Abstract:

Complex thoracic aortic diseases are of diverse forms, for which endovascular therapy may convert the untreatable conditions into treatable ones mainly by means of prolonging the proximal landing zone. The specific measures include chimney stent technique, hybrid surgery, in-situ fenestration and pre-fenestration technologies, and also include the selection of the appropriate aortic stent and the branched stent technology which will be used in clinical settings in the near future. The choice of various methods is mainly based on the location and characteristics of the lesion and the patient’s economic conditions, and the experience of the surgeon also should be considered.

Abstract:The placement of inferior vena cava filters (IVCF) is a safe and effective way to reduce the incidence of pulmonary embolism, but the complications of its long-term implantation are also well documented. The ideal IVCF should contain many benefits with some general features, such as clot-trapping efficiency, satisfactory fixation to the venous wall, fewer complications and lower costs. So, practitioners should have a general knowledge of the characteristics of different IVCF, and establish new concepts, enhance management and pay enough attention to retrieval of IVCF.

Abstract:Objective: To investigate the treatment method for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR). Methods: The clinical data of 3 patients with relatively severe type II endoleak after EVAR treated in the Department of Vascular Surgery of Xiangya Hospital from 2011 to 2016 were retrospectively analyzed. Of the patients, one case with a continuous enlargement of the aneurysmal sac after hybrid operation (reconstruction of the visceral vessels plus EVAR) for thoracoabdominal aortic aneurysm, a retrograde endoleak from the celiac axis was found by CTA examination; the other two cases had a retrograde endoleak from inferior mesenteric artery after EVAR for abdominal aortic aneurysm. Results: The patient with retrograde endoleak from the celiac axis was treated with Interlock detachable coil embolization, and the other two patients were treated with conventional coil embolization. Embolization was successfully performed and the endoleak disappeared in the 3 patients. Conclusion: Embolization using different approaches is an effective method for type II endoleak after EVAR.

Abstract:

Objective: To investigate the clinical significance and interrelationship among intraluminal thrombus (ILT) thickness and peripheral blood concentrations of homocysteine (Hcy) and C reactive protein (CRP) in patients with abdominal aortic aneurysm (AAA). Methods: Sixty AAA patients admitted from January 2014 to December 2015 were selected, and their peripheral blood Hcy and CRP concentrations were measured by ELISA and ILT thicknesses were determined by imaging analysis. The relations of ILT thickness with clinical factors and the relationship among ILT thickness, Hcy and CRP were analyzed. Results: The proportion of cases with hypertension history, and Hcy and CRP concentrations in patients with thick ILT thickness (thickness≥7.8 mm) were significantly higher than those in patients with thin ILT thickness (thickness<7.8 mm) (all P<0.05). Correlation analysis showed that Hcy level had a significant positive correlation with ILT thickness (r=0.942), the ratio of ILT thickness to AAA maximum diameter (r=0.844), and AAA maximum diameter (r=0.505) (all P<0.05), while CRP level had no significant correlation with other factors (all P>0.05). Conclusion: ILT thickness and peripheral blood Hcy and CRP concentrations are all potential risk factors for AAA progression. Further, there may be a mutual promotion between ILT thickness and Hcy concentration.

Abstract:Objective: To investigate the technique of retrograde stent placement for superior mesenteric artery (SMA) occlusion. Methods: The data of a patient undergoing retrograde recanalization for symptomatic SMA occlusion in February 2017 in the Department of Vascular Surgery of Zhongshan Hospital, Fudan University were reviewed. Results: The patient was a 47-year-old woman, and was diagnosed as chronic mesenteric ischemia (CMI) caused by SMA occlusion, and then underwent endovascular treatment for SMA recanalization. Both brachial artery and femoral artery approaches failed to cross the lesion, due to the complete occlusion and no stump left at the origin of the SMA. Then, the SMA occlusion was revascularized via retrograde crossing through the gastroduodenal collateral pathway between the celiac axis and SMA. After docking with the guidewire, the catheter via brachial artery was anterogradely and uneventfully advanced through the lesion, and then balloon dilation and stent placement were completed. The symptoms of CMI of the patient disappeared after operation, and follow-up CTA performed 3 months later demonstrated appropriate stent positioning and distal vascular patency. Conclusion: For patients with SMA occlusion after failed attempts by conventional interventional approaches, retrograde recanalization through collateral pathway remains feasible.

Abstract:Objective: To evaluate the methods for revascularization in Riles type 1A common carotid artery occlusion (CCAO) and the efficacy. Methods: From August 2012 to September 2015, 9 patients underwent revascularization for Riles type 1A CCAO. Of the patients, 5 cases underwent bypass graft and 4 cases underwent in situ reconstruction. Results: Operations were successfully completed in all patients, and their symptoms disappeared or were significantly improved after operation. Two patients (2/9) developed hyperperfusion syndrome that improved after strict blood pressure control and reducion of intracranial pressure by cerebral dehydration, and no serious complications such as cerebral hemorrhage occurred. During follow-up period, patients were generally in good condition and their symptoms were significantly improved or disappeared; at 6 months after operation, mild to moderate proximal in-stent stenosis (<50%) was found by ultrasound in one patient who had combined carotid endarterectomy and carotid artery stenting, but the patient had no subjective symptoms and no treatment was given; one patient with coronary artery disease died due to myocardial infarction 17 months later. Conclusion: Revascularization in Riles type 1A CCAO is safe and effective; the surgical treatment should be individually tailored and the in situ reconstruction should be recommended in qualified medical institutions.

Abstract:Objective: To evaluate the efficacy of simultaneous carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) in treatment of carotid stenosis and concomitant coronary disease. Methods: The clinical data of 25 patients with carotid stenosis and concomitant coronary disease treated in China-Japan Friendship Hospital from January 2007 to December 2014 were retrospectively analyzed. Of the patients, 11 cases underwent simultaneous CAS and CABG (one-stage group), and 14 cases underwent staged CAS and CABG (two-stage group). The main clinical variables between the two groups of patients were compared. Results: The preoperative general data were comparable between the two groups. In one-stage group compared with two-stage group, the median operative time (250 min vs. 280 min) and median length of hospital stay (19 d vs. 24 d) were significantly reduced (both P<0.05), while the median intraoperative blood loss (750 mL vs. 600 mL), blood infusion (1 000 mL vs. 1 200 mL), length of ICU stay (23 h vs. 24 h) and time on ventilator (19 h vs. 16.5 h) all showed no statistical difference (all P>0.05). Minor stroke within 30 d after operation, transient ischemia attack and perioperative pulmonary infection occurred in one case each and transient postoperative hypotension occurred in 3 cases in one-stage group; TIA occurred in one case, transient postoperative hypotension occurred in 4 cases, re-thoracotomy for hemostasis was required in one case and perioperative pulmonary infection occurred in one case in two-stage group. No myocardial infarction or death occurred in either of the groups. Conclusion: Both simultaneous and staged CAS and CABG are safe and reliable in treatment of carotid stenosis concomitant with coronary disease, and the simultaneous procedure can reduce operative time and hospitalization. However, the appropriate treatment method should be chosen according to the patients’ characteristics.

Abstract:Objective: To investigate the efficacy of endovascular atherectomy in treatment of femoropopliteal artery stenosis with outflow obstruction. Methods: From July 2014 to June 2015, 21 patients who had femoropopliteal artery stenosis with distal outflow tract obstruction and severe intermittent claudication as the main symptom underwent endovascular atherectomy, and then they were followed up. Results: Compared with preoperative findings, the claudication distances of the patients at 3, 6 and 12 months after operation were all significantly increased with a rising trend (all P<0.05), and the ankle-brachial indexes of the patients on 2 d, and at 3, 6 and 12 months after operation were all significantly increased (all P<0.05). Restenosis of the target vessel did not occur in any of the patients at 3 months after operation, but occurred in one case (1/21) 6 months after operation and in 2 cases (2/21) at 12 months after operation, and all stenoses were of a moderate degree. Conclusion: Endovascular atherectomy offers a satisfactory short-term efficacy in treatment of femoropopliteal artery stenosis with outflow obstruction.

Abstract:

Objective: To evaluate the clinical efficacy of hybrid procedures in treatment of complex arteriosclerosis obliterans in the femoropopliteal segment. Methods: The clinical data of 56 patients (65 limbs) with complex arteriosclerosis obliterans affecting the femoropopliteal segment undergoing hybrid operation from March 2013 to June 2015 were retrospectively analyzed. The treatment efficacy was evaluated by analyses of the ankle brachial index (ABI), Rutherford category and patency rate. Patency was analyzed by using Kaplan-Meier method. Results: The hybrid procedures were successfully performed in all the 56 patients (65 limbs), no amputation was needed and no death occurred and the incidence of perioperative complications was 14.29% (8/56). The postoperative average ABI was increased compared with preoperative value (0.76 vs. 0.28), and the distance of intermittent claudication was prolonged from 168 m before operation to 530 m after operation, and both differences had statistical significance (both P<0.05); the Rutherford grades were improved in different degrees. The patients were followed up for 12 to 33 months, and the 0.5-, 1- and 2-year primary patency rate was 93.85%, 81.54% and 70.77%, and secondary patency rate was 98.46%, 95.38% and 90.77%, respectively. Conclusion: Hybrid procedures are safe and effective in treatment of complex arteriosclerosis obliterans in the femoropopliteal segment.

Abstract:Objective: To inrestigate the changes of elastin and elastic fibers in the tunica media of the ascending aorta in patients with Stanford type A aortic dissection (AD). Methods: Ten specimens of dissected ascending aortic wall tissue obtained from patients with Stanford type A AD during surgery, and 10 specimens of normal ascending aortic wall tissue taken from brain-dead donors during organ donation surgery or patients undergoing coronary artery bypass grafting were collected. In the tunica media of the two groups of specimens, the elastin expressions were determined by Western blot, and the morphological features and contents of elastic fibers were analyzed by EVG staining. Results: Results of Western blot showed that the elastin level in the tunica media of the dissected ascending aorta was significantly lower than that in the tunica media of the normal ascending aorta [(0.32±0.07) vs. (1.12±0.17), t=6.722, P=0.003]. Results of EVG staining demonstrated that the morphology and arrangement of the elastic fibers in the tunica media of dissected ascending aorta were disordered with elastic lamina fracture and loss in dissected ascending aorta, while the elastic fibers were densely and orderly arranged with integrated structure and distinct gradations of the elastic lamina; the content of elastic fibers in tunica media of the dissected ascending aorta was significantly lower than that in tunica media of the normal ascending aorta [(85 762.8±106.2) vs. (164 482.8±161.4), t=5.902, P<0.001]. The elastin and elastic fiber contents were positively correlated in tunica media of both dissected and normal ascending aortas (r=0.953, 0.973, both P<0.001). Conclusion: The contents of elastin and elastic fibers are reduced and the morphology and arrangement of the elastic fibers are disordered in the tunica media of ascending aorta in patients with Stanford A type AD, and these changes may play an important role in the pathogenesis of AD.

Abstract:Objective: To investigate the effects of Rho-associated coiled-coil containing protein kinase I/II (ROCK I/II) on migration and proliferation in human aortic vascular smooth muscle cells (HA-VSMCs) induced by transforming growth factor β1 (TGF-β1). Methods: The protein expressions of ROCK I and ROCK II among HA-VSMCs respectively treated with ROCK I siRNA transfection, ROCK II siRNA transfection, TGF-β1 alone, and ROCK I siRNA or ROCK II siRNA transfection plus TGF-β1 were compared. The migration and proliferation abilities among HA-VSMCs respectively treated with TGF-β1 alone, ROCK I siRNA or ROCK II siRNA transfection plus TGF-β1, and ROCK I inhibitor Y-27632 plus TGF-β1 were compared. Untreated HA-VSMCs were used as blank control for all experiments. Results: Compared with blank control HA-VSMCs, the ROCK I protein expression was significantly increased (P<0.05) but ROCK II protein expression was unchanged (P>0.05) in HA-VSMCs after TGF-β1 alone treatment, the corresponding target protein expression was significantly decreased in HA-VSMCs after ROCK I siRNA or ROCK II siRNA transfection (both P<0.05), and the increased ROCK I protein expression in HA-VSMCs induced by TGF-β1 was significantly inhibited by ROCK I siRNA transfection (P<0.05). Compared with blank control HA-VSMCs, the number of migrating cells in HA-VSMCs after TGF-β1 alone treatment was significantly increased (P<0.05), and this effect was significantly inhibited by ROCK I siRNA transfection or Y-27632 pretreatment (both P<0.05), but was not influenced by ROCK II siRNA transfection (P>0.05); the proliferation in HA-VSMCs was significantly enhanced by TGF-β1 alone treatment, and the TGF-β1-induced proliferation was not affected by either ROCK I siRNA, ROCK II siRNA transfection or Y-27632 pretreatment (all P>0.05). Conclusion: ROCK I may play a major role in TGF-β1-induced migration of HA-VSMCs, but either ROCK I or ROCK II may not participate in TGF-β1-induced proliferation of HA-VSMCs.

Abstract:Objective: To investigate the changes in phenotype and function of vascular smooth muscle cells (VSMCs) from varicose great saphenous vein. Methods: Thirty specimens of varicose great saphenous vein (varicose group) and 15 specimens of normal great saphenous vein (normal group) were collected, and the VSMCs in the two groups of specimens were isolated and cultured. In the two groups of VSMCs, the proliferation, migration, adhesion and aging status and cytoskeletal protein expression, as well as the expressions of apoptosis associated factors and extracellular matrix metabolism associated factors were determined. Results: In VSMCs of varicose group compared with VSMCs of normal group, the expression of cytoskeletal protein F-actin was increased; the proliferative ability and numbers of migrating, adhering, and aging cells were significantly increased (all P<0.05); the mRNA and protein expressions of pro-apoptotic factor Bas and apoptotic executioner caspase-3 were significantly decreased, while mRNA and protein expressions of anti-apoptotic factor Bcl-2 was significantly increased (all P<0.05); the mRNA and protein expressions of matrix metalloproteinases (MMP-2 and MMP-9) and matrix metalloproteinase inhibitors (TIMP-1 and TIMP-1) were significantly increased (all P<0.05). Conclusion: VSMCs from varicose great saphenous vein feature evident dedifferentiation and demonstrate increased proliferative and synthetic capacity. These phenotypic and functional abnormalities in VSMCs may be one of the pathogeneses for varicosity.

Abstract:Objective: To investigate the methods and technical skills for complicated filter retrieval of the retrievable inferior vena cava filter (IVCF). Methods: The data of 29 patients with lower extremity deep vein thrombosis (DVT) undergoing complicated filter retrieval were analyzed. All patients underwent venography first to assess the status of the filter. In patients with the retrieval hook engaged to the vessel wall, IVCF retrieval was performed by using pigtail catheter assistance, guidewire looping and stirring techniques, bidirectional guidewire, and gooseneck snare catheter combined with guidewire looping, respectively; in those with thrombus in the inferior vena cava, a new filter was placed into the inferior vena if necessary, and then the filters were retrieved after thrombolysis and thrombus extraction. Results: IVCF retrieval was successfully performed in 24 patients, was unsucessful in one patient and was abandoned in 4 patients, and the retrieval rate was 83.9%. No complications such as inferior vena cava rupture and pulmonary embolism occurred during operation. The retrieved filters were noted to be intact with no fractures. Follow-up was conducted for a period of at least 6 months after treatment, and the inferior vena cavae were patent, with no thrombus formation and no obvious fluid collections in the abdominal cavity. Conclusion: The methods of use of catheter, guidewire and gooseneck snare assistance, as well as thrombolysis and thrombus extraction can increase the retrieval rate of the complicated retrievable IVCF retrieval, and thereby, reduced complications caused by long-term filter retention.

Abstract:Objective: To investigate the efficacy of DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis (DVT). Methods: From August 2012 to November 2016, 87 patients with mixed type and central type acute lower extremity DVT underwent DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis. Effectiveness evaluation was performed by comparison of the limb circumference differences before and after thrombolysis and observation of the angiographic evidence of deep venous patency after thrombolysis. Results: Of the 87 patients, successful puncture was performed in 80 cases (91.9%), of whom 68 cases underwent posterior tibial vein puncture and 12 cases underwent anterior tibial vein puncture; 7 cases with failed puncture underwent catheterization by posterior tibial vein incision. Clot fragmentation combined with catheter-directed thrombolysis was performed in all patients after successful catheterization. Compared with findings before thrombolysis, the limb circumference difference was significantly reduced [(4.28±1.02) cm vs. (1.06±0.42) cm] and venous patency score was significantly decreased [(10.25±1.84) vs. (1.92±0.5)], and all differences had statistical significance (all P<0.05). Conclusion: DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis is a simple and effective method for treatment of acute lower extremity DVT.

Abstract:Objective: To investigate the safety and clinical effect of self-expandable bare-metal stent for acute brachial artery injury. Methods: The clinical data of 18 cases with acute brachial artery injury were retrospectively analyzed. All patients underwent emergency angiography for confirmation of the diagnosis, and then received angioplasty and self-expandable bare-metal stent placement. Results: The technical success rate of the endovascular procedures was 100%, and the mean operative time was 50 (30–90) min. Thirteen patients underwent single-layered stent placement and 5 patients underwent two overlapping stents insertion, with a total of 23 self-expandable bare-metal stents deployed. Angiography immediately after stent placement showed that the blood flow of the injured brachial artery was restored, pseudoaneurysms disappeared and no stent stenosis or contrast agent extravasation was observed. All the 18 patients were followed up for an average period of 20.2 months, 17 patients had complete blood flow restoration or minor stenosis (required no treatment), while one patient developed a >50% in-stent stenosis, which was resolved by balloon dilation. No stent displacement, rotation or fracture was found, no ischemic necrosis occurred and no amputation surgery was needed during the follow-up period. Conclusion: Self-expandable bare stent placement is safe and effective in treatment of acute brachial artery injury, with satisfactory short- and medium-term efficacy.

Abstract:Objective: To investigate the BCL11A expression in triple-negative breast cancer (TNBC) tissue, and the impact of neoadjuvant chemotherapy on its expression. Methods: The BCL11A expressions in 43 specimens of TNBC (before and after neoadjuvant chemotherapy), as well as in 49 specimens of luminal type breast cancer and 50 cases of HER-2 positive breast cancer were determined by immunochemical staining. The relations of BCL11A expression with the clinicopathologic factors of TNBC and the influence of neoadjuvant chemotherapy on BCL11A expression in TNBC were analyzed. Results: The positive expression rate and expression level of BCL11A in TNBC tissue were significantly higher than those in luminal type breast cancer tissue or HER-2 positive breast cancer tissue (all P<0.05); the positive BCL11A expression was significantly associated with the size of the primary tumor of TNBC (P<0.05); both positive expression rate and expression level of BCL11A in TNBC tissue after neoadjuvant chemotherapy were significantly reduced compared with TNBC tissue before neoadjuvant chemotherapy (both P<0.05). Conclusion: BCL11A expression is increased in TNBC tissue, which may probably be a proliferation promoting factor, and neoadjuvant chemotherapy can reduce BCL11A expression in TNBC tissue.

Abstract:Thoracoabdominal aortic aneurysm (TAAA) refers to an abnormal widening of the aorta involving both its descending and abdominal segments. It is a highly lethal condition as far as its natural history is concerned and the surgical intervention is difficult to perform. Open surgery is the traditional method for TAAA repair, but with the development of endoscopic technology, hybrid surgery and endovascular therapy represented by fenestrated or branched stent grafts are already showing great promise in treatment of TAAA, and the newly developed octopus technique further enriched the choice of its endovascular therapy. Minimally invasive treatment of TAAA is now gradually becoming possible.

Abstract:

In recent years, thoracic endovascular aortic repair (TEVAR) has shown promising results for Stanford type B aortic dissection. The aortic arch has a complex structure, with non-planar curvature and its supra-aortic arch branches are supplying vessels of the brain, upper limbs and other important areas, in which the left subclavian artery gives off important branches that include the vertebral artery perfusing the left upper limb and posterior portion of the brain. For ensuring sufficient landing zone, some special treatments should be made if the distance between proximal entry tear and the opening of the left subclavian artery is less than 1.5 cm. Here, the authors address the treatments of the left subclavian artery during endovascular repair of Stanford type B aortic dissection.

Abstract:With the development of technologies in recent years, endovascular intervention has increasingly matured and gradually taken the place of traditional surgery as a main treatment modality for lower limb arteriosclerosis obliterans (ASO). The efficacy of endovascular intervention in treatment of lower limb ASO is demonstrable, and the technological innovations make its superiority more and more strengthened. Here, the authors, after a comprehensive relevant literature review, extract the achievements from the related clinical trials, and discuss its development prospects.

Abstract:Photodynamic therapy is a newly emerging treatment modality against cancer, which has high selectivity and less toxicity compared with traditional treatment modalities. At present, photodynamic therapy has been used to treat several types of gastrointestinal cancers such as gastric cancer, colorectal cancer and squamous cell anal cancer, and shown significant efficacy in some patients. However, there is a lack of large randomized controlled trials. Here, the authors review the studies on photodynamic therapy for gastrointestinal cancers conducted at home and abroad in recent years, so as to provide support for both basic research and clinical practice.