were more Ki67(+) cells and the wounding area which was covered by cells became larger. The expression of alpha-actin was detected. After addition of cyclopamine (40 micromol/L), there were less Ki67(+) cells and the wounding area which was covered by cells became smaller. CONCLUSION: Shh can promote proliferation, migration and phenotypic modulation of vascular adventitial fibroblasts.

The role of estrogen in the formation of experimental abdominal aortic aneurysm.

OBJECTIVE: The current study sought to investigate the role of estrogen in the formation of experimental abdominal aortic aneurysm (AAA). METHODS: Elastase perfusion of infrarenal AAA animal model was performed in 20 female and 20 male Wistar rats that were randomly divided into an ovariectomized/sham-operated group and an estradiol (E2) experimental/saline control group, respectively. At day 14, E2 was detected, while the mRNA and protein expressions of matrix metalloproteinases 2 and 9 (MMP-2 and -9) in AAA tissue were detected by immunohistochemistry and polymerase chain reaction (PCR). RESULTS: The ovariectomized group showed lower estrogen levels and a higher aneurysm dilatation rate and significantly higher MMP-2 and -9 expression compared with the sham-operated group (P < .01), which was in accordance with MMP-2 and -9 mRNA expression. The E2 group showed higher estrogen levels and a lower aneurysm dilatation rate and significantly lower MMP-2 and -9 expression than did the saline control group (P < .01), which was in accordance with MMP-2 and -9 mRNA expression. CONCLUSIONS: In the pathogenesis of AAA, estrogen may play an inhibitory role by decreasing expression of MMP-2 and MMP-9 synthesis.

[The comparison of operative and non-operative treatment for acute embolism of upper extremity artery].

OBJECTIVE: To compare surgical and non-surgical therapy of the upper extremity after acute arterial occlusion. To analyze the relation between prognosis and relevant factors of different therapeutic methods. METHODS: Sixty patients with acute upper extremity arterial embolism treated between January 1990 and October 2007 were retrospectively studied in The First Hospital of China Medical University. RESULTS: There were 60 patients, 32 men and 28 women, with a mean age of 63 years (21 - 86 years). Among them, 31 underwent thrombembolectomies with the Fogarty catheter and 29 received anti-coagulation and thrombolytic therapy. Therapeutic effects were evaluated by Cooley's standard. Therapeutic efficacy was better in the surgical group than in the non-surgical group (P < 0.05). There was no relationship between post-operative ischemic recovery and pre-operative ischemia severity and the site of embolism in the surgical group, while there were significant relationships in the nonsurgical group. The result of Cox proportional hazard regression model showed that the age and Cooley's standard of the patient was correlated with survival time. CONCLUSIONS: A more active surgical approach is better for the treatment of acute arterial occlusion of the upper extremity.