Abstract:Abstract:Objective:To study the therapy effect and review of the technique of endovascular treatment for iliac artery occlusion.
Methods :Thirty-four patients with occlusion of iliac artery were treated with endovascular therapy. The technical success rate, complication rate, the mid-term to long-term results were analyzed.
Results:The technical success rate was 100%. Iliac artery rupture in one case(2.94%) and no other major intraoperative complication occurred. Ankle-brachial index increased from (0.40±0.14) to (0.81±0.13) (t=2.67, P=0.02). All patients were followed up with mean time (19.32±2.22) months(range from 3 to 42 months). Iliac artery re-stenosis occurred in seven cases and re-occlusion in 3 cases. The primary, primary-assisted and secondary patency rate was 86.27%, 74.40%, 61.81%, 52.98%; 96.43%, 92.57%, 85.96%, 85.96% and 100%, 100%, 100%, 100% at 6m, 1, 2, 3 years after treatment, respectively.
Conclusions:Comprehensive application of “capturing guide wire” and other endovascular techniques can improve the success rate of recanalization of iliac artery occlusion. Maintenance of mid-term and long-term patency of endovascular treatment requires careful follow-up and prompt treatment of restenosis and reocclusion.

Abstract:Abstract:Objective:To investigate the effectiveness and limb salvage rate of treatment for occlusion of PTFE grafting in the lower limb.
Methods :From July 1998 to May 2007, 86 lower limbs with PTFE grafting occlusion in 79 patients were treated in Xuanwu Hospital. Thrombectomy for PTFE grafting occlusion was performed in 37 limbs (43.1%); thrombectomy combined with new PTFE prosthesis to reconstruction the distant artery was performed in 13 limbs (15.1%); thrombectomy combined with interventional therapy was performed in 13 limbs (15.1%); Re-grafting with new PTFE graft was carried out in 9 limbs (10.5%); medical treatment was used in 7 limbs (8.1%); amputation was performed in 7 limbs (8.1%).
Results:Twenty-two limbs in 21 patients were amputated. Eight patients died. The limb salvage rate in revascularization patients was 63%.
Conclusions:Thrombectomy in the occluded PTFE graft, thrombectomy combined with graft-tibial or peroneal artery bypass, thrombectomy in PTFE graft combined with interventional therapy, and re-grafting with a new PTFE graft can be used. Those methods are effective treatment and can avoid amputation in most patients.

Abstract:Abstract:Objective:To evaluate the effect of percutaneous transluminal angioplasty(PTA) with microballoon for patients with infrapopliteal artery occlusive disease.
Methods :The clinical materials of 32 cases(37 limbs) with infrapopliteal artery occlusive disease treated by PTA with microballoon were retrospectively studied.According to Fontaine staging, 22 limbs(59.5%) were in stage Ⅲ and 15 limbs(40.5%) in stage Ⅳ.Preoperative ABI was 0.22±0.20.
Results:The technical success rate was of 94.6% (35 limbs).Of these limbs,rest pain disappeared in 21 limbs(66.0%) and clinical symptoms were relieved obviously in 12 limbs(34.3%).Of the preoperative foot ulcers in 9 limbs,3 healed.Of the 6 limbs with foot or toe gangrene,1 underwent below-knee amputation and 2 received partial foot amputation.The postoperative ABI was 0.73±0.21.All the 35 limbs with successful operation were followed up with an average period of 13.6 (1~29) months. During follow-up, 2 limbs had recurrence of rest pain at 6m and 14m after operation, respectively; and the symptoms were relieved after a second PTA. The signs and symtpoms in the other 33 limbs did not increase or recur.
Conclusions:PTA with microballoon is a feasible technique in the treatment of infrapopliteal artery occlusive disease,especially in poor risk patients.Long-term results need to be further studied.

Abstract:Abstract:Objective:To analyze the operative effect of carotid-subclavian bypass grafting for subclavian artery occlusion.
Methods :Seventeen patients with subclavian artery disease were diagnosed by arteriography and received carotid-subclavian bypass grafting. Graft patency was determined by Duplex ultrasound scan examinations.
Results:All 17 patients undergoing bypass grafting achieved immediate relief of symptoms. The blood pressure differences between the treated and the healthy arms were less than 10 mmHg after operation. The ratio of healthy/diseased side of the mean blood pressure index increased from 0.64±0.12 preoperatively to 0.98±0.10 postoperatively (P＜0.01). No perioperative stroke or death occurred. By 7.1 years of the mean follow-up, the patency rate at 1 and 5 years was 100% and 94.1%,respectively.
Conclusions:Carotid-subclavian bypass grafting for subclavian artery disease has shown to be very safe and effective, and with excellent long-term patency. We think it shoud be offered to good-risk surgical candidates who may be seeking a more durable procedure.

Abstract:Abstract:Objective:To compare the therapeutic effect of endovascular repair(EVAR) and open surgical repair (OSR) of abdominal aortic aneurysm, and discuss how to select a proper time and method of operation.
Methods :The clinical data of fifty-one patients with infrarenal abdominal aortic aneurysm who received surgical treatment in the recent four years were analyzed. The perioperative and short term advantages and disadvantages of OSR group (n=37) were compared with EVAR group (n=14).
Results:Compared to OSR group, the EVAR group had shorter time of operation and intensive care(P<0.05), and shorter hospital stay after operation (P<0.01), but the cost of hospitalization was far higher than that of OSR group［(137 000±47 000) vs. (34 000±7 000)］.There was no statistically significant difference in short term postoperative complications between the two groups.
Conclusions:EVAR is safer and less traumatic method than OSR, and patients can recover more rapidly. But the cost of hospitalization of EVAR remains too exorbitant.Large randomized controlled trial is necessary to validate the long term effects of EVAR.

Abstract:Abstract:Objective:To observe the effect of elevated local sheer stress of abdominal aota on its caliber and wall expression of MMP-9, and analyse the action of high shear stress on arterial remodling.
Methods :Forty-eight SD rats were randomly divided into 4 experiment and 4 comparison groups. An infra-renal aortocaval fistula was constructed by needle puncture using a 0.4mm needle in the experiment groups.The aorta proximal to the fistula was harvested after 1 d, 7 d,14 d and 28 d respectively,while sham operation was done in the comparison groups.The diameter and wall thickness of the aorta were measured after fistula was made and before harvest. The level of change of MMP-9 was observed by immunohistochemistry.
Results:The diameter of aorta proxinal to the fistula was enlarged in the 1d group (P＜0.05),and the values increased with time; but wall thickness was decreased. MMP-9 expression reached the peak value at 7d (P＜0.01),and remained at a high level of expression at 28 d.
Conclusions:Increased shear stress of abdominal aorta in rats can induce positive remodelling with increase in dieameter of arterial wall and decrease in wall thickness, and expression of MMP-9 is upregulated. This positive remodelling is closely related to expression of MMP-9. Increased shear force and increased expression of MMP-9 are important factors in the gradual dilatation of the proximal and distal segments after arteriovenous fistula formation.

Abstract:Abstract:Objective:To investigate the structural, physical performance and antigenic changes of allogenic small vessels after treatment by removal of endothelial cells, gelsiccation and irradiation. This research was intended to learn whether treated allogenic small vessels are suitable for blood vessel transplantation.
Methods :The blood vessels were randomly divided into A group and B group, in which A group was control group while B group had removal of endothelial cells as well as gelsiccation and irradiation. The tissue structure of each group was examined by light microscopy,and the condition after removal of endothelial cells was examined under electron microscope.The dilated diameter, expanded length and the largest force that the vessels could sustain in transverse and perpendicular directions when the vascular tension reached 15, 30, 45, 60, 90, 120N and 180N were calculated, and the degree of change both in transverse and perpendicular directions of the vessels under such forces was calcalated. Finally, the expressive level of major histocompatibility complex (MHC)-Ⅱantigens both pre-and post treatment was detected using immunohistochemistry S-P statistic way.
Results:The blood vessels maintained almost the same tissue structure after treatment in B group, and the changed rates both in transverse and perpendicular directions of the vessels under different tensions of the two groups had no statistical significance (P＞0.05). However, in B group, the greatest tension that the vessels could withstand in the transverse and perpendiculaar direction at the time of rupture was significantly greater than that of the control(P<0.01 and P<0.05, respectively). The MHC-Ⅱantigen level of B group was significantly lower compared to control group (P＜0.01).
Conclusions:There is no obvious change in tissue structure of allogenic blood vessels after treatment by removal of endothelial cells, gelsiccation and irradiation, meanwhile, the blood vessels could maintain certain physical characteristics. The MHC-Ⅱantigen level decreased dramatically. The vessel after treated with the method of B group basically meets the demands for vascular transplantation, and is an ideal material for such kind of operation.

Abstract:Abstract:Objective:To observe the effect of external segmental irradiation at a total dose of 35Gy after prosthetic vessel replacement of abdominal aorta on the patency rate, the neointima proliferation and the covering of vascular endothelial cell of the vascular graft.
Methods :Prosthetic vessel replacement of abdominal aorta with ePTFE vascular graft was done in 20 mistus dogs, which were divided into control group and radiotherapy group, 10 dogs respectively. The specimen in each group were harvested at 4 weeks and 8 weeks after surgery. H-E staining, immunohistochemistry test of PCNA and CD34 were done.
Results:There was 1 case in each group with thrombosis in prosthetic vascular graft, and the patency rate was 90% in each group. Four weeks after surgery, the neointima of prosthetic vascular graft was formed completely in each group, and the intimal thickness or the PCNA expression had no statistically difference(P>0.05) between the radiotherapy and control groups, and the coverage of vascular endothelial cell was incomplete in each group; 8 weeks after surgery, the intimal thickness of radiotherapy group was statistically thinner than that of control group(P<0.05), and the intimal thickness of vascular graft in control group at the proximal, middle, and distal segment was: (72.30±9.15)μm,(40.46±7.75)μm and (98.06±6.90)μm respectively，and that in radiotherapy group was: (37.67±6.77)μm,(21.16±4.98)μm and (56.64±5.13)μm respectively. The PCNA expression was statistically less in radiotherapy group than that in control group(P<0.05). The vascular endothelial cell coverage was complete in each group.
Conclusions:The external segmental radiotherapy at a total dose of 35 Gy after prosthetic vessel replacement of abdominal aorta does not affect the patency rate of prosthetic vascular graft, and not significantily affect the vascular endothelial cell coverage, but it can inhibit the neointima proliferation and PCNA expression.

Abstract:Abstract:Objective:To investigate the role of AGE-RAGE system on intimal hyperplasia in autogenous vein graft of diabetic rats.
Methods :The experiments were performed on 40 male Sprague-Dawley rats which divided into two groups: diabetes group and control group. Autogenous vein graft model was established in all rats. Specimens were harvested 7 days and 14 days after surgery for histological examination, and RAGE, NF-κB p65 and VCAM-1mRNA were measured by semi-quantitative reverse transcription-PCR. Western Blotting and immunohistochemistry were used to detect the protein expression of RAGE, NF-κB p65 and VCAM-1. At the same time, the levels of serum AGE were tested.
Results:Compared with non-diabetic rats of control group, the intimal hyperplasia of vein graft in diabetic rats obviously increased (P<0.05). At the same time, themRNA and protein expression of RAGE, NF-κB p65 and VCAM-1 obviously increased (P<0.05), and the level of the serum AGE obviously increased (P<0.05).
Conclusions:AGE-RAGE system activated NF-κB and enhanced the expression of VCAM-1, which might be the cause of increased intimal hyperplasia in autogenous vein graft of diabetic rats.

Abstract:Abstract:Objective:To observe the intimal changes of inferior caval vein (ICV) wall after combined thrombolysis and anticoagulation therapy for acute thrombosis in rats.
Methods : The inferior caval venous thrombosis model was established in 105 rats and they were randomly diride into 3 treated groups: heparin (A) treatment group （n=35），urokinase (B) treatment group （n=35），and combination of urokinase and heparin (C) treatment group （n=35），and also eslablished a sham (D) group（ n=30）. The thrombosed caval veins were taken 1， 4，7，14，and 28 d after thrombosis. Changes of thrombus structure and orgainization and intimal hyperplasia were observed by light microscope. The expression areas of collagen fiber were measured by histochemistry. Scanning electron microscopy was used to observe the damage of endothelial cells.
Results:The intimal hyperplasia in A group was the most severe. The expression area of collagen fiber in group C was less than that of A and B groups（P<0.01）. At 7 d, intimal injury in B and C groups was less than A group (P<0.05). At 28 d, intimal injury in the C group was less than that in A and B groups (P<0.05).
Conclusions:Combination of urokinase and heparin for the treatment of acute inferior caval venous thrombosis of rat has good short and mid-term effect. It effectively maintains the integrety of endothelium of vein wall and decreases the fibrocellular proliferation of the thrombosed vein.

Abstract:Abstract:Objective:To study the effet of ET-1 and ECE on endothelial proliferation of autografted vein.
Methods :An animal model of the autogenous vein graft was established in 80 Wistar rats. The expression of ECE and EF-1 gene was determined by RT-PCR and immunohistological method to test the mRNA and protein expresion level respectively.
Results: PCNA positive smooth muscle cells appeared 6 hours after transplantation, increased with time, and reached a peak at 1 to 2 weeks. After 2 weeks, PCNA positive SMC in the tunica media began to decline and recovered to the 6 hour level at 8 weeks after the operation. mRNA of ECE increased with the time after the operation, reached a peak after 1-2 weeks, declined afterwards, and became stable at around 8 weeks. Expression change of ET1 was similar to the change of ECE, reached the peak after 1-2 weeks and was stable after 8 weeks (r=0.975).
Conclusions:The time and pattern of change of the pathologic process of intimal hyperplasia are in agreement with the expression of ET-1 and ECE, and suggests that ECE is involved in the process of intimal hyperplasia of vein graft.

Abstract:Abstract:Objective:To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor (VEGF) as preparation for later use for genetic transfection.
Methods :Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316. Subsequently, this newly constructed plasmid pDC316-VEGF, after identification by nuclease digestion analysis and sequencing analysis, was transfected into human embryonic kidney cells HEK293 by lipofectamine 2000 mediation, together with adenovirus-packaging plasmid pBHGE3. Based on the homologous recombination of the two plasmids within HEK293 cells, the recombinant adenovirus vector carrying VEGF, VDC316-VEGF, was created. VDC316-VEGF was subsequently identified using PCR, purified using repeated plaque passages, proliferated using freezing and melting within HEK293 cells, and titrated using 50% Tissue Culture Infective Dose (TCID50) assay.
Results:The newly constructed recombinant adenovirus was confirmed carrying rat VEGF by PCR, and its titration value determined based on TCID50 assay was 3×109pfu／ml.
Conclusions:The recombinant adenovirus carrying rat VEGF was successfully constructed. The newly constructed adenovirus can produce a sufficiently high titration value within HEK293 cells, providing a reliable tool for genetic transfection in further gene therapy researches.

Abstract:Abstract:Objective:To explore the effect of amino-functional Fe3O4 nanoparticles-mediated pcDNA3.1(+)-p53(-p53) on human hepatoma cell line-HepG2 cell.
Methods :(1) Use of functional Fe3O4 nanoparticle as a vector to transfect-p53 into HepG2 cells, calulate the transfected rate, and compare it with lipofectamine vector group, blank functional Fe3O4 nanoparticles(FFN) group and control group. (2) Observation of the trasfected rate and velocity of FFN under addition of extra-magnetic field. (3) Observation of the inhibition effect of trasfected-p53 on HepG2 cells growth.
Results:(1) RT-PCR and Western blot examination comfirmed that FFN could successfully transfect-p53 into HepG2 cells, the transfection rate(39%) was slightly higher than that of liposome (36%)(P>0.05). (2) The transfection rate and velocity could be increased by addition of extra-magnetic field. (3) Transfected-p53 obviously inhibited the growth of HepG2 at G1 phase; the growth inhibition rate of HepG2 was 46%.
Conclusions:(1) FFN is a good vector for gene transfection, it can successfully transfect the gene into target cells. (2) Transefected-p53 can effectively inhibit the growth of HepG2. This result can establish a foundation for animal experimental research of gene therapy of malignancy.

Abstract:Abstract:Objective:To evaluate intra-artery transcatheter thrombolytic therapy for the treatment of acute lower extremity deep vein thrombosis (LEDVT).
Methods :A total of 68 patient with LEDVT were randomly divided into two groups to respectively receive intra-artial transcatheter thrombolysis (Group A), or intra-venous thrombolysis (Group B). The PT, FIB, D-dimer and the perimeter of limbs were examined and measured before and after treatment, the circumference difference between normal and affected limbs was measured to assess the reduction of edema, and the venous patency score and the patency improvement were observed by venograms or Duplex.
Results:No haemorrhage occurred during the treatment in Group A, but 4 patients in Group B had clinical haemorrhage. After treatment, increase of PT, and decrease of FIB and D-dimer was found in both groups (P<0.05). The reduction of edema in Group A after treatment was significantly more than that in Group B(P<0.01), and the mean rate of venous patency improvement was also significantly different(P<0.01)between the two groups［Group A (54.81±3.21)%,Group B (31.52±3.89)%］.
Conclusions:The preliminary experience suggests that intra-arterial transcatheter thrombolytic therapy is a safe and effective treatment for acute LEDVT.

Abstract:Abstract:Objective:To comparatively study the treatment effects of three surgical approaches for saphenous vein varicosity.
Methods :During the past 5 years,180 cases of saphenous vein varicosity were treated by new stripper, traditional stripper, laser or radio-frequency respectively each group had 60 cases. The time of surgery, amount of bleeding, hospitalization fee, mean length of hospital stay and postoperative of complications of the 3 group were compared.
Results:Time of surgery and amount of bleeding were less with new stripper than that with traditional stripper (P＜0.01), hospitalization fee and mean length of hospital stay were similar. Time of surgery and hospitalization fee were also less with new stripper than that with laser or radio-frequency(P＜0.01), but amount of bleeding was more with new stripper and mean length of hospital stay was similar. Postoperative complication rate was similar in the three groups.
Conclusions:The therapeutic effect of surgery for saphenous vein varicosity with new stripper was better than that with traditional stripper, and as good as surgery with laser or radio-frequency, treatment.

Abstract:Abstract:Objective:To explore the factors related to effects and prognosis of surgical treatment of hilar cholangiocarcinoma.
Methods :The clinical data of 41 patients with hilar choIangiecarcinoma (HCCA) admitted in recent seven years were investigated and anlyzed retrospectively.
Results:Among 41 patients with HCCA,the accuracy rate of diagnosis by imaging technology was 95.1% before operation. Thirty-two cases were treated by surgical resection, of which 15 cases had radical resection and 17 cases had palliative resection, the total resection rate was 78.1%, and 9 cases had biliary internal drinage procedure. Two cases died during hospitilization. The rate of one-,three-and five-year survival for surgical resection was 70.0%，40.0% and 23.3％ respectively,and for palliation drainage was 44.4%，11.1%，and 0%, respectively.The median survial time was 28 months and 8 months for surgical resction and palliation drainage, respectively.The difference between surgical resction and palliation drainage on survival rate and median survival time was signigicant (P<0.05 and P<0.05 respectively).In 14 of the cases were treated with R0, the 1-,3-and 5-year survival rate and median survival time was 85.7%、64.3%、35.7% and 52 months respectively; and different rank of operation had different curative effects(P<0.05).Acording to Bismuth type,type II had a the higher survival with 1-,3-and 5-year survival rate and median survival time of 85.7%、71.4%、42.9% and 72 months respectively. The resection rate for papillary and highly differentiated adenocarcinoma was 77.8% and 78.3%, respectively, and the 1-,3-and 5-year survival rate was 77.8%, 44.4%,33.3%,and 73.9%,65.2% 17.4%, respectively; while it was 20%, 0% and 0% respectively for low differentiated carcinoma.Conclusions:The curative efficacy of surgery and postoperative prognosis of HCCA depend largely on different clinical characteristics, pathological type and surgical method. Radical resection plays a key role to improve long-term survival.

Abstract:Abstract:Objective:To evaluate the effect of laparoscopic cholecystectomy (LC) combined with bile duct exploration and stone removal (BDE) and LC with endoscopic sphincterotomy (EST) in treating cholecystolithiasis with choledocholithiasis.
Methods :Among 256 cases of cholecystolithiasis and choledocholithlasis, 132 patients were treated by LC+LCBDE, and 124 cases by EST combined with LC. The operation success rate, operation time and cost, complication rate, and length of hospital stay of the two groups were compared.
Results:There was no statistical difference in the operation success rate, complication rate, stone clearance rate, and average hospital stay between the two groups, but EST+LC group had significantly longer operation time and higher cost.
Conclusions:There are respective indications, advantages and disadvantages in the two groups. EST+LC is the better choice for patients with diameter of CBD＜1.0 cm, stones impacted in the distal CBD, or old age. Otherwise, for patients with diameter of CBD>1.0cm and with multiple choledocholithiasis, especially for middle-aged patients, the better way is LC+LCBDE.