Foam sclerotherapy for patients with Klipple-Trenaunary syndrome complicated by frequent cellulitis of lower extremity: A case report.

RATIONALE: Klipple-Trenaunary Syndrome (KTS) complicated by frequent cellulitis of lower extremity seriously affects a patient quality of life. The hemodynamic characteristics of the disease are still unclear. Direct skin incision or puncture to remove malformed veins at the lesion site carries the risk of non-healing of the surgical incision. Our aim is to explore initial management strategies based on the hemodynamic characteristics of this disease. PATIENT CONCERNS: A 29-year-old Manchu man was affected by KTS from childhood, characterized by an increase of the circumference and superficial varicose veins of the lower extremity. In the past 5 years, he suffered from frequent cellulitis in the left leg every 15 days or so. DIAGNOSES: KTS complicated by frequent cellulitis of lower extremity. INTERVENTIONS: The clinical and hemodynamic characteristics of KTS were evaluated by Doppler ultrasonography (DUS) combined with CT venography (CTV), and foam sclerotherapy and postoperative elastic bandage compression were performed accordingly. OUTCOMES: Based on evaluations, the reason for frequent cellulitis was the continuous increase of venous hypertension in the calf caused by the malformed superficial vein and its penetrating vein. After 3 operations, the patient had no recurrence of cellulitis of the leg. Follow-up for 1 year showed no recurrence of left leg cellulitis. LESSONS: This report emphasizes that foam sclerotherapy can significantly improve the clinical symptoms of KTS, such as cellulitis, and provide a safe skin environment for the implementation of other surgical methods, based on the evaluation of the pathological characteristics of KTS by DUS combined with CTV.

A multicenter retrospective analysis of the clinical outcome following endovascular treatment of extremity arteriovenous malformation.

BACKGROUND: The arteriovenous malformation (AVM) represents a complicated pathology with high recurrence risk. This study aimed at reporting the clinical outcome of embolotherapy in treating extremity AVMs and exploring the potential risk factors for the recurrence of the lesion. METHODS: A multicenter retrospective review of the electronic medical records database was performed to enroll extremity AVM cases. Based on the follow-up findings, patients were allocated into the recurrence group and non-recurrence group. Univariable comparisons were performed to find relevant factors for AVM recurrence, then each potential factor was assessed by Kaplan-Meier analysis to determine whether it could influence the time-dependent recurrence possibility. RESULTS: Between January 2010 and December 2020, we screened 339 cases and enrolled 35 patients (24 male, average age: 45.23±17.57 years). During an average follow-up period of 5.91±3.22 months, recurrence of AVM was found in 18 cases. Univariable analysis documented type IIIb AVM and previous surgical attempts potentially indicated a high recurrence possibility, whereas type II, application of coil and ethanol during the intervention, as well as optimal embolization might be helpful to control the pathology. Of these relevant factors, further Kaplan-Meier analysis found that previous surgical attempts (P=0.002), application of ethanol (P=0.015), AVM type II (P=0.048), and IIIb (P=0.030) might have a significant impact on recurrence probability. CONCLUSIONS: Previous surgical attempts might increase the recurrence risk after embolotherapy of the AVM, whereas using ethanol as the embolic agent seems to contribute to a lower recurrence probability. Type II AVM may respond better to embolization than type IIIb.

Up-and-over access is not an optimal pathway for percutaneous catheter-directed thrombolysis in acute iliofemoral popliteal venous thrombosis.

OBJECTIVE: To analyze the feasibility and results of up-and-over access (UOA) for catheter-directed thrombolysis (CDT) in acute iliofemoral popliteal venous thrombosis (IFPVT). METHODS: From June 2020 to June 2021, a total of 26 patients (26 lower limbs) undergoing CDT for IFPVT were included. According to the vascular access, the patients were divided into UOA group (n = 11, 10 left limbs and 1 right limb) and ipsilateral popliteal vein (ILPV) (n = 15, 15 left limbs) access group. The differences in preoperative characteristics and technical details between the two groups were compared. RESULTS: Patients in UOA group were older than those in ILPV access group (67.64 ± 4.11 years VS. 52.73 ± 15.63 years, p = .003). The BMI of UOA group was significantly higher than that of ILPV access group (26.03 ± 1.62 kg/m2 VS 24.71 ± 1.46 kg/m2, p = .039). There were significantly more patients with simultaneous three comorbidities in UOA group than in ILPV access group (45.5% vs. 0, p = .043). Compared with ILPV access group, the duration of operation and fluoroscopy of UOA group were significantly longer (20.64 ± 3.41 min vs. 10.20 ± 1.42 min, p < .001; 18.18 ± 2.99 min vs. 6.13 ± 0.92 min, p < .001), but the technical success rate was significantly lower (54.5% vs. 100%, p = .007). In UOA group, the operation-related complications occurred, including catheter straying into lateral sacral vein (9.1%), retroperitoneal hematoma (9.1%), and thrombus shedding into filter (9.1%). CONCLUSION: The UOA may be attempted in patients who are unable to be prone, but this access is not an optimal pathway for CDT.

A Molten-Salt Method to Synthesize Ultrahigh-Nickel Single-Crystalline LiNi0.92 Co0.06 Mn0.02 O2 with Superior Electrochemical Performance as Cathode Material for Lithium-Ion Batteries.

Ni-rich layered oxides have been intensively considered as promising cathode materials for next-generation Li-ion batteries. Nevertheless, the performance degradation caused by intergranular cracks and electrode/electrolyte interface parasitic reactions restricts their further application. Compared with secondary particles, single-crystal (SC) materials have better mechanical integrity and cycling stability. However, the preparation of ultrahigh-nickel layered SC cathode still remains a serious challenge. Herein, a novel LiOH-LiNO3 -H3 BO3 molten-salt method is proposed to synthesize SC LiNi0.92 Co0.06 Mn0.02 O2 with considerable crystallinity and uniformity. The critical impacts of calcination temperature and boric acid on the microstructure and electrochemical property of Ni-rich layered oxides are systematically investigated. The results show that the crystal growth is promoted and the stability of crystal structure is improved by this synthesis method. In particular, the optimal electrode demonstrates a superior initial discharge capacity of 214.8 mAh g-1 with a high capacity retention of 86.3% over 300 cycles as tested by pouch-type full cells at 45 ºC. This work not only prepares an ultrahigh-nickel layered CS cathode with superior electrochemical performances, but also provides a feasible method for the synthesis of other CS layered cathode materials.

Congener Substitution Reinforced Li7P2.9Sb0.1S10.75O0.25 Glass-Ceramic Electrolytes for All-Solid-State Lithium-Sulfur Batteries.

Glass-ceramic sulfide solid electrolytes like Li7P3S11 are practicable propellants for safe and high-performance all-solid-state lithium-sulfur batteries (ASSLSBs); however, the stability and conductivity issues remain unsatisfactory. Herein, we propose a congener substitution strategy to optimize Li7P3S11 as Li7P2.9Sb0.1S10.75O0.25 via chemical bond and structure regulation. Specifically, Li7P2.9Sb0.1S10.75O0.25 is obtained by a Sb2O5 dopant to achieve partial Sb/P and O/S substitution. Benefiting from the strengthened oxysulfide structural unit of POS33- and P2OS64- with bridging oxygen atoms and a distorted lattice configuration of the Sb-S tetrahedron, the Li7P2.9Sb0.1S10.75O0.25 electrolyte exhibits prominent chemical stability and high ionic conductivity. Besides the improved air stability, the ionic conductivity of Li7P2.9Sb0.1S10.75O0.25 could reach 1.61 × 10-3 S cm-1 at room temperature with a wide electrochemical window of up to 5 V (vs Li/Li+), as well as good stability against Li and Li-In alloy anodes. Consequently, the ASSLSB with the Li7P2.9Sb0.1S10.75O0.25 electrolyte shows high discharge capacities of 1374.4 mAh g-1 (0.05C, 50th cycle) at room temperature and 1365.4 mAh g-1 (0.1C, 100th cycle) at 60 °C. The battery also presents remarkable rate performance (1158.3 mAh g-1 at 1C) and high Coulombic efficiency (>99.8%). This work provides a feasible technical route for fabricating ASSLSBs.

A systematic review and meta-analysis of the performance of flow-diverting stents in the treatment of peripheral and visceral artery aneurysms.

OBJECTIVE: This meta-analysis aims to evaluate the safety and efficacy of flow-diverting stents (FDS) in treating peripheral and visceral artery aneurysms (PAA/VAAs). BACKGROUND: Though rare, PAA/VAAs can represent a life-threatening condition due to their propensity of rupture. The FDS emerges as a new solution to exclude these aneurysms while maintaining collateral branches, but convincing evidence is lacking on its clinical effectiveness. METHODS: A systematic literature search was performed to identify studies related to FDS in treating PAA/VAAs. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was applied to guide the data extraction, quality assessment, and synthesis of outcomes of interest. Random effect models were applied to calculate the event rates of major endpoints. OpenMeta[Analyst] software was used for statistical analysis. RESULTS: Of 130 records screened, 10 cohort studies (including 220 patients, average age: 66.0 years, 78.4% male) were enrolled in the meta-analysis. Pooled data suggested a technical success rate of 98.5% (95% CI: 97.0-100%). During a mean follow-up period of 14.1 months, 93.6% (95% CI: 88.6-98.5%) side branches remained patent, 89.8% (95% CI: 84.3-95.3%) aneurysms were totally thrombosed, whereas shrinkage/stabilization of the aneurysm was documented in 93.4% (95% CI: 88.4-98.4%) cases. The primary stent patency rate was estimated to be 87.9% (95% CI: 81.0-94.8%). Overall clinical success was achieved in 83.2% (95% CI: 74.4-92.0%) patients. CONCLUSIONS: The FDS features a potential advantage of preserving side branches while inducing sac thrombosis and aneurysm shrinkage/stabilization. Further prospective, comparative studies in larger patient cohorts are anticipated to draw a robust conclusion.

Blocking Interleukin-1 Beta Reduces the Evolution of Thoracic Aortic Dissection in a Rodent Model.

OBJECTIVE: Thoracic aortic dissection (TAD) is associated with matrix changes, biochemical changes, and inflammatory markers like interleukin-1 beta (IL-1ß). However, the exact mechanism remains unknown. This study aimed to investigate the role of IL-1ß, matrix metalloproteinase (MMP)-2, MMP-9, smooth muscle cell apoptosis, and elastic fibre fracture in the development of TAD in a rat model. METHODS: The TAD rat model was induced by ß-aminopropionitrile (BAPN). TAD was investigated in 112 male Sprague-Dawley rats, which were equally divided into four groups of 28 rats (Control, BAPN, BAPN + IL-1ß, and BAPN + IL-1ß antibody). Systolic blood pressure, survival, and the development of TAD were measured after six weeks. Expression of IL-1ß, MMP-2, and MMP-9 was measured by Western blot. Apoptosis, aortic elastin concentration, and biomechanical characteristics were measured by the TdT mediated dUTP nick end labelling assay, Victoria blue staining, and in vitro testing. RESULTS: During six weeks, the mortality was 0% (0/28) in the control group, 53.6% (15/28) in the BAPN group (p < .001 compared with the control group), 75.0% (21/28) in the BAPN + IL-1ß group (p = .007 compared with the BAPN group), and 35.7% (10/28) in the BAPN + IL-1ß antibody group (p = .023 compared with BAPN group and p < .001 compared with the BAPN + IL-1ß group). IL-1ß treatment deteriorates BAPN induced mortality and aneurysm expansion, which were attenuated by anti-IL-1ß treatment. In BAPN + IL-1ß group, stress and strain parameters were decreased by 13.5%-53.5% and elastin content was decreased by 14%, and IL-1ß, MMP-2, and MMP-9 were expressed higher by 117%, 108%, and 75% when compared with the rats in the BAPN group. Contrarily, in the BAPN + IL-1ß antibody group, the above changes could be completely (strain, elastin content, and expression of MMP-2) or partly (elasticity modulus, stress, and expression of MMP-9) blocked by anti-IL-1ß treatment. CONCLUSION: IL-1ß plays a critical role in TAD formation by altering the expression of MMP-2 and MMP-9, degrading the aortic wall matrix, causing elastic fibre rupture, and changing the stress or strain of the aortic wall. Anti-IL-1ß reduces the later effects and could be one of the molecular targets for prognosis and drug treatment of TAD in the future.

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations.

Purpose: To evaluate the midterm outcomes of thoracic endovascular aortic repair (TEVAR) using chimney grafts (ch-TEVAR) or thoracic stent-grafts with fenestrations made on the back table (f-TEVAR) to treat thoracic aortic dissection (TAD) and thoracic aortic aneurysm (TAA). Materials and Methods: A retrospective analysis was conducted of 474 consecutive patients (mean age 62.3±10.7 years; 346 men) treated with either f-TEVAR (n=110) or ch-TEVAR (n=364) for 352 TADs (81 f-TEVAR and 271 ch-TEVAR) or 122 TAAs (29 f-TEVAR and 93 ch-TEVAR) from 2008 to 2016. The primary endpoints at 30 days and during follow-up were overall mortality, aorta-related mortality, and major complications. The secondary endpoints were endoleak and reintervention. The patency of the target branches, cost of hospitalization, and the use of antiplatelet drugs were also analyzed. Results: Intraoperative type I endoleaks were treated in 69 (14.6%) cases (4 f-TEVAR and 65 ch-TEVAR, p<0.01) to achieve 100% technical success. Four (0.8%) patients died within 30 days [1 (0.9%) f-TEVAR and 3 (0.8%) ch-TEVAR]. Perioperative cerebral ischemia (1 fatal stroke) occurred in 9 (1.9%) patients: (1 f-TEVAR and 8 ch-TEVAR, p=0.39). During the mean follow-up of 50.6±20.0 months (49.5±18.3 months in f-TEVAR and 50.9±20.6 months in ch-TEVAR), 11 (2.3%) patients died of an aorta-related event. Type I endoleak was present in 40 (8.4%) patients (1 f-TEVAR and 39 ch-TEVAR, p<0.01). Eleven (2.3%) patients experienced stent-graft migration and 13 (2.7%) had a retrograde dissection. One hundred (16.9%) of the 593 branch stents occluded (4/75 in the f-TEVAR group and 96/518 in the ch-TEVAR group, p<0.01). The branch reintervention rate was 7.2% (34/474). The f-TEVAR group had a significantly higher probability of freedom from branch occlusion (92%) than the ch-TEVAR group (83%, p=0.007). Conclusion: Off-the-shelf techniques employing chimney grafts and homemade fenestrations are both suitable options for TAD and TAA involving the supra-aortic branches, with a low incidence of reintervention. Fenestrated TEVAR seems to have more favorable short- and midterm outcomes. Further study of these off-the-shelf techniques for aortic arch repair is warranted.

Hydrothermal synthesis of cotton-based BiVO4/Ag composite for photocatalytic degradation of C.I. Reactive Black 5.

Photocatalytic materials with high efficiency and convenient recyclability have attracted great interest for the treatment of printing and dyeing wastewater. In this paper, a narrow band gap BiVO4 photocatalyst was loaded onto Ag modified cotton fabric by a hydrothermal method. The prepared composite materials were characterized by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and ultraviolet visible light absorption spectroscopy (UV-vis). The composite materials as prepared show superb photocatalytic activity and reusable performance for the degradation of C.I. Reactive Black 5 (RB5). The degradation rate can reach 99% within 90 min under 1 kW xenon lamp irradiation, and over 90% of the photocatalytic performance is preserved even after five recycles. Furthermore, the photocatalytic mechanism was proposed by spectral analysis and free radical trapping experiments.

Long-term outcome of sac filling with fibrin sealant after endovascular aneurysm repair of abdominal aortic aneurysm with challenging aortic neck anatomy.

OBJECTIVE: A retrospective single-center study is reported here to assess the safety and long-term effectiveness of applying a fibrin sealant (FS) sac-filling strategy to eliminate type IA endoleak (TIAE) after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. METHODS: Characteristics of abdominal aortic aneurysm patients who had challenging proximal aortic neck anatomy (short or angulated) and underwent FS sac filling to resolve TIAE after traditional EVAR in Changhai Hospital between December 2006 and July 2010 were collected and reviewed. Intrasac pressure was measured with a preloaded catheter before and after FS filling to observe the immediate curative effect. The 7- to 10-year long-term effect was evaluated on the basis of the occurrence of endoleak, maximum aneurysm diameter, all-cause mortality, and other severe complications by annual aortic computed tomography angiography check. RESULTS: There were 107 patients with short (≤15 mm; 83/107 [77.6%]) or angulated (>60 degrees; 27/107 [25.2%]) aneurysm neck who underwent FS sac filling. The mean age of the patients was 71.1 ± 12.1 years (68 male patients). Of the 107 endoleaks, 106 (106/107 [99.1%]) were resolved, and 3 (3/107 [2.8%]) patients died in the perioperative period. Intrasac systolic, diastolic, mean, and pulse pressures decreased significantly in the treated cases (systolic pressure, 114.1 ± 16.7 mm Hg vs 59.5 ± 20.4 mm Hg; diastolic pressure, 65.0 ± 10.4 mm Hg vs 51.4 ± 18.2 mm Hg; mean pressure, 81.3 ± 11.4 mm Hg vs 54.1 ± 18.8 mm Hg; pulse pressure, 49.1 ± 12.8 mm Hg vs 8.2 ± 5.2 mm Hg; P < .01). During a median follow-up period of 89.1 months, the mean maximum aneurysm diameter became significantly smaller than that observed before the operation (53.23 ± 10.9 mm vs 59.86 ± 11.77 mm). The postoperative maximum aneurysm diameter decreased in 76 patients and was stable in 22 patients. One patient with aneurysm enlargement was transferred to open surgery because of a type IV endoleak, and another patient with no blood flow into the aneurysm sac observed by computed tomography angiography was closely followed up. Four patients received repeated endovascular treatment after the occurrence of type IB endoleak and aneurysm enlargement. After a median follow-up of 89.1 months, the cumulative survival rate was 90.7%, 80.4%, 72.0%, 58.9%, and 51.4% after 1 year, 3 years, 6 years, 8 years, and 10 years after the operation, respectively. There was no recurrent type I endoleak, distal embolization, migration, kinking, or malfunction after FS injections during the perioperative period and follow-up. CONCLUSIONS: FS sac filling combined with intrasac pressure measurement is a simple and effective treatment method to eliminate TIAE after EVAR, especially for patients with challenging proximal neck anatomy. This method could expand the current indications of EVAR.

Postoperative glucocorticoid enhances recovery after endovascular aortic repair for chronic type B aortic dissection: a single-center experience.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has been chosen as a less invasive alternative for type B aortic dissections (TBADs). However, the therapeutic effect of TEVAR has been challenged by postoperative adverse events, which were induced by inflammatory response. Glucocorticoids have been widely used because of the powerful and effective anti-inflammatory properties. Nevertheless, the prognostic effect of glucocorticoids after TBAD patients underwent TEVAR remains unclear. The objective of this study was to assess the potential effect of postoperative glucocorticoids on the prognosis of TEVAR for TBADs. METHODS: A total of 92 chronic TBADs patients underwent TEVAR with epidural anesthesia between June 2012 and June 2014 was retrospectively reviewed. The patients were stratified into dexamethasone (DXM) and non-dexamethasone group (N-DXM). The indications for TEVAR were as following: malperfusion (n = 28); contained or impending rupture (n = 17); persistent intractable chest/back pain (n = 32); refractory hypertension (n = 15). RESULTS: No 30-day mortality and incision infection occurred in each group. The postoperative pain score on the second day was significantly higher in N-DXM group (3.60 ± 0.21 versus 4.83 ± 0.32, P = 0.001). The differences of white blood cell, body temperature and heart rate were pronounced in both groups judged by the peak values (13.01 ± 0.58 × 10(9)/L versus 10.04 ± 0.61 × 10(9)/L, 37.67 ± 0.08 °C versus 37.92 ± 0.09 °C and 89.06 ± 1.21 bpm versus 95.95 ± 1.70 bpm, P = 0.002, 0.04 and 0.001, respectively). The white blood cells in DXM group significantly increased on the second and third postoperative day (P = 0.009 and 0.023), while the body temperature and heart rate showed an apparent decline on the second (P = 0.001 and 0.028), third (P = 0.007 and 0.005) and fourth postoperative days (P = 0.024 and 0.018). However, the changes of false lumen volumes and the endoleak incidence at 3-month follow-up were comparable in the two groups. No significant difference of post-implantation syndrome was observed either. CONCLUSIONS: Although postoperative prophylactic glucocorticoids administration was unable to influence mortality, incision infection or the change of false lumen volumes, it enabled to enhance the recovery of vital signs and alleviate the postoperative pain. A prospective, randomized controlled trial has been registered (NCT02523300), which will be warranted before prophylactic administration of glucocorticoids after TEVAR procedure could be recommended in the clinical work.

Total endovascular repair of thoracoabdominal aortic aneurysms with non-customized stent grafts.

BACKGROUND: Total endovascular repair of thoracoabdominal aortic aneurysms with customized branched or fenestrated endografts could be technically challenging outside large-volume centers. This study aims to describe a new endovascular strategy for use of both noncustomized stent grafts and flow-diverting stents in treating complicated thoracoabdominal aortic aneurysms. METHODS: Patients diagnosed with thoracoabdominal aortic aneurysms and deemed unfit for open surgical repair were recruited. The aim of the procedure was to cover the renovisceral segment of the aorta with flow-diverting uncovered stents, while covering the remaining aneurysm with stent grafts. Aneurysm morphologic evolution and the patency of the visceral branches were assessed at follow-up. RESULTS: Between February 2012 and August 2013, 6 selective patients (4 men, mean age 58 years) underwent the novel joint procedure. During mean follow-up of 14 months, aneurysm shrinkage (maximum diameter decrease ＞5 mm) was demonstrated in 4 patients and aneurysm stabilization (maximum diameter decrease ＜5 mm) was observed in 2 patients. No aneurysm expansion was observed in any participants. Mean aneurysm diameter decreased from 65.0±8.8 mm to 58.5±12.2 mm (p=0.054), with a significant increase in average sac thrombus deposition volume (sac thrombosis ratio increased from 23.3%±7.4% to 98.0%±3.3%, p＜0.001). The majority of side branches (23 of 24) were successfully preserved. CONCLUSIONS: Complete endovascular repair of thoracoabdominal aortic aneurysms with this novel joint procedure may be a feasible alternative in high surgical risk patients. Further validation of this technique is required to substantiate these results.