Abstract:In recent years, the scale of the endovascular abdominal aortic aneurysm repair (EVAR) in China has rapidly expanded, while the operation units have expanded from the regional center hospitals in the early years to the medium-sized hospitals in many provinces and cities. The quality problems related to the poor homogeneity of medical level and the unreasonable consumption of medical resources have gradually emerged. The major issue of how to evaluate and improve the quality of medical care and improve the utilization efficiency of national healthcare expenditures has drawn great attention from the national health authorities. All members of Working Group on Vascular Surgery, National Center for Cardiovascular Quality Improvement have discussed and formulated process index, outcome index and structural index for EVAR. Process index includes preoperative CTA examination, blood pressure monitoring and control during the operation, suitable oversizing of stent graft, and postoperative CTA review. Outcome index includes risk-adjusted 30-day mortality, risk-adjusted 30-day all-cause re-admission rate, incidence of conversions to open surgery, incidence of re-intervention for the access vessel, re-intervention rate for the abdominal aorta and iliac arteries, operation time, ICU stay time, incidence of prolonged mechanical ventilation, postoperative renal insufficiency, and postoperative hospitalization days. Structural index includes participation rate of registration researches. With the promoting and assessing of above-mentioned key indexes, the homogeneity of EVAR surgical quality in different hospitals from different regions and levels will hopefully be improved.uation; Expert Consensus.

Abstract:The techniques of endovascular treatment for arteriosclerotic occlusive disease of lower limbs have developed rapidly in recent years. With the concern of restenosis after the traditional balloon dilatation and metal bare stent implantation looming large, various kinds of drug-carrying apparatus have been developed, and the drug eluting stent (DES) is a typical one among them. DES has been widely used in the treatment of femoropopliteal and below-the-knee arterial diseases, and relative clinical trials have also been widely conducted. The safety, efficacy and superiority of DES in treatment of short-segment lesions have been well demonstrated, while its value in treating long-segment lesions still needs to be verified by further clinical trials.

Abstract:The neck of the abdominal aortic aneurysm (AAA) is an important parameter for endovascular repair. Currently, the methods for short-neck AAA mainly include suprarenal fixation, large-scaffold or anatomical fixation techniques, chimney technology, and fenestration (bifurcated stent) technology, which need to be specifically solved in light of the facts of the individual patient and the specific conditions of the surgeon and the hospital. In addition, an endless stream of new materials and new technologies are also advancing the progress of endovascular repair techniques for short-neck AAA.

Abstract:Aortic dissection is a catastrophic condition characterized by sudden onset and high risk. Some patients with either Stanford type A or B aortic dissection will develop a chronic dissecting aneurysm after an acute stage, for which, open surgery will cause severe trauma. In recent years, endovascular repair which emerged as an alternative has achieved favorable clinical results. Using fenestrated stent-grafts for repair of distal tears of chronic aortic dissection has just been initiated, and has shown good short-term results. However, lack of good landing zone, narrow true lumen, and false lumen in the origin of the visceral branches are bottlenecks for this technology, and it faces many challenges in these respects. Some new ways of thinking, such as "opening", "chiseling", "dredging" and "expanding", will help to promote this technology.

Abstract:Objective: To evaluate the safety and efficacy of using TurboHawk atherectomy device in combination with drug-coated balloon (DCB) in treatment of femoropopliteal occlusive diseases. Methods: During April 2016 to October 2017, the treatment of using TurboHawk atherectomy device in combination with DCB was performed in 17 patients with femoropopliteal occlusive diseases. Of the 17 patients, the average age was (66.9±10.5) years; 14 cases were male and 3 cases were female; 13 cases had femoropopliteal stenosis and 4 cases had femoropopliteal occlusion; the preoperative Rutherford classification ranged from 2 to 5 and the preoperative ankle brachial index (ABI) was 0.49+0.18. Doppler ultrasound, CTA or MRA was used to evaluate the patency of target-lesion, postoperatively. Results: Endovascular recanalization of the target lesions were successfully performed in all the 17 patients, of whom, one case with femoral artery perforation underwent salvage covered-stent placement, and one case with distal embolization achieved vascular patency after balloon catheter embolectomy via incision of the femoral artery, and the technical success rate was 88.2%. The postoperative ABI was 0.99±0.27, and it was significantly higher than the preoperative value (P=0.03). The primary patency rate at postoperative 3 and 6 months was 94.1% and 88.2% respectively, and the secondary patency was 100%. Conclusion: Using TurboHawk atherectomy device in combination with DCB is safe and effective in treatment of femoropopliteal occlusive diseases, with favorable short-term results.

Abstract:Objective: To investigate feasibility and efficacy of catheter-directed thrombolysis (CDT) by using a coude catheter in the treatment of short segment occlusion (≤10 cm) of the popliteal artery. Methods: The clinical data of 50 patients (55 limbs) with short-segment occlusion of the popliteal artery undergoing CDT from February 2012 to February 2016 was analyzed. Of the patients, 18 cases (21 popliteal arteries) underwent CDT by using a coude catheter (coude catheter group) and 32 cases (34 popliteal arteries) received conventional CDT (conventional catheter group). The thrombolysis efficiency and incidence of complications of the two groups were compared. Results: Thrombolysis failed in 2 limbs in each group, and the symptoms in the remaining 51 affected limbs were significantly improved. The average length of lesion removed by thrombolysis in coude catheter group was significantly greater than that in conventional catheter group (38.3 mm vs. 25.8 mm, P<0.05); the average ΔABI in coude catheter group was significantly higher than that in conventional catheter group (0.47 vs. 0.32, P<0.05). The incidence of hemorrhagic complications was 10.5% (2/19) and 15.6% (5/32) in coude catheter group and conventional catheter group respectively, which showed no significant difference (P>0.05). Conclusion: CDT with a coude catheter for no more than 10 cm short-segment occlusion of the popliteal artery is technically feasible and operationally simple with relatively high thrombolysis efficiency. It has certain application value in clinical practice.

Abstract:Objective: To compare the clinical efficacy of open surgery and endovascular repair for popliteal artery aneurysm. Methods: The clinical data of 33 patients with popliteal artery aneurysm treated from January 2008 to December 2017 were retrospectively analyzed. Of the patients, 22 cases (23 limbs) underwent open surgery (open surgery group) and 11 cases (13 limbs) received endovascular repair (endovascular repair group). The general data, perioperative variables and follow-up results of the two groups of patients were analyzed and compared. Results: The age and proportion of cases with concomitant hypertension were significantly greater in endovascular repair group than those in open surgery group (χ2=8.250, P=0.008; χ2=6.203, P=0.024), while no significant differences were noted in terms of other concomitant diseases, preoperative diameter of aneurysm and wound complications between these two groups (all P>0.05). All patients in open surgery group and 6 patients (54.5%) in endovascular repair group underwent operation under general anesthesia (χ2=12.257, P=0.002). The length of postoperative hospital stay and total hospital stay in endovascular repair group were significantly reduced compared with open surgery group (t=–4.221, P=0.000; t=–3.090, P=0.002). Mean follow-up time was 36 months (1 month to 120 months), during which time, 5 patients in open surgery group received reintervention, of whom, 2 cases underwent major amputations; 2 patients received reintervention in endovascular repair group. Kaplan-Meier curve showed that there was no significant difference in freedom from reintervention between these two groups (P>0.05). Conclusion: For PAA patients with advanced age, high risk from open surgery, appropriate anatomic conditions and favorable outflow vessels, endovascular repair may be a safe alternative to open surgery, which has demonstrable efficacy with a short length of hospital stay and rapid perioperative recovery.

Abstract:Objective: To investigate the predictive factors for the success of conservative treatment of isolated superior mesenteric artery dissections (ISMAD). Methods: The clinical data of 37 patients with ISMAD admitted from January 2012 to March 2017 were retrospectively analyzed. Of the patients, conservative treatment was successful in 18 cases, and failed in 19 patients. The relevant factors were compared between the two groups of patients to determine the predictive factors for the success of conservative treatment. Results: In patients having successful conservative treatment compared with those who had unsuccessful conservative treatment, the age and course of disease showed no statistical difference (both P>0.05), while the proportion of cases with superior mesenteric artery-distal aorta angle (SAA) less than or equal to 75° was significantly decreased (27.8% vs. 63.2%, P<0.05), the average distance of dissection was significantly prolonged (2.34 cm vs. 1.47 cm, P<0.01), the length of dissection was significantly shorter (3.13 cm vs. 4.57 cm, P<0.05), and the average degree of true lumen stenosis was significantly smaller (33.9% vs. 65.8%, P<0.01). Conclusion: SAA greater than 75°, relatively long distance of dissection, relatively short length of dissection and relatively small degree of true lumen stenosis are the predictors for success of conservative treatment of ISMAD. When conservative treatment is unsuccessful, safe and effective endovascular therapy can be selected.

Abstract:Objective: To investigate the clinical characteristics and therapeutic strategies of spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: The clinical data of 16 patients with SISMAD treated in Xiangya Hospital during September 2012 to October 2017 were retrospectively analyzed. Of the patients, 12 cases were male and 4 cases were female; the median ages ranged from 47 to 70 years, with a median age of 56.5 years; 14 cases presented with acute-onset abdominal pain or periumbilical pain, and 2 patients were accidently diagnosed by review CT scan for kidney stones and thymus cancer, respectively. The diagnosis in all patients was confirmed by CT scan. The treatment methods included conservative treatment, endovascular revascularization and open surgery. Results: Ten patients were successfully treated by conservative treatment, 5 patients were successfully treated with endovascular revascularization, and one patient received successful revascularization of the superior mesenteric artery by open arteriorrhaphy for suspicious dissection rupture/hemorrhage due to blood pressure decrease during conservative treatment. Follow-up was conducted in all of the 16 patients for 4 to 60 months, with an average period of (28±13) months. No recurrent abdominal pain or symptoms of intestinal ischemia was noted during follow-up. The review CT showed that there was no aneurysmal expansion of the dissection in patients who received conservative treatment, and the stents were patent in patients undergoing successful endovascular therapy. Conclusion: For SISMAD, conservative treatment should be the first treatment option in patients with definite diagnosis and no severe influence of dissection on the blood supply of the superior mesenteric artery and no signs of peritonitis; endovascular revascularization should be considered when there are no signs of ischemic intestinal necrosis or peritonitis, but no obvious relief of the abdominal pain after conservative treatment; open surgery should be immediately performed in those with signs of dissection rupture/hemorrhage, intestinal necrosis, or peritonitis.

Abstract:Objective: To evaluate the feasibility of establishing portal vein thrombosis (PVT) in rats by repeated interruption of the portal vein. Methods: Ninety SD rats were randomly and equally divided into experimental group and control group. Rats in experimental group underwent repeated ligation of the portal vein for induction of PVT, and those in control group underwent exposure of the portal vein after laparotomy. At preoperative and postoperative 30 min as well as postoperative 3, 6, 12 and 24 h, the PVT formation in the two groups of rats was observed by vascular Doppler ultrasound, and the levels of P-selectin, D-dimer and fibrinogen in the venous blood of the rats were determined. All rats were sacrificed 24 h after operation, and PVT formation was observed by gross examination and pathological examination was also performed. Results: In experimental group, 5 rats died, 6 rats did not have PVT formation and 34 rats (75.56%) developed stable PVT at 24 h after operation; in control group, 2 rats died, a small amount of mural thrombus was seen in 3 rats and no thrombosis was observed in the other 40 rats, and the difference in PVT formation had statistical significance between the two groups (P<0.05). The length of the thrombus in rats of experimental group was gradually increased with time prolongation. The variables associated with thrombosis showed no significant difference between the two groups at preoperative 30 min and postoperative 30 min and 3 h (all P>0.05), but they were significantly higher in experimental group than those in control group at each time point from postoperative 6 h (all P<0.05). Conclusion: Repeated interruption of the portal vein can generate a stable and clinical relevant PVT model in rats. P-selectin level, D-dimer content and fibrinogen content can be used as reference indexes.

Abstract:Objective: To investigate the influence of paclitaxel on expression of autophagy-associated protein LC3 in triple negative breast cancer (TNBC) cells and the significance. Methods: The inhibitory effect of paclitaxel on proliferation of TNBC MDA-MB-231 cells was determined by CCK-8 assay and then the 25% inhibition concentration (IC25) value was calculated. In MDA-MB-231 cells after treatment with IC25 concentration of paclitaxel, the expressions of LC3 protein and apoptosis-associated proteins as well as the cell apoptosis rates were determined by immunofluorescence histochemistry, Western blot analysis and flow cytometry, respectively. Results: The proliferation effect of TNBC-MDA-MB-231 cells was significantly inhibited by paclitaxel in a concentration-dependent manner (P<0.05), with an IC25 value of 3.11 μg/mL. In MDA-MB-231 cells after treatment with 3.11 μg/mL paclitaxel, the expression level of LC3 protein as well as LC3B/LC3A ratio were significantly increased, the expression levels of the apoptosis-related protein Bax and caspase-3 were significantly decreased, and the total and early apoptosis rates were significantly decreased (all P<0.05). Conclusion: Paclitaxel can induce the increased expression of the autophagy-related protein LC3, and this action may probably reduce the cell apoptosis and thereby cause paclitaxel resistance in TNBC cells.

Abstract:Objective: To evaluate the diagnostic value of the combined detection of D-dimer (D-D) and thrombin time (TT) in exclusion of deep venous thrombosis (DVT) of lower extremity in patients with peritoneal carcinomatosis. Methods: Two hundred and forty-one patients with peritoneal carcinomatosis treated between May 2015 and May 2017 were enrolled. The variables of coagulation and fibrinolysis of the patients before operation were determined. The likelihood of DVT of the patients was evaluated by using Wells clinical model. All patients received venous ultrasonography of the lower extremities for DVT diagnosis, and the events of symptomatic venous thromboembolism (VTE) during perioperative period were observed. Results: Of the 241 patients, 21 cases (8.7%) were diagnosed as DVT of lower extremity by venous ultrasonography. No symptomatic VTE events occurred during the postoperative follow-up period in any of the patients. In patients with DVT compared with those without DVT, the TT was significantly shortened, and levels of fibrin/fibrinogen degradation products and D-D were significantly increased (all P<0.05). As determined by the ROC curve, the optimal cut-off value of TT for diagnosing DVT in patients with peritoneal carcinomatosis was 13.55 s, and its negative predictive value was 100% and in combination with D-D detection the rate of missed diagnosis was 0. Regardless of high or low probability of DVT assessed by Wells scoring, the negative predictive value of this combined detection was 100%. Conclusion: There is certain incidence of lower extremity DVT in patients with peritoneal carcinomatosis at admission. The combined detection of D-D and TT has strong negative predictive value for exclusion of DVT, which is independent on Wells score. Lower extremity DVT can be safely excluded in those with negative result from the combined detection (D-D<243 ng/mL DDU and TT>13.55 s) without confirmation by venous ultrasonography.

Abstract:Objective: To investigate the clinical treatment of chronic venous lower-extremity ulcers and the treatment efficacy. Methods: The clinical data of 48 patients with chronic venous leg ulcers treated from March 2014 to September 2015 were retrospectively analyzed. The treatment modalities included the correction of the primary causal disease, drug therapy, physiotherapy, high ligation of the greater saphenous vein plus stripping, circular ligation around ulcers, combined free skin flap coverage for those with large ulcer area (≥48.0 cm2), and long-term use of elastic stockings to promote venous blood return after ulcer surface healing. Results: After treatment, complete primary healing was achieved in 12 patients (25.0%), of whom, all the skin grafts survived in the 5 patients with large ulcer area; ulcer healing area of more than 70% was achieved in 27 patients (56.3%), and also reached 50% in the remaining 9 patients (18.7%). The average length of hospitalization was 17.8 d. Patients with residual leg ulcers received sterile dressings by regular clinic visits. The patients were followed up for 3 to 12 months and all ulcers were healed with an average healing time of 1.5 months. Conclusion: Based on the correction of the primary causal disease, the integrated multi-therapy approach combined with surgical treatment for chronic venous leg ulcers has satisfactory effect for fast ulcer healing and low recurrence.

Abstract:Objective: To investigate the construction of a predictive model for estimation of central cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) based on the ultrasonographic features of the nodules and clinical data of the patients. Methods: The clinical data of 121 patients with PTMC that was confirmed by surgical and pathological findings and their ultrasonic images of 166 thyroid nodules were collected. The relevant factors for central cervical lymph node metastasis were analyzed and picked up by statistical methods, and then, the Logistic and Additive scoring models for estimating risk of central cervical lymph node metastasis were established, respectively. Results: The results of statistical analyses showed that age, multifocal lesion, nodule size, relationship between nodule and thyroid capsule, and imaging feature of perinodular enhancement were closely related to the risk of central cervical lymph node metastasis (all P<0.05). These factors were numerically assigned and scored. According to the total score evaluated by the area under the ROC curve (AUC), when the score derived from the Logistic model reached 6.5, the AUC was 0.964 with a sensitivity of 98.4% and a specificity of 74.1%; when the score derived from Additive model reached 33.5, the AUC was 0.928 with a sensitivity of 88.9% and a specificity of 84.5%. Hosmer-Lemeshow goodness of fit test indicated that Logistic model had a better fit. Conclusion: The constructed Logistic model has certain predictive value for estimating risk of central cervical lymph node metastasis in PTMC, and it can provide a quantitative basis for the treatment plan selection of PTMC. When its score is equal to or greater than 7, the possibility of central cervical lymph node metastasis should be highly suspected.

Abstract:The mode of endovascular treatment for atherosclerosis obliterans of the lower limbs has evolved significantly over the last decade, from the initial percutaneous transluminal angioplasty (PTA) to stenting, and then to the implant-free surgery following the "leave nothing behind" concept that is represented by drug-coated balloon, plaque excision and laser erosion. In an attempt to overcome the stubborn problem of high restenosis rates after PTA and stenting, the attempts of using drug-coated balloon in treatment of atherosclerosis obliterans of the lower limbs have been started worldwide in the past five years and especially in China since June 2016, and favorable therapeutic results have been obtained. Here, the authors provide an overview of the rationale and the technology of DCB and review currently available data from randomized controlled trials.

Abstract:Phenotypic transformation of the vascular smooth muscle cells (VSMCs) is considered the cytological basis of vascular remodeling. VSMCs with contractile phenotype and synthesis phenotype exhibit different functions, and they can transform to each other reciprocally. Here, the authors review and extract the research progress in terms of the concept and characteristics of phenotypic transformation, phenotype markers, and proliferation and migration of the VSMCs derived from the great saphenous vein, as well as the relation of the matrix metalloproteinases and their inhibitors, apoptosis, and epigenetic factors with their phenotypic transformation, so as to provide a theoretical foundation for screening the drug targets associated with prevention and treatment of varicose veins.

Abstract:

Diabetic vascular disease is one of the common complications of diabetes, which can endanger all body organs, and is an important cause of death in patients with diabetes. Current conventional treatment methods have limited effects on severe diabetic vascular disease. Vascular smooth muscle cells (VSMCs) play a key role in the progression of diabetic vascular disease. Therefore, the regulation of VSMCs may have broad application prospects for reversing the diabetic vascular lesion. Here, the authors address the biological characteristics of VSMCs and their phenotypic conversion features in diabetes, as well as the therapeutic strategies of regulation of VSMCs for diabetic vascular disease.