Three-Dimensional Printing to Guide Fenestrated/Branched TEVAR in Triple Aortic Arch Branch Reconstruction With a Curative Effect Analysis.

PURPOSE: To summarize experience with and the efficacy of fenestrated/branched thoracic endovascular repair (F/B-TEVAR) using physician-modified stent-grafts (PMSGs) under 3D printing guidance in triple aortic arch branch reconstruction. MATERIALS AND METHODS: From February 2018 to April 2022, 14 cases of aortic arch aneurysms and 30 cases of aortic arch dissection (22 acute aortic arch dissection and 8 long-term aortic arch dissection)were treated by F/B-TEVAR in our department, including 34 males and 10 females, with an average age of 59.84 ± 11.72 years. Three aortic arch branches were affected in all patients. A 3D-printed model was made according to computed tomography angiography images and used to guide the fabrication of PMSGs. All patients were followed up. RESULTS: A total of 132 branches were successfully reconstructed with no case of conversion to open surgery. The average operation time was 4.97 ± 1.40 hours, including a mean 44.05 ± 7.72 minutes for stent-graft customization, the mean postoperative hospitalization duration was 9.91 ± 4.47 days, the average intraoperative blood loss was 480.91 mL (100-2810 mL), and the mean postoperative intensive care unit monitoring duration was 1.02 days (0-5 days). No deaths occurred within 30 days of surgery. Postoperative neurological complications occurred in 1 case (2.3%), and retrograde type A dissection occurred in 1 case (2.3%). CONCLUSION: Compared with conventional surgery, triple aortic arch branch reconstruction under the guidance of 3D printing is a minimally invasive treatment method with the advantages of accurate positioning, rapid postoperative recovery, few complications, and reliable short- to mid-term effects. CLINICAL IMPACT: At present the PMSG usually depend on imaging data and software calculation. With the guidance of 3D printing technology, image data could be transformed into 3D model, which has improved the accuracy of the positioning of the fenestrations. The diameter reduction technique and the internal mini cuff technique have made a complement to the slimed-down fenestration selection process and the low rate of endoleak. As reproducible study, our results may provide reference for TEVAR in different cases.

Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease.

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

Comparison of Foam Sclerotherapy Alone or Combined With Stripping of the Great Saphenous Vein for Treating Varicose Veins.

BACKGROUND: Varicose veins (VVs) have a substantial impact on patients' quality of life. OBJECTIVE: The study aimed to retrospectively compare the short-term clinical outcomes of 2 treatment methods for VVs, namely high ligation and stripping (HL/S) of the great saphenous vein combined with foam sclerotherapy (FS), and FS alone. MATERIALS AND METHODS: Totally, 180 patients with VVs were included and treated with FS alone or HL/S+FS. Assessments included the first injection efficacy, postoperative status, complications, operative time, and recovery time. A follow-up duration was performed. Patient satisfaction was also recorded. RESULTS: No significant differences in the complete occlusion rate of the varicose tributaries, as well as in postoperative complications, were found between the treatment groups (p > 0.05). The complete occlusion rates of the varicose tributaries in the FS and HL/S+FS groups were 90% and 90%, respectively. Although mild phlebitis and local pigmentation were found in both groups, they disappeared during the follow-up period. Operative and recovery times were higher in the HL/S+FS group than in the FS group. CONCLUSION: The HL/S+FS and FS alone showed equivalent efficacy for treating patients with VVs. Considering the increased operative and recovery times, FS alone is recommended to treat VVs in clinical practice.

[Qualitative Determination of Organic Vapour Using Violet and Visible Spectrum].

Vapours of organic matters were determined qualitatively employed with ultraviolet-visible absorption spectroscopy. Vapours of organic matters were detected using ultraviolet-visible spectrophotometer employing polyethylene film as medium, the ultraviolet and visible absorption spectra of vegetable oil vapours of soybean oil, sunflower seed oil, peanut oil, rapeseed oil, sesame oil, cotton seed oil, tung tree seed oil, and organic compound vapours of acetone, ethyl acetate, 95% ethanol, glacial acetic acid were obtained. Experimental results showed that spectra of the vegetable oil vapour and the organic compound vapour could be obtained commendably, since ultra violet and visible spectrum of polyethylene film could be deducted by spectrograph zero setting. Different kinds of vegetable oils could been distinguished commendably in the spectra since the λ(max), λ(min), number of absorption peak, position, inflection point in the ultra violet and visible spectra obtained from the vapours of the vegetable oils were all inconsistent, and the vapours of organic compounds were also determined perfectly. The method had a good reproducibility, the ultraviolet and visible absorption spectra of the vapours of sunflower seed oil in 10 times determination were absolutely the same. The experimental result indicated that polyethylene film as a kind of medium could be used for qualitative analysis of ultraviolet and visible absorption spectroscopy. The method for determination of the vapours of the vegetable oils and organic compounds had the peculiarities of fast speed analysis, well reproducibility, accuracy and reliability and low cost, and so on. Ultraviolet and visible absorption spectrum of organic vapour could provide feature information of material vapour and structural information of organic compound, and provide a novel test method for identifying vapour of compound and organic matter.

Antioxidant Vitamin C attenuates experimental abdominal aortic aneurysm development in an elastase-induced rat model.

BACKGROUND: We investigated the hypothesis that an antioxidant, Vitamin C, could attenuate abdominal aortic aneurysm (AAA) development in a rat model. METHODS: An AAA model induced by intraluminal infusion was created in 36 male Sprague Dawley rats, which were randomly distributed into three groups: Sham (saline infused, placebo treated), Control (elastase infused, placebo treated), and Vitamin C (elastase infused, vitamin C treated). Vitamin C and placebo were intraperitoneally injected, initiating 1 wk before the infusion and continuing throughout the study. The aortic dilatation ratio was measured, and aortic tissues were further examined using biochemical and histologic techniques. RESULTS: Vitamin C attenuated the development of AAA, decreasing maximal aortic diameter by 25.8% (P < 0.05) and preserving elastin lamellae (P < 0.05). Vitamin C also decreased 8-hydroxyguanine (a marker of oxidative damage to DNA) and 8-isoprostane content (a marker of oxidative stress) in aortic tissues (P < 0.05, respectively). The proteins of matrix metalloproteinase (MMP)-2, MMP-9, and interleukin 6 were markedly downregulated (P < 0.05, respectively), accompanied with notably reduced messenger RNA expression of tumor necrosis factor-α, MMP-2/9, and interleukin 1ß (P < 0.05, respectively). However, messenger RNA of tissue inhibitors of metalloproteinase-1 and tissue inhibitors of metalloproteinase-2 were both significantly upregulated in Vitamin C group. Vitamin C treatment had no significant effect on systolic blood pressure (P > 0.05). CONCLUSIONS: Vitamin C attenuated AAA development in an elastase-induced rat model via crucial protective effect, which was mediated by an increased level of antioxidant in cooperation with preserving elastin lamellae, inhibiting matrix-degrading proteinases and suppressing inflammatory responses.

Pyrroloquinoline quinone protects mouse brain endothelial cells from high glucose-induced damage in vitro.

AIM: To investigate the effects of pyrroloquinoline quinone (PQQ), an oxidoreductase cofactor, on high glucose-induced mouse endothelial cell damage in vitro. METHODS: Mouse brain microvascular endothelial bEND.3 cells were exposed to different glucose concentrations (5.56, 25 and 40 mmol/L) for 24 or 48 h. The cell viability was examined using MTT assay. Flow cytometry was used to analyze the apoptosis and ROS levels in the cells. MitoTracker Green staining was used to examine the mitochondria numbers in the cells. Western blot analysis was used to analyze the expression of HIF-1α and the proteins in JNK pathway. RESULTS: Treatment of bEND.3 cells with high glucose significantly decreased the cell viability, while addition of PQQ (1 and 10 µmol/L) reversed the high glucose-induced cell damage in a concentration-dependent manner. Furthermore, PQQ (100 µmol/L) significantly suppressed the high glucose-induced apoptosis and ROS production in the cells. PQQ significantly reversed the high glucose-induced reduction in both the mitochondrial membrane potential and mitochondria number in the cells. The high glucose treatment significantly increased the expression of HIF-1α and JNK phosphorylation in the cells, and addition of PQQ led to a further increase of HIF-1α level and a decrease of JNK phosphorylation. Addition of JNK inhibitor SP600125 (10 µmol/L) also significantly suppressed high glucose-induced apoptosis and JNK phosphorylation in bEND.3 cells. CONCLUSION: PQQ protects mouse brain endothelial cells from high glucose damage in vitro by suppressing intracellular ROS and apoptosis via inhibiting JNK signaling pathway.

Tanshinone IIA attenuates elastase-induced AAA in rats via inhibition of MyD88-dependent TLR-4 signaling.

BACKGROUND: The purpose of this study was to determine whether myeloid differentiation factor88-dependent Toll-Like Receptor-4 (TLR-4) signaling contributed to the inhibition of abdominal aortic aneurysm (AAA) by Tanshinone IIA (Tan IIA). MATERIALS AND METHODS: Male Sprague-Dawley rats (n = 12 / group) were randomly distributed into three groups: Tan IIA, control, and sham. The rats from Tan IIA and control groups under-went intra-aortic elastase perfusion to induce AAAs, and those in the sham group were perfused with saline. Only the Tan IIA group received Tan IIA (2 mg / rat / d). Aortic tissue samples were harvested at 24 d after perfusion and evaluated using reverse transcriptase-polymerase chain reaction, Western blot, immunohistochemistry and immunofluorescence. RESULTS: The over-expression of Toll-Like Receptor-4 (TLR-4), Myeloid Differentiation factor 88 (MyD88), Phosphorylated Nuclear Factor κB (pNF-κB) and Phosphorylated IκBα (pIκBα) induced by elastase perfusion were significantly decreased by Tan IIA treatment. CONCLUSIONS: Tan IIA attenuates elastase-induced AAA in rats possibly via the inhibition of MyD88-dependent TLR-4 signaling, which may be one potential explanation of why Tan IIA inhibits AAA development through multiple effects.

[Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease].

OBJECTIVE: To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease. METHODS: From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years (range 49 to 87 years) with a male predominance (26 males, 72.2%). The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency. RESULTS: All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94.4% of patients. The mean duration of follow-up was 24.2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72.2%, 83.3% and 94.4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P = 0.041, 0.012). Cox regression analysis did not reveal any independent predictor of primary patency. CONCLUSION: Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.

Small-caliber vascular prosthesis prototype based on controlled release of heparin from mesochannels and its enhanced biocompatibility.

A novel small-caliber vascular prosthesis prototype is proposed on the basis of a new heparin release system, that is, the controlled delivery of heparin from mesochannels. Fabrication of mesochannels on artificial biomaterials is successfully achieved through epitaxial growth of mesoporous silica nanoparticles on expanded polytetrafluoroethylene grafts, and thus heparin can be immobilized through a space limitation effect, thereby avoiding the loss of bioactivity and enabling long-lasting release. The adsorption and release of heparin are controlled by adjusting the adsorbate-adsorbent interaction through tailoring the mesostructure. Owing to the continuous and sustained release of heparin, the performances of artificial vessels are greatly improved, thus paving a new way to prepare functional blood-contacting biomaterials with high biocompatibility.

Inhibition of experimental abdominal aortic aneurysm in a rat model by way of tanshinone IIA.

BACKGROUND: The purpose of the present study was to investigate whether tanshinone IIA (Tan IIA), one of the major lipophilic components of Salvia miltiorrhiza Bunge, could inhibit the development of elastase-induced experimental abdominal aortic aneurysms (AAAs). METHODS: Male Sprague-Dawley rats (n = 12/group) were randomly distributed into three groups: Tan IIA, control, and sham. The rats from the Tan IIA and control groups underwent intra-aortic elastase perfusion to induce AAAs, and the rats in the sham group were perfused with saline. Only the Tan IIA group received Tan IIA (2 mg/rat/d). The maximum luminal diameter of the abdominal aorta was measured before and 5, 12, 18, and 24 d after perfusion. The systolic blood pressure was measured twice using the tail cuff technique before administration and death. Aortic tissue samples were harvested at 24 d and evaluated using reverse transcriptase-polymerase chain reaction, Western blot, immunohistochemistry, and Miller's elastin-Van Gieson staining. RESULTS: The rats in the control group had significantly increased aortic sizes compared with the sham group after 24 days (P < 0.05), and the Tan IIA group had a significant reduction in aortic size (Tan IIA versus control, P < 0.05) without affecting blood pressure (P > 0.05). The overexpression of matrix metalloproteinase-2, metalloproteinase-9, monocyte chemotactic protein-1, and inducible nitric oxide synthase and the depletion of elastic fibers and vascular smooth muscle cells induced by elastase perfusion were significantly decreased by Tan IIA treatment (P < 0.05). CONCLUSIONS: Tan IIA inhibited the development of elastase-induced experimental AAAs by suppressing proteolysis, inflammation, and oxidative stress and preserving vascular smooth muscle cells. It could be a new pharmacologic therapy for AAAs.

[Tanshinone IIA attenuates the development of elastase-induced abdominal aortic aneurysm of rat].

OBJECTIVE: To determine if tanshinone IIA (Tan IIA) can influence the development of elastase-induced experimental abdominal aortic aneurysms (AAAs). METHODS: Totally 36 male Sprague-Dawley rats were randomly distributed into three groups (12 in each group): Tan IIA group, control group, and sham group. Rats of Tan IIA and control groups underwent intra-aortic elastase perfusion to induce AAAs, while rats of sham-group were perfused with saline. Rats of Tan IIA-group received Tan IIA treatment (2 mg/d). The luminal diameter of the aneurysm at the segment with maximum diameter were measured pre-perfusion and on the 4 time point after perfusion. Systolic blood pressure was measured by tail-cuff technique. Aortic tissue samples were obtained on 24 days after perfusion and evaluated by RT-PCR, Western blot, immunohistochemistry and Miller's elastin-Van Gieson's (EVG) staining. RESULTS: Twenty-four days after perfusion, Tan IIA significantly reduced increased aortic size compared to control group ((0.210 ± 0.002) cm vs. (0.304 ± 0.004) cm, t = 78.858, P = 0.000) without affecting blood pressure (t = -1.237 to -1.221, P > 0.05). The over-expression of matrix metalloproteinases (MMP)-2/9 (t = 25.943, P = 0.000; t = 42.815, P = 0.000), monocyte chemotactic protein-1 (MCP-1) (t = 4.518, P = 0.000), inducible nitric oxide synthase (iNOS) (t = 17.685, P = 0.000) and the destruction of elastic fibers in aortic tissue of control group were significantly less than Tan IIA group (0.469 ± 0.040 vs. 0.230 ± 0.024, t = 17.944, P = 0.000). CONCLUSION: Tanshinone IIA attenuates the development of elastase-induced experimental AAAs possibly by down-regulating MMP-2/9, MCP-1 and iNOS expression.

[Treatment of thoracoabdominal aortic diseases through hybrid operation].

OBJECTIVES: To review the experience with the hybrid operations for patients with thoracoabdominal aortic diseases, as well as to evaluate and discuss the outcomes. METHODS: Between June 2008 and September 2011, 11 patients (9 male and 2 female, mean age 52 years) were treated by hybrid operation. Hybrid operation includes debranching of the visceral arteries, followed by endovascular repair of the diseases (include aneurysmal disease, aortic dissection, or Takayasu's arteritis). RESULTS: All the operations were successful. The mean operating time was 8.5 hours for patients done in one stage and 8.1 hours for the first stage of patient related in two stages. The endovascular stage took on average 2.0 hours. Overall mortality rate was 1/11 and morbidity was 4/11. No aneurysm-related death occurred. Two patients developed endoleak. Permanent paraplegia and renal failure rate was 0. Mean follow-up was 13.5 months. CONCLUSION: Hybrid operation is a mini invasive and safe method for thoracoabdominal aortic diseases with acceptable morbidity and mortality.

Treatment of Stanford type A aortic dissection with triple pre-fenestration, reduced diameter, and three-dimensional-printing techniques: A case report.

BACKGROUND: A 63-year-old female was diagnosed with acute Stanford type A aortic dissection. The patient had pain in the chest and back for 1 wk. The computed tomography angiography (CTA) showed Stanford type A aortic dissection (Myla type III aortic arch). The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta. CASE SUMMARY: Preoperatively, a three-dimensional (3D)-printed model of the aortic arch was made according to CTA data. Then, under the guidance of the 3D-printed aortic model, a pre-fenestrated stent-graft was customized, and the diameter of the stent-graft was reduced intraoperatively by surgeons. 3D printing, triple pre-fenestration, and reduced diameter techniques were used during the surgery. The CTA examinations were performed at the 3rd mo and 1st year after the surgery; the results showed that the aortic dissection was repaired without endoleak, and all three branches of the aortic arch remained unobstructed. CONCLUSION: Applying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case. The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.

[Determination of metals in Ginkgo biloba leaves by atomic absorption spectrometry with microwave digestion].

Microwave digestion technique was used in the decomposition of Ginkgo biloba leaves from six different trees at the same age in the same area. HNO3-H2O2 (5 : 1 v/v) was used as microwave digestion agent at a suitable temperature and time. The contents of Ca, Mg, K, Na, Cu, Zn and Zn/Cu were determined by flame atomic absorption spectrometry to study the distribution rule of metallic elements in the trees at the same age and in the same area. The recovery ratio ranged from 95.2% to 104.6%. The results showed that there were certain differences between different trees in the distribution of metallic elements. The contents of calcium were from 39 586 to 48 320 microg x g(-1), and those of magnesium from 10 076 to 12 918 microg x g(-1), of potassium from 2 004 to 5 240 microg x g(-1), of sodium from 9.05 to 35.30 microg x g(-1), and of copper from 1.50 to 3.05 microg x g(-1), while Zn/Cu values were from 2.68 to 5.93 in the leaves of 6 different trees in the same growing area. Therefore there were abounding calcium, magnesium and potassium, while the content of sodium and Zn/Cu values were lower, and the metal contents were different in the leaves. The experimental results provided useful bases for studying the distribution rule of metallic elements in Ginkgo biloba leaves, the relationship between the contents of calcium, magnesium, potassium and sodium and the Zn/Cu value in ginkgo biloba leaves and the treatment for cardio-cerebral vascular disease.

[Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases].

OBJECTIVE: to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease. METHODS: from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency. RESULTS: all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively). CONCLUSIONS: Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.

[New strategy for decision making of Pilon fracture].

OBJECTIVE: To study the guidance of four column theory in decision making of Pilon fractures and its result. METHODS: Ninety-one cases of Pilon fractures classified by four column method and treated by open reduction internal fixation (ORIF) were reviewed from March 2005 to June 2009. Four column classification:lateral column of 67 cases were involved, posterior column of 34 cases were involved, medial column of 34 cases were involved and anterior column of 34 cases were involved. Among all the 94 fractures, single column of 20 fractures were involved, 2 columns of 49 fractures were involved, 3 columns of 15 fractures were involved and all of 4 columns of 10 fractures were involved. RESULTS: Eighty-nine cases had been followed up. The average follow-up time was 16.2 months ranging between 6.0 and 39.0 months. The average healing time was 3.7 months ranging from 3.0 to 5.0 months. Reduction of 91% reviewed Pilon cases were good or acceptable according to Burwell and Charley's radiology evaluation system. Ankle function of 87.6% cases were excellent or good according to AOFAS evaluation system. CONCLUSION: As a simple and comprehensive classification, four column classification can contribute to reasonable operating decision making and good prognosis of Pilon fracture.

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report.

BACKGROUND: A 46-year-old male underwent ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection in 2016. However, an intraoperative stent-graft was deployed in the false lumen inadvertently. This caused severe iatrogenic thoracic and abdominal aortic dissection, and the dissection involved many visceral arteries. CASE SUMMARY: The patient had pain in the chest and back for 1 mo. A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection. The ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior. An intraoperative stent-graft was deployed in the false lumen. Endovascular aneurysm repair was performed to address this intractable situation. An occluder was used to occlude the proximal end of the true lumen, and a covered stent was used to direct blood flow back to the true lumen. A three-dimensional printing technique was used in this operation to guide pre-fenestration. The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired, with all visceral arteries remaining patent. The patient did not develop renal failure or neurological complications after surgery. CONCLUSION: The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive. Our procedures provided a new solution for stent-graft deployed in the false lumen, and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.

Intensified nitrogen removal by heterotrophic nitrification aerobic denitrification bacteria in two pilot-scale tidal flow constructed wetlands: Influence of influent C/N ratios and tidal strategies.

This study investigated the influence of C/N ratios and tidal strategies on nitrogen removal and bacterial communities in two pilot-scale tidal flow constructed wetlands (TFCWs) with simultaneous nitrification-denitrification process. Heterotrophic nitrification aerobic denitrification (HNAD) was the main nitrogen transformation pathway in both TFCWs. High C/N ratios and effluent circulation at low temperature promoted HNAD in TFCWs with high nitrogen removal efficiencies (72.6%-95.5% for NH4+-N and 70.9%~91.8% for TN). Effluent circulation had more influence on bacterial community structure and diversity than C/N ratios. Among 16 detected genera related to nitrogen removal, HNAD bacteria (HNADB) were abundant. Especially, some dominant HNADB (e.g. Aeromonas, Hydrogenophage and Gemmobacter) were core genera, showing positive interactions with other genera related to nitrogen removal. Tidal strategies had more contribution to the shifts in these genera than C/N ratios. This study highlights the importance of HNADB in pilot-scale TFCWs and their responses to C/N ratios and tidal strategies.

[The treatment of complications of endovascular repair of aortic dissection].

OBJECTIVE: To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR). METHODS: Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure. RESULTS: Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage. CONCLUSIONS: The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.

Dual compression is not an uncommon type of iliac vein compression syndrome.

Typical iliac vein compression syndrome (IVCS) is characterized by compression of left common iliac vein (LCIV) by the overlying right common iliac artery (RCIA). We described an underestimated type of IVCS with dual compression by right and left common iliac arteries (LCIA) simultaneously. Thirty-one patients with IVCS were retrospectively included. All patients received trans-catheter venography and computed tomography (CT) examinations for diagnosing and evaluating IVCS. Late venography and reconstructed CT were used for evaluating the anatomical relationship among LCIV, RCIA and LCIA. Imaging manifestations as well as demographic data were collected and evaluated by two experienced radiologists. Sole and dual compression were found in 32.3% (n = 10) and 67.7% (n = 21) of 31 patients respectively. No statistical differences existed between them in terms of age, gender, LCIV diameter at the maximum compression point, pressure gradient across stenosis, and the percentage of compression level. On CT and venography, sole compression was commonly presented with a longitudinal compression at the orifice of LCIV while dual compression was usually presented as two types: one had a lengthy stenosis along the upper side of LCIV and the other was manifested by a longitudinal compression near to the orifice of external iliac vein. The presence of dual compression seemed significantly correlated with the tortuous LCIA (p = 0.006). Left common iliac vein can be presented by dual compression. This type of compression has typical manifestations on late venography and CT.