Outcomes Following Different Management of Mycotic Infrarenal Abdominal Aortic Aneurysms.

OBJECTIVE: The objective was to present our experience on managing mycotic infrarenal abdominal aortic aneurysm (MIAAA) through a retrospective cohort study. METHODS: Data of patients with MIAAA managed in our center from July 2016 to October 2022 were retrospectively analyzed. The diagnosis of MIAAA was made based on: (1) preoperative clinical signs of infection; (2) elevated serologic infection parameters; (3) para-aneurysmal infection features on enhanced computed tomography; and (4) positive blood or tissue cultures. All the patients received standard antibiotic therapy. Surgical management including endovascular aneurysm repair (EVAR), initial EVAR followed by open re-operation, and initial open surgical repair (OSR) were conducted according to disease seriosity, physical condition, and patient's will. Infection index and clinical outcome were evaluated during the follow-up time. RESULTS: A total of 23 patients (21 men; averaged=66.3 years, range=49-79 years) were included, with a mean follow-up time of 19.9 months (range=1-75 months). Bacteria culture from blood or tissue specimen was positive in 15 patients (Salmonella, n=8; Escherichia coli, n=3; methicillin-sensitive Staphylococcus aureus [MSSA], n=1; Klebsiella pneumoniae, n=1; Staphylococcus epidermidis, n=1; Mycobacterium tuberculosis, n=1). Seven patients received OSR as the initial surgical intervention, whereas 14 patients chose EVAR instead. The 2 conservatively managed patients (refused surgery) died within 30 days. The 7 patients who received initial OSR survived till now. Among the 14 patients who underwent initial EVAR, infection deteriorated without exception (14/14, 100%). Three of these patients refused re-operation and died within 6 months. Eleven patients received secondary surgical intervention (10 cases of aneurysm and endograft resection, thorough debridement, subclavian to bi-femoral artery bypass, or in situ aorta reconstruction; 1 case of laparoscopic debridement) and 7 survived the follow-up time. The overall mortality rate was 39.1% (9/23). The mortality rates differed greatly following different intervention methods (merely antibiotic management, 100%; initial open operation, 0%; initial EVAR without secondary operation, 100%; initial EVAR plus secondary operation, 36.4%). CONCLUSIONS: Open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely EVAR is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary OSR. CLINICAL IMPACT: The management of mycotic or primary-infected aortic aneurysm is challenging; treatment remains controversial. Our center has reviewed our experience over the past 6 years and found that open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely endovascular aneurysm repair (EVAR) is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary open surgical repair.

Treatment of High Surgical Risk Thoracoabdominal Aortic Aneurysms with Stent Graft and Multilayer Bare Stents Joint Technique: Mid-Long-Term Clinical Results.

BACKGROUND: This study aims to present the performance data on stent-graft and multilayer bare stents (MBS) joint technique in the treatment of high-risk thoracoabdominal aortic aneurysm (TAAA). METHODS: From May 2012 to December 2015, 8 selective TAAA cases (ages 46-75 years) ineligible for surgical repair underwent the stent-graft and MBS joint procedure, and were closely followed up for a median of 32 months (range 14-58). Using computed tomography images, the aneurysm size, luminal blood flow diameter, and the covered visceral branches were analyzed. RESULTS: Technical success was achieved in all patients (100%, 8/8). Twenty-four visceral branches were covered by MBS in total. There was no complication or death during hospital stay. During follow-up period, no death or complication occurred. Aneurysm shrinkage (maximum diameter decrease ≥5 mm) was observed in 7 patients. No aneurysm expansion was observed. Total aneurysm sac thrombosis was observed in all patients. The majority of covered side branches (23/24) were successfully preserved. No visceral ischemia or bleeding complications was observed during follow-up. CONCLUSIONS: Total endovascular repair of TAAA using stent-graft and MBS joint technique may be a safe and effective alternative in high surgical risk patients. More approving clinical evidences about the safety and efficacy of this procedure are anticipated.

Impact of Plaque Calcification and Stent Oversizing on Clinical Outcomes of Atherosclerotic Femoropopliteal Arterial Occlusive Disease Following Stent Angioplasty.

OBJECTIVE: Plaque calcification and stent oversizing are two key factors contributing to in stent restenosis (ISR) following femoropopliteal stent angioplasty. This study aimed to explore a pre-operative quantitative assessment method of plaque calcification and rational parameters of stent oversizing in the femoropopliteal artery. METHODS: A total of 115 patients with atherosclerotic femoropopliteal arterial occlusive disease treated from January 2013 to January 2016 were included retrospectively. Computed tomography angiography (CTA) imaging was performed to analyse calcified plaque parameters (calcified plaque volume [CV], standard CV [SCV], burden of calcified plaque) and stent oversizing parameters at different vessel segments (distal oversizing, maximum oversizing, plaque oversizing). Optimal cut offs for the six parameters were determined by the maximum Youden's index. The relationship between calcified plaque, stent oversizing, and clinical outcomes were assessed by correlation analysis and multivariable Cox regression models. RESULTS: The one year primary patency rate was 77.4%; the rates of ISR, major amputation, target lesion revascularisation, and mortality were 40.9%, 8.7%, 17.4%, and 12.2%, respectively. For all six parameters, patients with values greater than the cut offs had a significantly higher incidence of ISR than those with values below the cut offs. ISR was positively correlated with all six calcification and oversizing parameters. Amputation and mortality were positively correlated with calcification parameters. Multivariable Cox regression analysis demonstrated that all six parameters were independent risk factors for ISR. All calcification parameters were identified as independent risk factors for amputation, while only CV and SCV were independent risk factors for mortality. CONCLUSION: Calcified plaque in the femoropopliteal artery can be quantitatively analysed on pre-operative CTA images. High calcified plaque burden and excessive stent oversizing were associated with unfavourable outcomes following stent angioplasty.

[Ultrasonic monitoring foam sclerotherapy for serious varicosis of lower extremity].

OBJECTIVE: To evaluate the efficacy and safety of foam sclerotherapy for lower extremity varicosis in C4 to C6 patients. METHODS: A total of 32 patients (32 limbs) with serious lower extremity varicosis classified as C4 to C6 were enrolled. Ultrasonic monitoring of foam sclerotherapy was performed after subfascial endoscopic perforator suture and saphenous vein ligation. They were followed up monthly at outpatient department. Duplex Doppler scan was performed during each interview. RESULTS: All patients were treated successfully. An average of 3.2 perforators were ligated per leg (1-5 perforators). The average volume of foam sclerosing agent was 27.5 ml per leg. Mild chest tightness was observed in one patient but computed tomography (CT) scan excluded pulmonary embolism. Obvious local inflammatory reaction was observed in 4 patients. Residual vein mass without blood signal was seen in 3 patients. No such serious complication as cerebral ischemia was observed. The average follow-up period was 4.8 (1-10) months. Obvious varicose veins and clinical symptoms disappeared at 1 month. And venous ulcers in patients classified as C5 healed within 3 months. CONCLUSION: Ultrasonic monitoring of foam sclerotherapy, incorporation with saphenous vein ligation and subfascial endoscopic perforator suture, is both safe and effective in the treatment of serious lower extremity varicosis classified as C4 to C6.

[Fabrication of tissue engineered vein containing valve scaffolds].

OBJECTIVE: To fabricate porous biodegradable tissue engineered vein containing valve scaffolds. METHODS: Based on the self-made cast, the tissue engineered vein containing valve scaffolds was fabricated by injection molding plus thermally induced phase separation. Poly (lactic-co-glycolic acid) (PLGA, LA/GA mole ratio 75:25) was used as matrices. Morphological structures and biocompatibility of scaffolds were tested. Cell seeding on scaffold was performed and the mechanic characteristics of cellular constructs evaluated. RESULTS: The scaffold had an inner diameter of 9 mm with a wall thickness of 0.9 mm and the thickness of valves was (0.32 ± 0.04) mm. Scanning electron microscopic (SEM) micrographs showed regular ladder-like porous structures and the average pore size and porosity of scaffolds were 10 - 20 µm and 90%. The PLGA scaffolds were biocompatible. The cellular constructs were tested in vitro, and the valve leaflets were functionally capable of opening and closing when stimulated. CONCLUSION: Based on the self-made cast, the tissue engineered vein containing valve scaffolds can be fabricated by injection molding plus thermally induced phase separation. Further researches are warranted.

[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.

[Potential causes and optimal treatment strategy of recurrent venous ulceration in lower limb].

OBJECTIVE: To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation. METHODS: Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52.6 years (ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months (ranging from 5 to 37 months). Average diameter of ulcers was 3.7 cm (ranging from 1.3 to 6.5 cm). Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70.4%), primary deep vein insufficiency in 38 limbs (46.9%), post-DVT syndrome in 16 limbs (19.8%), reflux of accessory saphenous veins in 11 limbs (13.6%) and residual/re-opened great saphenous vein in 8 limbs (9.9%). Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality. RESULTS: All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation. Only 3 limbs (3.7%) suffered again from recurrence 1 year after re-operation. CONCLUSIONS: Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.

[Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases].

OBJECTIVE: To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages. METHODS: The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups. RESULTS: All covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups. CONCLUSIONS: EVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.

[Risk factors and therapeutic management of deep venous thrombosis in hospitalized children].

OBJECTIVE: The incidence and treatment regimen for deep venous thrombosis (DVT) in hospitalized children in China are rarely reported. This report was to assess the incidence, risk factors and treatment strategy for deep venous thrombosis (DVT) among hospitalized children admitted to the First Affiliated Hospital, Sun Yat-sen University, a single tertiary-care hospital. METHODS: In twenty years between 1989 and 2009, 12 DVTs in hospitalized children (< 17 years old) were identified in this hospital. Clinical data were retrospectively reviewed. RESULTS: The incidence of DVT in hospitalized children was low, however, it demonstrated increasing trend from 0.52 per 10 000 admissions between 1989 and 1999 to 3.18 per 10 000 admissions between 2000 and 2009 in this hospital. Infection and trauma were the mostly frequent causes of DVT in hospitalized children. The catheter-related DVT was increasingly prevalent cause for DVT in hospitalized children. The other causes included nephritic syndrome, tumor, systemic lupus, and congenital plasma C protein deficiency. Two patients were complicated with pulmonary embolism. Only one neonate died due to kernicterus. Anticoagulation therapy was the first recommended treatment choice in hospitalized children with DVT, especially more low-molecular-weight heparin in recent 10 years. Antithrombotic treatment was used in 9 children older than 30 days through peripheral venous access, its application should be meticulously cautious in dosage. No bleeding occurred in all the patients. CONCLUSIONS: Cautions should be given to DVT among hospitalized children due to its increasing incidence and special treatment pattern compared with adult patients.

[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.

[The value of regulated upon activation normal T cell expressed and secreted in the pathogenesis of varicose ulcer of lower limbs].

OBJECTIVE: To study the effectiveness of RANTES in the pathogenesis of venous ulceration. METHODS: 40 Chronic venous insufficiency (CVI) individuals were enrolled in the study and separated into the ulceration group (n=20) and non-ulceration group (n=20), according to CVI with or without ulceration, 10 healthy individuals were enrolled as control group. The expression of RANTES mRNA was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) in blood. Immunohistochemical staining of RANTES were carried in normal skin, in the tissue at the brim of ulceration and in the tissue of cured or curing ulceration. RESULTS: In ulceration group, the expression of RANTES mRNA in blood increased obviously. Compared with the other two groups, they were significant different (P < 0.05). The difference was also significance in the other two groups (P < 0.05). The average number of RANTES positive expression in normal skin is 28 +/- 13, in the tissue at the brim of ulceration is 107 +/- 44, and in the tissue of cured or curing ulceration is 35 +/- 20. There are significant difference between normal skin and the tissue at the brim of ulceration (P < 0.05). The average number of RANTES positive expression in the tissue of cured or curing ulceration is lower than that's in the tissue at the brim of ulceration. CONCLUSION: The high expression of RANTES may be one of the important mechanisms of varicose ulcer.

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.

[RANTES expression in venous ulceration of lower limbs].

OBJECTIVE: To investigate the expression of RANTES in venous ulceration. METHODS: From patients with lower limb venous ulceration, patients with non-ulcerous venous insufficiency, and healthy individuals, peripheral blood was collected from the lower limb veins for measurement of RANTES mRNA using RT-PCR. RESULTS: In the ulceration group, the expression of RANTES mRNA was significantly increased as compared with the other two groups (P<0.01). RANTES mRNA expression was also significant higher in the non-ulcerous group than the control group (P<0.01). CONCLUSION: High expression of RANTES mRNA may be one of the important mechanisms of venous ulceration.

[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.

[A random, comparative study on endovenous laser therapy and saphenous veins stripping for the treatment of great saphenous vein incompetence].

OBJECTIVE: To evaluate the therapeutic effects of endovenous laser therapy (EVLT) and saphenous veins stripping in the treatment of great saphenous vein incompetence. METHODS: Eighty cases (80 limbs) with great incompetent saphenous vein were randomly divided into 2 equal groups: EVLT group and stripping group. The patients in the EVLT group underwent EVLT and those in the stripping group underwent upper ligation and stripping of great saphenous vein. The duration of operation, blood losing, complications, pain grade, and hospitalization time were compared. All cases were followed up for 6 months and 12 months using Doppler sonography and air Plethysmography. RESULTS: The blood losing (P < 0.01), hospitalization time (P < 0.05) and pain grade (P < 0.05) in the EVLT group were all significantly less than those in the stripping group, while the operation duration and complication were not significantly different between the two groups (P > 0.05). All patients in both groups got improvements of venous volume (P < 0.05), Venous Filling Index (P < 0.01), and residual Venous Fraction (P < 0.01), yet there were no statistical differences between the two groups (P > 0.05). CONCLUSION: Endovenous laser therapy is a safe, effective, minimal invasive procedure for the patients with great saphenous vein incompetence. Its short-time efficiency is similar to that of the traditional upper ligation and laceration of greater saphenous vein.

[Clinical effects of endovenous laser therapy plus transilluminated powered phlebectomy in treatment of primary varicose veins].

OBJECTIVE: To evaluate the clinical and cosmetic effects of endovenous laser therapy (EVLT) plus transilluminated powered phlebectomy (TIPP) in the treatment of primary varicose veins. METHODS: The clinical effects of EVLT plus TIPP in treatment of 82 patients of primary varicose vein with 105 extremities were evaluated. The procedure-related parameters, clinical outcomes, and complications were recorded. The venous function was assessed by venous photoelectric plethysmography (VPPG). Aberdeen Varicose Veins Questionnaire (AVVQ) and Venous Clinical Severity Score (VCSS) surveys were used to appraise the quality of life and symptomatic alleviation. RESULTS: The successful rates of EVLT and TIPP was 98.1% (103/105) and 100% (105/105) respectively. The average operating time was 53.8 min (35 approximately 108 min). The average number of wounds was 4.4 (3 approximately 7). The postoperative hospitalization time was 4.8 d (2 approximately 6 d). The follow-up rates 3, 6, and 12 months after operation were 100%, 93.9%, and 35.4% respectively. Obvious symptom alleviation or entire disappearance was noticed in all the limbs 3 months after operation. The hemodynamic parameters, such as venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) were significantly ameliorated 1 month after the operation compared with those measured preoperatively (all P<0.01). No further improvements were noticed from then on (P>0.05). Disease specific quality of life was greatly improved after operation (P=0.000). 91.5% of the patients were satisfied with the postoperative appearance of the involved limbs. CONCLUSION: EVLT plus TIPP is an efficacious minimally invasive strategy for the treatment of primary varicose veins, resulting in approving cosmetic effect as well.

[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.

[Primary study of genes related to uterine leiomyoma].

BACKGROUND & OBJECTIVE: The occurrence of uterine leiomyoma is related to the abnormal expression of some genes, but the molecular mechanism has not been clarified yet, the study screened genes related to uterine leiomyoma by comparing different genes expressed in uterine leiomyoma tissues with normal myometrium uterine tissues. METHODS: To compare different genes expressed in uterine leiomyoma tissues with normal myometrium uterine tissues by fluorescent differential display reverse transcription polymerase chain reaction (FDD-RTPCR). Four sets of anchor primers and three sets of arbitrary primers, totally twelve primer combinations, were used for FDD-RTPCR amplification. Differentially expressed cDNA fragments were cloned, sequenced, and analyzed in origin. And one of differentially expressed bands was analyzed by RT-PCR. RESULTS: Twenty-seven cDNA fragments were isolated from uterine leiomyoma. N(568) cDNA fragment shared 96% homology with the sequence of GCRG114 gene. RT-PCR confirmed that this gene was expressed lowlier in uterine leiomyoma tissues than in normal myometrium uterine tissues. CONCLUSION: N(568) cDNA fragment is highly homologous with the sequence of GCRG114 gene, and it may be related to the development of uterine leiomyoma.