Volume 28,Issue 6,2019 Table of Contents

1 Treatment of pediatric venous thromboembolism--interpretation of the American Society of Hematology 2018 Management Guidelines for Venous Thromboembolism

DAI Tingting , HUANG Jianhua , YIN Tao , TANG Hongying , HU Lin , HUANG Qi

2019, 28(6):649-653. DOI: 10.7659/j.issn.1005-6947.2019.06.001

[Abstract](803) [HTML](1070) [PDF 1.04 M](1333)

Abstract:
The American Society of Hematology has issued its 2018 Guidelines for Management of Venous Thromboembolism: Treatment of Pediatric Venous Thromboembolism in 2018. The guidelines provide 30 recommendatory proposals for the treatment of venous thromboembolism in children. Based on the existing evidence-based medical data and combined with the actual problems in the treatment of pediatric thrombotic diseases, the authors emphatically interpret the recommendatory proposals for the treatment of pediatric venous thromboembolism provided by the guidelines, hoping that the medical personnel in related fields can understand and follow the guidelines.

2 Application of Angiojet mechanical thrombectomy in patients with postoperative deep venous thrombosis and its efficacy

HUANG Jiaqi , LU Huaxiang , LIU Xiaobing , LU Xinwu

2019, 28(6):654-660. DOI: 10.7659/j.issn.1005-6947.2019.06.002

[Abstract](848) [HTML](1208) [PDF 1.29 M](1018)

Abstract:
Objective: To evaluate the early efficacy and safety of Angiojet mechanical thrombectomy in treatment of patients with postoperative deep venous thrombosis (DVT).
Methods: The clinical data of 91 patients with acute DVT (central or mixed type) treated from September 2015 to January 2017 were retrospectively analyzed. Of the patients, 30 cases had postoperative DVT (observation group) and 61 cases had non-postoperative DVT (control group). The relevant clinical variables between the two groups were compared.
Results: There were no significant differences in terms of preoperative data between the two groups of patients (all P>0.05). The stent implantation rate as well as the diameter and length of the stents showed no significant differences between the two groups (all P>0.05), but the average time for thrombolysis in control group was significantly longer than that in observation group (2.31 d vs.1.50 d, P<0.05). There were no serious complications such as major bleeding events and cardiovascular events or death occurred in either of the groups. Puncture site bleeding occurred in 6 cases and 4 cases and newly developed symptomatic pulmonary embolism occurred in
2 cases and 1 case in control group and observation group respectively, and the differences showed no statistical significance (both P>0.05). The 1-year patency rate (control group: 88.52% vs. observation group: 90.00%), VRI score and Villalta score showed no statistical difference between the two groups (all P>0.05).
Conclusion: Using Angiojet mechanical thrombectomy in treatment of postoperative DVT is safe and effective.

3 Short- and long-term efficacy of catheter thrombolysis combined with iliac vein stenting for Cockett syndrome and concomitant lower extremity deep vein thrombosis

YANG Wei , LI Xiaoqiang , DING Aixing

2019, 28(6):661-667. DOI: 10.7659/j.issn.1005-6947.2019.06.003

[Abstract](844) [HTML](918) [PDF 1.09 M](1279)

Abstract:
Objective: To investigate the short- and long-term efficacy of catheter-directed thrombolysis (CDT) combined with iliac vein stenting for patients with Cockett syndrome and concomitant lower extremity deep vein thrombosis (DVT).
Methods: Ninety patients with Cockett syndrome and DVT admitted from January 2013 to January 2015 were randomly assigned to observation group and control group by the random number table, with 45 cases in each group. Patients in observation group underwent CDT plus stenting, and those in control group underwent CDT alone. The short- and long-term efficacy, severities of vascular injury and changes in inflammatory factors between the two groups were compared.
Results: There was no significant difference in postoperative efficacy between the two groups (H=0.518, P=0.604). All patients were followed up for 36 to 40 months, and no stent fracture, displacement, collapse, disintegration or perforation was noted. In observation group, the re-occlusion rate was lower (11.1% vs. 37.8%, P<0.05) and the primary patency rate (88.9% vs. 62.2%, P<0.05) was higher than those in control group. The Villalta score and VCSS score were significantly lower and the CIVIQ score was significantly higher in observation group than those in control group at the last follow-up (all P<0.05). The postoperative vascular injury score and serum TNF-α and IL-10 levels in both groups were significantly increased compared with their preoperative values, but their increasing amplitudes in observation group were significantly greater than those in control group (all P<0.05). The vascular injury score and serum TNF-α and IL-10 levels in patients with re-occlusion were significantly higher than those without re-occlusion in observation group (all P<0.05), which showed no significant differences between patients with and without re-occlusion in control group (all P>0.05). There was no significant difference in incidence of adverse reactions between the two groups (P>0.05).
Conclusion: For patients with Cockett syndrome and lower limb DVT, the short-term efficacy of CDT plus iliac vein stenting is similar to that of CDT alone, but its long-term efficacy is better than CDT alone. Re-occlusion after CDT plus stenting may be associated with inflammatory factor release and vascular injury induced by stent implantation.

4 Comparison of safety and efficacy of percutaneous mechanical thrombectomy versus catheter-directed thrombolysis for acute arterial thrombosis of the lower extremity

LI Fei , CHU Haiwei , SHEN Yang , CHEN Guang , ZHAO Wenjun

2019, 28(6):668-672. DOI: 10.7659/j.issn.1005-6947.2019.06.004

[Abstract](369) [HTML](1014) [PDF 415.01 K](931)

Abstract:
Objective: To compare the safety and efficacy of percutaneous mechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) in treatment of acute arterial thrombosis of the lower extremity.
Methods: The clinical data of 67 patients undergoing endovascular interventional therapy for acute arterial thrombosis of lower extremity from July 2015 to March 2018 were retrospectively analyzed. Of the patients,
37 cases received PMT treatment (PMT group), and 37 cases received CDT treatment (CDT group). The main perioperative variables between the two groups were compared.
Results: There were no significant differences in preoperative variables, the number of cases requiring further balloon dilatation and stenting after respective operation, primary revascularization rate and 12-month primary vascular patency rate between the two groups of patients (all P>0.05). In PMT group compared with CDT group, the average length of hospital stay was significantly decreased [ (5.8±0.8) d vs. (8.9±0.6) d, P<0.05], while the average hospitalization cost was significantly increased [ (70 000±11 000) yuan vs. (48 000±8 000) yuan, P<0.05]. No significant differences were noted in incidence of severe bleeding, postoperative amputation, puncture site hematoma, puncture site infection and renal insufficiency between the two groups (all P>0.05), but the overall incidence of complications in PMT group was significantly lower than that in CDT group (5.4% vs. 26.7%, P<0.05).
Conclusion: PMT is as safe and effective as CDT in treatment of acute arterial thrombosis of the lower extremity, the incidence of complications and length of hospital stay are decreased, but hospitalization cost is increased in PMT compared to CDT.

5 Catheter-directed thrombolysis for acute superior mesenteric artery thrombosis: a report of 24 cases

QIN Shaohua , LIU Ping , HAO Tingjia , ZHAO Tanghai

2019, 28(6):673-678. DOI: 10.7659/j.issn.1005-6947.2019.06.005

[Abstract](323) [HTML](1299) [PDF 1.80 M](955)

Abstract:
Objective: To investigate the effectiveness and safety of catheter-directed thrombolysis (CDT) in treatment of acute superior mesenteric artery thrombosis (ASMAT).
Methods: The clinical data of 24 patients with ASMAT undergoing CDT from January 2012 to February 2017 were retrospectively analyzed.
Results: Of the 24 patients, 14 cases were males and 10 cases were females, with an average age of (68.6±11.2) years; the average time from onset to consultation was (8.2±3.4) h. All patients underwent CDT or CDT plus other endovascular procedures, with an average time of (42.8±8.3) h for CDT. Eighteen patients (75.0%, 18/24) were cured, of whom, the onset time was less than 6 h in 10 cases and 6-12 h in 8 cases; 14 cases underwent CDT alone, 2 cases underwent CDT plus percutaneous transluminal angioplasty (PTA), and 2 cases underwent CDT plus PTA and stent implantation. Four patients (16.7%, 4/24) were improved, of whom, the onset time was 6-12 h in 3 cases and 20 h in 1 case; all underwent CDT plus PTA. Treatment failed in 2 patients (8.3%, 2/24), of whom, the onset time was 9 and 19 h respectively; 1 case showed peritoneal irritation signs 30 h after CDT, then underwent bowel resection and anastomosis with approximately 150.0 cm of small bowel resected, and after that, the abdominal symptoms disappeared and the postoperative recovery was satisfactory, while the other case showed peritoneal irritation signs 10 h after CDT, then underwent bowel resection and anastomosis, but the remnant small bowel was only about 200 cm in length and after that, short bowel syndrome occurred and the patient died of myocardial infarction on the 7th day after operation. Twenty-three patients were followed up for (43±17) months, no recurrence and aggravation occurred; CTA showed about 50% stenosis within the stent in
1 case with stent implantation, for which no treatment was given because of no clinical symptoms.
Conclusion: CDT is a safe, effective and minimally invasive method in treatment of ASMAT.

6 Endovascular treatment of recurrence of symptomatic isolated superior mesenteric artery dissection after initial successful conservative treatment: a report of 8 cases

LI Huaqing , HOU Kai , CHEN Gang , LU Weifeng , HONG Shichai , HONG Xiang , WANG Lixin , JIANG Junhao , GUO Daqiao , FU Weiguo , WANG Yuqi

2019, 28(6):679-686. DOI: 10.7659/j.issn.1005-6947.2019.06.006

[Abstract](415) [HTML](1090) [PDF 1.49 M](992)

Abstract:
Objective: To investigate the efficacy of endovascular treatment in patients with recurring symptoms after initial successful conservative treatment for symptomatic isolated superior mesenteric artery dissection (ISMAD).
Methods: The clinical data of 8 patients who experienced recurring symptoms after initial successful conservative treatment for symptomatic ISMAD undergoing endovascular treatment between July 2015 to June 2017 in the Department of Vascular Surgery of the Affiliated Zhongshan Hospital of Fudan University were retrospectively analyzed.
Results: All the 8 patients were male with an average age of 51.14 years. The clinical symptoms of the patients recurred after conservative treatment, and the CT scan findings were aggravated compared with the initial observation. Endovascular treatment was successfully performed in 5 patients with 11 stents implanted. Endovascular treatment was unsuccessful in 3 patients because the guide wire failed to enter the distal true lumen, of whom, 2 cases were continued with conservative treatment and 1 case was converted to open surgery. Clinical symptoms of the 5 patients with successful endovascular treatment were completely alleviated during the perioperative period. In the 3 failed patients, 2 cases presented with peritoneal stimulation, of whom, 1 case died due to severe peritonitis and multiple organ dysfunction and the clinical symptoms disappeared in another one who underwent open surgery after distal blood supply restoration; 1 case presented with persistent symptoms of superior mesenteric artery (SMA) ischemia and improved after medical treatment. The median follow-up time was 15 months. In the 5 patients with endovascular treatment, 2 cases had unsatisfactory remodeling of the SMA (partial thrombolization of the false lumen, stenosis in the distal true lumen and sparse display of the branches),
1 case had partial remodeling and 2 cases had complete remodeling. The patient undergoing open surgery recovered well and the symptoms of chronic SMA ischemia disappeared. The symptoms of chronic SMA ischemia were still observed in the patients undergoing conservative treatment bur were markedly relieved compared with those at admission.
Conclusion: Symptomatic ISMAD has certain risk of recurrence after initial successful conservative treatment. After recurrence, the disease may markedly worsen compared to the first onset, and the difficulty and failure rate of endovascular intervention are increased, which may cause severe adverse consequences.

7 Efficacy and safety of cerebrospinal fluid drainage for prevention and treatment of spinal cord injury after thoracoabdominal aortic aneurysm repair: a systematic review and Meta-analysis

SU Yiming , WEI Lichun , HOU Peiyong , LI Qiyi , ZHENG Zhiyong

2019, 28(6):687-695. DOI: 10.7659/j.issn.1005-6947.2019.06.007

[Abstract](391) [HTML](1111) [PDF 615.50 K](958)

Abstract:
Objective: To systematically evaluate the efficacy and safety of cerebrospinal fluid drainage (CSFD) in prevention and treatment of spinal cord injury (paraplegia and paresis) after endovascular repair of thoracic-abdominal aortic aneurysm (TAAA).
Methods: The randomized controlled trials (RCTs) publicly published concerning CSFD for prevention and treatment of spinal cord injury after endovascular repair of TAAA were collected from several national and international databases by computer-based online and manual search. Systematic evaluation and Meta-analysis were performed by using RevMan 5.3 software.
Results: Five RCTs were included, involving 424 patients, of whom, 232 cases received CSFD treatment (CSFD group) and 192 patients did not receive CSFD treatment (control group). Results of Meta-analysis showed that the incidence of spinal cord injury in CSFD group was significantly lower than that in control group (OR=0.45, 95% CI=0.26–0.76, P=0.003); the overall mortality rate at the end of treatment and follow-up was lower in CSFD group than that in control group, but it did not reach a statistical significance (OR=0.67, 95% CI=0.31–1.44, P=0.31). Complications associated with CSFD therapy occurred in 6 cases in CSFD group and 0 cases in control group, but the difference in incidence of complications reached no statistical significance between the two groups (OR=4.38, 95% CI=0.75–25.49, P=0.10).
Conclusion: CSFD has a definite effect on prevention and treatment of spinal cord ischemia injury after endovascular repair for TAAA, but the quality of evidence and recommendation level are relatively low. There is still some controversy about the operative risk. CSFD is advisable for patients with high risk of paraplegia or those who already have presence of paraplegia. However, the risk-benefit ratio should be fully assessed and the operation should be cautiously performed for patients with low risk of paraplegia and complications such as bleeding.

8 Fenestrated endografts versus chimney stent repair for abdominal aortic aneurysms: a Meta-analysis

YIDIRESI?Aishan , LI Xinxi , TIAN Ye , BAI Chao , YANG Zhenwei , ZHANG Lei , LUO Jun

2019, 28(6):696-705. DOI: 10.7659/j.issn.1005-6947.2019.06.008

[Abstract](426) [HTML](1129) [PDF 1.17 M](1070)

Abstract:
Objective: To compare the clinical efficacy of fenestrated endovascular aneurysm repair (F-EVAR) and chimney endovascular aneurysm repair (Ch-EVAR) in treatment of abdominal aortic aneurysm.
Methods: The controlled studies comparing F-EVAR and Ch-EVAR in treatment of abdominal aortic aneurysm published in English and Chinese were searched through online databases. The retrieval time was up to December 2018. After the data extraction of the included studies, NOS was employed for quality assessment. Meta-analysis was conducted by using RevMan5.1 software.
Results: Eight studies were finally included involving 466 patients, with 283 cases in F-EVAR group and 183 cases in Ch-EVAR group. A total of 909 vessels were involved in these processes. The results of Meta-analysis showed that in F-EVAR group compared with Ch-EVAR group, the incidence of type I endoleak was reduced (OR=0.35, 95% CI=0.13–0.94, P=0.04), but the presence of target organ injury was increased (OR=2.92, 95% CI=1.25–6.81, P=0.01), while no significant differences were observed in terms of technical success rate, vascular re-stenosis/re-occlusion rate, 30-d mortality and re-intervention rate (all P>0.05).
Conclusion: Both F-EVAR and Ch-EVAR are safe and effective treatments for abdominal aortic aneurysm. F-EVAR has relative low incidence of type I endoleak but relatively high prevalence of target organ damage. However, this result still needs to be verified by further studies.

9 Expression of eukaryotic initiation factor 4A1 in gastric cancer and its role in proliferation, invasion and migration of gastric cancer cells

XIAO Zhongfu , HU Kuan

2019, 28(6):706-712. DOI: 10.7659/j.issn.1005-6947.2019.06.009

[Abstract](361) [HTML](921) [PDF 923.03 K](1181)

Abstract:
Objective: To investigate the expression of eukaryotic initiation factor 4A1 (eIF4A1) in gastric cancer and its role in the proliferation, invasion and migration of gastric cancer cells.
Methods: A total of 116 paired specimens of gastric cancer and their adjacent normal tissue were collected, and then, the expressions of eIF4A1 were analyzed by immunohistochemical staining, RT-RCR and Western blot. The effects of different concentrations of eIF4A1 inhibitor hippuristol (0.125, 0.25, 0.5, 1 and 2 μmol/L) on the proliferation of gastric cancer cell line AGS and MGC-803 as well as normal gastric mucosa cell line GES-1 were analyzed by MTT assay. The influences of hippuristol on invasion and migration abilities of the gastric cell lines were determined by Transwell assay and scratch assay.
Results: The results of immunohistochemical staining showed that the expression level of eIF4A1 in gastric cancer tissue was significantly higher than that in the adjacent normal tissue (P<0.05), and the results of RT-PCR and Western blot were consistent with the results of immunohistochemical staining. Results of MTT assay showed that the proliferative abilities in gastric cancer AGS and MGC-803 cells were significantly inhibited by hippuristanol in a time- and concentration-dependent manner, and not in the normal gastric mucosa GES-1 cells until the concentration of hippuristanol over 0.5 μmol/L (all P<0.05). In AGS and MGC-803 cells after exposure to 0.125 μmol/L hippuristanol for 24 h, the invasion and migration abilities were significantly reduced (both P<0.05).
Conclusion: The expression of eIF4A1 is increased in gastric cancer, which is closely associated with the malignant characteristics of gastric cancer cells. The eIF4A1 inhibitor may be expected to become a drug candidate for the treatment of gastric cancer.

10 Expression of YEATS domain-containing protein 4 in pancreatic cancer tissue and its prognostic significance

CHEN Jixiang , ZHANG Junya , DANG Shengchun , QIAN Xiaobao , CUI Lei

2019, 28(6):713-718. DOI: 10.7659/j.issn.1005-6947.2019.06.010

[Abstract](253) [HTML](891) [PDF 1.24 M](906)

Abstract:
Objective: To investigate the expression of YEATS domain-containing protein 4 (YEATS4) in pancreatic cancer tissue and its clinical significance.
Methods: Eighty surgical specimens of pancreatic cancer tissue and adjacent tissue confirmed by pathological examination were used to construct the tissue microarrays. The YEATS4 expressions in pancreatic cancer and adjacent tissues were detected by immunohistochemical staining. The relations of the YEATS4 expression in pancreatic cancer tissue with the clinicopathologic features and prognosis of pancreatic cancer patients were analyzed.
Results: The results of immunohistochemical staining results showed that the positive expression rate of YEATS4 in pancreatic cancer tissue was significantly higher than that in adjacent tissue (56.25% vs. 26.25%, P<0.05). The positive YEATS4 expression was significantly associated with sex (P=0.037), TMN stage (P<0.001), perineural invasion (P=0.006), lymphatic metastasis (P<0.001) and vascular metastasis (P=0.042) in patients with pancreatic cancer. In the entire group, the survival rate in patients with negative YEATS4 expression was significantly higher than that in those with positive YEATS4 expression (χ2=7.593, P=0.0059); subgroup analysis showed that the significant relationship between positive YEATS4 expression and unfavorable prognosis only was only seen in patients with TNM stage III/IV, lymphatic metastasis, perineural invasion, and vascular metastasis (all P<0.05). YEATS4 expression was an independent risk factor for the prognosis of pancreatic cancer patients (HR=2.1, 95% CI=1.1–4.2, P=0.026).
Conclusion: The YEATS4 expression in pancreatic cancer is significantly increased, which may be involved in the progression of pancreatic cancer, and it may be a potential prognostic marker and therapeutic target for pancreatic cancer.

11 Anatomic features in Chinese patients with abdominal aortic aneurysms involving iliac arteries and applicability of iliac branch devices: an analysis of 58 cases in a single center

WANG Guili , ZHANG Wei , HOU Kai , ZHOU Xiushi , PENG Tifang , LIU Fei , WANG Lixin , FU Weiguo ,

2019, 28(6):719-724. DOI: 10.7659/j.issn.1005-6947.2019.06.011

[Abstract](585) [HTML](1212) [PDF 1.02 M](1166)

Abstract:
Objective: To analyze the relationship between the anatomic features of the iliac arteries in Chinese patients with abdominal aortic aneurysms (AAA) involving the iliac arteries and the applicability of iliac branch devices (IBDs) through a single-center clinical investigation.
Methods: The clinical data of 58 patients with AAA involving bilateral or unilateral iliac arteries admitted in the Department of Vascular Surgery of Affiliated Zhongshan Hospital, Fudan University from July 2015 to March 2017 were reviewed. The imaging data of the patients were analyzed using a three-dimensional workstation, and the relevant variables were measured. According to the instructions for use based on anatomic distinctions, the applicability of two types of IBDs (Cook IBD, Gore IBE) among these patients and their restricting factors were analyzed.
Results: Of 58 AAA patients, bilateral common iliac arteries were affected in 49 cases and unilateral common iliac artery was affected in 9 cases. The mean length of affected common iliac artery was (57.9±18.1) mm for the left common iliac artery and (56.7±17.4) mm for the right common iliac artery, with the mean diameter of (17.7±7.2) mm for the left common iliac artery and (25.1±9.4) mm for the right common iliac artery, respectively. Based on the instructions for use of the two types of IBDs, the ratio of applicability in the affected iliac arteries was 26.1% (28/107) for Cook IBD and 20.6% (22/107) for Gore IBE. The main restricting factor for Cook IBD was the diameter of the internal iliac artery9 mm (50/107, 46.7%), and the most common reason for exclusion from Gore IBE was the diameter of the common iliac artery <25 mm (67/107, 62.6%).
Conclusion: The applicability of anatomic criteria-based IBDs in Chinese patients with AAA aneurysms involving the iliac arteries is relatively low. The unconformities in the diameters of the common iliac artery and internal iliac artery are the main restricting factors for their use.

12 Clinical efficacy of transposition of cephalic vein to basilic or axillary vein plus arteriovenous fistula constriction for cephalic arch stenosis in patients with high-flow brachiocephalic fistula

HUANG Xiaomei , WANG Yin , XIAO Wei , ZHANG Yi , GAO Bo , LI Jingjing , JIANG Zhongtao , YE Fei , MA Weiguo , QIAN Shuping

2019, 28(6):725-730. DOI: 10.7659/j.issn.1005-6947.2019.06.012

[Abstract](488) [HTML](1010) [PDF 1.06 M](914)

Abstract:
Objective: To evaluate the clinical efficacy of transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction in treatment of cephalic arch stenosis (CAS) in patients with high-flow brachiocephalic fistula (BCF).
Methods: Between January 2014 and June 2017, 22 patients with high-flow BCF admitted due to CAS were selected, and then underwent transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction. The changes in fistula hemodynamics 24 h after operation were measured by Doppler ultrasound, and the postoperative primary and secondary patency rates were also observed.
Results: Of the 22 patients before operation, the average time of hemodialysis was (73.5±44.4) months, the average inner diameter of the cephalic arch was (2.1±0.5) mm, and percutaneous transluminal angioplasty (PTA) was performed (1.9±0.4) times per patient. On 24 h after operation, the brachial resistance index and inner diameter of the brachial artery showed no significant changes (both P>0.05), but the average blood flow of the brachial artery and inner diameter of the anastomosis/venous outflow track were significantly reduced compared with preoperative values (both P<0.05). The patients were followed up for 21.5 months, the primary patency rates at 6, 12, 24 and 36 months after operation were 100%, 100%, 93.3% and 58.3% respectively, and the primary patency rate was significantly higher than that when they underwent PTA (χ2=49.23, P=0.000); all of the secondary patency rates at 6, 12, 24 and 36 months after operation were 100%. Subcutaneous hematoma occurred in only two patients after operation, which required no treatment; no thrombotic event occurred in any of the patients after operation or during the follow-up period.
Conclusion: Transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction for CAS in patients with high-flow BCF is safe and controllable, and can provide high long-term primary patency rates.

13 Treatment of vertebral artery dissection aneurysm keeping parent artery patent: a report of 28 cases

FANG Xinggen , CHENG Shaowen , WU Dan , LI Kai , LI Zhenbao , WU Degang , LAI Niansheng , ZHAO Xintong , YUAN Jinlong , LIU Jiaqiang

2019, 28(6):731-736. DOI: 10.7659/j.issn.1005-6947.2019.06.013

[Abstract](353) [HTML](1011) [PDF 1.26 M](842)

Abstract:
Objective: To investigate the treatment method for vertebral artery dissecting aneurysms keeping the parent artery patent and the efficacy.
Methods: The clinical data of 28 patients with vertebral artery dissecting aneurysms treated with the parent artery patent from January 2013 to October 2018 were retrospectively analyzed.
Results: Of the 28 patients, 12 cases had unruptured lesions and 16 cases had ruptured lesions, with an average age of (51.8±7.5) years. The surgical technical success rate of the 28 patients was 100%. Five patients with unruptured aneurysms were implanted with two or more stents. Immediate postoperative angiography showed that the contrast agent was retained in the aneurysm. The follow-up angiography showed that the aneurysms disappeared or diminished, with the Raymond grade I in 3 cases (3/5) and grade II in 2 cases (3/5). The other 23 patients were treated with double overlapping stent-assisted coil embolization. Immediate postoperative angiography showed Raymond grade I in 11 cases (11/23), grade II in 5 cases (5/23) and grade III in 7 cases (7/23), of whom, 19 cases (19/23) were followed up for (14.5±7.9) months, and the follow-up imaging results showed Raymond grade I in 16 cases (16/19), grade II 3 cases (3/19) and no grade III lesion. In the 16 patients with ruptured lesions, 2 cases developed in-stent thrombosis or perforating branch events, which were resolved after thrombolytic therapy. The prognostic mRS score ≤2 in 27 patients and ≥3 in one patient.
Conclusion: Leaving the parent artery patent, multiple stent placement or multiple stent assisted coil embolization can achieve good clinical results in treatment of vertebral artery dissection aneurysms.

14 Huge retroperitoneal leiomyosarcoma with hemorrhage: an analysis of one case and literature review

JIANG Chao , LIU Xueyan , SUN Dawei , ZHANG Ping , WANG Meng

2019, 28(6):737-742. DOI: 10.7659/j.issn.1005-6947.2019.06.014

[Abstract](918) [HTML](1241) [PDF 3.33 M](802)

Abstract:
Objective: To investigate the clinical features, imaging manifestation and treatment strategies of retroperitoneal leiomyosarcoma, so as to provide reference for the diagnosis and treatment of similar cases.
Methods: The clinical data of one admitted patient with retroperitoneal leiomyosarcoma was analyzed retrospectively, and the relevant literature was reviewed.
Results: The patient had abdominal pain and anemia, and the preoperative imaging examination indicated a malignant tumor with hemorrhage in hypogastric region. The patient underwent fluid replacement therapy and interventional embolization first, and then ultrasound-guided puncture and drainage to avoid the occurrence of abdominal compartment syndrome. After tumor size reduction and anemia correction, the tumor was completely resected, and the pathological diagnosis was leiomyosarcoma. Postoperative follow-up was conducted for
16 months, and the patient had an uneventful recovery.
Conclusion: Retroperitoneal leiomyosarcoma is a rare malignant tumor, which has an insidious onset and is more likely to develop recurrence and metastasis. Complete surgical excision is the main treatment method, which in combination with multimodality therapy such as chemotherapy and radiotherapy can improve the prognosis of patients.

15 Research status of signaling pathways associated with specific intimal hyperplasia in vessels

FU Pinting , WU Guangmin , GUO Yuanyuan

2019, 28(6):743-748. DOI: 10.7659/j.issn.1005-6947.2019.06.015

[Abstract](317) [HTML](1398) [PDF 1.06 M](817)

Abstract:
Arteries and veins are different not only in their structure and function, but also in gene content. The molecular fingerprints EphrinB2/EphB4 play a vital role in angiogenesis and vascular remodeling. Selective intervention of one of the components of the EphrinB2/EphB4 signaling pathways may be helpful in the treatment of the specific intimal hyperplasia in blood vessels. Therefore, the studies on the expression regulation of EphrinB2/EphB4 and the related signaling pathways are particularly important.

16 Advances in endovascular treatment of in-stent restenosis of femoropopliteal artery

HE Yi , WANG Bing

2019, 28(6):749-755. DOI: 10.7659/j.issn.1005-6947.2019.06.016

[Abstract](423) [HTML](1055) [PDF 1.06 M](889)

Abstract:
In recent years, with the extensive use of endovascular stenting in treatment of femoropopliteal artery stenosis and occlusion disease, the in-stent restenosis (ISR) is increasingly becoming a growing problem. Although the use of drug-coated balloon (DCB) reduces the prevalence of ISR, the treatment of ISR remains a clinical challenge. Despite that, the plain old balloon angioplasty (POBA), cutting balloon, frozen balloon, and re-stent implantation have been applied in the treatment of ISR, but the results are not satisfactory. Both debulking technique and DCB have certain limitations. However, their combination can exert their respective advantages, which may be an effective way to treat ISR of the femoropopliteal artery in the future.

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Volume 28,Issue 6,2019 Table of Contents

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