The Management of Superior Mesenteric Artery Aneurysm: Experience with 16 Cases in a Single Center.

BACKGROUND: Superior mesenteric artery aneurysm (SMAA) represents a rare but potentially fatal condition. This study aimed to present the individual management protocol of SMAA in our center and to discuss a potential preliminary treatment algorithm. METHODS: SMAA patients treated in our center between January 2007 and December 2014 were retrospectively reviewed on January 2015. RESULTS: Sixteen patients with SMAA were identified, including 1 female and 15 males, with a mean age of 48.9 ± 12.9 years. Three patients (3/16, 18.8%) were treated by multiple overlapping bare stents and one (1/16, 6.3%) initially by a single bare stent. Two cases (2/16, 12.5%) were treated by a covered stent implantation, but one of those suffered from SMAA rupture 7 days later, whereas the other had inner-stent thrombosis one month after discharge and died from multiple organ-dysfunction syndrome. Nine patients (9/16, 56.2%) received conservative therapy, one of who received multiple overlapping bare stents implantations for persistent abdominal pain. One patient underwent open surgery. There were 2 major complications, with no death during hospitalization and 1 death during follow-up. CONCLUSIONS: SMAA treatment needs to be individually prescribed, based on clinical manifestation, anatomy, and etiology. Multiple overlapping bare stents are safe and effective in selective patients with SMAA, and covered stents should be used with caution to avoid covering proximal branches; open surgery should be reserved for patients with suspected intestinal necrosis.

Surface Coating of Polytetrafluoroethylene with Extracellular Matrix and Anti-CD34 Antibodies Facilitates Endothelialization and Inhibits Platelet Adhesion Under Sheer Stress

Expanded polytetrafluoroethylene (ePTFE) polymers do not support endothelialization because of nonconductive characteristics towards cellular attachment. Inner surface modification of the grafts can improve endothelialization and increase the long-term patency rate of the ePTFE vascular grafts. Here we reported a method of inner-surface modification of ePTFE vascular graft with extracellular matrix (ECM) and CD34 monoclonal antibodies (CD34 mAb) to stimulate the adhesion and proliferation of circulating endothelial progenitor cells on ePTFE graft to enhance graft endothelialization. The inner surface of ECM-coated ePTFE grafts were linked with CD34 mAb in the presence of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) solution and the physicochemical properties, surface morphology, biocompatibility, and hemocompatibility of the grafts were studied. The hydrophilicity of CD34 mAb-coated graft inner surface was significantly improved. Fourier transform infrared spectroscopy analysis confirmed ECM and CD34 mAb cross-linking in the ePTFE vascular grafts with our method. Scanning electron microscopy analysis showed protein layer covering uniformly on the inner surface of the modified grafts. The cell-counting kit-8 (CCK-8) assay confirmed that the modified graft has no obvious cytotoxicity. The modified graft showed a low hemolytic rate (0.9%) in the direct contact hemolysis test, suggesting the modification improved hemocompatibility of biopolymers. The modification also decreased adhesion of platelets, while significantly increased the adhesion of endothelial cells on the grafts. We conclude that our method enables ePTFE polymers modification with ECM and CD34 mAb, facilitates endothelialization, and inhibits platelet adhesion on the grafts, thus may increase the long-term patency rate of the prosthetic bypass grafts.

Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.</p><p><b>METHODS</b>It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.</p><p><b>RESULTS</b>Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.</p><p><b>CONCLUSIONS</b>Endovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.</p>

Hybrid treatment of aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.</p><p><b>METHODS</b>From January 2002 to June 2013, 10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital, Sun Yat-sen University. There were 9 male and 1 female patients with a mean age of (54 ± 14) years (ranging from 34 to 71 years). Of the 10 patients, 8 were aortic dissection and 2 were thoracic aortic aneurysm. All aortic arch debranching was performed with mid-sternotomy, including 7 ascending aorta to innominate artery and left common carotid artery bypass, and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently, simultaneous (n = 5) and staged (n = 5, mean interval (7 ± 4) days) endovascular repair were performed via femoral artery.</p><p><b>RESULTS</b>Technical success rate was 10/10. The 30 day-mortality was 3/10, including 1 brain stem infarction, 1 circulatory failure and 1 aorto-tracheal fistula. Complication included 1 type II endoleak. The median time of follow-up was 24 (14) months. CT scanning was performed at 1, 3 months and annually thereafter. There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type II endoleak.</p><p><b>CONCLUSION</b>Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.</p>

Preliminary fabrication of tissue engineered veins containing valves using bone marrow mesenchymal stem cells and biodegradable scaffolds in vitro / 中国组织工程研究

BACKGROUND:Chronic venous insufficiency is a major health problem worldwide. Clinical treatments include venous valve repair and venous segment containing valve transplantation. However, these are invasive procedures, and the supply of vein containing valves is limited. Significant progress in the fields of tissue engineering and regenerative medicine has been made towards the creation of tissue engineered vascular grafts for the repair of damaged or malformed vessels. It has been reported that using tissue engineering, a tissue engineered vein containing valves constructed with self-derived endothelial cells and al ogeneic acellular matrices can provide the complex physiological valve structure and mechanical stability, but this elicited an immunogenic response. OBJECTIVE:To create a viable and functional vein containing valves, which has the ability to grow, repair, and imitate natural tissues. METHODS:Bone marrow mesenchymal stem cells were obtained from Beagle dogs by density gradient centrifugation and adherence methods. Bone marrow mesenchymal stem cells were cultured in vitro. Fol owing isolation and culture the cells were examined using flow cytometry and identified by direct induction towards the osteogenic and adipogenic lineages. We fabricated biodegradable venous scaffold containing valves using the method of injection molding combined with thermal y induced phase separation. Based on the self-made cast, a three-dimensional biodegradable vein scaffold containing valves was constructed from poly(lactic-co-glycolic acid). Morphological structure was tested. Bone marrow mesenchymal stem cells were used as seed cells to be seeded onto the lumen of the tissue engineered vein scaffold containing valves in vitro and then incubated for 2 weeks. RESULTS AND CONCLUSION:Scanning electron microscopy images showed that the scaffold demonstrated sufficient porosity. Cultured cells expressed mesenchymal cellmarkers, CD44 and CD29, but did not express hematopoietic cellmarkers, CD34 and CD45 at the same time point. Scaffolds were nontoxic to cells and were favorable for the growth and migration of bone marrow mesenchymal stem cells. cells attached on the surface of poly(lactic-co-glycolic acid) scaffolds formed a confluent layer after incubation. The cellular constructs were tested in vitro, and the valve leaflets were functional y capable of opening and closing when stimulated. These results suggested that the tissue engineered vein containing valves have been successful y constructed by using a three-dimensional poly(lactic-co-glycolic acid) scaffold and bone marrow mesenchymal stem cells as seed cells. Tissue engineered vein containing valves is potential y useful for the substitution and regeneration of vein valves.

Interference of IP-10 expression inhibits vascular smooth muscle cell proliferation and intimal hyperplasia in carotid artery: a new insight in the prevention of restenosis.

After vascular angioplasty, vascular smooth muscle cell (VSMC) proliferation causes atherosclerosis and intimal hyperplasia leading to restenosis. Interferon-γ-inducible protein (IP)-10 plays a role in atherogenesis, but the mechanism remains unclear. We evaluated the role of IP-10 in intimal hyperplasia and restenosis. IP-10 expression was determined in arterial specimens from 20 arteriosclerotic obliteration patients and 6 healthy individuals. VSMCs were stimulated in vitro with IFN-γ and transfected with IP-10 siRNA. Silencing was verified with RT-PCR/Western blot; cell proliferation rate was detected by methyl-thiazol-tetrazolium. The carotid artery model of atherosclerosis injury was established with IP-10 siRNA. IP-10 expression was detected at 1 and 4 weeks using RT-PCR and immunohistochemistry. Artery morphology was assessed with hematoxylin-and-eosin staining, and intimal hyperplasia was evaluated by electron microscopy. IP-10 was overexpressed in arteriosclerotic obliteration group compared with control group (P < 0.05). IP-10 expression in transfected group was significantly lower than in untransfected group. The intima-to-media ratio of transfected group at 4 weeks was lower than that of untransfected group (P < 0.01). The transfected group exhibited more regular intimal structure and less hyperplasia under electron microscopy. We, therefore, concluded that IP-10 played an important role in intimal hyperplasia as siRNA-mediated IP-10 silencing inhibited aberrant VSMCs hyperplasia and reduced restenosis.

Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency / 中华外科杂志

<p><b>OBJECTIVE</b>To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency.</p><p><b>METHODS</b>Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins.</p><p><b>RESULTS</b>Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene).</p><p><b>CONCLUSION</b>C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.</p>

Venohemodynamics after superficial vein and calf perforating vein surgery / 中国普通外科杂志

Objective To assess the role of superficial vein and calf perforating vein in chronic venous insufficiency of lower limbs. Methods Consecutive seventy-five cases (78 limbs) of slight PDVI ( I? -Ⅱ?) were evaluated. Venous hemodynamics were detected by color duplex, color Doppler velocity profile technology and APG preoperatively, in the first month, the third month and the first year postoperatively. Data were statistically analyzed. Results Symptoms and signs disappeared in 88. 5% (69/78) limbs. The ulcer-healing rate was 92. 8% ( 13/14). The postoperative VFI at each check-point significantly decreased than that before operation (P0.01). Conclusions Superficial venous reflux can be effectively broken up by the operations. Venous stasis on calf effectively decreased by subfascial endoscopic perforator surgery (SEPS). But neither of the two procedures greatly improve the hemodynamic status of deep vein.

Down-regulation of desmuslin in primary vein incompetence / 中国病理生理杂志

AIM: Utilizing mRNA fluorescent differential display RT-PCR in our previous study,we found that the mRNA expression level of an intermediate protein(IF)-desmuslin was dramatically down-regulated in the abnormal veins of patients with primary vein incompetence.In this study,we testified the alteration of desmuslin expressing style at gene transcription and translation levels.METHODS: Specific PCR primers were designed according to the sequence of desmuslin mRNA.The cDNA fragments of desmuslin obtained from differential display were labeled by DIG as specific probes.Then semi-quantitative RT-PCR and Northern blotting techniques were applied to investigate the expression level of desmuslin mRNA in normal and abnormal veins.Simultaneously,the specific single-cloned antibody bestowed by Yuji Mizuno was used to evaluate the amount of DMN protein in the two groups by Western blotting and immunohistochemical techniques.RESULTS: In the abnormal veins isolated from the patients with primary vein incompetence,the expression of desmuslin mRNA was significantly down-regulated,compared with that in control group(semi-quantitative RT-PCR: 0.19?0.05 vs 0.83?0.08,P