[Advances in non-invasive treatment of aortic diseases].

With the further development and long-term follow-up of endovascular treatment for aortic diseases, increasing evidence shows that in many cases, there are difficulties in the diagnosis of causes, decision-making of treatment timing, and lack of effective evaluation of treatment prognosis in endovascular treatments. Therefore, it is necessary to conduct in-depth research on non-invasive treatment including prevention, diagnosis, treatment, and prediction of aortic diseases. The non-invasive treatment of aortic disease is mainly applied to high-risk populations with aortic dissection, regulating key targets and mechanisms, and adopting drug intervention in advance to achieve the goal of controlling aortic dilation and preventing the occurrence of dissection. It also conducts precise multi omics analysis to determine the optimal intervention timing and treatment strategy, and aims at complications related to aortic disease or endovascular treatment for patients with a positive family history of aortic dilation and those who have developed aortic dissection. Precise regulation can control the progression of aortic aneurysm and aortic dissection, delay or achieve long-term stable coexistence with aortic disease, and even reverse disease progression and achieve benign aortic remodeling through new intervention vectors. Ultimately achieving the ideal state of complete thrombosis and mechanized healing of the aortic aneurysm or aortic dissection false lumen.

[Advances in the classification and treatment of isolated superior mesenteric artery dissection].

Isolated superior mesenteric artery dissection (ISMAD) has attracted more and more clinicians' attention in recent years. Patients onset of ISMAD often present with abdominal pain. The misdiagnosis or miss diagnosis is common because of the non-specific symptoms and signs, which even can endanger lives in serious cases. Imaging classification is of great significance for diagnosis and treatment of ISMAD. The Sakamoto classification and the Yun classification are two classical classified methods. However, with the further study of ISMAD, various new classifications emerge. Conservative treatment was once considered as the preferred. As the rapid development of endovascular therapy and the great progress of new devices, stenting therapy can significantly improve symptoms and achieve satisfactory long-term effects, and be even expected to become the preferred method for clinical therapy of ISMAD. However, the long-term effects of endovascular therapy still need a large number of follow-up data, and complications after stent implantation can't be ignored.

[The efficacy of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery].

Objective: To examine the safety and effectiveness of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Methods: The data of 32 patients admitted to First Hospital of Jiaxing (20 cases) and Jinling Hospital (12 cases) with SIDSMA from January 2016 to January 2021 were retrospectively analyzed. There were 27 males and 5 females, aging (54.8±9.4) years (range: 36 to 75 years). All patients were treated with thin struct bare stents. Controllable spring coils were used to fulfill the false lumen in 2 cases. Symptoms, vascular remodeling pattern at the SIDSMA lesion, and patency of the stents were observed during follow-up. Results: The surgical success rate was 100%. According to the length of the lesions and stents, the number of stents implanted was 1 in 17 cases, 2 in 11 cases and 3 in 4 cases. The angiography showed that blood flow in the stent was smooth and that the false lumen disappeared or weakened. The numerical rating scale for abdominal pain decreased from 6.1±1.5 (range: 4 to 10) preoperatively to 1.0 (1.0) (range: 0 to 3) 1 hour postoperatively (W=528, P<0.01). The compression rate of the true lumen of the superior mesenteric artery decreased from (92.3±6.7)% (range: 25% to 94%) preoperatively to 0.8 (1.2)% (range: 0 to 3.2%) 1 month postoperatively (W=528, P<0.01). The primary patency rate of CT angiography at 1 month postoperatively was 100%. The vascular remodeling rate was (92.3±6.7)% (range: 80% to 100%). All patients were followed for (46.3±17.0) months (range: 24 to 76 months). The cumulative patency rates in 1, 2 and 5 years were all 100%. Conclusion: The use of thin struct bare stents for SIDSMA is safety and efficacy.

[Advances in the effects on false lumen thrombosis after the endovascular treatment of aortic dissection and its intervention strategies].

Aortic dissection is a urgent and dangerous disease, and the endovascular treatments can cure it in an effective and efficient way. As an important indicator of aorta remodeling, false lumen thrombosis is related to the prognosis of aortic dissection after endovascular treatment. The relationships among false lumen thrombosis after endovascular treatment and prognosis of aortic dissection, and the clinical techniques that can promote the false lumen thrombosis are reviewed in this paper. The aim is to promote a comprehensive evaluation of aorta remodeling.

Two-end intimal flap suturing method for establishing Stanford B type aortic dissection in a canine model.

OBJECTIVE: To establish an animal model of Stanford type B aortic dissection using a two-end intimal flap suturing. DESIGN: Twelve adult mongrel dogs of either sex were studied and followed up, at intervals, up to 1 year. MATERIALS AND METHODS: A lateral clamp was placed on the proximal descending aorta after general anaesthesia and left thoracotomy. Half the circumference of the aorta, including the media and adventitia, was cut open transversely, leaving the intima intact. The aortic wall was separated inferiorly. The intima was transversely cut and both ends of the distal intimal flap were sutured to the adjacent aorta. To close, the distal adventitia and media were sutured to the proximal aorta. Before thoracic cavity closure, digital subtraction angiography (DSA) and colour Doppler ultrasound were performed. RESULTS: Formation and distal extension was observed immediately after removal of the partial aortic clamp in 11 dogs. True and false lumens were seen in eight dogs; the false lumen was larger than the true lumen. Sacrifice at set intervals, 7 days to 12 months after surgery, showed a typical dissection tear, intima, septum, adventitia, thrombi and distal dissection blind pocket. CONCLUSION: This model of aortic dissection using the two-end aortic intimal flap suturing method is similar to human Stanford type B aortic dissection.

[Ultrastructure and elemental composition of pancreatic stones].

Four patients with pancreatic duct stones (PDS) and one with calcium deposits (CD) were diagnosed and surgically cured. The ultrastructure and elemental composition of PDS were studied by scanning electron microscopy and energy dispersive X-ray fluorescence. The results indicated that the outer shell of PDS, with dense texture, contained 96.29% of calcium (Ca), while the amorphous reticular inner nidus mainly contained sulphur (S) and chlorine (Cl). CD and PDS were manifestations in the process of pancreatic stones (PS) formation at different stages. As regards the formation of PS, the depressed gene expression played a key role in the reduction of PSP (Pancreatic Stone Protein), which made pancreatic acini reduce PSP biosynthesis rates. The consequence arising therefrom was that the supersaturated calcium carbonate (CaCO3) in pancreatic juice became inadequately inhibited. Thus the calcium carbonate became crystallized and deposited onto the reticular inner protein nidus (RIPN), which developed from the compilation of micro-protein-plugs that had grown from pathologically hyperconcentrated total proteins (mainly containing lactoferrin) in pancreatic juice. The RIPN gave a basis on which the calcium carbonate precipitated and formed PS.

[Superficial femoral vein valvuloplasty under direct angioscopic vision].

Superficial femoral vein valvuloplasty (SFV) under direct angioscopic vision without venotomy was designed and performed in 18 patients (20 limbs), suffering from primary SFV valve incompetence and the primary popliteal vein valve insufficiency. The indication of the operation is that the valves developed completely inborn, but with the effects of postnatal pathogenic factors, the leaflets prolapsed and became redundant, irregular diastema between leaflets emerged and the valve-ring dilated. The operation has several advantages: (1) Angioscopy confirms primary venous valve incompetence. (2) The technique precludes venotomy and valve exposure, reducing the rate of postoperative venous thrombosis. (3) The operation eliminates the blindness of kistner's external surgical technique, overcoming its empiricism. The initial clinic use of the technique has shown that it is of excellent short-term effect without complications.

[Air plethysmography in the diagnosis of primary venous insufficiency of lower extremities].

Through the assessment 101 limbs of 77 subjects by air plethysmography (AP), we studied the method of AP test and the values of various indices in diagnosis of primary venous insufficiency (PVI). Venous filling index (VFI) was found valuable to quantitate the venous reflux with its value beyond the threshold of 5 ml/sec. It has a potential value to assess the effect of operations on PVI, such as valvuloplasty aiming to abolish venous reflux. Ejection fraction (EF) was found to be abnormal with its value less than 40%. It may be used to evaluate the function of calf pump quantitatively, predict the ulcer formation, and help make a decision of surgery timely. The comprehensive analysis of VFI, EF, RVF (residual volume fraction) and AVP (ambulatory venous pressure) indicated that there seems to be different types of PVI: type 1, low ejection (low EF) high venous reflux (high VFI); type 2, high ejection low venous reflux; type 3, low ejection low venous reflux. This new classification may impose some on the selection of adequate therapies, which will be further investigated.