Abstract:Infected abdominal aortic aneurysm (IAAA) is a catastrophic disease, which is difficult to treat and has a high mortality rate. The goal of surgical treatment is to eliminate the lesion, prevent rupture of the aneurysm and maintain the channels of blood flow. The early and full course of antibiotic medications is the basis of treatment. The traditional surgical procedures that include the in situ prosthetic reconstruction and axillofemoral bypass are consistent with surgical principles. However, the graft infection rate is relatively high after debridement and in situ prosthetic reconstruction, and serious complications such as graft obstruction or aortic stump rupture may occur after axillofemoral bypass operation. Although endovascular procedures are not entirely consistent with surgical principles, the available clinical data suggest that they are still applicable in elderly patients who are unable to tolerate open surgery. Retroperitoneal bypass can effectively reduce graft infection and maintain graft patency, so it is a more rational surgical procedure for IAAA.

Abstract:Objective: To investigate the feasibility of using in vitro fenestration and scallop in thoracic aortic endovascular repair (TEVAR) for the treatment of aortic arch disease.
Methods: The clinical data 23 patients undergoing TEVAR with in-vitro fenestration and scallop for aortic arch diseases between September 2016 and April 2019 were retrospectively analyzed.
Results: In the 23 patients, the covered stent graft was deployed at proximal landing zone 0 in 3 case, at zone 1 in 6 cases, and at zone 2 in 14 cases respectively. A total of 40 branch vessels were revascularized, including 
3 innominate arteries, 9 left common carotid arteries, 23 left subclavian arteries, 3 aberrant left vertebral arteries and 2 aberrant right subclavian arteries, and of them, 15 cases were reconstructed by scallop and 25 cases by fenestration. The origins of 9 left subclavian arteries were covered, and the technical success rate was 77.5%. Thirty-one branch vessels were patent after operation, one of them developed thrombosis during follow-up and 6 of them were lost to follow-up. Endoleak occurred in 4 patients (17.4%), which disappeared in 2 cases and lessened in one case during follow-up. During the perioperative period, ischemic stroke occurred in 2 patients and death in one patient, but no case of paralysis occurred. 
Conclusion: Using in-vitro fenestration and scallop techniques in TEVAR are feasible and effective methods for the treatment of aortic arch disease. 

Abstract:Objective: To investigate the risk factors for the occurrence of perioperative complications in patients undergoing open surgery for Takayasu arteritis (TA).
Methods: The data of the 136 TA patients undergoing open revascularization from January 2003 to December 2018 were retrospectively analyzed and the risk factors for perioperative complications of open surgery were determined by univariate and multivariate statistical tests. 
Results: In the 136 patients, open operation was performed 141 times, involving 257 lesions. Thirty-six episodes (25.5%) of perioperative complications occurred in the patients, including death in 5 patients (3.7%). The results of univariate analysis showed that the history of cerebral infarction, preoperative increased CRP level, carotid artery involvement, perioperative blood transfusion, number of involved vessels, artery occlusion time and intraoperative blood loss were associated with the occurrence of perioperative complications (all P<0.05). The results of multivariate Logistic regression analysis showed that the history of cerebral infarction (OR=3.141, 
95% CI=1.062–9.288, P=0.039), number of vascular involvement (OR=1.280, 95% CI=1.016–1.612, P=0.036) and artery occlusion time (OR=1.045, 95% CI=1.007–1.084, P=0.019) were independent risk factors for perioperative complications. tions. 
Conclusion: Preoperative history of cerebral infarction, multiple vascular involvement and prolonged artery occlusion will increase the risk of perioperative complications in TA patients undergoing open surgery.

Abstract:Objective: To investigate the safety and efficacy of TurboHawk debulking combined with drug-coated balloon (DCB) in treatment of complicated femoropopliteal artery in-stent restenosis (ISR). 
Methods: Twenty-one patients with femoropopliteal artery ISR from May 2017 to May 2018 were treated by TurboHawk atherectomy plus DCB. Of the patients, 13 cases (61.9%) were males and 8 cases (38.1%) were females; the preoperative ABI was 0.45±0.14; the preoperative Rutherford classification was grade 2 in one case (4.7%), grade 3 in 3 cases (14.3%), grade 4 in 7 cases (33.3%), grade 5 in 8 cases (38.1%) and grade 6 in 2 cases (9.5%); the preoperative Tosaka classification was class I lesion in 2 cases (9.5%), class II lesion in 7 cases (33.3%), and class III lesion in 12 cases (57.1%).
Results: Technical and procedural success was achieved in all the 21 patients, and no surgery-associated adverse events occurred. The postoperative Rutherford classification was grade 0 in 2 cases (9.5%), grade 1 in 9 cases (42.8%), grade 2 in 3 cases (14.2%), grade 3 in one case (4.7%), grade 4 in 3 cases (14.2%) and grade 5 in 3 cases (14.2%). One patient died due to coronary heart disease on 9 months after operation, and one patient was lost to follow-up. Among the 18 patients who were followed up until 12 months, the ABI ranged from 0.69 to 1.45, with an average of 0.84±0.12, the primary patency rate was 83.3%, and the rate of freedom from clinically-driven target lesion revascularization was 88.9%.
Conclusion: TurboHawk debulking combined with DCB for complicated femoropopliteal artery ISR is safe and effective, and the short-term results are satisfactory.

Abstract:Objective: To summarize the clinical characteristics of carotid body tumor (CBT) as well as the diagnostic and treatment experience.
Methods: The clinical data of 38 CBT patients treated in the Department of Vascular Surgery, Xiangya Hospital, Central South University during October 2008 to April 2019 were retrospectively analyzed. Of the patients, 
14 cases were males and 14 cases were females, with age ranging from 23 to 76 years; 36 cases had unilateral lesion and 2 cases had bilateral lesions. In the 40 tumors, 6 were classified as Shamblin type I, 12 were type II and 
22 were type III.
Results: Definitive diagnosis was made in all patients by neck CTA or MRA. Of the 38 patients, 3 cases with unilateral lesion underwent conservative treatment, and the remaining 35 cases with a total of 37 lesions underwent surgical resection, of whom, one case underwent DSA examination and embolization in bilateral external carotid arteries. No death occurred during operation, the average operative time was (140±48) min and intraoperative blood loss was (194±148) mL. All Shamblin type I lesions were treated by simple CBT resection, and the Shamblin type II and III lesions were treated by simple CBT resection or CBT resection combined with other procedures (division, reconstruction or ligation of the carotid arteries). All the resected lesions were diagnosed as benign paraganglioma by postoperative pathology. Transient cranial nerve injury occurred in 
8 patients, and permanent cranial nerve injury occurred in 2 patients, and death occurred in one patient after operation. The incidence of cranial nerve injury was higher in patients undergoing simple CBT resection than that in patients undergoing CBT resection plus other procedures (P<0.05). All patents were followed up for half a month to 10 years, no tumor recurrence or other complications were noted in patients undergoing surgical treatment, and the 3 patients receiving conservative treatment still had their tumor, but they were alive.
Conclusion: For CBT, CTA or MRA is the first diagnostic option and surgical resection is the first treatment option. The selection of surgical procedures should be made based on the size and shape as well as the classification of the tumor.

Abstract:Objective: To determine the safety and clinical efficacy of endovascular procedures in treatment of total subclavian artery occlusion.
Methods: The clinical data of 32 patients with total subclavian artery occlusion undergoing endovascular treatment from April 2013 to June 2019 were reviewed. The surgical success rate, complications and follow-up results of the patients were analyzed.
Results: Endovascular procedures were performed via a femoral artery approach (17 cases), brachial artery approach (1 case) and combined femoral/brachial approach (14 cases) in the 32 patients, and stents were successfully placed in 26 patients (81.25%), including balloon-expandable stent in 15 cases and self-expandable stent in 11 cases. The symptoms of patients were obviously relieved after stenting. Six patients underwent bypass operation or conservative treatment after failure of recanalization of the occlusion. During operation, dissection of the subclavian artery occurred in 2 cases, vagal reflex occurred in one case and femoral artery pseudoaneurysm occurred in one case, and no cerebrovascular complications occurred. In the 26 patients undergoing stent placement, 24 cases were followed up for (34.6±4.2) months, and the cumulative 1-, 3- and 5-year primary patency rates were 92.31%, 80.77% and 73.08%, respectively.
Conclusion: Endovascular treatment for total occlusion of the subclavian artery is safe and effective, and it offers relatively high mid- and long-term patency rates. In patients with vertebral artery involvement, a self-expandable stent is strongly recommended to be used.

Abstract:Objective: To investigate the feasibility and effectiveness of creating rabbit abdominal aortic aneurysm (AAA) model by using drug induction plus abdominal aortic outflow coarctation.
Methods: Twenty-four female New Zealand white rabbits were equally randomized into 4 groups, in which, AAA model was induced by wrapping and infiltrating the vessel with a cotton strip containing a solution of CaCl2 
(0.75 mol/L) or trypsin (0.04 g/mL) in two groups, and the model was constructed by CaCl2 or trypsin infiltration plus abdominal aorta outflow constriction (50% 60% constriction) in the other two groups. After the operation, the change in diameter of the affected blood vessel was monitored by veterinary ultrasound. The experimental animals were sacrificed 2 weeks after the operation, and the injured abdominal aorta was harvested to prepare tissue sections for HE and EVG staining. The effect of outflow tract coarctation on AAA formation was evaluated by computer simulation.
Results: Ultrasound examination on 2 weeks after operation showed that no evident dilatation of the affected vessel was seen, and no vessel reached the standard of AAA formation in the two groups undergoing drug infiltration alone; the affected vessel was obviously dilated in the two group undergoing drug infiltration plus abdominal aortic outflow coarctation, in which, the AAA formation rate was 66.67 % (4/6) in CaCl2 plus coarctation group, with an average 1.61-fold expansion, and the AAA formation rate was 83.33% (5/6) in trypsin plus coarctation group, with an average 1.89-fold expansion. Compared with the normal abdominal aorta, the thickness of abdominal aorta intima was significantly increased after CaCl2 infiltration (both P<0.05), but the thickness of abdominal aorta intima did not significantly change after trypsin infiltration (both P>0.05); the thickness of the tunica media was significantly increased and the percentage of the area occupied by the elastic fibers was significantly reduced in all groups, and these changes were most evident in CaCl2 plus coarctation group (all P<0.05). Computer numerical simulation demonstrated that the vascular wall stress increased and the AAA formation rate increased after the outflow coarctation.
Conclusion: Drug induction plus abdominal aortic outflow coarctation can successfully establish the AAA model in rabbits, and shorten the time for model generation. Moreover, the modelling method of trypsin infiltration combined with abdominal aortic outflow coarctation is superior to that of CaCl2 infiltration combined with abdominal aortic outflow coarctation.

Abstract:Objective: To investigate the regulatory mechanism of miRNAs on intimal hyperplasia of the vein graft through analyzing the expression profile of microRNAs (miRNAs) of autologous vein graft in rats.
Methods: The rat vein graft models were established by grafting the autologous external jugular vein into the infrarenal abdominal aorta. The vein grafts were harvested on postoperative day (POD) 3 and 14, using the normal rat external jugular veins as control, and then, the miRNA expression profiles were determined by high-throughput sequencing after total RNA extraction, the differentially expressed miRNAs were screened out and their target genes were estimated. Finally, GO enrichment analysis and KEGG pathway analysis of the target genes were performed.
Results: Compared with the normal vein, the total number of differentially expressed in the vein graft miRNAs on POD 14 was 265, in which, 183 miRNAs were up-regulated and 82 miRNAs were down-regulated. There were 158 differentially expressed miRNAs between the vein graft on POD 14 and POD 3, including 94 up-regulated miRNAs and down-regulated 64 miRNAs. The GO analysis of the target genes of the miRNAs showed that the enriched genes were mainly involved in the regulation of DNA transcription, the regulation of intercellular signal transduction and the regulation of protein phosphorylation. The KEGG pathway analysis showed that the enriched pathways were MAPK signaling pathway, cAMP signaling pathway, Wnt signaling pathway, tight junction and cGMP-PKG signaling pathway.
Conclusion: MiRNAs participate in the biological process of intimal hyperplasia of the vein graft through complex regulatory networks. The discovered miRNA and their regulatory networks may provide the reference framework for investigating the mechanism of intimal hyperplasia of the vein graft and its interventions.

Abstract:Objective: To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in treatment of stenosis and occlusion of the arteriovenous graft (AVG).
Methods: The clinical data of 66 patients undergoing PTA for AVG stenosis or occlusion from January 2016 to March 2018 were retrospectively analyzed.
Results: A total of 105 times of PTA were performed in the 66 patients, with a technical success rate of 96.2%. The primary patency time of AVG after PTA was (12.1±1.20) months in the whole group of patients, which in patients with stenotic lesion was (16.3±1.95) months and in patients with occlusive lesion was (10.3±1.36) months, and the difference had statistical significance (χ2=4.335, P=0.037). The cumulative patency time of AVG in whole group of patients after PTA was (19.7±1.46) months, which in patients with stenotic lesion was (21.0±2.45) months and in patients with occlusive lesion was (19.0±1.80) months, and the difference had no statistical significance (χ2=0.392, P=0.531). The 6-month and 1-year primary patency rate of AVG in whole group of patients was 62.7% and 38.8%, which in patients with stenotic lesion was 78.1% and 48.9%, and in patients with occlusive lesion was 53.5% and 33.1%, respectively. The 6-month and 1-year cumulative patency rate of AVG in whole group of patients was 80.9% and 74.1%, which in patients with stenotic lesion was 86.9% and 79.6%, and in patients with occlusive lesion was 77.8% and 71.4%, respectively. 
Conclusion: For AVG stenosis or occlusion, PTA treatment has the advantages of lesser trauma, being safe and effective, and good patients’ experience and high post-intervention patency rate. Stenotic lesions have a higher incidence of restenosis after PTA, so regular follow-up examinations are needed. If the stenotic lesion meets the indication for re-intervention, treatment should be taken in time to avoid fistula occlusion. In cases with significant elastic retraction or rupture of the vessels which cannot be stopped by balloon compression during PTA surgery, the covered stent implantation can be used as a treatment.

Abstract:Objective: To observe the clinical efficacy and adverse reactions of recombinant human prourokinase (rhPro-UK) for catheter-directed thrombolysis (CDT) in treatment of acute iliofemoral deep venous thrombosis (DVT).
Methods: The clinical data of 66 patients with acute iliofemoral DVT undergoing CDT therapy from October 2016 to December 2018 were retrospectively analyzed. Of the patients, 33 cases underwent CDT with rhPro-UK (observation group), and the other 33 cases underwent CDT with urokinase (UK) (control group). The relevant clinical variables between the two groups of patients were compared. 
Results: There was no significant difference in general clinical features between the two groups of patients (all P>0.05) The thrombolytic rate (≥50%) in observation group was significantly higher than that in control group (81.8% vs. 60.6%, χ2=4.889, P<0.05), but no significant difference was noted in treatment effective rate between the two groups at hospital discharge (81.8% vs. 75.7%, χ2=4.889, P>0.05). No severe complications such as evident bleeding and anaphylactic reactions occurred in either group. 
Conclusion: Both rhPro-UK and UK are safe thrombolytic agents for acute iliofemoral DVT. The thrombolytic rate of rhPro-UK is superior to that of UK, but the long-term efficacy still needs to be further assessed.

Abstract:Objective: To evaluate the safety and effectiveness of using enhanced recovery after surgery (ERAS) programs in pancreatic surgery.
Methods: Two-hundred patients scheduled to undergo pancreatic surgery were enrolled and assigned to ERAS group or control group according to the order of operation time. Patients in ERAS group received perioperative care with the ERAS protocol, and those in control group underwent the conventional protocol for pancreatic surgery. Ninety-seven patients in ERAS group and 90 patients in control group were finally selected, and the relevant clinical variables between the two groups of patients were compared and analyzed.
Results: There were no significant differences in sex, age, surgery type and surgical procedure between the two groups of patients (all P>0.05). In ERAS group, the postoperative VAS score was significantly reduced, the time to first anal gas passage was significantly shortened, the incidence of pulmonary infection was significantly decreased, and the length of postoperative hospital stay was significantly reduced compared with control group (all P<0.05). There were no significant differences in terms of the time of anesthesia awareness, incidence rates of postoperative nausea/vomiting, and re-insertion of the urethral catheter, and incidence rates of other surgical complications as well as the rates of unplanned return to the operating room and unplanned return to hospital after discharge (all P>0.05).
Conclusion: ERAS pathway can be safely applied to pancreatic surgery, and it can promote the recovery of body function, shorten the length of hospital stay and improve the patient’s healthcare experience.

Abstract:Objective: To compare the effectiveness of temporary aortic ligation (TAL) and lower abdominal aortic balloon occlusion (LABO) in preventing hemorrhage during cesarean section in women with dangerous placenta previa complicated by placenta accreta. 
Methods: The clinical data of 84 patients with dangerous placenta previa and concomitant placenta accreta giving birth in the Maternal and Child Health Hospital of Hunan Province from January 2016 to July 2018 were reviewed. Of the patients, 48 cases underwent open TAL and 36 cases underwent temporary LABO to prevent hemorrhage. The variables that included the preoperative general conditions, intraoperative parameters, postoperative results and newborns’ conditions between the two groups were compared.
Results: There were no significant differences in age, times of pregnancy and childbirth, delivery interval, gestational weeks, and placental score between the two groups of patients (all P>0.05). There were no significant differences in time of cesarean section, intraoperative blood loss, amount of packed red blood cell transfusion, and hysterectomy rate between the two groups of patients (all P>0.05). There were no significant differences in Apgar score and weight of the newborn as well as the length of hospital stay between the two groups of patients (all P>0.05). The incidence of vascular complications after cesarean section was significantly higher and the hospitalization cost was significantly lower in TAL group than those in LABO group (19.4% vs. 0; 40 278 yuan vs. 29 100 yuan, both P<0.05).
Conclusion: In cesarean section for pregnancies with dangerous placenta previa complicated by placenta accreta, the hemostatic effects and hysterectomy rates of TAL and LABO are similar, but the former is more safe and cost-effective with lesser incidence of complications, so it is recommended to be used.

Abstract:Lower extremity arteriosclerosis obliterans (ASO) is a common and frequently-occurring disease among middle-aged and elderly adults, and its incidence has been on the rise over the years. Because of the advantages of being minimally invasive, safe and effective as well as quick recovery, endovascular therapy has become the preferred treatment option for ASO. At present, the introduction of the endovascular debulking namely the concept of “leave nothing behind” and the rapid update of endovascular instruments have provided a new development direction for endovascular therapy of ASO. Percutaneous transluminal angioplasty represented by the application of drug-coated balloon (DCB) and the new emerging endovascular debulking technology has been the forefront of the development of ASO in recent years. Debulking atherectomy (DA), as an important technique of intravascular volume reduction of ASO, combined with DCB therapy can continuously inhibit intimal hyperplasia by using anti-proliferative drugs on the basis of expanding the lumen volume, and thereby maximally increase the rates of mid- and long-term lumen patency. The combined use of the two techniques currently may be the optimal treatment strategy for ASO of lower limbs, and it will also be one of the main measures with the greatest development potential in the next decade. Here, the authors, based on the characteristics of DA technique and DCB, address the application status and research progress of the combined treatment of the two techniques for ASO in lower limbs, such as femoropopliteal arteriosclerosis obliterans, below-the-knee atherosclerotic disease, arterial trans-articular disease of the lower limb and in-stent restenosis.

Abstract:Incompetent perforating veins (IPV) of the lower limb are known to be an important cause for delayed healing of venous leg ulcers and recurrence of varicose veins after surgery of the lower limb. The treatment of IPV is a major issue in clinical practice. In this article, the authors briefly describe the pathogenesis of IPV, address the procedures as well as the pros and cons of the open division of perforating veins, subfascial endoscopic ligation of perforating veins (SEPS) and percutaneous ablation of perforating veins (PAPS), and indicate that minimally invasive techniques are becoming prevalent in the treatments of IPV. The authors intend to provide reference for the treatments of IPV in clinical practice. 

Abstract:Acute pancreatitis (AP) is an inflammatory disorder of the pancreas. Because the mechanism is not yet fully elucidated, there is clinically no effective treatment for the severe AP. Calcium overload, premature trypsinogen activation, endoplasmic reticulum stress, autophagy, mitochondrial dysfunction and inflammatory response are considered to be closely associated with the injury of pancreatic acinar cells. Here, the authors address the research progress in this field.