[Clinical Analysis of the Treatment of Iliac Limb Occlusion Following Endovascular Abdominal Aortic Aneurysm Repair].

Objective To explore the cause and the treatment strategies of iliac limb occlusion after endovascular abdominal aortic aneurysm repair(EVAR). Methods The patients receiving EVAR in PUMC Hospital from January 2015 to December 2020 were retrospectively analyzed.Sixteen(2.7%)cases of iliac limb occlusion were identified,among which 6,9,and 1 cases underwent surgical bypass,endovascular or hybrid procedure,and conservative treatment,respectively. Results Fifteen cases were successfully treated.During the 10.6-month follow-up,2 cases receiving hybrid treatment underwent femoral-femoral bypass due to re-occlusion of the iliac limb. Conclusions Iliac limb occlusion mostly occurs in the acute phase after EVAR,and endovascular or hybrid treatment can be the first choice for iliac limb occlusion.It is suggested to focus on the risk factors for prevention.

[Risk Factors for Patients Using Intraoperative Vasopressor Infusions During Carotid Body Tumor Excision].

Objective To investigate the risk factors for patients using intraoperative vasopressor infusions during carotid body tumor(CBT)excision.Patients' mean arterial pressure(MAP)and heart rate(HR)fluctuations as well as their requirements for vasoactive agents during surgery were assessed. Methods The patients receiving CBT excision in Peking Union Medical College Hospital from May 1,2013 to July 31,2017 were included for a retrospective cohort study.The potential factors of intraoperative requirement for vasopressor infusions were investigated using univariate analysis and Logistic multivariate analysis.Furthermore,the relationships of Shamblin types of CBT with intraoperative MAP/HR fluctuations and requirements for vasoactive agents were analyzed. Results A total of 108 patients with 116 CBTs were included.Univariate analysis revealed that maximum tumor diameter >4 cm,intraoperative internal carotid artery injury,internal carotid artery reconstruction,malignant pathology,advanced Shamblin types(type Ⅱ and Ⅲ),estimated blood loss ≥400 ml,and operation duration >4 hours were associated with intraoperative requirements for vasopressor infusions.Logistic analysis showed that Shamblin type Ⅲ(OR=2.286,95% CI=1.324-14.926,P=0.016)and operation duration >4 hours(OR=3.874,95% CI=1.020-14.623,P=0.046)were risk factors for intraoperative requirements for vasopressor infusions during CBT surgery.In addition,Shamblin type Ⅲ was associated with intraoperative abnormal HR elevation and requirements for vasopressors.Conclusions Shamblin type Ⅲ and operation duration>4 hours are risk factors for intraoperative requirements of patients for using vasopressor infusions during CBT surgery.Shamblin type Ⅲ is associated with intraoperative abnormal HR elevation and requirements for vasopressors.

Association of Serum SorLA with Intimal Hyperplasia after Carotid Endarterectomy Operation: A Retrospective Analysis.

BACKGROUND: To study the relevance between serum sorting protein-related receptor containing the low-density lipoprotein receptor class A (SorLA) and intimal hyperplasia (IH) after carotid endarterectomy (CEA) operation. METHODS: Seventy-nine carotid artery stenosis patients receiving CEA operation from September 2013 to March 2015 were included. Serum SorLA level was detected by enzyme linked immunosorbent assay method preoperatively. All the 79 patients received regular follow-up to diagnose the IH of target lesions, postoperatively. Based on the follow-up data, the patients were divided into IH group (n = 10) and non-IH group (n = 69). Serum SorLA levels were analyzed using t-test. Receiver-operating characteristic curve was applied to determine the value of serum SorLA to predict the occurrence of IH after CEA operation. RESULTS: Patients in severe IH group had a higher level of serum SorLA than patients in non-IH group (1.648 ± 0.246 ng/mL vs. 1.278 ± 0.281 ng/mL, P < 0.001). When 1.44 ng/mL was designated as the cutoff value of serum SorLA, the predicting value had a sensitivity of 90% and a specificity of 73.5%. CONCLUSIONS: High serum SorLA level is related to IH after CEA operation. A serum SorLA level of 1.44 ng/mL can be used as a predicting index of postoperative IH.

The Efficacy and Safety of AngioJet Rheolytic Thrombectomy in the Treatment of Subacute Deep Venous Thrombosis in Lower Extremity.

BACKGROUND: The aim of this study is to examine the efficacy and safety of AngioJet rheolytic thrombectomy for the treatment of subacute deep venous thrombosis (DVT) in lower limbs. METHODS: A retrospective study was performed on 90 patients with subacute DVT (15-90 days) in lower limbs in our center from November 2015 to December 2016. In total, 27 patients with subacute DVT in lower limbs treated with AngioJet rheolytic thrombectomy were included in the study, including 17 men and 10 women. The onset time of thrombosis was between 15 and 75 days. Five patients were diagnosed bilaterally; 5 patients were diagnosed in the right lower limb; and 17 patients were affected by thrombosis in left lower limb. All the 27 cases received AngioJet rheolytic thrombectomy. RESULTS: After AngioJet thrombectomy, 17 cases were improved to grade II (50-99%), and 10 cases were grade I (<50%). Nineteen cases were treated with subsequent catheter-directed thrombolysis (CDT), and the average time of thrombolysis was 3.2 days, with an average urokinase administration dose of 7.32 million units. Among the 27 cases, 21 of them received iliac venous balloon dilation, with 10 of them being implanted with the iliac vein stent; 12 stents were implanted in total. Finally, the angiography suggested that 25 cases (92.6%) obtained a recanalization rate higher than grade II, and no serious complications occurred during the perioperative period. All patients were followed up regularly for 3 to 15 months, and 2 patients died from malignant tumor during the follow-up period. Twenty-three cases were followed up for more than 6 months; 17 cases finished 12-month follow-up. The primary patency rate at 6 and 12 months was 96.3% and 88.9%, respectively. The Villalta score of postoperative postthrombosis syndrome symptom at 6 and 12 months was 3.3 ± 2.8 and 3.5 ± 2.8, respectively. CONCLUSIONS: It is safe and feasible to use the AngioJet rheolytic thrombectomy in the treatment of subacute DVT in lower limbs. In patients without high risk of bleeding, combination of AngioJet thrombectomy and CDT is an effective treatment to reduce the thrombus volume.

Renal Function Preservation in Surgical Resection of Primary Inferior Vena Cava Leiomyosarcoma Involving the Renal Veins.

OBJECTIVE: This retrospective study aimed to show the practice of preserving renal function during curative resection of inferior vena cava leiomyosarcoma (IVCL) involving the renal veins at a single institution over a 7 year period. MATERIALS AND METHODS: From February 2009 to February 2017, 10 patients (6 women; median age 49 years) with IVCL involving the renal veins were treated surgically at Peking Union Medical College Hospital. En bloc resections were performed in all patients, and the renal outflows were preserved in eight patients using a new method: venoplasty of the renal ostia (VRO). Data regarding patient details, pre-operative preparation, surgical procedures, post-operative recovery, and follow-up results were obtained and reviewed retrospectively. RESULTS: Computed tomography and intra-operative examinations revealed that renal vein confluences were involved but not invaded in all cases except Patient 4. All patients underwent curative en bloc tumour excision; a right nephrectomy was performed in only one patient (Patient 4) whose tumour invaded the right renal vein. The mean operation time was 358 min and the mean blood loss 1935 mL. At a median follow-up of 54.5 months, the 5 year local recurrence, distant metastasis, overall survival, and disease-free survival rates were 20%, 10%, 68.6%, and 38.1%, respectively. CONCLUSIONS: Venoplasty of the renal ostia is an effective method of preserving the renal veins and reconstructing renal outflow.

[Interval-spaced Sessions of Partial Splenic Artery Embolization in Juvenile Patients with Hypersplenism].

Objective To determine whether interval-spaced sessions of partial splenic artery embolization(PSE) is a safe and effective alternative treatment for hypersplenism in juvenile patients. Methods Eight patients(3 males and 5 females) were included in this retrospective study.All patients were diagnosed as hypersplenism and underwent PSE in 2-3 sessions separated by 1-2 month intervals.Immediate,short,and long term follow-up were done.The effectiveness of the treatment was evaluated.Results No major postoperative complication was noted.No patient developed septic shock,splenic abscess,or spleen rupture.Postoperative pain and fever were common and manageable;only two patients developed loculated pleural effusions,which were well alleviated after conservative treatment.All patients showed significant increase in thrombocytes and white blood cells count after the first session of embolization.The cell counts became remarkable after the last session and remained at normal levels during the follow-up period.Conclusions PSE using 2-3 interval-spaced sessions can effectively decrease spleen size and reverse hypersplenism in juvenile patients.Also,it may reduce the postoperative complications commonly seen in traditional PSE.

Caffeoylquinic acid derivatives rich extract from Gnaphalium pensylvanicum willd. Ameliorates hyperuricemia and acute gouty arthritis in animal model.

BACKGROUND: The Gnaphalium pensylvanicum willd. is used in China as a folk medicine to treat anti-inflammatory, cough and rheumatism arthritis. The aim of this study was to evaluate the potential of the extract of G. pensylvanicum to treat hyperuricemia and acute gouty arthritis in animal model. METHODS: G. pensylvanicum extract was evaluated in an experimental model with potassium oxonate (PO) induced hyperuricemia in mice which was used to evaluate anti-hyperuricemia activity and xanthine oxidase (XO) inhibition. Therapies for acute gouty arthritis was also investigated on monosodium urate (MSU) crystal induced paw edema model. RESULTS: G. pensylvanicum extract showed activity in reducing serum uric acid (Sur) through effect renal glucose transporter 9 (GLUT9), organic anion transporter 1 (OAT1) and urate transporter 1 (URAT1) mainly and inhibited XO activity in vivo of mice with PO induced hyperuricemia. The extract of G. pensylvanicum also showed significant anti-inflammatory activity and reduced the paw swelling on MSU crystal-induced paw edema model. Meanwhile, 13 caffeoylquinic acid derivatives and 1 flavone were identified by UPLC-ESI-MS/MS as the main active component of G. pensylvanicum. CONCLUSIONS: The extract of G. pensylvanicum showed significant effect on evaluated models and therefore may be active agents for the treatment of hyperuricemia and acute gouty arthritis.

Endovascular Repair for Acute Type B Aortic Dissection.

Objective To report experience and result of endovascular repair for acute type B aortic dissection (ATBD). Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and 10 cases underwent visceral artery revascularization. No perioperative mortality occurred. Meanwhile,the perioerative major adverse events included renal infarction (n=1),renal artery bleeding (n=2),stroke (n=2),myocardial infarction (n=1),and renal dysfunction (n=2;one of them suffered from permanent dialysis),and incision complication (n=5). The mean cost during hospital stay was (112 657±58 921) Yuan;more specifically,the cost for complicated dissection cases was significantly higher than uncomplicated cases [(171 623±93 635)Yuan vs. (92 531±48 721) Yuan,P<0.001]. All the patients received regular follow-up for 3-120 months [mean (23.5±11.2) months],except that 14 cases (11.2%) lost to follow-up. During the follow-up,three deaths were reported,among whom one died due to rupture of distal dissection one year after primary operation. No re-intervention case was noted. Conclusions Endovascular repair for ATBD is safe and feasible. Emergency repair for complicated ATBD cases can get satisfactory results,although the medical cost is higher than uncomplicated cases.

Unconventional interventional therapy for cavernous transformation of the portal vein.

Cavernous transformation of the portal vein (CTPV) is a mass-like network of collateral veins around the portal vein as the sequel to extrahepatic portal vein obstruction. The common clinical manifestations include esophageal varices, splenomegaly, and hypersplenism. The patient may present with recurrent hematemesis and tarry stool. We report a woman who presented with CTPV, which was managed with an unconventional interventional method to recanalize the superior mesenteric vein and main portal vein.

[Open construction of experimental abdominal aortic aneurysm swine models with Dacron patch for evaluating endovascular aneurysm repair techniques].

OBJECTIVE: To construct an experimental abdominal aortic aneurysm (AAA) swine model with Dacron patch for evaluating endovascular aneurysm repair (EVAR) technique. METHODS: The experimental pigs were generally anesthetized for the open procedure of an aneurysm model creation with Dacron and subsequent arteriography and EVAR with stent graft. Repeat arteriography was performed after 3-month follow-up. RESULTS: AAA models were successfully constructed in all 10 experimental pigs. The average aneurysm diameter was (26.3±3.1)mm, increasing by (15.7±3.1)mm comparing to the primary aorta diameter (10.5±0.4)mm. The aorta diameter before and after the experiment showed significant difference (P<0.001). All the animals were survived after the procedure. One swine died 24 hours after the subsequent EVAR because the covering of both renal arteries by the stent graft. The rest 9 animals survived well after the whole operation and 3-month follow-up. The surviving rates at 1 month and 3 months after the operation were both 90%. One type 2 endoleak (10%) was observed after the EVAR, which disappeared at 3-month follow-up. CONCLUSIONS: Open construction of experimental AAA swine models with Dacron patch is safe and feasible. The model can be used in the developing new EVAR techniques and implant training.

[Clinical analysis of two carotid endarterectomy procedures in treating carotid artery stenosis].

OBJECTIVE: To analyze the effectiveness and costs of the eversion carotid endarterectomy (eCEA) and the carotid endarterectomy with patch angioplasty (pCEA) in treating carotid artery stenosis. METHODS: Patients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study. According to the two different surgical procedures, the patients were divided into eCEA group and pCEA group. RESULTS: The two groups were not significantly different in terms of gender ,age ,risk factors, stenosis degree of carotid artery, and the ratio of bilateral lesions (all P>0.05).The ratio of shunt and antibiotics application, operative time, hospitalization cost, and length of hospital stay in the eCEA group were significantly lower than those in pCEA group (P<0.05).The therapeutic effectiveness, complications, surgery-related death, restenosis, and ipsilateral stroke were not significantly different between these two groups (P>0.05). CONCLUSION: Both surgical procedures are safe and effective in treating the carotid artery stenosis;however, eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.

[Efficacy analysis of two surgical procedures of carotid endarterectomy in the treatment of carotid artery stenosis].

OBJECTIVE: To analyze the efficacy and safety of eversion carotid endarterectomy (eCEA) and carotid endarterectomy with patch angioplasty (pCEA) in the treatment of carotid artery stenosis. METHODS: The clinical data were collected and analyzed for the patients with carotid artery stenosis undergoing carotid endarterectomy at Department of Vascular Surgery, Peking Union Medical College Hospital from October 2009 to October 2012. According to two different surgical procedures, they were divided into 2 groups of eCEA and pCEA. RESULTS: A total of 248 patients received a follow-up. Among 274 cases of endarterectomy, 101 cases of eCEA and 173 cases of pCEA were performed. No significant difference (P > 0.05) existed between two groups in gender, age, risk factors, stenotic degree of carotid artery or ratio of bilateral lesions. The ratio of shunt (15.8%) and antibiotics (26.7%) application, the duration of operation (88 ± 20) min, intraoperative blood loss (45 ± 16) ml and the length of stay (16 ± 4) days in the group eCEA were significantly lower than those of group pCEA (P < 0.05). There was no significant difference (P > 0.05) between two groups in the ratio of complications, surgery-related mortality, restenosis and ipsilateral stroke. CONCLUSION: Both surgical procedures are both safe and effective in the treatment of carotid artery stenosis. However eCEA offers potential advantages. The choice of a particular surgical procedure depends on the surgeon experience and specific circumstances of carotid artery lesions.

[Progress of mechanism research on the neurotransmitters in treatment of insomnia with acupuncture by regulating sleep architecture].

Low-quality sleep in patients with insomnia is closely related to sleep architecture imbalance and neurotransmitter impairment. Acupuncture may reduce the duration of light sleep and its proportion, increase the time of deep sleep and rapid- eye-movement sleep as well as their proportions so as to modulate the sleep architecture for insomnia. The paper summarized the related studies of acupuncture for improving sleep architecture through regulating serotonin, norephinephrine, dopamine, γ-aminobutyric acid, acetylcholine and orexin; and explored the effects of acupuncture on the neurotransmitters and their specific performance in regulating sleep architecture. It is anticipated that the review may provide the literature evidences of acupuncture for improving sleep quality in patients with insomnia, and the approaches to the mechanism research of acupuncture for regulating sleep architecture.

Identification of type II interferons and receptors in an osteoglossiform fish, the arapaima Arapaima gigas.

In mammals, type II interferon (IFN; i.e. IFN-γ) signalling transduces through its specific receptors IFN-γR1 and IFN-γR2. In an osteoglossiform fish, the arapaima Arapaima gigas, three type II IFNs, IFN-γ-like, IFN-γ and IFN-γrel, and their four possible receptor subunits IFN-γR1-1, IFN-γR1-2, IFN-γR2-1 and IFN-γR2-2 were identified in this study. The three type II IFN genes are composed of four exons and three introns, and they all contain IFN-γ signature motif and signal peptide, with the presence of potential nuclear localization signal (NLS) in IFN-γ-like and IFN-γ. The IFN-γR1-1, IFN-γR1-2, IFN-γR2-1 and IFN-γR2-2 are composed of seven exons and six introns, with predicted IFN-γR1-1 and IFN-γR1-2 proteins containing JAK1 and STAT1 binding sites, and IFN-γR2-1 and IFN-γR2-2 containing JAK2 binding sites. Gene synteny analysis showed that the type II IFN and their receptor loci are duplicated in arapaima. All these genes were expressed constitutively in all organs/tissues examined, and responded to the stimulation of polyI:C. The prokaryotic recombinant IFN-γ-like, IFN-γ and IFN-γrel proteins can significantly induce the upregulation of immune-related genes in trunk kidney leucocytes. The ligand-receptor relationship analyses revealed that recombinant IFN-γ-like, IFN-γ, and IFN-γrel transduce downstream signalling through IFN-γR1-1/IFN-γR2-1, IFN-γR1-2/IFN-γR2-2, and IFN-γR1-1, respectively, in xenogeneic cells with the overexpression of original or chimeric receptors. In addition, tyrosine (Y) 366 and Y377 in the intracellular region may be essential for the function of IFN-γR1-2 and IFN-γR1-1, respectively. The finding of type II IFN system in A. gigas thus provides different knowledge in understanding the diversity and evolution of type II IFN ligand-receptor relationships in vertebrates.

[Surgical management of limb prosthetic vascular graft exposure].

OBJECTIVE: To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure. METHODS: The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed. Among 17 cases, 5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia, whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis. The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft. RESULTS: All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure. After the surgery, the prosthetic vascular graft was successfully salvaged in 14 cases. The total successful rate was 82.4%. The surgery failed in three patients, in whom the prosthetic vascular grafts were finally removed. CONCLUSION: Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.

[Acupoint compatibility effect and mechanism of Shenmen (HT7) and Sanyinjiao (SP6) in improving daytime fatigue and sleepiness of insomnia].

OBJECTIVE: To observe the acupoint compatibility effect of Shenmen (HT7) and Sanyinjiao (SP6) in improving daytime fatigue and sleepiness of insomnia, and its mechanism in regulating hypothalamic-pituitary-adrenal (HPA) axis and suprachiasmatic nucleus-pineal gland-melatonin (SCN-PG-MT) system. METHODS: Ninety patients with insomnia were randomly divided into HT7, SP6 and HT7-SP6 (HT7 plus SP6) groups, with 30 cases in each group. Electroacupuncture (EA,5 Hz/25 Hz) was applied to HT7, SP6 or HT7-SP6 in each group for 30 min. The EA treatment was conducted once daily, 5 days a week for 2 weeks. Before and after treatment, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were observed, separately. The contents of serum adrenocorticotrophic hormone (ACTH), cortisol (CS) and melatonin (MT) were detected by ELISA. RESULTS: Compared with before treatment, the sleep quality, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI in the three groups after treatment were decreased (P<0.05), the time to fall asleep score of PSQI and total score of ESS were decreased in the SP6 and HT7-SP6 groups (P<0.05). After treatment, the sleep quality, time to fall asleep, sleep efficiency, daytime dysfunction scores, total score of PSQI and total score of ESS in the HT7-SP6 group were lower than those in the HT7 group (P<0.05), the sleep quality, sleep efficiency and total score of PSQI in the SP6 group were lower than those in the HT7 group (P<0.05). Compared with before treatment, the serum ACTH and CS levels in the three groups were decreased (P<0.05), and the serum MT levels in the SP6 and HT7-SP6 groups were increased (P<0.05). After treatment, the ACTH and CS levels in the HT7-SP6 group were lower than those in the HT7 group (P<0.05), and the serum MT levels in the SP6 and HT7-SP6 groups were higher than that in the HT7 group (P<0.05). CONCLUSION: The compatibility of HT7 and SP6 has a synergism effect on the improvement of night sleep quality and daytime fatigue and sleepiness of insomnia patients, the mechanism may be related with its function in down-regulating the serum ACTH and CS levels and increasing the serum MT content. SP6 has a better effect than HT7, and plays a major role in acupoint compatibility.

[Combined use of Shenmen (HT 7) and Sanyinjiao (SP 6) to improve the anxiety and depression in patients with insomnia: a randomized controlled trial].

OBJECTIVE: To observe the effect of electroacupuncture (EA) at Shenmen (HT 7) and Sanyinjiao (SP 6) on anxiety and depression in patients with insomnia, and to explore the mechanism of its compatibility effect. METHODS: Ninety patients of insomnia were randomly divided into a combination group, a Shenmen group and a Sanyinjiao group, 30 cases in each group. In addition, 37 cases with anxiety (12 cases in the combination group, 13 cases in the Shenmen group and 12 cases in the Sanyinjiao group) and 42 cases with depression (14 cases in the combination group, 14 cases in the Shenmen group and 14 cases in the Sanyinjiao group) were identified. The patients in the combination group, Shenmen group and Sanyinjiao group were treated with EA (dilatational wave, frequency of 5 Hz/25 Hz) at Shenmen (HT 7)-Sanyinjiao (SP 6), Shenmen (HT 7) and Sanyinjiao (SP 6), respectively, 30 min each treatment, once a day. The consecutive 5 days of treatments were taken as a course of treatment, and 2 courses of treatment were given. The insomnia severity index (ISI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were evaluated before and after treatment, and the serum contents of dopamine (DA) and norepinephrine (NE) were measured. RESULTS: Compared before treatment, the ISI, SAS and SDS scores in the three groups were all decreased after treatment (P<0.05), and the ISI score in the combination group was lower than that in the Shenmen group (P<0.05). Among the patients with anxiety, compared before treatment, the ISI, SAS scores and serum contents of DA were all decreased after treatment in the three groups (P<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (P<0.05); the SAS score and serum contents of NE in the combination group and Shenmen group as well as the ISI score in the combination group were lower than those in the Sanyinjiao group (P<0.05). Among the patients with depression, compared before treatment, the ISI, SDS scores and serum contents of DA were all decreased after treatment in the three groups (P<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (P<0.05); the ISI, SDS scores and serum contents of NE in the combination group as well as SDS score in the Shenmen group were lower than those in the Sanyinjiao group (P<0.05). CONCLUSION: EA at Shenmen (HT 7) and Sanyinjiao (SP 6) has advantages over EA at Sanyinjiao (SP 6) on improving insomnia, anxiety and depression. Shenmen (HT 7) plays a major role in improving anxiety and depression. Shenmen (HT 7) and Sanyinjiao (SP 6) may play a compatibility effect of regulating consciousness and sleeping by reducing the level of serum NE.

[Surgical treatment of spontaneous isolated middle aortic dissection].

OBJECTIVE: To explore the diagnosis and treatment of spontaneous isolated middle aortic dissection (SIMAD). METHODS: The clinical data of 7 SIMAD patients admitted into our hospital between January 2007 and June 2011 were retrospectively analyzed. RESULTS: There were 3 males and 4 females with an average age of 53 years old. Five patients had an acute onset. According to the original tear location and flow of celiac artery, 6 patients received endovascular repair and another patient underwent abdominal aorta-bilateral-femoral artery bypass with artificial graft. All cases were successfully treated. Six patients recovered well from the procedures. One patient suffered acute coronary artery syndrome at Day 2 after endovascular treatment. After transferral into cardiology unit, emergency percutaneous transluminal coronary angioplasty was performed with a satisfactory outcome. The postoperative examinations of CTA (computed tomography angiography) of all patients demonstrated that the false lumen of dissection was basically thrombolized without endoleak or stent migration. CONCLUSION: Vascular surgeons should pay more attention to SIMAD with the potentials of rupture and aneurysm. Endovascular graft exclusion may be a first-line therapy as long as the anatomical conditions allow. However, longer follow-up and further evaluations should be performed to determine the long-term benefits.

[Investigation of endovascular aneurysm repair of complex abdominal aortic aneurysm in high-risk patients].

OBJECTIVE: To evaluate the results of a variety of alternative endovascular techniques applied to patients with complicated abdominal aortic aneurysm complex abdominal aortic aneurysm (cAAA) and unsuitable for open surgery. METHODS: From January 2001 to December 2010, charts of all patients having an abdominal aortic aneurysm (AAA) were reviewed. Endovascular aneurysm repair (EVAR) was done in 138 patients, in which 9 patients were defined as cAAA such as juxta-renal AAA, short or angulated AAA neck, AAA with bilateral iliac artery aneurysms. There were 8 male and 1 female patients, aged from 26 to 87 years with a mean of 67 years. All these patients at high risk for open surgery were offered a modified EVAR technique including fenestrated technique, scallop technique, chimney technique, balloon assisted U-turn stenting and reverse-U stent-graft in 2, 5, 1 and 1 patients respectively. RESULTS: All techniques were successful and without severe postoperative complications. An intraoperative endoleak was found in 4 patients and was corrected immediately. One patient with type I and III endoleaks underwent dilatation with a compliant balloon. Two patients with type I endoleak underwent coil embolization (1 patient) and bare stent (1 patient). During follow-up, one patient with a type II endoleak who demonstrated no increase in sac diameter during follow-up was observed. Mean follow-up was 25.9 months (ranging from 4 to 79 months). No rupture occurred and 8 aneurysms shrink significantly. In 7 patients, critical vessels (renal and mesenteric arteries) were protected during the initial procedure and remained patent except in one patient who was performed reverse "U" stent graft with thrombosis in hypogastric artery. CONCLUSION: High-risk patients with cAAA inappropriate for traditional EVAR can be successfully treated by using simple ancillary endovascular techniques with acceptable short or mid-term results.

[Endovascular repair of descending aortic pseudoaneurysms].

OBJECTIVE: To evaluated the feasibility, efficacy, and outcome of endovascular repair for descending aortic pseudoaneurysms. METHODS: From April 2007 to November 2010, 20 patients of descending aortic pseudoaneurysm were treated. There were 18 male and 2 female, aged from 28 to 82 years with a mean of (58 ± 16) years. In this group, 4 patients were diagnosed as Behçet's syndrome, 6 patients as mycotic pseudoaneurysms with positive blood culture, 6 patients as suspected mycotic pseudoaneurysms, 1 patient with iatrogenic pseudoaneurysm and 1 patient with chronic grain-mononuclear cell leukemia, the other 3 patients with unknown reasons. The 88.5% of aortic pseudoaneurysms were located at abdominal aorta. Fifteen patients underwent endovascular therapy and 2 patients were treated by traditional open surgery. The other 3 patients underwent conservative treatments. The data of treatments and follow-up in the 15 patients who received endovascular repairs were retrospectively analyzed. RESULTS: Endovascular therapy was performed successfully on the 15 patients, and the technique successful rate was 15/15. Total 15 stents were transluminal placed including 6 bifurcate stent-grafts, 6 abdominal straight stent-grafts, 2 thoracic straight stent-grafts and 1 abdominal bare stent. One patient was treated by stent assisted embolization. Perioperative mortality rate was 0. Only 2 primary type IV endoleaks were found. Fourteen patients were successfully followed up. During a mean follow-up of 538 days, 8 (57.1%) patients were uneventful. Six (42.9%) patients were complicated by aneurysm related events, including 4 (28.6%) aneurysm-related deaths, 1 (7.14%) with delayed endoleak and 1 (7.14%) with recurrent pseudoaneurysm which was retreated by another stent-graft. CONCLUSIONS: Endovascular therapy for descending aortic pseudoaneurysms is a feasible and mini-invasive option with high technique success rate and low perioperative mortality rate. However, risk of recurrence and rupture to death of pseudoaneurysm remains high during follow-up. Treating the underlying reasons and intensively follow-up may be good for improving the prognosis of descending aortic pseudoaneurysms treated by endovascular therapy.