Abstract:The inferior vena cava filter that is widely used in clinical practice is very effective in preventing the life-threatening pulmonary embolism (PE). As to the removal of IVCF, especially when the conventional methods cannot deliver the intended results, how to deal with the removal of IVCF in challenging situations, requires special attention and consideration by the performers in clinical work. In order to facilitate the application of various new types of IVCFs and retrieval techniques, the characteristics of the new instruments should be fully mastered, as well as the features and limitations of different operation methods should be known by us. This paper discusses the issues involving the difficult IVCF retrieval.

Abstract:The 2020 updated and revised edition of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system was published online by the American Venous Forum on February 27, 2020. These revisions included adding corona phlebectatica as the C4c clinical subclass, introducing the modifier “r” for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. Based on up-to-date clinical practice guidelines and consensus documents combined with the current literature, the purpose of this article is to interpret the 2020 updated edition of the CEAP classification system and reporting standards, and provide a reference for the popularization and application of this classification system.

Abstract:Background and Aims: Vena cava filter implantation is the most direct and effective approach to prevent the occurrence of pulmonary embolism in patients with deep vein thrombosis of the lower limbs, and has been widely used in clinical practice. The convertible vena cava filter has more flexible time limits and simpler conversion operation in using for prevention of pulmonary embolism. However, the data of its clinical application are still limited. Therefore, this study was conducted to comprehensively assess the clinical application characteristics of convertible vena cava filters through a single-center retrospective analysis. 
Methods: The clinical data of 52 patients undergoing convertible vena cava filter implantation under DSA guidance in our center were retrospectively analyzed. The parameters for each individual case were measured to identify the safe distance of placement, which included the diameter of inferior vena cava, the distance between the bifurcation of the iliac veins and the opening of the low-side renal vein, the length of forward motion during release, and the length and width of the filter after release. In addition, the conversion time and intra-operative situation during filter conversion were collected, and the conversion skills in complicated cases were discussed.
Results: After measurement, the mean distance between the bifurcation of the iliac veins and the opening of the low-side renal vein was (116.4±13.2) mm, which was far much longer than (54.6±1.3) mm of the mean length of filter after release. The mean width of filter after release was (22.9±3.0) mm, which was slightly greater than (20.8±3.4) mm of the mean diameter of the inferior vena cava. Forward motion during release occurred in 19 patients (36.5%), and the mean length of forward motion was (6.5±1.8) mm. There was no filter tilt occurred in all cases after release. In the 48 patients planned to perform filter conversion, filter was successfully unlocked in one session in 42 cases (87.5%) with anaverage time of (4.5±0.8) min, of whom, 39 cases (81.3%) with unopened or in completely opened after removal of the retrieval hook, the filters were completely opened by the assistance of pigtail catheter stirring. In the 41 patients undergoing overdue conversion (>2 months), filter conversion was finished in 37 cases (90.2%) in one attempt, of whom, 4 cases (8.5%) underwent the conversion by assistance of gooseneck snare catheter combined with guidewire looping technique, because of the vessel wall attachment of the retrieval hook.
Conclusion: Convertible vena cava filter is a safe and easy-conversion filter option. Forward motion phenomenon should be considered during filter release. In patients exceeding the time limit of conversion, the conversion rate in one session is still high.

Abstract:Background and Aims: The popliteal vein is the mainstream approach currently to perform catheter-directed thrombolysis (CDT) for patients with deep vein thrombosis (DVT) of the lower limbs. However, for some patients with mixed DVT or specific postural requirements in whom the popliteal vein access cannot be established, the lower leg deep venous puncture approach may be an alternative treatment option. Therefore, this study was conducted to investigate the feasibility and safety of using lower leg deep venous puncture approach to perform CDT for the treatment of patients with acute mixed DVT. 
Methods: The clinical data of 172 patients with acute mixed DVT admitted from January 2012 to December 2017 were retrospectively analyzed. Of the patients, 89 cases underwent CDT treatment through the lower leg deep venous puncture approach (puncture group), 54 cases underwent CDT by posterior tibial vein puncture under direct vision after exposure of the posterior tibial vein (incision group) and 29 cases underwent thrombolysis via dorsal superficial vein of foot (superficial vein group). The relevant clinical variables of the three groups of patients were analyzed and compared.
Results: In puncture group, deep venous puncture was successfully performed in 86 patients (96.6%), including 37 cases of the posterior tibial vein, 21 cases of the fibular vein, and 28 cases of the anterior tibial vein. In incision group, the vascular sheath was successfully inserted from the posterior tibial vein in all patients (100%). Gastrointestinal hemorrhage and cerebral hemorrhage in 2 patients each in puncture group, and gastrointestinal hemorrhage occurred in 3 patients in incision group and occurred in one patient in superficial vein group, respectively. The incidence rates of bleeding events among the three group had no statistical difference (P>0.05). The patency rate of CDT was 86.5% (77/89) in puncture group and 59.3% (32/54) in incision group, and the difference was statistically significant (P=0.034). The reduction of the thigh circumference and the dose of urokinase used in puncture group were significantly larger than those in the other two groups (all P<0.05). The difference in reduction of the calf circumference showed no statistical difference among the three groups (F=1.152, P=0.320). The incidence rates of mild to moderate post-thrombotic syndrome (PTS) showed no statistical differences among the three groups at 6, 12, 18 and 24 months after operation (χ2=0.301, P=0.860; χ2=0.875, P=0.646; χ2=3.010, P=0.222; χ2=4.446, P=0.108), and no severe PTS occurred in all the three groups. There was no statistical difference in the Villalta scores among the three groups at 6 months after operation (F=1.177, P=0.302), but the Villalta scores in puncture group were superior to those in the other two groups at 12, 18 and 24 months after operation, and except for no statistical significance reached between puncture group and incision group at 12 months after operation (P=0.108), all other differences had statistical significance (all P<0.05). The CIVID-2 scores in puncture group were all superior to those in the other two group at 6, 12, 18 and 24 months after operation, and all differences reached a statistical significance (all P<0.05).
Conclusion: Using lower leg deep venous puncture approach to perform CDT has a higher thrombolysis rate than those of CDT after deep vein exposure and superficial vein thrombolysis, with no increase in major bleeding events. So, it is a preferred choice for acute mixed DVT.

Abstract:Background and Aims: Acute iliofemoral deep venous thrombosis can lead to serious complications. The techniques such as catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT) and manual aspiration thrombectomy (MAT) are currently available treatment methods. The aim of this study was to compare the efficacy and safety of MAT versus PMT followed by stent placement in treatment of patients with iliofemoral deep venous thrombosis caused by iliac vein occlusion, so as to provide the reference for clinical treatment options. 
Methods: The clinical data of 63 patients undergoing treatment in the vascular surgery department for iliofemoral deep venous thrombosis caused by iliac vein occlusion were retrospectively analyzed. Among these patients, 28 cases received MAT (MAT group) and 35 cases underwent PMT with AngioJet system (PMT group). Patients in both groups underwent simultaneous stent implantation of the iliac vein after thrombectomy. 
Results: The clinical technical success rates were 100% for both groups. There were no significant differences between the two groups in terms of rate of grade III thrombus clearance, degree of detumescence at 24 h. proportion of cases requiring postoperative CDT, length of hospital stay and length of the stent used (all P>0.05). In MAT group, the operative time was shorter, but the gamma exposure time was longer than those in PMT group, the intraoperative blood loss was less, but the dose of urokinase used was greater than those in PMT group, and the total hospital cost was less than that in PMT group, and all differences had statistical significance (all P<0.05). No severe complications and adverse reactions in both groups. Postoperative follow-up was conducted for 12 to 24 months, and stent patency rate and the Villalta scores showed no significant differences between the two groups (both P>0.05).   
Conclusion: Acute thrombus removal using MAT or AngioJet PMT with simultaneous stent implantation of the iliac vein has the same efficacy and safety in the treatment of IFDVT. However, by comparison, MAT has the advantages of requiring no specific equipment, less costs and easy operation as well as reduced use of thrombolytic drug. So, It is a recommendable treatment method. 

Abstract:Background and Aims: Vascular negative remodeling characterized by excessive neointimal hyperplasia is the main cause for restenosis after reascularization of arterial ischemic diseases. The application effects of current methods for inhibiting neointimal hyperplasia are not sufficient enough. Previous studies demonstrated that the intestinal microbial metabolite trimethylamine N-oxide (TMAO) is associated with the risks of cardiovascular disease, but the relationship between TMAO level and the arterial remodeling process after injury is not reported so far. Therefore, this study was conducted to investigate the role of TMAO in specific neointimal hyperplasia and the mechanism, so as to provide a referential framework for studying the problem of restenosis after arterial injury.  
Methods: A total of 50 SD rats were used. Ten rats were served as normal control group, and the remaining 40 rats were equally randomized into 4 groups after creation of abdominal aortic balloon-injury model, and then were fed with the regular diet (model group), 1.5%TMAO solution (TMAO enhancing group), 1.0%DMB (inhibitory agent of TMAO production) solution (TMAO inhibition group), and suspending solution of fecal microbiota from normal rats through suspending (fecal microbiota transplantation group), respectively. Four weeks after model creation, the arterial blood samples were extracted to measure the plasm TMAO concentration by LC/MS, and injured segments of the abdominal aorta were harvested to observe the pathological changes by HE and EVG staining as well as the CD31 positive endothelial cells by immunohistochemical staining, and determine the expressions of eNOS and phosphorylation of eNOS at Ser1177 (p-eNOS Ser1177) by Western blot, as well as the ROS expression by immunofluorescence.
Results: Compared with the normal control group, in the other 4 groups, the plasma TMAO concentrations were all increased to different extents, with varied degrees of neointimal thickening and fragmentation or loss of the elastic fibers in the injured vascular segment, and all these changes were most marked in TMAO enhancing group followed by model group, with all differences significant (all P<0.05), while some differences were not significant between TMAO inhibition group or fecal microbiota transplantation group versus normal control group (all P>0.05). There was no significant difference in CD31 positive cells among the groups (P>0.05). There was no significant difference in the total eNOS expression levels among the groups (P>0.05), but the p-eNOS Ser1177 expression levels and numbers of ROS positive cells were reduced in all the modeling groups compared with normal control group, and these changes were also most evident in TMAO enhancing group followed by model group with all differences significant (all P<0.05), while the p-eNOS Ser1177 expression levels in TMAO inhibition group and fecal microbiota transplantation group showed no significant difference with normal control group, and the number of ROS positive cells showed no significant difference in fecal microbiota transplantation group and normal control group (all P>0.05).
Conclusion: TMAO level is increased after artery injury, and TMAO can promote the negative remodeling of the artery after injury. The mechanism may be associated with its facilitating the pathological migration and proliferation of the endothelial cells via eNOS-ROS pathway and thereby accelerating the neointimal hyperplasia.

Abstract:Background and Aims: Studies have demonstrated that caveolin-1 is associated increased angiogenesis, and also closely related to the pathological process of diabetes. Based on speculation that caveolin-1 may play a role in diabetic lower limb ischemia, this study conducted an experiment in acute lower limb ischemia in diabetic rats to investigate its effect and mechanism. 
Methods: Eighty healthy male SD rats were used to construct diabetes models by STZ induction. Then, rats with successful modeling were randomly divided into 4 groups, and underwent femoral artery isolation only (sham operation group), division of the femoral artery and its branches (model group), division of the femoral artery and its branches plus tail vein injection of plasmid containing caveolin-1 (transfection group), and division of the femoral artery and its branches plus tail vein injection of liposome solution without caveolin-1-bearing plasmid (empty transfection group), respectively. After 14 days, gastrocnemius muscle tissues in rats of each group were harvested, the morphological alterations and infiltration of inflammatory cells were observed by HE staining, the NO level was detected by ELISA assay, and the expressions of caveolin-1 and eNOS as well as the CD34 marked microvascular density (MVD) were determined by immunohistochemical staining, respectively. 
Results: Compared with sham operation group, obvious atrophy and marked inflammatory cell infiltration of the gastrocnemius muscle tissue were observed in model group and empty transfection group, while the muscle atrophy was not obvious and inflammatory cell infiltration was attenuated in transfection group; the NO levels in the gastrocnemius muscle tissue of model group and empty transfection group were significantly decreased, while the NO level in transfection group was significantly increased (all P<0.01); the expression levels of caveolin-1 in model group, empty transfection group and transfection group were all increased, but the increasing amplitude in transfection group was significantly greater (all P<0.01); the expression levels of eNOS showed no significant differences in model group and empty transfection group (both P>0.05), but was significantly increased in transfection group (P<0.01); the MVD values in model group, empty transfection group and transfection group were all increased, but the increasing amplitude in transfection group was significantly greater (all P<0.01). All differences in above parameters showed no statistical significance between model group and empty transfection group (all P>0.05).
Conclusion: The high expression of caveolin-1 can effectively improve the diabetic lower limb ischemia, and its mechanism may be related to its activating eNOS/NO pathway and thereby increasing the NO production.

Abstract:Background and Aims: The development and promotion of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) have significant prolonged the survival of patients, but also accompanied by an increasing incidence of long-term complications, and among them, the most serious one is postoperative dilation and eventual rupture of the aortic/iliac artery, which is highly severe and difficult to treat. This study was conducted to investigate and summarize the treatment strategies for this condition through retrospective analysis of cases with late rupture of the abdominal aortic/iliac artery aneurysm after previous EVAR treated in our center.
Methods: The clinical data of 21 patients with late rupture of the abdominal aortic/iliac artery aneurysm after EVAR for AAA undergoing surgical treatment from June 2016 to August 2020 were retrospectively analyzed. Of the patients, 18 cases (85.7%) were males; the maximal diameter of aortic and iliac artery were (111.1±13.1) mm and (100.4±6.6) mm; the duration from EVAR to aortic rupture was (62.0±21.2) months; the reasons including type I endoleak in 15 cases (71.4%), type II endoleak in 4 cases (19.0%) and unclear endoleak in 2 cases (9.5%).
Results: Five patients (23.8%) received emergency operation, 10 patients (47.6%) underwent endovascular procedure and 11 patents (52.4%) were subjected to open surgery of balloon occlusion of the balloon plus coarctation suture of the aortic/iliac artery. The average operative time for endovascular and open surgery were (68.1±12.0) min and (236.4±48.6) min. Perioperative death occurred in one patient (4.8%). The length of intensive care unit stay after open surgery was 1–3 d. The mean follow-up period was (21.3±17.7) months, and 2 patients (2/9, 22.2%) undergoing endovascular treatment received secondary operation for abdominal aortic complications.
Conclusion: Late rupture of abdominal aortic/iliac artery aneurysm is a severe long-term complication after EVAR. Endoleak, especially the type I endoleak, is the main cause for this condition. Endovascular aortic repair is the first treatment option. The open surgery of balloon occlusion of the balloon plus coarctation suture of the aortic/iliac artery is relatively safe and effective.

Abstract:Background and Aims: Interventional procedures have become the main part of vascular surgery practice. The closure of the femoral arterial puncture site directly related to the operation is an essential step at the end of surgical procedures. Considering the lack of high-level evidence on the application effect of the simulator training for occlusion and hemostasis system at home and abroad, this study aimed to evaluate the clinical application effect of the simulator training in implementation of femoral arterial puncture point closure using ExoSealTM vascular closure device and the application value of the simulator training in the basic teaching and training of vascular intervention operation. 
Methods: Using a prospective controlled design, 8 interventional vascular surgeons from 7 centers were selected during May 2020 to October 2020 to receive two different approaches for closure operation training. Four interventional surgeons were trained by reading the instructions of ExoSealTM vascular closure device and watching the videos (control group), and the training method for the other 4 interventional surgeons was the use of simulator under the guidance of professionals in addition to the training for control group (study group). After completion of the training, under the supervision of the attending surgeons, each participant performed puncture site closure using the ExoSealTM vascular closure device in patients undergoing endovascular interventional procedures and with 6-F sheaths in the common femoral artery. After this operation was performed in 50 cases by each group, the operative time, blood loss, equipment success rate, incidence of femoral artery embolism, secondary intervention rate and incidence of 24-h hematoma formation were compared between the two groups. 
Results: During the operation of ExoSealTM vascular closure device, the operative time and blood loss in study group were significantly less than those in control group (24.50 s vs. 30.00 s, P=0.003; 8.60 mL vs. 11.22 mL, P=0.019). The equipment success rate in study group (98%) was higher than that in control group (96%), but it did not reach a statistical significance (P=0.558). There were no arterial embolism, second intervention 24-h hematoma formation in both groups. 
Conclusion: The training of ExoSealTM vascular closure device simulator can improve the safety and effectiveness of femoral arterial puncture site sealing. The training of the simulator is recommended to be routinely used in the basic teaching and training of vascular intervention operation. 

Abstract:Background and Aims: For long-segment chronic symptomatic internal carotid artery occlusion (ICAO), either carotid endarterectomy (CEA) or endovascular surgery has its respective limitations. However, the reports on the efficacy of their combined surgery are still not enough. Therefore, this study was conducted to investigate the safety and effectiveness of CEA combined with endovascular technique in the treatment of chronic symptomatic ICAO. 
Methods: The clinical data of 37 patients with long-segment chronic ICAO (involving at least the petrous or more distal segments) undergoing combined surgery from March 2017 to June 2019 were retrospectively analyzed. The proximal occlusion lesion located at the cervical segment (C1 segment) in all patients, the distal occlusion lesion extended to the cavernous segment (C4 segment) or more proximal segments in 20 patients (proximal group), and the distal occlusion lesion extended to clinoid segment or more distal segments in 17 patients (distal group). The changes in clinical symptoms, the scores of the modified Rankin scale (mRS) before and after operation as well the CTA reviewed 3 to 6 months after operation of the patients were analyzed.
Results: All 37 patients with received combined surgical treatment, of whom, the occluded segment in 30 cases were successfully recanalized, and the surgical success rate was 81.1%. In proximal group, the overall recanalization rate was 95.0% (19/20), in which, the recanalization rate for either C2 or C3 segment was 100%, and for C4 segment was 66.7% (6/9); in distal group, the overall recanalization rate was 64.7% (11/17), in which, the recanalization rate for C5 segment was 66.7% (6/9), C6 segment was 57.1% (4/7) and C7 segment was 100% (1/1). The overall recanalization rate in proximal group was significantly higher than that in distal group (P=0.033). The clinical symptoms were improved to different extents in the recanalized patients, the postoperative CTA demonstrated a patent right internal carotid artery, and the PWI images at 1 week after operation showed that the intracranial perfusion hemodynamic indicators were significantly improved compared with their preoperative conditions. Follow-up was conducted for 6 to 17 months in the 30 recanalized patients, the patency rate of the target vessel was 90.0% (27/30), which was 94.7% (18/19) in proximal group and 81.8% (9/11) in distal group, and the difference was no significant between the two groups (P=0.543). The mRS score of the patients at 6 months after operation was significantly better than that before operation (t=6.238, P<0.01).
Conclusion: CEA combined with endovascular technique is a safe and feasible method for the treatment of chronic symptomatic ICAO, and the recanalization rate is higher in patients with distal ICA occlusion at the cavernous more proximal segments.

Abstract:Background and Aims: Stent placement has been widely applied for the treatment of arteriosclerosis obliterans of lower extremities. However, the incidence of postoperative femoropopliteal in-stent restenosis (ISR) remains a difficult clinical problem. Studies have demonstrated that ISR is closely associated with the nutritional and inflammatory markers, and the availability of reliable predictive factors for ISR after lower extremity arterial stenting is of great clinical value. Therefore, this study was conducted to investigate the value of C-reactive protein (CRP)/albumin ratio (CAR) in prediction of ISR and its severity after lower extremity artery stenting. 
Methods: The clinical data of 186 patients undergoing lower limb artery stenting in the First Affiliated Hospital of Jinzhou Medical University from January 2017 to May 2019 were retrospectively collected. The occurrence of ISR within 12 months after operation as well as the severity of ISR were analyzed. The influencing factors for ISR were determined by univariate and multivariate Logistic regression analysis, and the predictive abilities of CAR, CRP and albumin for ISR and its severity were evaluated by ROC curve analysis 
Results: During a follow-up period for 12-month, ISR occurred in 54 patients (29.0%), of whom, 24 cases had a severe disease (ISR>75%). In patients with ISR, the numbers of male, smoking and diabetes cases as well as the values of CRP and CAR were higher, and the values of albumin and ankle-brachial index (ABI) were lower than those in patients without ISR (all P<0.05). The results of multivariate regression analysis showed that male sex (P=0.023), having diabetes (P=0.002), smoking (P=0.023), low albumin (P=0.007) and high CRP (P<0.001) were independent risk factors for ISR after lower extremity artery stenting. The area under the curve (AUC) of CAR for predicting ISR was 0.846, which was superior to that of CRP (AUC=0.835) and albumin (AUC=0.822), where the optimal cutoff value was 0.6, with the sensitivity and specificity 70.4% and 87.2%, respectively. The AUC of CAR for predicting the severity of ISR was 0.662, which was better than that of CRP (AUC=0.646) and albumin (AUC=0.630), where the optimal cutoff value was 1.066, with the sensitivity and specificity of 75% and 42.4%, respectively. 
Conclusion: CAR can be used for early prediction of ISR and the severity of ISR in patients undergoing lower extremity artery stenting, which is more accurate than that of CRP or albumin alone. The value of CAR>0.6 suggests that the risk of ISR may be increased, and CAR>1.06 suggests that the severity of may be exacerbated.

Abstract:Deep venous thrombosis (DVT) is a venous reflux disorder caused by abnormal blood coagulation in the deep veins, which often occurs in the legs. Thrombus shedding can cause pulmonary embolism (PE). DVT and PE are collectively referred to as venous thromboembolism (VTE), and it is the manifestation of the same disease in different stages. The High incidence of DVT and the risk of sudden death caused by PE have been widely concerned by clinicians. When anticoagulation is contraindicated or anticoagulation treatment fails in VTE patients, an inferior vena cava filter (IVCF) can be inserted to capture blood clots through its mesh filter structure to prevent fatal PE. IVCF has been widely used in the world. According to the usage, it can be divided into permanent type, temporary type and retrievable type. Permanent IVCF cannot be removed unless the vena cava is surgically incised after implantation, The long-term occurrence rate of filter fracture, displacement, embolism and symptomatic perforation is high, which has been eliminated in clinical practice. Temporary IVCF is easy to be recovered by connecting with external catheter and fixed equipment, but it is easy to be infected, so it is rarely used in clinical practice. The retrievable IVCF has a hook-like structure for retrieving. When the patient's VTE risk period has passed, it can be removed by interventional surgery, which is the main type of clinical application. However, due to a series of complications caused by the treatment time of some patients exceeding the filter indwelling time window and the loss of follow-up, the actual recovery rate is low, and the related disputes are increasing. At the same time, the research and development of new IVCF is being carried out closely. Drug-eluting IVCF is coated with inhibition of smooth muscle proliferation and anti-inflammatory drugs, which can prevent the excessive proliferation of vascular intima, prolong the indwelling time of IVCF and facilitate the retrieval; In order to reduce the long-term complications, convertible IVCF allows the filter structure to be transformed in vivo from filter screen to open stent, but the converted metal stent can’t be removed, and the long-term effect on vena cava still needs long-term follow-up observation; Biodegradable IVCF can be completely absorbed by the body and avoid secondary surgery, which is a hot research topic of scholars at home and abroad. However, there is no clear research data to confirm how to design materials to ensure that IVCF maintains its strength before the thrombus intercepted by the filter is absorbed, so as to prevent the hemostatic clot or degraded fragment from thromboembolism again. The new type of IVCF with controllable degradation characteristics is a clear research and development goal. On the other hand, some scholars have used computer simulation to analyze the influence of different structures of filter units and the number of support rods on the performance of the filter, which provided a more scientific reference and theoretical basis for the study of new type of IVCF with optimal structure and minimal hemodynamic impact. In summary, on the basis of advocating the application of more meticulous patient management and clinical follow-up to improve the IVCF removal rate, it is imminent and significant to further develop an ideal IVCF. The new type of IVCF should have the following functions: it can effectively intercept blood clots to prevent new or recurring PE; after the high-risk period of VTE, it can be remotely controlled for conversion or overall simultaneous degradation; the filter is well fixed, maintaining good radial support performance at the same time does not damage the vena cava wall; has good biocompatibility; has little impact on hemodynamics; can be clearly visualized in imaging examinations for follow-up. It is believed that with the in-depth research and development in the fields of materials science and tissue engineering, a new type of IVCF with excellent clinical efficacy and few complications can be developed as soon as possible.

Abstract:Deep vein thrombosis (DVT) is one of the common complications during the perioperative period of abdominal surgery. Execution of lower limb movements is the most basic and important measure to prevent DVT during the perioperative period of abdominal surgery, because of its effects of promoting blood flow and overcoming thrombus formation. In this paper, the authors review the risk factors for perioperative DVT in abdominal surgery, and its incidence rate, and different lower limb movement patterns with their current application status in abdominal surgery as well as the limitations of lower limb movements, so as to provide recommendations for future research.

Abstract:The natural prognosis of thoracic-abdominal aortic aneurysm (TAAA) is poor. Multiple visceral arteries are often involved, which brings challenges to safe surgical treatment. The current surgical treatment of TAAA include: open repair, hybrid surgery and total endovascular repair. Open repair is the standard approach with satisfactory long-term efficacy, but it is also a surgically complex and highly invasive procedure with high incidence of complications. Hybrid procedure and endovascular repair developed in recent years have shown their advantages, but there are still shortcomings. The surgical treatment options for TAAA should follow the principle of individualization. Multidisciplinary collaboration can minimize the risk of surgery and maintain long-term durable outcomes for TAAA patients.

Abstract:Platelets (PLTs), the second most abundant cell type in peripheral blood, are circulating fragments of nucleated cells that originate from the megakaryocytes in the bone marrow and play an important role in hemostasis and initiating wound healing. In recent years, studies have shown that several parameters of PLTs in breast cancer patients are significantly different from those in normal subjects and that PLTs can secrete a variety of cytokines to promote epithelial-mesenchymal transition and proliferation of breast cancer cells. PLTs assist circulating tumor cells to survival in the circulatory system, evade immune attack and promote the growth of metastatic cancer foci. Here, the authors address the role of PLTs in breast cancer in terms of the parameter characteristics of the PLTs in breast cancer patients, the mechanism of interaction between PLTs and breast cancer, and the potential of PLTs in the treatment of breast cancer, so as to provide reference for the diagnosis and treatment of breast cancer.