The oxidized phospholipid PGPC impairs endothelial function by promoting endothelial cell ferroptosis via FABP3.

Ferroptosis is a novel cell death mechanism that is mediated by iron-dependent lipid peroxidation. It may be involved in atherosclerosis development. Products of phospholipid oxidation play a key role in atherosclerosis. 1-palmitoyl-2-glutaroyl-sn-glycero-3-phosphocholine (PGPC) is a phospholipid oxidation product present in atherosclerotic lesions. It remains unclear whether PGPC causes atherosclerosis by inducing endothelial cell ferroptosis. In this study, human umbilical vein endothelial cells (HUVECs) were treated with PGPC. Intracellular levels of ferrous iron, lipid peroxidation, superoxide anions (O2•-), and glutathione were detected, and expression of fatty acid binding protein-3 (FABP3), glutathione peroxidase 4 (GPX4), and CD36 were measured. Additionally, the mitochondrial membrane potential (MMP) was determined. Aortas from C57BL6 mice were isolated for vasodilation testing. Results showed that PGPC increased ferrous iron levels, the production of lipid peroxidation and O2•-, and FABP3 expression. However, PGPC inhibited the expression of GPX4 and glutathione production and destroyed normal MMP. These effects were also blocked by ferrostatin-1, an inhibitor of ferroptosis. FABP3 silencing significantly reversed the effect of PGPC. Furthermore, PGPC stimulated CD36 expression. Conversely, CD36 silencing reversed the effects of PGPC, including PGPC-induced FABP3 expression. Importantly, E06, a direct inhibitor of the oxidized 1-palmitoyl-2-arachidonoyl-phosphatidylcholine IgM natural antibody, inhibited the effects of PGPC. Finally, PGPC impaired endothelium-dependent vasodilation, ferrostatin-1 or FABP3 inhibitors inhibited this impairment. Our data demonstrate that PGPC impairs endothelial function by inducing endothelial cell ferroptosis through the CD36 receptor to increase FABP3 expression. Our findings provide new insights into the mechanisms of atherosclerosis and a therapeutic target for atherosclerosis.

High-density lipoprotein regulates angiogenesis by long non-coding RNA HDRACA.

Normal high-density lipoprotein (nHDL) can induce angiogenesis in healthy individuals. However, HDL from patients with coronary artery disease undergoes various modifications, becomes dysfunctional (dHDL), and loses its ability to promote angiogenesis. Here, we identified a long non-coding RNA, HDRACA, that is involved in the regulation of angiogenesis by HDL. In this study, we showed that nHDL downregulates the expression of HDRACA in endothelial cells by activating WW domain-containing E3 ubiquitin protein ligase 2, which catalyzes the ubiquitination and subsequent degradation of its transcription factor, Kruppel-like factor 5, via sphingosine 1-phosphate (S1P) receptor 1. In contrast, dHDL with lower levels of S1P than nHDL were much less effective in decreasing the expression of HDRACA. HDRACA was able to bind to Ras-interacting protein 1 (RAIN) to hinder the interaction between RAIN and vigilin, which led to an increase in the binding between the vigilin protein and proliferating cell nuclear antigen (PCNA) mRNA, resulting in a decrease in the expression of PCNA and inhibition of angiogenesis. The expression of human HDRACA in a hindlimb ischemia mouse model inhibited the recovery of angiogenesis. Taken together, these findings suggest that HDRACA is involved in the HDL regulation of angiogenesis, which nHDL inhibits the expression of HDRACA to induce angiogenesis, and that dHDL is much less effective in inhibiting HDRACA expression, which provides an explanation for the decreased ability of dHDL to stimulate angiogenesis.

IP-10/CXCR3 Axis Promotes the Proliferation of Vascular Smooth Muscle Cells through ERK1/2/CREB Signaling Pathway.

Excessive proliferation of vascular smooth muscle cells is one of the main pathological processes leading to atherosclerosis and intimal hyperplasia after vascular interventional therapy. Our previous study has shown that interferon-γ inducible protein-10 contributes to the proliferation of vascular smooth muscle cell. However, the underlying mechanisms remain unclear. Extracellular signal-regulated kinase 1/2, serine/threonine kinase Akt, and cAMP response element binding protein are signaling pathways, which are considered to play important roles in the processes of vascular smooth muscle cell proliferation. Moreover, chemokine receptor 3 and Toll-like receptor 4 are potential receptors of inducible protein-10 in this process. In the present study, IP-10 was found to directly induce vascular smooth muscle cell proliferation, and exposure to inducible protein-10 activated extracellular signal-regulated kinase 1/2, serine/threonine kinase, and cAMP response element binding protein signaling. Inhibitor of extracellular signal-regulated kinase 1/2, rather than inhibitor of serine/threonine kinase, inhibited the phosphorylation of cAMP response element binding protein and reduced inducible protein-10-stimulated vascular smooth muscle cell proliferation. Knockdown of cAMP response element binding protein by siRNA inhibited inducible protein-10-induced vascular smooth muscle cell proliferation. Moreover, anti-CXCR3 IgG, instead of anti-Toll-like receptor 4 IgG, reduced inducible protein-10-induced vascular smooth muscle cell proliferation and inducible protein-10-stimulated extracellular signal-regulated kinase 1/2 and cAMP response element binding protein activation. Together, these results indicate that inducible protein-10 promotes vascular smooth muscle cell proliferation via chemokine receptor 3 and activation of extracellular signal-regulated kinase 1/2 inducible protein-10-induced vascular smooth muscle cell proliferation. These data provide important targets for future studies to modulate atherosclerosis and restenosis after vascular interventional therapy.

The in vivo performance of small-caliber nanofibrous polyurethane vascular grafts.

BACKGROUND: In a previous in vitro study, we confirmed that small-caliber nanofibrous polyurethane (PU) vascular grafts have favorable mechanical properties and biocompatibility. In the present study, we examined the in vivo biocompatibility and stability of these grafts. METHODS: Forty-eight adult male beagle dogs were randomly divided into two groups receiving, respectively, polyurethane (PU) or polytetrafluoroethylene (PTFE) grafts (n = 24 animals / group). Each group was studied at 4, 8, 12, and 24 weeks after graft implantation. Blood flow was analyzed by color Doppler ultrasound and computed tomography angiography. Patency rates were judged by animal survival rates. Coverage with endothelial and smooth muscle cells was characterized by hematoxylin-eosin and immunohistological staining, and scanning electron microscopy (SEM). RESULTS: Patency rates were significantly higher in the PU group (p = 0.02 vs. PTFE group). During the first 8 weeks, endothelial cells gradually formed a continuous layer on the internal surface of PU grafts, whereas coverage of PTFE graft by endothelial cells was inhomogeneous. After 12 weeks, neointimal thickness remained constant in the PU group, while PTFE group showed neointimal hyperplasia. At 24 weeks, some anastomotic sites of PTFE grafts became stenotic (p = 0.013 vs. PU group). Immunohistological staining revealed a continuous coverage by endothelial cells and an orderly arrangement of smooth muscle cells on PU grafts. Further, SEM showed smooth internal surfaces in PU grafts without thrombus or obvious neointimal hyperplasia. CONCLUSIONS: Small-caliber nanofibrous PU vascular grafts facilitate the endothelialization process, prevent excessive neointimal hyperplasia, and improve patency rates.

Promising plasmid DNA vector based on APTES-modified silica nanoparticles.

Nanoparticles have an enormous potential for development in biomedical applications, such as gene or drug delivery. We developed and characterized aminopropyltriethoxysilane-functionalized silicon dioxide nanoparticles (APTES-SiNPs) for gene therapy. Lipofectamine(®) 2000, a commonly used agent, served as a contrast. We showed that APTES-SiNPs had a gene transfection efficiency almost equal to that of Lipofectamine 2000, but with lower cytotoxicity. Thus, these novel APTES-SiNPs can achieve highly efficient transfection of plasmid DNA, and to some extent reduce cytotoxicity, which might overcome the critical drawbacks in vivo of conventional carriers, such as viral vectors, organic polymers, and liposomes, and seem to be a promising nonviral gene therapy vector.

[Assessment of the mechanical properties and biocompatibility of a new electrospun polyurethane vascular prosthesis].

OBJECTIVE: To develop a small-caliber vascular grafts and study its morphologies, mechanical properties and biocompatibility. METHODS: The effects of electrospinning conditions on the microstructure and porosity of the resulting scaffolds were investigated for preparation of a small-caliber (4 mm) polyurethane vascular grafts with optimum microstructures and mechanical properties. The mechanical properties and biocompatibility of the prepared grafts were evaluated. RESULTS: The polyurethane vascular grafts showed a three-dimensional reticular structure consisting of nanofibers, with an average porosity of (51.48∓4.47)% and tensile strength of 5.85 ∓ 0.62 MPa. The grafts provided a better long-term support than e-PTFE graft for endothelial cell growth and endothelialization. CONCLUSION: The polyurethane vascular prosthesis possessed favorable microstructures, excellent mechanical properties and good biocompatibility for potential clinical application.

Tolerable hemodynamic changes after femoral artery ligation for the treatment of infected femoral artery pseudoaneurysm.

BACKGROUND: We analyzed the hemodynamic changes induced by femoral artery ligation with concomitant thrombectomy in intravenous drug abusers with infected femoral artery pseudoaneurysm (IFAP) and their clinical significance. METHODS: Between January 2000 and November 2007, a total of 55 patients presented to our clinic with IFAP. Among these patients, 54 were treated by femoral artery ligation with concomitant thrombectomy. Open collateral circulations were assessed by intraoperative angiography, including detection of mean artery pressure (MAP) of back-flow from the profunda femoris artery and the superficial femoral artery after operation. Patients were followed up for 3-72 months (mean 35). The data were then subjected to statistical analysis. RESULTS: Preoperative death occurred in one patient due to acute onset of drug addiction in the ward. Preoperatively, massive necrosis developed in the left limb of the only patient with bilateral IFAPs. All 54 patients underwent femoral artery ligation with concomitant thrombectomy, including nine cases of ligation of the external iliac artery and one case of above-knee limb amputation. All wounds were completely healed within 3 months. Six late deaths (11.1%), resulting solely from refractory drug addiction, were observed during the follow-up period, of which two occurred 2 years, one 4 years, and three 5 years postoperatively. No toe amputations were noted during the follow-up period. Fourteen patients (25.9%) developed intermittent claudication. One postoperative limb was lost. Of all 54 patients, 38 were subjected to collateral circulation assessment by intraoperative angiography. Collateral circulations were found well open in a baseline path with four stations down to the distal lower limbs of all assessed patients. Four preferred types of iliac-femoral collaterals were defined. Postoperatively, compared to the external iliac artery, the MAP levels of back-flow from the profunda femoris artery and the superficial femoral artery significantly dropped to 43.89+/-2.75 and 18.08+/-2.76 mm Hg, respectively. CONCLUSION: As a result of femoral artery ligation without reconstruction, well open collateral circulations and acceptable distal arterial runoff blood are seen, which suggests that this procedure is a reliable alternative to the emergent treatment of IFAPs in drug addicts. However, arterial reconstruction may be used as a backup approach if necessary during observation.

[Risk factors and therapeutic strategies of deep venous thrombosis during pregnancy].

OBJECTIVE: To summarize the epidemiology and risk factors of deep venous thrombosis (DVT) during pregnancy and develop therapeutic strategies. METHODS: Twenty-nine pregnant women with DVT were admitted into our hospital between 1991 and 2010. And their clinical data were retrospectively reviewed. RESULTS: Among all cases, the occurrence (69%, 20/29) of DVT in the first trimester was highest as compared with those in the second and third trimesters. A previous history of DVT was a leading risk factor (24%, 7/29). Twenty-four cases (82.8%, 24/29) involved left lower extremities. Anticoagulation was the primary therapy. All cases were initially intravenously administrated with unfractioned heparin (UFH) or injected subcutaneously with low-molecule-weight heparin (LMWH). LMWH continued throughout pregnancy in 7 cases. The fetus had a normal development. Due to financial problems, 11 cases in the first trimester and 2 cases in the second trimester switched to oral warfarin from LMWH after the initial treatment. And warfarin was substituted by LMWH by Week 34. However the fetuses died in 4 cases while the other fetuses were normal. Nine cases in the first trimester decided to terminate pregnancy. CONCLUSION: Treatment decisions during pregnancy carry potential implications for both maternal and fetal health and life. Therefore the DVT strategies during pregnancy differ from those during non-pregnancy. Special cautions should be exercised for the treatment of DVT during pregnancy.

[Experience of surgical treatment of carotid body tumor after preoperative embolization of feeding vessels].

OBJECTIVE: To evaluate the effect of preoperative embolization of the feeding vessels of carotid body tumor in the treatment thereof. METHODS: 33 patients with carotid body tumors not less than 3 cm in diameter were examined by color Doppler ultrasound. Polyvinyl alcohol particle 250-1000 microm in diameter were suspended in meglumine diatrizoate or Ultravist and then injected via microcatheter into the feeding vessels until detainment or reflux was seen. Operation was performed 1 day later on 23 patients and 4 days later on 10 patients. External carotid artery to internal carotid artery bypass was performed on 1 case, anastomosis of common carotid to internal carotid artery with auto-saphenous vein interposition on 3 cases, and repair of internal carotid artery on 1 case. RESULTS: One-stage resection was completed on all tumors. One case suffered contralateral hemiplegia two times in the operative day, on the next day the contralateral lower limb could move, but the patient could not speak clearly and his tongue was not in right position, after 3 months he was completely recovered and MRI illustrated cranial infarction. CONCLUSION: An important adjunct in treating large carotid body tumor, preoperative embolization makes the surgical exploration proceed much smoother, blood loss become less, and morbidity lower.

Stent-grafting for unfavorable abdominal aortic aneurysm: a practical challenge.

BACKGROUND: The endovascular treatment of abdominal aortic aneurysm (AAA) has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm (uAAA). METHODS: During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months (mean 20.5 months). RESULTS: Technical success rate was 97.6% (40/41) with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine (22.5%) type I endoleaks (5 proximal and 4 distal) were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 (5.0%) type I endoleaks at 30 days; one type I patient was treated by open conversion, another type I patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type II endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type I endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type II endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminal angioplasty. There was no additional aneurysm rupture or any endograft imgration. CONCLUSION: The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.

Effects of antiatherosclerosis in carotid artery by RNAi-mediated silencing of MCP-1 expression.

BACKGROUND: Our objective was to identify the effects of MCP-1 siRNA in vivo transfection in an atherosclerosis model on local expression of MCP-1 and pathogenesis of atherosclerosis. METHODS: Carotid atherosclerosis was induced in 28 New Zealand white rabbits. Rabbits were divided into three groups randomly: RNAi group, model group, and blank plasmid group. siRNA-expressing vector was transfected to blood vessels by liposomes. The carotid arteries were processed for morphological evaluation. Local expression of MCP-1 was detected by immunohistochemistry, RT-PCR, and Western blot. RESULTS: On hematoxylin and eosin-stained sections, partial endothelial cells detached while intimae were less thickened in the RNAi group compared to the model and blank plasmid groups; the I:M ratio was significantly reduced to 1.46 in the RNAi group compared to the model and blank plasmid groups (5.55 and 5.27, respectively). The results of immunohistochemistry showed that MCP-1 expression was less colorized and less positive in the RNAi group. RT-PCR and Western blot showed reduced expression in the RNAi group than in the model and blank plasmid groups. There were highly positive correlations between semiquantitative RT-PCR and the I:M ratio (r = 0.968). CONCLUSION: Expression of MCP-1 was successfully inhibited by transfecting MCP-1 siRNA expression plasmid to the carotid artery, and the progression of atherosclerosis was restricted by RNAi-mediated silencing of MCP-1 expression.

[Early to mid-term results of endovascular repair of aortic dissection: report of 165 cases].

OBJECTIVE: To evaluate the early and midterm outcomes of endovascular repair of aortic dissection (AD). METHODS: Between January 2001 and December 2006, 165 patients (145 male and 20 female) with AD were treated with endovascular repairing. The mean age of the patients was 52.8 years (range, 30-82 years). Among them, 36 patients had Stanford type A dissection, 121 had type B dissection and 8 had aortic ulcer. Among the dissection patients, 47 were acute AD (the interval between onset and surgery was < or = 7 days), 69 were subacute AD (the interval between onset and surgery was 8-30 days) and 41 were chronic AD (the interval between onset and surgery was > 30 days). RESULTS: The stents were placed technically successfully in 164 patients (99.4%). The rate of endoleak within 30 days after placement of stents was 7.3% (12/165) and neurologic complication rate was 2.5% (4/165). The mortality rate within 30 days was 6.1% (10/165), and the mortality of acute, subacute and chronic AD was 12.8%, 1.4% and 7.3%, respectively. One hundred and forty-five cases were followed up for 6 to 75 months (median, 28.2 months). Complete thrombosis in false lumen was achieved in 62 patients (42.8%), while partial thrombosis was achieved in 83 patients (57.2%). Nine patients died during fellow-up. CONCLUSION: It's indicated that endovascular repair of AD is a microinvasive, safe and effective methods for aortic dissection. However, the long-term efficacy needs to be evaluated further.

[Endovascular stent-graft treatment for DeBakey I aortic dissection].

OBJECTIVE: To study endovascular treatment of DeBakey type I aortic dissecting aneurysm. METHODS: Seven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach. RESULTS: The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed. CONCLUSIONS: Endovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.

[Endovascular stent-graft repair for Stanford type A aortic dissection with extra-anatomic bypass].

UNLABELLED: OBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass. METHODS: To perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach. RESULTS: Thirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning. CONCLUSIONS: Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.

Effect of external valvuloplasty of the deep vein in the treatment of chronic venous insufficiency of the lower extremity.

OBJECTIVE: This study was conducted to verify the efficacy of external valvuloplasty of the femoral vein in the treatment of primary chronic venous insufficiency (PCVI). METHODS: Forty patients with PCVI of the bilateral lower extremities were enrolled at the time of surgical management. All 80 limbs were classified as CEAP C2 to C4, with moderate incompetence of the deep vein. The limbs of each patient were randomized into one of two groups according to the operative method, so that when one limb was randomized to group A, regardless of whether it was the right or left limb, the other limb was assigned to group B. In group A, external valvuloplasty of the femoral vein was combined with surgery of the superficial venous system; in group B, surgery of the superficial venous system alone was performed. The therapeutic effects between the limbs in groups A and B were compared by color duplex scanning, a color Doppler velocity profile, air plethysmography (APG), and a CEAP severity score at 1 month, 1 year, and 3 years postoperatively. RESULTS: Within each group of limbs, no significant differences were found in the average operative time within each group of limbs. The varicose veins resolved, there were no deep vein thromboses, and the wounds healed well postoperatively in all cases. Leg heaviness was relieved completely in 90% of group A limbs (36/40) and 55% of group B limbs (22/40). Venous valve competence was achieved in 100%, 98.1%, and 90.9% of group A limbs at 1 month, 1 year, and 3 years postoperatively, respectively. The amount of venous reflux, APG indices, and CEAP severity scores were not significantly different between the two groups preoperatively (P > .05). The amount of venous reflux, reflux indices, CEAP severity scores, and muscle pumping indices improved markedly in group A limbs postoperatively compared with group B limbs (P < .01); muscle pumping indices did not improve significantly in group B limbs postoperatively (P > .05). There were significant differences in the amount of venous reflux, reflux indices, and CEAP severity scores between group A and B limbs at 1 month and 1 year postoperatively (P < .01). There were significant differences in all parameters assessed between group A and B limbs 3 years postoperatively (P < .05). CONCLUSIONS: External valvuloplasty of the femoral vein combined with surgical repair of the superficial venous system improved the hemodynamic status of the lower limbs, restored valvular function more effectively, and achieved better outcomes than surgical repair of the superficial venous system alone.

[Endovascular stent-graft exclusion of giant and long-segment thoracic aortic aneurysms].

OBJECTIVE: To discuss the availability of endovascular stent-graft exclusion in giant and long-segment thoracic aortic aneurysms. METHODS: Endovascular stent-graft exclusion was performed on 3 male patients with giant and long-segment thoracic aortic aneurysm. Multiple stent-grafts were connected as a long stent-graft to repair these thoracic aortic aneurysms, of which one with 28 cm in length and 7.3 cm in maximum diameter was excluded by 4 stent-grafts with different diameters and same length of 130 mm. The preliminary bypass between right common carotid artery and left common carotid artery or left common carotid artery and left subclavian artery was performed on 2 patients. RESULTS: Three patients underwent the operation successfully, and achieved the good results. There was no endoleak at the conjunction of stent-grafts in 2 cases, and a little endoleak in 1 case, which disappeared 1 year after operation. One case presented temporal cerebral ischemia, which disappeared after 1 month. CONCLUSIONS: The endovascular deployment with multiple stent-grafts connection is a safe, mini-invasive and effective therapeutic method for giant and long-segment thoracic aortic aneurysm, but long-term outcomes will be gotten after the follow-up study.

[Effect of external vavuloplasty of deep vein in the treatment of chronic venous insufficiency of lower extremity].

OBJECTIVE: To verify the role and effect of external vavuloplasty in the treatment of chronic venous insufficiency (CVI) of lower extremity. METHODS: Thirty patients with CVI of bilateral lower extremities were enrolled to accept surgical management of vein systems. Both limbs of each patient were randomized into two groups respectively according to the operating style. One limb was given external vavuloplasty of the superficial femoral vein and surgery of superficial venous system (group A), the another limb was only given the surgery of superficial venous system (group B). The effect comparison between both limbs of each patient and two groups by color duplex scanning, color doppler velocity profile (CDVP), air plethysmography and CEAP score system one month and 3 years after operation. RESULTS: All 60 limbs of 30 cases were CEAP C(2)-C(4) with degree III reflux (Kistner's method) in the deep veins confirmed by color duplex scanning and venography. In 1 month and 3 years after surgery, all the indexes of the limb in the group A were dramatically improved compared with those of the limbs in the group B. The average value of venous reflux degree, reflux volume, and venous filling index (VFI) had significant difference between the two groups (P < 0.001). In 3 years after surgery, there was significant difference between the two groups on ejective fraction (EF)and residual volume fraction (RVF) (P < 0.05) and CEAP clinical score (P < 0.001). CONCLUSION: External vavuloplasty of deep vein may reduce the reflux volume of the affected deep vein and improve the valve function, and can result in better outcomes when combined with surgery of the superficial venous system.

[Single or staged endovascular stent-graft repair for aortic dissection with multi-tears].

OBJECTIVE: To evaluate the single or staged endovascular stent-graft repair for aortic dissection with multi-tears. METHODS: The stent-grafts were inserted through the femoral artery to seal the tears of dissection. RESULTS: Between January 2001 and June 2004, 8 patients with aortic dissection underwent stent-graft placement. There were 5 tears in one patient, 4 tears in two patients, 3 tears in two patients and 2 tears in three patients. There were 11 tears located at descending thoracic aorta, 11 at abdominal aorta and 4 at iliac artery. Six patients underwent operation in single stage, and 2 in staged maneuver. Total 23 stent-grafts were used, including 20 straight type grafts and 3 bifurcated grafts. Placement of the stent-graft was technically successful in all patients. Follow-up with CT or MRA examination after 3, 6, 12 and 24 months postoperatively showed the dissection disappeared with thrombosis in the false lumen, no endoleak occurred. All patients survived to present. CONCLUSION: Single or staged endovascular stent-graft repair is a promising, safe and effective procedure for aortic dissection with multi-tears.

[Endografting for refractory aortic dissection and dissecting aneurysm].

OBJECTIVE: To explore the safety and feasibility of endograft repair in refractory aortic dissection and dissecting aneurysm. METHODS: The clinical data of 13 refractory cases of aortic dissection and dissecting aneurysm, 11 males and 2 females, aged 52 (38-82), out of the 68 consecutive patients with aortic dissection and dissecting aneurysm who underwent endograft repair from Jan 2001 to Oct 2004, were analyzed. Nine of the 13 cases were diagnoses as with aortic dissection and dissecting aneurysm of Stanford type A, 3 of which had tears in the ascending aorta (DeBakey type I), 3 had tears in aortic arch, and 3 had tears on the distal aortic arch with ascending aorta involved; and the other four out of the 13 cases were diagnosed as Stanford type B, one with Marfan's syndrome. Eight of the 13 cases had more than 2 entries, 3 of which had suffered from shock and hemathorax due to rupture preoperatively. Follow-up ranging 2 months to 3 years was carried out after the operation. RESULTS: Transluminal placement of stentgratf was technically successful in all patients. Three patients with DeBakey type I dissections received stent-grafts introduced through the left common carotid or right femoral artery, of which one case died from gastrointestinal hemorrhage 1 month postoperatively. For the patients with tears in aortic arch preliminary Y type bypass from ascending aorta to left common carotid artery and left subclivian artery was performed in 2 cases, and carotid-carotid artery bypass was performed in one case, and then stent-grafts were deployed through right femoral artery. The 3 cases with tears in the distal arch and ruptured aneurysm, received stent-grafts implantation through the femoral artery emergently, and closed thoracic drainage and anti-shock treatment, one of which died from another aneurysm rupture 27 hours postoperatively. Out of the 4 cases with Stanford type B dissection with multiple tear entries, 3 underwent multiple stent-grafts repair and 1 underwent emergent abdominal-bilateral iliac arteries Y-type graft bypass due to rupture of iliac dissecting aneurysm. During the follow-up CT, MRI and color Doppler sonography showed that all 11 patients remained healthy with the former tears well closed and thrombosis in the false lumen. CONCLUSION: Endograft repair for refractory aortic dissecting aneurysm is feasible and technically successful, especially for the patients with tears in the ascending aorta or aortic arch.