Risk Factors for Patients Using Intraoperative Vasopressor Infusions During Carotid Body Tumor Excision / 中国医学科学院学报

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.

Sleeve Shaping Technique for Two Cases of Peripheral Artery Aneurysms Involving Important Branches / 中国医学科学院学报

Peripheral artery aneurysms,with low incidence and complex anatomic structure,often involve important branches.This paper introduces a new surgical technique-sleeve shaping on the basis of two cases.The basic data,including characteristics,imaging,operation and follow-up data of the cases,were collected.The data were then combined with the previous literature for explaining in detail that this technique can be used as a supplementary method of reconstruction following resection or endovascular repair.

Treatment of Concomitant Intra-abdominal Malignancy and Abdominal Aortic Aneurysm / 中国医学科学院学报

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.

Role of Vascular Aging in the Pathogenesis of Abdominal Aortic Aneurysm and Potential Therapeutic Targets / 中国医学科学院学报

Abdominal aortic aneurysm(AAA)is a common aortic degenerative disease in the elderly,and its incidence is gradually increasing with the aging of the population.There are no specific drugs available to delay the expansion of AAA.Once the aneurysm ruptures,the mortality will exceed 90%,which seriously threatens the life of patients.Given the high incidence of AAA in the elderly,this review discusses the role of vascular aging in the pathogenesis of AAA,involving chronic inflammation,oxidative stress,mitochondrial dysfunction,protein homeostasis imbalance,increased apoptosis and necrosis,extracellular matrix remodeling,nutritional sensing disorders,epigenetic changes,and increased pro-aging factors.Meanwhile,several potential aging-related drug targets of AAA are listed.This review provides new ideas for basic and translational medical research of AAA.

Clinical Analysis of the Treatment of Iliac Limb Occlusion Following Endovascular Abdominal Aortic Aneurysm Repair / 中国医学科学院学报

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.

Differences of Gut Microbiota Diversity between Patients with Abdominal Aortic Aneurysm and Atherosclerosis / 中国医学科学院学报

Objective To investigate the differences of gut microbiota between patients with abdominal aortic aneurysm and atherosclerosis.Methods From December 2018 to June 2019,20 fresh stool samples were collected respectively from the patients with abdominal aortic aneurysm and atherosclerosis treated at the Department of Vascular Surgery,Peking Union Medical College Hospital.The 16S rDNA high-throughput sequencing was employed to compare the composition,abundance,and α and β diversities of gut microbiota between the two disease groups,and further determine the significantly differential genera.Results The two groups had great similarities in the composition of gut microbiota.There was no statistical difference in α diversity.Although β diversity did not have statistically significant difference,certain microbial taxa showed differences between the two groups.The LEfSe demonstrated that the abdominal aortic aneurysm group had higher relative abundance of

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors / 中华耳鼻咽喉头颈外科杂志

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdominal Aortic Aneurysm Repair: A Meta-Analysis / 中国医学科学杂志(英文版)

Objective Type Ⅱ endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair (EVAR). The efficacy of transarterial (TA) embolization and translumber (TL) embolization in the management of type Ⅱ endoleak remains equipoise. The aim of this study is to compare the technical and clinical success between TA embolization and TL embolization for type Ⅱ endoleak after EVAR.Methods The protocol was registered (CRD 42018114453) and the electronic databases (Pubmed, Embase, Web of Science, and Cochrane) were systematically searched till March 2019. The search terms included EVAR, type Ⅱ endoleak, and embolization. The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type Ⅱ endoleak after EVAR. The technical and clinical success rates were meta-analyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type Ⅱ endoleaks were included. The pooled odds ratio () of technical success rate for TA . TL was 0.56 (95% , 0.10-3.18; =0.51) and the pooled of clinical success rate for TA TL was 0.31(95% , 0.07-1.29; =0.11). As a limitation, 6 articles were all retrospective studies which may lead to bias.Conclusion Both TA and TL could be effective procedure of embolizations to resolve the type Ⅱ endoleak. The meta-analysis result indicated that TA embolization was not inferior to TL embolization in technical success and clinical success.

Methods for Creating Medium and Large Animal Models of Peripheral Atherosclerosis / 中国医学科学院学报

Atherosclerosis (AS) is the main pathological basis for the occurrence of many vascular diseases and has a strong association with metabolic syndrome. Peripheral arterial diseases caused by AS have high morbidities and mortalities but lack still effective treatment. AS animal models are highly valuable for research on peripheral arteriosclerotic diseases. While small and medium AS animal models based on high-fat feeding and balloon injuries have been successfully established,few literatures have described the creation of large animal models for AS treatment. This article elucidates the current methods for creating medium and large animal models of peripheral atherosclerotic disease,with an attempt to further promote the clinical translation of AS treatment research.

Leiomyosarcoma of the Great Saphenous Vein:Report of One Case and Meta-analysis / 中国医学科学院学报

Leiomyosarcoma(LMS)of the great saphenous vein(GSV)is a rare condition that is often misdiagnosed due to the lack of typical clinical manifestations.This article reported a GSV-LMS case diagnosed and treated in Peking Union Medical College Hospital.Meta-analysis of the current case and 41 cases derived from CNKI,WANFANG DATA,and MEDLINE database was also conducted,which revealed that the male to female ratio of GSV-LMS was 11:10;the median age of disease onset was 59.5 years;the most commonly affected region was thigh.Due to lack of specific clinical features,42.9% of GSV-LMS patients were misdiagnosed at presentation.Radical resection is the most effective therapy,and the indications,effectiveness and protocols of adjuvant radiochemotherapy remain unclear.The 3-and 5-year overall survival rate was 86.1% and 77.5%,respectively.Recurrence and metastasis occurred in 31.0% of patients after surgery.

Interval-spaced Sessions of Partial Splenic Artery Embolization in Juvenile Patients with Hypersplenism / 中国医学科学院学报

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.

Role of Family with Sequence Similarity 3A in High Glucose-induced Oxidative Damage of Human Umbilical Vein Endothelial Cells / 中国医学科学院学报

Objective To investigate the role of family with sequence similarity 3A(Fam3A) in high glucose-induced damage of human umbilical vein endothelial cells (HUVECs). Methods HUVECs were divided into control group and high glucose group, which were cultured in endothelial cell medium (ECM) containing 5.5 mmol/L of glucose and ECM containing 33.3 mmol/L of glucose, respectively. Real-time quantitative polymerase chain reaction was used to detect the mRNA expression of Fam3A, whereas the protein expression of Fam3A was detected by enzyme-linked immunosorbent assay. HUVECs in control group and high glucose group were transfected with siNT and siFam3A, respectively, and the levels of reactive oxygen species(ROS), ATP, mitochondrial oxygen consumption rate(OCR), and P-p38 protein were detected.Results After HUVECs had been cultured for 24h, the relative mRNA expression of Fam3A between high glucose group and control group was 2.52±0.19 (t=13.296,P=0.000). The Fam3A protein level was (173.82±33.28)pg/ml in the high glucose group, which was significantly higher than that [(39.45±33.78)pg/ml] in the control group (t=4.907,P=0.006). The intracellular ROS content in siNT-high glucose group was (8217±794)RFU, which was significantly higher than that [(3982±398)RFU] in siNT control group (t=15.109,P=0.002). The intracellular ROS content of siFam3A high glucose group was (11 910±1 001)RFU, significantly higher than that [(4171±402)RFU] of siFam3A control group (t=9.705,P=0.010) and than that of siNT high glucose group (t=4.026,P=0.048). The relative amounts of ATP synthesis in siNT high glucose group, siFam3A control group and siFam3A high glucose group were (61.2±5.6)%, (94.6±8.4)%, and (29.7±2.7)% of the siNT control group respectively; thus, it was significantly lower in siNT high glucose group than in siNT control group (t=12.001,P=0.007) and was also significantly lower in siFam3A high glucose group than in siFam3A control group (t=20.742,P=0.002) and in siNT high glucose group(t=18.814,P=0.003). The mitochondrial OCR was (0.57±0.05)pMO/(μg protein·min) in siNT high glucose group, significantly lower than that [(1.12±0.09)pMO/(μg protein·min)] of siNT control group (t=6.804,P=0.021). The mitochondrial OCR of siFam3A high glucose group was (0.31±0.03)pMO/(μg protein·min), significantly lower than that [(1.01±0.09)pMO/(μg protein·min)] of siFam3A control group (t=19.876,P=0.003), which was significantly lower than that of siNT high glucose group (t=21.444,P=0.002). The relative expression of P-p38 in siNT high glucose group, siFam3A control group, and siFam3A high glucose group was 2.239±0.353, 0.816±0.120, and 1.160±0.185, respectively; thus, it was significantly higher in the siNT high glucose group than in siNT control group (t=6.075,P=0.026); in addition, it was significantly higher in the siFam3A high glucose group than in siFam3A control group (t=6.242,P=0.024) and significantly lower than in siNT high glucose group (t=9.686,P=0.010). Conclusions High glucose can induce high expression of Fam3A in HUVECs. Knockdown of Fam3A gene expression can exacerbate the decrease of ATP synthesis and mitochondrial OCR caused by high glucose and promote the generation of ROS in high glucose. Fam3A may regulate high glucose-induced ROS production in HUVECs via the p38 MAPK signaling pathway.

Outcomes of Chimney and/or Periscope Techniques in the Endovascular Management of Complex Aortic Pathologies / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The chimney/periscope technique has been used to address complex aortic pathologies. This study aimed to report the outcomes and experiences of chimney and/or periscope grafts (CPGs) used in the endovascular management of complex aortic pathologies.</p><p><b>METHODS</b>Twenty-two patients with complex aortic pathologies were retrospectively studied from January 2013 to August 2016 in two vascular centers of teaching hospitals. All patients were diagnosed using computed tomography angiography (CTA). The patients were followed up at postoperative 1, 3, 6, and 12 months and yearly thereafter with X-ray, ultrasound, and/or CTA.</p><p><b>RESULTS</b>Twenty-two cases (17 males; mean age 60.7 ± 16.3 years) with complex aortic pathologies were analyzed. Nineteen patients underwent CPGs only, and the other three cases underwent the simultaneous implantation of chimney/periscope and fenestrated/scallop grafts. Twenty-six arteries were managed with forty CPGs during the procedures. Complete angiographies revealed two Type I endoleaks, one Type III endoleak, and one Type IV endoleak. Other intraoperative complications included brachial thrombosis, external iliac artery rupture, and left renal stenosis. The 30-day mortality was 0. The mean follow-up was 26.1 ± 10.1 months with a range of 2-39 months. During the follow-up, two Type I endoleaks and one Type IV endoleak were observed. One right renal stent occlusion occurred in the 5th month and turned patent after reintervention. Three patients died during the follow-up, one due to an aneurysm rupture as a Type I endoleak, and two due to myocardial infarction. The instant technical success was 96%. The primary and secondary patencies were 92% and 96%, respectively. The overall survival rates were 95%, 84%, and 84% at 12, 24, and 36 months, respectively. Stent migration was not observed in any patient.</p><p><b>CONCLUSIONS</b>Chimney/periscope techniques could be used to tackle complex aortic pathologies, but the indications must be strictly controlled, and additional experiences are required.</p>

Surgical Treatment Strategies of Intravenous Leiomyomatosis withRight Cardiac Cavities Extension / 中国医学科学院学报

Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome.Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.

Endovascular Repair for Acute Type B Aortic Dissection / 中国医学科学院学报

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.

Change of Serum Angiopoietin-related Growth Factor in Patients with Abdominal Aortic Aneurysm and Its Clinical Significance / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the changes and value of plasma angiopoietin-related growth factor (AGF) in patients with abdominal aortic aneurysm (AAA).</p><p><b>METHODS</b>Serum AGF level was analyzed in 50 AAA patients and in 56 healthy subjects. AGF and adiponectin were quantified by enzyme-linked immunosorbent assay. Routine testing of blood biochemistry and high-sensitivity C-reactive protein were performed.</p><p><b>RESULTS</b>The plasma AGF level was significantly higher in AAA patients than in the controls [(87.91±96.87) μg/L vs. (56.89±41.32) μg/L, P=0.040],while serum adiponectin level showed no significant difference between these two groups. The plasma AGF level in patients with an AAA>5 cm and those with AAA between 3 cm and 5 cm were (96.08±68.61) μg/L and (75.27±46.05) μg/L.</p><p><b>CONCLUSIONS</b>Plasma AGF is highly expressed in AAA patients. Higher serum AGF level is associates with larger AAA. Thus, AGF may be a potential serum biomarker for AAA.</p>

Clinical analysis of two carotid endarterectomy procedures in treating carotid artery stenosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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).</p><p><b>CONCLUSION</b>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.</p>

New method to predict cerebral hyperperfusion syndrome after carotid endarterectomy by transcranial Doppler / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the diagnostic value for predicting cerebral hyperperfusion syndrome (CHS) by adding a transcranial Doppler (TCD) measurement at the end of the carotid endarterectomy (CEA) at the operating room.</p><p><b>METHODS</b>Patients who underwent CEA between August 2009 and December 2011 of the prospective clinical trial in whom both intra- and post-operative TCD monitoring were performed were included. The middle cerebral artery velocities pre-clamping, post-declamping and post-operatively were measured by TCD. The intra-operative velocity increase ratio (VR1) was compared to the postoperative velocity increase ratio(VR2) in relation to CHS by calculating the sensitivity,specificity, positive predictive value, negative predictive value. The receiver operating characteristic curve (ROC) were also performed. The area under the curve (AUC) of ROC of VR1 and VR2 were compared.All the data were analyzed using SPSS 20.0 software.</p><p><b>RESULTS</b>VR1 > 100% was identified in 6 patients, while VR2 > 100% was identified in 18 patients, respectively. Ten patients were diagnosed with CHS. The AUC of VR2 (0.728) was higher than AUC of VR1 (0.636). The best fit cutoff point of VR2 was 100%. The sensitivity, specificity, positive predictive value, negative predictive value were 70%, 83%, 39%, 95%, respectively, which demonstrates a better predictive power than VR1.</p><p><b>CONCLUSION</b>Besides the commonly used intra-operative TCD monitoring, additional TCD measurement at the end of the carotid endarterectomy at the operating room is more useful to more accurately predict CHS.</p>

Revascularization for lower limbs thromboangiitis obliterans-early and mid-term outcome report / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the outcome of revascularization for lower limbs thromboangiitis obliterans (TAO) and evaluate risk factors affected outcomes.</p><p><b>METHODS</b>Between January 2008 and December 2011, a consecutive series of 24 TAO patients with lower limb ischemia were underwent revascularization. All the patients were male. The mean age was (33 ± 6) years (24-43 years). All patients presented with history of heavy smoking.Fifteen patients (62.5%) presented with ulcer or gangrene, 7 cases (29.2%) presented with rest pain, the rest 2 cases (8.3%) presented with severe intermittent claudication.Eight cases underwent bypass, including 6 autogenous vein graft, 1 prosthesis graft and 1 hybrid graft; 7 cases underwent catheter-directed thrombolysis combined with angioplasty; 3 cases underwent angioplasty and stenting directly; the rest 6 cases underwent thromboectomy and/or endarterectomy. The technical success, amputation and patency of target vessel were reported.Some risk factors were evaluated by multi-factors regression analysis to identify whether influenced outcomes.</p><p><b>RESULTS</b>Seventeen cases (70.8%) harvested primary technical success. Three cases (12.5%) suffered with major amputation due to failure of revascularization.Eight cases with bypass all were successful, 4 cases with thrombolysis got success, 2 cases with primary angioplasty and stenting got success, while the 3 cases with thromboemctomy and/or endarterectomy got success. Among the 7 failed cases, 3 cases needed major amputation, 2 cases underwent re-operation, and the rest 2 cases got conservation treatment. All the patients had effective follow-up between 1 and 40 months (mean (17 ± 11) months).No death occurred during the follow-up. Primary patency, secondary patency and limb salvage rate were 45.8% (11/24), 62.5% (15/24), and 79.2% (19/24), respectively.Risk factors regression analysis showed patients with ulcer or gangrene before revascularization got significant worse outcomes (Wald = 4.018, P = 0.043) . Bypass could improve outcomes significantly (Wald = 4.016, P = 0.045) .</p><p><b>CONCLUSIONS</b>Outcomes of revascularization for TAO with lower limb severe ischemia are acceptable. Autogenous vein graft bypass should be first choice. Thrombolysis with angioplasty could be a reasonable choice for those had no satisfied autogenous vein graft.</p>

Investigation of endovascular aneurysm repair of complex abdominal aortic aneurysm in high-risk patients / 中华外科杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>