Endovascular interventions for TransAtlantic InterSociety Consensus II C and D femoropopliteal lesions.

BACKGROUND: Peripheral artery disease accounts for more than 400 000 hospitalizations in the USA and results in symptoms ranging from claudication to gangrene. Recent advances in endovascular techniques have led to a more aggressive approach for treating peripheral artery disease. The aim of this retrospective study was to evaluate the outcomes of endovascular interventions on TransAtlantic InterSociety Consensus (TASC) II C and D femoropopliteal occlusive disease. METHODS: Data for all patients undergoing endovascular interventions for femoropopliteal occlusive disease from December 2007 through December 2010 were reviewed. Demographic data, risk factor data, preprocedural and postprocedural ankle-brachial indices, technical success rates, and complication rates were obtained. Primary, assisted primary, and secondary patency were determined by Kaplan-Meier survival analysis. Univariate and multivariate analyses were performed to identify factors adversely affecting primary patency. RESULTS: The study group included 52 TASC II C and 106 TASC II D limbs in 126 patients (mean age, (68.0 ± 18.0) years). The technical success rate was 91.1%. Complications occurred in 19 limbs (12.0%), including 8 (5.1%) major complications. The mean follow-up period was (17.6 ± 5.1) months (range, 12.0 - 48.0 months). Primary patency rates at 1, 2, 3, and 4 years were 95%, 78%, 74%, and 74% in TASC II C lesions and 89%, 62%, 52%, and 52% in TASC II D lesions, respectively. Secondary patency rates at 1, 2, 3, and 4 years were 97%, 94%, 94%, and 94% in TASC II C lesions and 97%, 95%, 83%, and 83% in TASC II D lesions, respectively. It is significantly different between primary patency rates (P < 0.05) but not secondary patency rates of TASC II C and D groups (P > 0.05). Predictors of restenosis/occlusion included hyperlipidemia, lesion length, and popliteal artery involvement. CONCLUSIONS: Endovascular treatment of TASC II C and D femoropopliteal artery occlusion has a high technical success rate with favorable mid-term secondary patency rate. Hyperlipidemia, lesion length, and popliteal artery involvement were independent risk factors for in-stent restenosis.

[Improving the dissolution rate of poorly water-soluble resveratrol by the ordered mesoporous silica].

The aim of this study is to synthesize the ordered mesoporous silica (OMS) as drug carrier to improve release property of insoluble drug and investigate the dissolution profile of insoluble drug from the porous carrier. The OMS was obtained by using cetyltrimethyl ammonium bromide as the template and resveratrol was selected as the model drug. The resveratrol-loaded OMS (Res-OMS) were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), N2 adsorption-desorption, X-ray diffraction (XRD) and FT-IR spectroscopy. In vitro drug release behavior was also investigated. It was found that the synthesized OMS showed a large surface area, a narrow pore size distribution and an important mesoporosity associated to hexagonally organized channels. Compared with physical mixture and crystalline powder, resveratrol was in amorphous or molecular form after loading into OMS. The release rate ofresveratrol from drug-loaded OMS was significantly increased suggesting the great potential application of OMS for the formulation of poorly soluble drugs.

[Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions].

OBJECTIVE: To evaluate the effectiveness, safety and feasibility of endovascular angioplasty in treating long iliac artery chronic total occlusions (CTO). METHODS: The clinical data from a consecutive series of patients with long (> 5 cm) iliac artery CTO who treated by endovascular angioplasty from January 2006 to December 2010 was retrospectively analyzed. There were 139 patients (157 limbs) with long iliac artery CTO treated by endovascular angioplasty in this study [male 93 and female 46, mean age (77 ± 10) years]. According to TASC II classification, there were 18 patients in type B, 89 patients in type C and 32 patients in type D. Recanalization of the occluded lesions was attempted with the left brachial and/or femoral access. RESULTS: The ankle brachial index increased from 0.42 ± 0.19 before treatment to 0.81 ± 0.26 after treatment. The rate of technical success was 96.2% (151/157) and the patency rate of iliac artery was 94.1% (111/118) during the follow-up. Significant restenosis or reocclusion was found in 7 iliac lesions and there were no major interventional complications, such as iliac artery rupture, stent displacement, pseudoaneurysms, and arteriovenous fistula. CONCLUSIONS: Endovascular angioplasty is an effective, safe and feasible method in treating long iliac CTO with high patency rate. Combined left brachial and femoral access can increase the technical success rate significantly.

[Early surgery for iliac-femoral post-thrombotic syndrome and related experimental study].

OBJECTIVES: To confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment. METHODS: IFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS). RESULTS: The positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05). CONCLUSIONS: The present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

Optimization of the model of abdominal aortic aneurysm by co-incubation of calcium chloride and collagenase in rats.

OBJECTIVE: To optimize the model of abdominal aortic aneurysm (AAA) in rats using calcium chloride (CaCl2) and collagenase together. METHODS: This study was performed at the 9th People's Hospital, Institute of Traumatic Medicine, Shanghai Jiao Tong University, School of Medicine, Shanghai, China from July 2008 to February 2009. Aortas of 55 adult male Sprague-Dawley rats were exposed and incubated for 20 minutes with fresh normal saline solutions supplemented with CaCl2 (0.4 M) and collagenase (4%, w/v) (group A), CaCl2 alone (group B), collagenase alone (group C), or normal saline alone (group D). After 4 weeks, the treated aortas were evaluated by digital measurement, angiography, and histological examination. RESULTS: In group A, there was a mean increase in diameter of 87.86% +/- 69.49% (range, 35.33-299.29%) weeks after surgery. The frequency of AAA in this group was 83.3% (10/12). One (1/13) AAA occurred in group C and none in other groups. Partial endothelial loss, elastin disruption, and abnormal collagen deposition were noted in the AAA tissues in group A, corresponded well to native aneurysms in human. CONCLUSION: The use of collagenase optimized the established CaCl2-induced rat model, giving a high frequency of AAA in a short period of time.

[The prevention and management of subintimal angioplasty complications].

OBJECTIVE: The purpose of this study was to assess the prevention and management of subintimal angioplasty (SIA) to treat lower extremity arterial occlusions. METHODS: From December 2003 to May 2008, 106 lower extremities with arterial occlusions (median length of 10.8 cm, range from 4.5 to 28.0 cm) were treated on an intention-to-treat basis with SIA. Twenty-one lower extremities had disabling claudication and 85 had limb-threatening ischemia. Main outcome measures included the occurrences of SIA complications and their prevention and management. In order to prevent and cure perforation of a vessel and the important collaterals being compromised, the recanalisation of SIA was performed in the "roadmap" of DSA, the guide wire was advanced with top loop through the subintimal plane until the occlusion was passed, the position of the catheter which was confirmed by injection of a small amount of contrast media during the manipulations. In order to prevent and cure acute reocclusion and embolisation, subintimal angioplasty of long occlusion was performed by long suitable diameter balloon catheters, with prolonged (2 to 3 min) inflation, stents were only placed with residual stenoses and intimal flaps. Anticoagulation was administered for 3 to 5 d and then antiplatelet treatment was given for 6 months. RESULTS: The subcutaneous light gore of arterial access sites was seen in five legs, no arterial embolisation occurred. The perforation rate was 6% (7 legs), but no serious outcomes occurred. One patient had been amputated because of important collaterals being compromised. Three legs had acute occlusion in subintimal recanalisation and one patient converted what would have been an above-knee bypass, into a below-knee bypass. CONCLUSIONS: The complications of subintimal angioplasty include perforation, embolisation, acute recanalisation occlusion and important collaterals being compromised. Most of these complications can be prevented and cured, few serious outcomes occur.

[Surgical treatment of visceral artery aneurysms].

OBJECTIVE: To analyze the experience with diagnosis and surgical treatment of visceral artery aneurysms (VAAs). METHODS: From June 2003 to December 2008, 8 patients (2 male and 6 female) with 9 VAAs underwent surgical treatment. Mean age was 49 years (ranged from 30 to 72 years). The site of aneurysmal disease was splenic artery in 4 cases, superior mesenteric artery in 2 cases, renal artery in 2 cases (3 aneurysms). In 1 patient of splenic artery aneurysm, portal vein hypertension coexisted. All the VAAs of preoperative diagnostic workup consisted of a ultrasound, computed tomography (CT) scan, and digital subtraction angiography. Six patients were operated on and two patients was treated with endovascular procedures. Only one small VAAs was treated with follow-up. RESULTS: No deaths or major complications occurred in the perioperative period. All the patients remained symptom free during a follow-up of 26.5 months (ranged from 2 to 60 months). Follow-up consisted of clinical and ultrasound scan examinations or CT scan at 1 and 6 months, and yearly thereafter. CONCLUSIONS: Aggressive approach to the treatment of VAAs is essential. Elective open surgical treatment and an endovascular procedure of visceral artery aneurysms are both safe and effective, and offers satisfactory early and long term results. There is some evidence that small (< 2 cm) and asymptomatic VAAs may be safely observed.

[The clinical values of subintimal angioplasty for treatment lower extremity arterial occlusions].

OBJECTIVE: The purpose of this study was to assess the technical feasibility and early outcomes of subintimal angioplasty to treat lower extremity arterial occlusions. METHODS: During a 2-year period (from December 2003 to December 2005), 36 lower extremities with arterial occlusions (median length, 11.5 cm; range, 4.5 to 28.0 cm) were treated on an intention-to-treat basis with SIA. Thirteen lower extremities had disabling claudication and twenty-three had limb-threatening ischemia. MAIN OUTCOME MEASURES: technical success, cumulative patency, clinical results and complications. RESULTS: The technical success rate was 80% and four out of seven failures were treated by conventional surgery. After 13.2 months follow-up, recanalization vessel patency rate was 70%, and clinical effectiveness rate was 81%, no serious complications occurred. CONCLUSION: In a selected group of patients, SIA is feasible with a high initial technical success rate and the short-term results are satisfied, SIA is a good treatment alternative in patients who are lower extremity arterial occlusions. The durability of this method of therapy is unknown, and our length of follow-up is not sufficient to answer this question.