Abstract:

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are currently the most commonly used and effective treatment methods for carotid atherosclerotic stenosis. However, because of differences in operative performance, applicable population and perioperative complications between the two procedures, there has been continued controversy over the selection of treatment method. In this paper, the authors review the developmental history of this issue and summarize the results of the related controlled clinical trials.

Abstract:

With the development and application of advanced materials and new techniques in recent years, encouraging achievements have been made in endovascular therapy of arteriosclerosis obliterans of the lower extremities. In this paper, the author summarizes the advances from recent related controlled clinical trials, and suggests the existing problems and future prospects.

Abstract:

In endovascular therapy of lower-extremity arteriosclerosis obliterans, attention has been focused on the proper management of the lesions involving the popliteal artery. In this paper, the author discussed the technical essentials of endovascular treatment for popliteal arteriosclerotic lesions from aspects of the anatomical features of the popliteal artery, choice of treatment method, whether stent placement is required and stent selection. It is pointed out that avoidance of stent implantation in the popliteal segment should be considered as the overriding principle; for those cases where stent treatment must inevitably be performed, the essential strategy for improving long-term efficacy is based on the appropriate selection of stent and a suitable stent implantation strategy, and lessening the alterations of the initial morphological pattern and hemodynamics of the popliteal artery after stent implantation.

Abstract:

Application of endovascular techniques has become increasingly common in treatment of arteriosclerotic lesions of the lower limbs. Their indications have gradually expanded and some "forbidden zones" considered previously are also successively explored. In this paper, the authors summarize and discuss the current indications, new explorations and methods as well as efficacy of endovascular techniques in treatment of lower-extremity arteriosclerotic lesions.

Abstract:

Objective: To investigate the safety and efficacy of Silverhawk atherectomy and adjunctive angioplasty in treatment of severe arterial atherosclerotic occlusive lesion below the knee. Methods: The clinical and follow-up data of 9 patients with this condition treated over the past 2 years were retrospectively analyzed. Of the patients, 3 cases were male and 6 were female, with a mean age of (64.0±9.1) years and mean disease course of (28.9±25.9) months; 5 cases had intermittent claudication, one case had rest pain, one case had toe ulcer, and 2 cases had toe gangrene; the occlusive lesion in 6 cases was located in the tibioperoneal trunk, in one case in the anterior tibial artery, and in 2 cases in the posterior tibial artery; one case underwent plaque excision alone and the other 8 cases underwent simultaneous endovascular procedure for the inflow arterial lesion. Results: All operations were successfully performed, and the recanalized artery was patent in all patients at discharge. The claudication distance increased to more than 500 m in the 5 claudication patients and the case with rest pain was relieved; the wound size of the one case with toe ulcer was reduced, and the gangrene in the 2 patients became dry and was not infected. Postoperative ankle brachial index (ABI) was increased in all patients compared with their preoperative value. All patients were followed-up for an average of (24.0±9.5) months. One patient died 23 months after operation due to myocardial infarction; claudication distance in one patient was decreased compared with the former best postoperative distance, but was still longer than the preoperative distance; the wound was healed in the ulcer patient; the rest pain that was present in one patient was relieved; of the 2 patients with toe gangrene, the dry state was kept in one case and in another case, the two gangrenous toes spontaneously detached and the wounds were healed. Conclusion: Silverhawk atherectomy and adjunctive angioplasty is a safe and effective method in treatment of severe arterial atherosclerotic occlusive disease below the knee, whereas, whether it will become a conventional treatment modality requires the verification by long-term results from randomized controlled trials.

Abstract:Objective: To present the experience in hybrid procedure for TASC type D peripheral artery diseases (PAD). Methods: The clinical data of 22 patients (24 limbs) undergoing hybrid procedure for TASC type D PAD from October 2009 to December 2013 were retrospectively analyzed. Of the patients, 12 cases underwent iliac artery stent placement plus common femoral endarterectomy (including deep femoral endarterectomy) and profundaplasty with femoropopliteal prosthetic bypass, 4 cases underwent common femoral endarterectomy (including deep femoral endarterectomy) plus femoropopliteal prosthetic bypass and balloon dilatation of the anterior tibial artery or posterior tibial artery, and 6 cases underwent Fogarty catheter embolectomy plus iliac artery stent placement and common femoral endarterectomy (including deep femoral endarterectomy). Results: Technique success was achieved in all patients, and no perioperative death occurred. After operation, the pain was relieved and skin temperature was increased in the affected limbs, and the average ankle brachial index was increased from the preoperative 0.38 to postoperative 0.75. Eighteen patients were followed-up for 3 to 28 months; 2 cases developed postoperative thrombosis in the prosthetic bypass and one case developed stenosis in the stent, while no prosthesis- or stent-related complications occurred in any of the remaining cases. Conclusion: Hybrid procedure is minimally invasive, effective and safe. It is an appropriate choice for TASC D PAD, especially for those with high risk for single endovascular therapy.

Abstract:Objective: To investigate the clinical efficacy of iliac artery stenting plus femoral endarterectomy and patch angioplasty in treatment of multisegment iliofemoral arteriosclerosis obliterans. Methods: Forty patients with multisegment iliofemoral occlusion admitted from March 2010 to March 2013 were selected, and all of them underwent iliac artery stenting plus femoral endarterectomy and patch angioplasty. Results: Operation was successfully performed in all patients, and the clinical symptoms in 37 patients (92.5%) were significantly improved after treatment. The intermittent claudication distance and resting ankle-brachial index were significantly higher than those before operation (both P<0.05). The forty patients were followed-up for 12 to 45 months after operation; the primary patency rate was 70.0%, the assisted primary patency rate was 82.5%, and the second-stage patency rate was 92.5%, respectively. Statistical analyses showed that the primary patency rate in patients with Fontaine stage II disease was significantly higher than those with stage III and IV disease (P=0.039; 0.015), and no independent influential factor for the postoperative primary patency rate was found. Conclusion: Minimally invasive operation has demonstrable efficacy in treatment of multisegment iliofemoral arteriosclerosis obliterans, and it should be performed at the early stage of development of clinical symptoms so as to obtain the best primary patency rate.

Abstract:Objective: To investigate the options of treatment strategy for acute limb ischemia (ALI). Methods: The clinical data of 15 patients with ALI, treated from 2012 to 2013, were retrospectively analyzed. Results: All patients underwent evaluation of the severity of acute limb ischemia before treatment. Of the patients, 11 cases were caused by embolism and 4 cases were caused by thrombosis; 9 cases had an aortic or iliac artery occlusion, 3 cases had superficial femoral artery occlusion, and one case each had a lesion in the popliteal artery, artery of the lower leg and brachial artery, respectively; limb ischemia in one case was classified as grade IIa, 12 cases were grade IIb, and 2 cases were grade III. All the patients, except one who refused primary amputation and received drug treatment only, underwent urgent revascularization that included surgical embolectomy in 11 cases, endovascular thrombolysis in 2 cases, and hybrid procedure in one case. During their hospital stay, no death occurred, amputation was performed in 2 cases, reperfusion injury developed in 3 cases but fasciotomy was not required in any of them, and the median length of hospital stay was 9 (3–27) d. During a mean follow-up period of 9 (1–21) months, 3 patients (20%) died, and no additional amputation was performed. The total limb salvage rate was 66.7%. Conclusion: Accurate evaluation of severity of ischemia, and prompt and appropriate revascularization procedure are crucial for treatment of ALI.

Abstract:Objective: To evaluate the clinical efficacy of catheter-directed thrombolysis (CDT) for arterial thrombosis after extremity injury (non-open injuries). Methods: The clinical data of 152 patients (152 limbs) with arterial thrombosis secondary to extremity injury admitted from March 2005 to March 2013 undergoing CDT treatment were retrospectively analyzed. All patients received CDT treatment that included CDT alone in 89 cases, CDT plus percutaneous transluminal angioplasty (PTA) in 51 cases, and CDT plus PTA with stent placement in 12 cases. Results: The CDT treatment time in the entire group ranged from 1 to 7 d with an average time of (4±1.5) d. One-hundred and five patients (69.1%) were cured, of whom 72 cases underwent CDT alone, 21 cases underwent CDT plus PTA, and 12 cases underwent CDT plus PTA with stent placement; 30 patients (19.7%) were improved and all of them underwent CDT plus PTA, while 17 patients (11.2%) were unimproved, of whom, primary amputation was performed in 15 cases (9.9%). A secondary embolization occurred in 5 patients during thrombolysis and they underwent thrombolysis therapy again after adjustment of the catheter position, and 23 patients (15.1%) underwent fasciotomy due to compartment syndrome of lower leg and their legs were salvaged. One-hundred and thirty-two patients (86.8%) were followed-up for 12 to 108 months, with an average time of (50±22) months. Except for 2 cases who were subjected to a two-stage amputation, no worsening or recurrence of the symptoms was noted in any of the follow-up patients. Conclusion: CDT is a safe, effective and minimally-invasive treatment method for arterial thrombosis after extremity injury.

Abstract:Objective: To investigate the influence of perioperative level of high-sensitive C-reactive protein (hs-CRP) and interleukin 6 (IL-6) on restenosis following femoropopliteal stenting. Methods: Forty-seven patients with femoropopliteal arterial occlusive disease undergoing stent implantation were selected, and their serum levels of hs-CRP and IL-6 on 24 h before and 3 d after operation were determined. Patients were followed-up for 6 months, and ultrasonography was used to detect intra-stent stenosis. The relations of hs-CRP and IL-6 level as well as the preoperative blood glucose concentration, lipid profile and degree of disease with postoperative restenosis were analyzed. Results: All the 47 patients were successfully managed with femoropopliteal stenting, and restenosis occurred in 13 cases during the postoperative follow-up period of 6 months. The levels of hs-CRP and IL-6 at 24 h before and 3 d after operation in restenosis group were all significantly higher than those in non-restenosis group (all P<0.05), and in both the restenosis group and non-restenosis group, the postoperative hs-CRP and IL-6 levels were increased compared with the levels before operation, but the differences in their increasing degrees between the two groups showed no statistical significance (both P>0.05). In addition, the ratio of patients with diabetes mellitus in restenosis group was higher than that in non-restenosis group (P<0.05), and the higher the preoperative TASC II grade was, the more frequent was the occurrence of postoperative restenosis (χ2=7.245, P=0.027). Conclusion: Increased preoperative levels of hs-CRP and IL-6 may increase the risk of restenosis after femoropopliteal stenting, and moreover, restenosis is also closely associated with diabetes mellitus and preoperative severity of the femoropopliteal arterial lesion.

Abstract:Objective: To observe the impact of high hydrostatic pressure on vasa vasorum in the walls of the great saphenous vein and splenic vein. Methods: The specimens of great saphenous varicose vein and portal hypertension-splenic vein (disease groups), along with the specimens of normal great saphenous vein and splenic vein (normal control groups) were collected. CD34 immunohistochemical staining and Masson staining were performed to calculate the number and cross-sectional area of the vasa vasorum in each group of vessel walls, and quantitative analysis was also conducted. Results: Morphological observation showed that there was remarkable vasa vasorum proliferation in both disease groups compared with their paired normal control groups. Quantitative analysis showed that the number and cross-sectional area of the vasa vasorum in either adventitia or tunica media in both disease groups were significantly higher than those in their paired normal control group (all P<0.05); the difference in number of the adventitial vasa vasorum between disease group and normal control group of the splenic vein was significant higher than that of the great saphenous vein, while the difference in average cross-sectional area of the adventitial vasa vasorum between disease group and normal control group of the greater saphenous vein was significantly higher than that of the splenic vein (both P<0.05), but both the differences in the tunica media between the two vessels had no statistical significance (both P>0.05). Conclusion: Under high hydrostatic pressure, the vasa vasorum is proliferated in the wall of the great saphenous vein and splenic vein, but its proliferation pattern has heterogeneity, which presented in the great saphenous vein mainly as enlargement of lumen size while in splenic vein mainly as increase of number.

Abstract:Objective: To investigate the alteration of the interleukin 6 (IL-6) level in the development of deep vein thrombosis (DVT) in rats and its actions. Methods: Sixty male SD rats were randomly divided into sham operation group (n=10) and model group (n=50). Rats in model group underwent bilateral femoral vein clamping plus plaster cast immobilization of the hind legs to induce hind limb DVT, and were sacrificed at 2, 5, 10, 15 and 25 h after operation respectively, with 10 rats in each time point, to obtain the vein samples. Then, the incidence of thrombus formation in the femoral vein specimens was observed, IL-6 mRNA level in the endothelial tissue of the femoral vein was measured by real-time PCR, and the serum levels of IL-6, plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA) were determined by ELISA assay. Results: No thrombus formation was observed in rats in model group 2 h after operation, but thrombosis began to occur 5 h after operation and was increased with time. In rats of model group, the IL-6 mRNA level in the endothelial tissue of the femoral vein was gradually increased after operation, and reached the peak at postoperative 15 h; the alterations of both the serum IL-6 and PAI levels showed the same pattern of the alteration of the IL-6 mRNA level, while the serum tPA level presented the completely opposite changing pattern of the serum IL-6 and PAI levels. All the differences in above parameters at each observed time point in model group reached statistical significance in comparison with those in sham operation group (all P<0.05). Conclusion: IL-6 level is increased during the process of development of DVT in rats, and this may promote thrombosis through increasing PAI production and inhibiting tPA activation.

Abstract:Objective: To construct the U6/H1 dual promoter siRNA expression cassettes (SEC) targeting human telomerase hTERT gene, and to observe the interfering effect of their transcription products on hTERT gene activity in HeLa cells. Methods: By fusion PCR, three U6/H1 dual promoter SECs targeting the open reading frame of the hTERT gene and one SEC targeting the 3’ untranslated region of the hTERT gene were constructed. The SECs were transferred into human cervical cancer HeLa cells respectively after identification, and then the telomerase activity in the HeLa cells was assessed by telomeric repeat amplification protocol (TRAP). Results: The four SECs targeting human telomerase hTERT gene were all successfully constructed, and after their transfection into the HeLa cells, the rate of telomerase activity inhibition was 36.8%, 57.39%, 80.47%, and 70.31%, respectively. Conclusion: The successful construction of SECs targeting human telomerase hTERT gene may provide a novel effective approach for study of the gene interference of tumor telomerase.

Abstract:Objective: To evaluate the safety and efficacy of emergent endovascular repair for acute Stanford type B aortic dissection with malperfusion syndrome. Methods: Between January 2006 and December 2013, a total of 23 patients with acute Stanford type B aortic dissection and concomitant malperfusion syndrome were admitted, and all patients were reliably diagnosed by CT angiography of the whole aorta before operation. Of the patients, 16 cases were male and 7 were female, and aged 42 to 68 years; 8 cases were complicated with renal malperfusion (6 cases were unilateral), 9 cases had malperfusion of the superior mesenteric artery, 5 cases had unilateral lower extremity malperfusion, and one case suffered from spinal cord malperfusion; 17 cases received emergent endovascular repair and associated adjuvant treatment, and 6 cases who refused the procedure underwent conservative treatment. Results: All the 6 patients undergoing conservative treatment died within 2 weeks. Closure of the primary entry tear with a covered stent-graft was performed in all of the 17 patients who received emergent operation; among whom, malperfusion of the aortic branches was improved in 13 cases after closure of the primary entry tear; in one case with the primary entry tear located at the middle portion of the descending aorta, a bare stent placement was performed first to dilate the true lumen and then the primary entry tear was closed with a covered stent-graft; 3 patients underwent additional bare stent placement for one renal artery or superior mesenteric artery after closure of the primary entry tear. No death occurred in 30 d after operation. During the follow-up period of 3 to 36 months for the 17 patients, one case died due to myocardial infarction 6 months after operation, while all the remaining patients were alive and no stent-related complications were observed. Conclusion: Emergent endovascular repair with restoration of visceral organ blood flow is important method for saving the lives of patients with acute Stanford type B aortic dissection and concomitant malperfusion syndrome.

Abstract:Objective: To investigate the diagnosis and treatment strategy of spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: The clinical data of 3 SISMAD patients treated in the Department of Vascular Surgery of Xiangya Hospital of Central South University from October 2012 to May 2013 were retrospectively analyzed. The clinical manifestations, imaging features, treatment strategy options and prognosis of the SISMAD patients were summarized. Results: Of the 3 SISMAD patients, 2 cases were male and one case was female; the clinical symptoms were abdominal pain with nausea and vomiting; pre-treatment CTA showed the formation of an intimal flap separating the true and false lumen in the superior mesenteric artery, which was identified as Sakamoto type II in 2 cases and type III in one case; no case was complicated with dissection rupture or bleeding, or intestinal necrosis. All of the 3 patients underwent initial anticoagulant therapy with low-molecular-weight heparin calcium, and then endovascular stent placement. No severe complications occurred and the abdominal pain of the patients was alleviated after treatment. Follow-up was conducted for 2 to 8 months; the 3 cases were all alive, their symptoms disappeared, and the stents were patent. Conclusion: CTA is recommended in patients suspicious for SISMAD to confirm the diagnosis, and endovascular stent placement based on anticoagulant therapy is a safe and effective treatment modality for those without dissection rupture/bleeding or intestinal necrosis.

Abstract:Objective: To investigate the clinical efficacy of integrated endovascular therapy for iliac vein compression syndrome (IVCS) with secondary deep vein thrombosis (DVT). Methods: From October 2004 to October 2012, 315 patients with IVCS and DVT were enrolled, with left leg involvement in 277 cases and right leg involvement in 38 cases. All patients underwent ipsilateral femoral vein puncture under local anesthesia, a 12- to 14-F sheath was inserted via a guidewire, and then mechanical thrombus aspiration or additional embolectomy with Fogarty balloon was performed, and the iliac vein stenosis or occlusion was treated with angioplasty or stent placement. Patients received anticoagulation therapy or/and catheter-directed thrombolysis after operation according to the degree of thrombus removal. Results: The swelling and pain in all the affected legs was alleviated 1-2 d after operation. Thrombus removal of grade III (removal rate greater than 95%) was 80.32%, grade II (removal rate between 50% and 95%) was 18.09%, and grade I (removal rate less than 50%) was 1.59%. The results of stent placement showed that 86.03% were excellent, 10.79% good, 2.54% improved and 0.64% unimproved. The differences between the leg circumference of the normal and affected extremities at 15 cm above and below the knee joint at time of discharge were all less than those at admission (both P<0.05). The follow up patency rate at 3-6 months was 95.87%, 7-12 months was 95.53%, 13-24 months was 94.25%, and 25-36 months was 92.33%, respectively. Conclusion: Integrated endovascular therapy for IVCS with DVT has demonstrable efficacy with fast recovery, so it is an effective and safe treatment method.

Abstract:Objective: To investigate the mid- and long-term results of endovascular-based procedures for Cockett syndrome. Methods: The clinical data of 412 patients with Cockett syndrome treated between January 2003 and February 2014 were retrospectively analyzed. In these patients, 231 cases were acute left iliac femoral vein thrombosis (group A), and 181 cases were chronic venous insufficiency (group B), and different endovascular procedures and/or hybrid procedures were performed. Results: In group A, the technique success rate was 100% (231/231); the left iliac vein in 5 patients showed no stenosis or occlusion, and the incidence of pathological changes in the left iliac vein was 97.8% (226/231); a total of 182 stents were implanted. In group B, the technique success rate was 99.4% (180/181); one patient developed a large retroperitoneal hematoma and hemorrhagic shock due to rupture of the left iliac vein during balloon-inflation angioplasty, and was resuscitated by aggressive efforts; the average pressure difference between the proximal and distal portion of the pathological left iliac veins decreased from preoperative (18±4.45) cmH2O to postoperative (4±3.02) cmH2O (P<0.01); 89 patients, complicated with valvular incompetence in the left superficial femoral vein, underwent a second-stage femoral valve repair. Follow-up ranged from 3 months to 8 years, with an average of 35.6 months, and intrastent thrombosis occurred in 15 cases of group A and in 2 cases of group B. Conclusion: Endovascular-based procedures offer favorable mid- and long-term results in treatment of Cockett syndrome, which in combination with Fogarty catheter thrombectomy or catheter-directed thrombolysis is a beneficial complementary treatment for those complicated with acute iliac femoral vein thrombosis.

Abstract:Objective: To evaluate the efficacy of intermittent pneumatic compression (IPC) therapy in thromboprophylaxis. Methods: The randomized controlled trials (RCTs) concerning IPC therapy for thromboprophylaxis were searched from several national and international databases. Meta-analysis was performed by using RevMan 5.2 software after a literature screen for inclusion and exclusion criteria. Results: Sixty-three RCTs were finally selected, with a total of 15 444 patients. Results of Meta-analysis showed that in IPC treatment group, the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) were significantly decreased compared with non-intervention group (OR=0.34, 95% CI=0.26–0.45, P<0.00001; OR=0.45, 95% CI=0.31–0.65, P<0.0001); the incidence of DVT was significantly decreased compared with group of treatment with thigh-length thromboembolic deterrent stockings (TEDS) (OR=0.55, 95% CI=0.35–0.88, P=0.00001). Compared with the group treated with anticoagulant therapy, IPC treatment had no superiority in thromboprophylaxis (OR=1.05, 95% CI=0.69–1.59, P=0.82), but the risk of bleeding was significantly reduced (OR=0.31, 95% CI=0.19–0.50, P<0.00001). Conclusion: IPC therapy has demonstrable efficacy in prevention of venous thrombosis in hospitalized patients and does not have the risk of bleeding caused by anticoagulant drugs.

Abstract:Objective: To assess the efficacy of double intervention approach in treatment of lower extremity deep vein thrombosis (DVT) complicated with acute pulmonary embolism (PE). Methods: The clinical data of 21 patients with lower extremity DVT and secondary acute PE, who underwent inferior vena cava filter placement with pulmonary artery catheter-directed fragmentation and thrombolysis, and in combination with catheter-directed thrombolysis of the affected lower extremity deep vein from January 2010 to May 2013, were retrospectively analyzed. PE was located in the main trunk of pulmonary artery in 2 cases, in the left pulmonary artery in 8 cases, in the right pulmonary artery in 6 cases, and in the lobar pulmonary artery in 5 cases. Results: The double intervention treatment was completed in all the 21 patients for dealing with their pulmonary arteries and lower extremity deep veins. Intraoperative immediate angiography showed the main trunk of pulmonary artery in the 2 cases was fully opened, and left or right pulmonary arteries were fully opened in 8 cases and largely opened in 6 cases, and the lobar pulmonary arteries in 5 cases were partially opened. Pulmonary arterial pressure was decreased from (52±7) mmHg to (27±4) mmHg, and PaO2 was increased from (62±6) mmHg to (82±6) mmHg (both P<0.01). Vascular doppler ultrasound examination showed that all the clots in the affected limbs were dissolved in varying degrees, with a partial or complete restoration of blood flow. The circumference differences 15 cm above and below the knee joint between the healthy and affected limb decreased from (9.0±4.0) cm and (5.0±2.0) cm to (2.3±0.9) and (1.0±0.7) cm, respectively (both P<0.01). Conclusion: For patients with lower extremity DVT and secondary acute PE, the double intervention approach can quickly restore pulmonary flow, correct hypoxemia, and improve the general condition of these patients, as well as dissolve the deep vein thrombus, improve circulation and reduce symptoms in the affected limb, and reduce the sequelae of DVT.

Abstract:Objective: To investigate the feasibility of using idiopathic deep venous thrombosis (IDVT) of the lower extremity as a model disease for research into the pathogenesis and genetic factors of lower extremity deep venous thrombosis (DVT). Methods: IDVT patients and healthy subjects undergoing health maintenance examination were randomly selected as case group and control group, with 120 cases in each group. The demographical data and parameters of hemodynamics, blood routine, blood biochemistry and clotting function between the two groups were compared. Results: The difference in age and gender composition had no statistical significance between the two groups (both P>0.05). In case group compared with control group, the flow velocity in the femoral and popliteal vein was decreased, and the inner diameter of the femoral and popliteal vein was increased; the red blood cell count and hemoglobin content were decreased and the white blood cell and blood platelet count were increased; the albumin level was decreased and aspartate aminotransferase and creatinine level were increased; the erythrocyte sedimentation rate, prothrombin and fibrinogen level and activated partial thromboplastin time were increased and thrombin time was decreased, and all the differences had statistical significance (all P<0.05). Conclusion: Because of few confounding factors and better equilibrium, lower extremity IDVT is an ideal model disease for clinical and genetic research of lower extremity DVT.

Abstract:Objective: To evaluate the application value of knee length compression stockings in prophylaxis of lower extremity deep venous thrombosis (DVT). Methods: The randomized controlled trials (RCTs) concerning medical compression stockings for prophylaxis of lower extremity DVT were searched from several national and international databases. Meta-analysis was performed by using RevMan 5.2 software after a literature screen for inclusion and exclusion criteria. Results: Twelve RCTs were finally included with a total of 6 049 patients. Meta-analysis results showed that the risk of lower extremity DVT occurrence was significantly reduced compared with the non-stockings control group among the long haul flight passengers (OR=0.08, 95% CI=0.03?0.22, P<0.00001); the difference in lower extremity DVT prevention had no statistical significance between knee length compression stockings group and thigh length compression stockings group among the hospitalized patients (OR=1.47, 95% CI=0.69?3.13, P=0.32); in the pooled analysis of hospitalized patients and long haul flight passengers, the risk of lower extremity DVT occurrence in knee length compression stockings group was significantly lower than that in non-knee length compression stockings group (OR=0.32, 95% CI=0.11?0.92, P=0.03). Conclusion: Knee length compression stockings can reduce the risk of lower extremity DVT in long haul flight passengers and hospitalized patients, and its efficacy is probably better than that of thigh length compression stockings. However, this requires confirmation by randomized controlled trials of large sample size and high quality.

Abstract:Objective: To investigate the early diagnosis and treatment of mesenteric vascular disease (MVD). Methods: The clinical data of 13 MVD patients admitted from January 2002 to October 2010 were retrospectively analyzed. Of the patients, 7 cases had mesenteric artery embolism (MAE) and 6 cases had mesenteric venous thrombosis (MVT). Results: All of the 13 patients were admitted to the hospital for acute abdominal pain, and underwent Doplex vascular ultrasound, CT, MRI and CTA examination respectively, and in 10 cases an early diagnosis of MVD was made by Doplex vascular ultrasound. Three patients received non-surgical treatment, and 10 cases with the signs of peritonitis underwent surgical treatment that included surgical venous embolectomy, Fogarty catheter embolectomy and resection of necrotic bowel, and postoperative anticoagulation therapy. The 13 patients recovered and were discharged. Conclusion: MVD can be easily confused with other acute abdominal conditions, and correct diagnosis depends on clinical vigilance and relevant examinations. Early diagnosis and aggressive management are essential elements for the successful outcome of these patients.

Abstract:Angiosome is an anatomic unit of tissue, which is consisted of skin, subcutaneous tissue, fascia, muscle and bone, as well as the source artery for its blood supply and its specific drainage veins. According to the angiosome concept, revascularization of the source artery of the below-the-knee (BTK) lesion might result in better wound healing and limb salvage rate in patients with critical limb ischemia (CLI) undergoing either bypass or endovascular operation. In this paper, the authors address the angiosome concept and its role in revascularization strategy making for CLI patients with BTK disease.

Abstract:The liver regeneration is a complex but precise regulative process involving multiple factors and steps, where the oxidative stress plays an important role. In this paper, the authors address the issues that include the definitions related to oxidative stress and liver regeneration, detrimental effect of oxygen stress on the liver, and relationship between oxidative stress and the liver regeneration, as well as the action mechanism of oxidative stress in liver regeneration process and effect of antioxidant on liver regeneration.