Remote endarterectomy for complex lower extremity ischemia / 中华普通外科杂志

Objective:To evaluate the effect of remote endarterectomy in the treatment of complex lower extremity ischemia.Methods:Twenty-one limb ischemic patients underwent remote endarterectomy in Beijing Hospital from Sep 2016 to Feb 2020. Clinical data including general condition, the lesion of lower artery before operation and follow up outcomes were collected. Then the patency rate and limb salvage rate were calculated.Results:The technique success rate was 71.4% (15/21). The 3, 6, 12 month patency rate were 93.3%, 85.6% and 74.1%, respectively. The 1-year limb salvage rate was 93.3% (14/15). In the 6 patients converted to artificial vessel bypass, the 3,6,12 months patency rates were 76.7%, 66.7% and 46.8%, respectively. The 1-year limb salvage rate was 66.7%.Conclusions:Remote endarterectomy of the lower extremity artery is an alternative option in the treatment of complex ischemic lesions of the lower extremity artery, other than artificial vessel bypass.

Risk factors of restenosis of percutaneous transluminal angioplasty of Takayasu arteritis / 中华普通外科杂志

Objective:To analyze the relevant risk factors for restenosis after percutaneous transluminal angioplasty of patients with Takayasu′s arteritis.Methods:Clinical data of 43 patients undergoing percutaneous angioplasty due to Takayasu arteritis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to explore the relevant risk factors for restenosis after percutaneous transluminal angioplasty.Results:There were 9 males and 34 females. The mean age was 23 (18-33) years old, 59 times of PTA were performed, including 44 in renal artery, 9 in aorta, 2 in iliac and 2 in carotid artery, 1 in brachiocephalic trunk and 1 in left subclavian artery. The mean follow up time was (64±42) months. The rate of restenosis was 47.5%(28/59)and the mean time of restenosis was (23±27) months. The restenosis rate of aorta and iliac artery was 9.1%, that of renal artery was 52.3% and that of supra aortic artery was 100% . The rate of restenosis was higher in patients with symptoms of headache, syncope and low back pain, the elevated ESR and CRP increased the risk of restenosis (all P<0.05). Multivariate Logistic analysis showed that preoperative elevation of ESR and CRP were risk factors for restenosis after percutaneous angioplasty for Takayasu arteritis. Conclusions:PTA was safe and effective in Takayasu arteritis involving aorta-iliac and renal artery, the elevated ESR and CRP was related to high risk of restenosis.

Excimer laser atherectomy combined with drug-eluting balloon for lower limb arteriosclerosis obliterans / 中华普通外科杂志

Objective To evaluate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of lower limb arteriosclerosis obliterans.Methods From Sep 2016 to Dec 2018 42 patients (42 limbs) underwent ELA combined with DCB therapy.Results There were 27 males and 15 females.The mean age was (65.7 ±9.7) years.The average lesion length was (14.3 ±7.5) cm.The technical success rate was 100％ and the remission rate of clinical symptoms was 92.9％.Ankle-brachial index was significantly improved from (0.45 ± 0.15) pre-operation to (0.85 ± 0.13) postoperation (P =0.001).The mean follow-up was 10.9 months.At 3,6,and 12 months follow-up,the primary patency rate was 95.2％,92.8％ and 84.9％.The 1-year limb salvage rate was 95.2％.Conclusion ELA combined with DCB has a good 1-year results as our data reveal.

Risk factors analysis of restenosis after renal artery endovascular therapy in patients with Takayasu arteritis / 中华普通外科杂志

Objective To analyze the risk factors of restenosis after renal artery endovascular treatment in patients with Takayasu arteritis.Methods In this study,39 patients with Takayasu arteritis underwent endovascular therapy from January 2003 to March 2014.Univariate and multivariate logistic regression analysis were used to analyze the risk factors relating to restenosis.Results There were 13 males and 26 females.The mean age was (27 ± 11) years.Seventeen unilateral and 22 bilateral renal artery stenosis were treated.A total of 54 endovascular procedures were successfully performed including 23 cases of unilateral percutaneous transluminal angioplasty (PTA),14 cases of unilateral stent implantation,12 cases of bilateral PTA,and 5 cases of bilateral stent implantation.The mean follow-up was (48 ±34) months,the restenosis rate was 38.9％ (21.54) and the mean time of restenosis was (11.5 ± 2.3) months.Elevated erythrocyte sedimentation rate (ESR) (OR =6.624,95 ％ CI:1.222-35.902) was independent risk factors for restenosis.Antiplatelet therapy (OR =0.158,95％ CI:0.028-0.887) and glucocorticoids or i mmunosuppressive therapy (OR =0.035,95 ％ CI:0.003-0.349) were protection factors against renal artery restenosis.Conclusion The elevated ESR increases the risk of restenosis after endovascular treatment in Takayasu arteritis associated renal artery stenosis.Antiplatelet therapy and glucocorticoids or immunosuppressive therapy were protection factors for renal artery restenosis.

A vascular endothelial growth factor activating transcription factor increases the endothelial progenitor cells population and induces therapeutic angiogenesis in a type 1 diabetic mouse with hindlimb ischemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Therapeutic angiogenesis has been shown to promote blood vessel growth and improve tissue perfusion. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis. However, it has side effects that limit its therapeutic utility in vivo, especially at high concentrations. This study aimed to investigate whether an intramuscular injection of a genetically engineered zinc finger VEGF-activating transcription factor modulates the endothelial progenitor cells (EPC) and promotes therapeutic angiogenesis in a hindlimb ischemia model with type 1 diabetes.</p><p><b>METHODS</b>Alloxan (intravenous injection) was used to induce type I diabetes in C57BL/6 mice (n = 58). The ischemic limb received ZFP-VEGF (125 µg ZFP-VEGF plasmid in 1% poloxamer) or placebo (1% poloxamer) intramuscularly. Mice were sacrificed 3, 5, 10, or 20 days post-injection. Limb blood flow was monitored using laser Doppler perfusion imaging. VEGF mRNA and protein expression were examined using real-time PCR and ELISA, respectively. Capillary density, proliferation, and apoptosis were examined using immunohistochemistry techniques. Flow cytometry was used to detect the EPC population in bone marrow. Two-tailed Student's paired t test and repeated-measures analysis of variance were used for statistical analysis.</p><p><b>RESULTS</b>ZFP-VEGF increased VEGF mRNA and protein expression at 3 and 10 days post-injection, and increased EPC in bone marrow at day 5 and 20 post-injection compared with controls (P < 0.05). ZFP-VEGF treatment resulted in better perfusion recovery, a higher capillary density and proliferation, and less apoptosis compared with controls (P < 0.05).</p><p><b>CONCLUSIONS</b>Intramuscular ZFP-VEGF injection promotes therapeutic angiogenesis in an ischemic hindlimb model with type 1 diabetes. This might be due to the effects of VEGF on cell survival and EPC recruitment.</p>

Importance of early intestinal barrier protection in severe acute pancreatitis / 中华肝胆外科杂志

Objective To observe the influence of early intestinal barrier protection in patients with severe acute pancreatitis(SAP). Methods To analyze the therapeutic methods and prognosis of 56 patients with SAP. The patients were randomly divided into the conventional therapy group (A) and the intestinal barrier protection group (B). The APACHE Ⅱ score, Ranson score, Marshall score, CT severity index (CTSI), gastrointestinal functions score (GFS), the ratio of Lactulose to Mannitol (L/M), plasma Endotoxin and Diamine Oxidase (DAO), serum C-reactive protein (CRP) and TNF-α, incidence of pancreatic infection and multiorgan dysfunction syndrome (MODS), and the hospitalization mortality were compared between the two groups. Results On the 7th day after admission, the APACHE Ⅱ score, GFS, L/M, Endotoxin, DAO, CRP and TNF-α were significantly less in group B than in group A (P0. 05)between the two groups at 2nd week after admission. The incidence of pancreatic infection and MODS in group B were significantly lower than in group A (P0. 05) between the two groups. Conclusion Early intestinal barrier protection in SAP alleviated systemic inflammatory response, and reduced the incidences of pancreatic infection and MODS, thus improved the prognosis.

Advancement in Intestinal Barrier Dysfunction of Severe Acute Pancreatitis / 中国普外基础与临床杂志

Objective To summarize the recent progress in pathogenetic,diagnostic and therapeutic researches on the intestinal barrier dysfunction(IBD) of severe acute pancreatitis(SAP).Methods The advancement of IBD in SAP,which was published recently at home and abroad,was collected and reviewed.Results The pathogenesis of IBD in patients with SAP was complex.Ischemia-reperfusion injury,endotoxin,inflammatory mediators and gastrointestinal hormone played an important role in the process of IBD.There were many ways to detect IBD,and the ratio of lactulose and mannitol,plasma diamine oxidase were relatively ideal markers.Medical therapies,such as treatment of SAP and maintaining the perfusion of intestines,were essential to cure IBD.On this basis,the propulsives,nutritional support and traditional Chinese drugs should be administered reasonably.Conclusions IBD is a sophisticated process of pathophysiology.In recent years,abundant of animal experiments and clinical researches have provided new clue for prevention and cure of IBD,but further researches are still needed on the mechanism of the cells and molecules implicated.