Short- and mid-term outcomes of endovascular repair for ruptured abdominal aortic aneurysms under standardized emergency protocols
Propensity score matching analysis of the safety and efficacy of Denali vs. Octoparms inferior vena cava filters
Clinical outcomes of Rotarex mechanical thrombectomy system in treating chronic thrombosis in PAD patients
Anatomy and localization of the recurrent laryngeal nerve using the middle cervical fascia as a landmark
Medial versus lateral approach for recurrent laryngeal nerve exposure in anterior chest approach endoscopic radical thyroidectomy
Multidisciplinary treatment of locally advanced thyroid cancer: a case report
Nanoparticle-delivered siRNA combined with sonodynamic therapy for colon cancer
Efficacy analysis of laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in 7 cases of early gastric cancer
Key techniques and focal issues of digestive tract reconstruction in laparoscopic right hemicolectomy
Analysis of the efficacy of enteral nutrition combined with step-up drainage in the treatment of acute necrotizing pancreatitis complicated by duodenal fistula
Application of mechanical principles in pancreaticoduodenectomy: "1-tube, 2-needle, 3-suture" pancreaticojejunostomy (with video)
Innovation and development of robotic hepatobiliary and pancreatic surgery
Advancements and deliberation on the International Consensus Guidelines on Robotic Pancreatic Surgery (2023 Edition)
Current development of paclitaxel nanoformulations and its application progress in biliary tract cancer
Observation and analysis of the morphological and ultrastructural characteristics of the intrahepatic cholangiocarcinoma cell line ICC-X1
Analysis of the safety and feasibility of laparoscopic surgery for repairing LC-related biliary injury
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ZHANG Xiong, HE Hao, LI Ming, LI Quanming, SHU Chang
2024,33(12):1941-1949, DOI: 10.7659/j.issn.1005-6947.2024.12.001
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In August 2024, the European Society of Cardiology (ESC) released the 2024 edition of the Guidelines for the Management of Peripheral Arterial and Aortic Diseases. This comprehensive guideline provides detailed recommendations on the diagnosis and treatment strategies for peripheral arterial and aortic diseases (PAAD). It covers topics such as the evaluation and screening, epidemiology, treatment options, and follow-up recommendations of PAAD. With the increasing prevalence of unhealthy lifestyles and the aging population, arterial diseases have become one of the major health threats to residents in China. The detailed recommendations in this edition can be integrated with domestic guidelines to offer feasible and optimal clinical practice strategies for vascular surgeons. This article summarizes the key points and updates of the latest guideline to serve as a reference for domestic scholars.
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SONG Kun, LIN Shumeng, LIU Heli
2024,33(12):1950-1957, DOI: 10.7659/j.issn.1005-6947.2024.12.002
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Gastric cancer is a common malignant tumor globally, particularly in East Asia (including China, Japan, and South Korea), where it exhibits high incidence and mortality rates. In China, gastric cancer ranks third among all cancers in terms of mortality, posing a severe threat to public health. The gastric cancer diagnosis and treatment guidelines published by the Chinese Society of Clinical Oncology (CSCO) and the National Comprehensive Cancer Network (NCCN) are essential tools guiding clinical practice. These guidelines encompass various aspects, including diagnosis, surgery, perioperative treatment, and postoperative follow-up, and are updated annually based on the latest clinical data. They provide evidence-based recommendations to guide diagnosis and treatment, offering standardized therapeutic advice to help physicians make better decisions in complex cases. Both guidelines share consistent views on the recommendation of treatment drugs for advanced gastric cancer, the importance of molecular biomarker testing, and the application of immunotherapy for advanced gastric cancer. However, they differ in recommendations regarding perioperative treatment strategies, neoadjuvant treatment or regimens, postoperative adjuvant therapy, the extent of lymph node dissection during surgery, and gastrointestinal reconstruction. The CSCO guidelines emphasize comprehensive treatment strategies tailored to China's specific conditions, include more detailed annotations, and have updated some novel antibody drugs. In contrast, the NCCN guidelines rely more on international data, offer more unified treatment recommendations, and provide a wider range of therapeutic drug options along with more detailed nutritional monitoring and management. Overall, both guidelines play significant roles in promoting the standardization and personalization of gastric cancer treatment, offering valuable guidance for clinicians. Early diagnosis and resistance-related issues highlighted in the guidelines still require further solutions. Future research on gastric cancer will continue to focus on advancing immunotherapy and targeted therapy to improve patients' survival rates and quality of life. By comparing the two guidelines, medical practitioners can provide more standardized and personalized optimal treatment plans for gastric cancer patients. They are encouraged to actively engage in relevant clinical trials to explore new drugs and treatment methods, so as to enhance treatment efficacy and patient survival rates.
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2024,33(12):1958-1966, DOI: 10.7659/j.issn.1005-6947.2024.12.003
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Perihilar cholangiocarcinoma (PHCC) is the most common type of cholangiocarcinoma and poses a serious threat to the life and health of the Chinese population. PHCC is often accompanied by bile stasis, abnormal hepatocyte metabolism within the hepatic lobules, and varying degrees of liver dysfunction. Additionally, systemic organs such as the kidneys and intestines are affected, leading to a higher risk of liver resection surgery for these patients. Currently, clinical methods are unable to accurately assess the regional liver reserve function in such patients, and many issues in assessment strategies remain unclear and unresolved. On the other hand, the strategies and efficacy of promoting hypertrophy of the future liver remnant before liver resection remain controversial. This article addresses these two issues, discussing their definitions, characteristics, and recent progress in detail.
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CHEN Ke, ZHA Binshan, ZENG Jiaqi, ZHAO Wenpeng, YANG Zhihao, LIU Zhao, ZHOU Min, QIAO Tong, ZHAO Xin, ZHOU Weimin, CHEN Zhiyong, LI Wendong, LI Xiaoqiang
2024,33(12):1967-1974, DOI: 10.7659/j.issn.1005-6947.2024.12.004
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Background and Aims Rupture is the most serious complication of abdominal aortic aneurysm, requiring rapid diagnosis, emergency surgery, and posing significant surgical challenges, with high mortality rates. Currently, there is very limited reporting on ruptured abdominal aortic aneurysm (rAAA) in our country, which presents numerous difficulties for the prevention and treatment of rAAA. This study collected the data of epidemiological characteristics, treatment outcomes, and prognosis of rAAA patients from multiple centers with a large sample size, analyzing the current status and trends of rAAA surgery in China over the past decade, aiming to provide reference for clinical practice.Methods The clinical and follow-up data of 161 rAAA patients treated at five major vascular surgery centers (50 from Drum Tower Hospital Affiliated to the Medical School, Nanjing University; 19 from the First Affiliated Hospital of Anhui Medical University; 33 from the Second Affiliated Hospital of Nanchang University; 31 from Qilu Hospital, Shandong University; and 28 from the First Affiliated Hospital of the University of Science and Technology of China) were retrospectively analyzed.Results Among the 161 patients, 124 (77.02%) were male and 37 (22.98%) were female, with an average age of 68.27 years. The median age at diagnosis was 70 years for males and 71 years for females. The overall mean aneurysm diameter was 7.11 cm, with males at 7.72 cm and females at 6.82 cm, showing a statistically significant difference (P<0.05). The main comorbidities were hypertension and coronary artery disease. Over 80% of patients presented with abdominal pain as the initial symptom, while 15% presented with low back pain, and 8 patients sought medical attention for dizziness or visual disturbances. Among the 161 patients, 86 underwent open surgical repair (OSR), and 75 received endovascular aneurysm repair (EVAR). The proportion of EVAR has increased annually, reaching nearly 70% in the past five years, and up to 90% in patients aged over 70 years. All OSR procedures were performed under general anesthesia, while 20 EVAR cases used local anesthesia and 55 used general anesthesia. Compared to the OSR group, the EVAR group showed significant differences in operative time (231.77 min vs. 162.49 min), intraoperative blood transfusion volume (1 578.56 mL vs. 843.87 mL), length of hospital stay (21.21 d vs. 15.34 d), ICU stay duration (8.28 d vs. 5.49 d), and hospitalization costs (108 500 CNY vs. 132 800 CNY) (all P<0.05). No significant differences were found between the EVAR and OSR groups in total complications or perioperative mortality rates (both P>0.05). The main causes of perioperative death included respiratory and circulatory failure, acute myocardial infarction, and severe infections. Postoperative follow-up was effectively conducted for 92 patients, with follow-up durations ranging from 10 to 142 months. Survival analysis revealed no significant difference in survival rate between the OSR and EVAR groups (P=0.318 2).Conclusion rAAA is a rare and high-risk disease, with certain clinical differences between male and female patients. The number of EVAR procedures has increased rapidly; however, EVAR has not shown a significant advantage over OSR in improving long-term survival rates.
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XIAO Yue, GUO Yuanyuan, GUO Xiuhai, CHEN Cheng
2024,33(12):1975-1982, DOI: 10.7659/j.issn.1005-6947.2024.12.005
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Background and Aims Ruptured abdominal aortic aneurysm (rAAA) is the most severe complication of abdominal aortic aneurysms, characterized by rapid progression and high mortality. Timely diagnosis and treatment are critical, with endovascular aneurysm repair (EVAR) currently serving as the first-line treatment. This study was conducted to evaluate the safety, efficacy, and short- to mid-term outcomes of EVAR for rAAA under standardized emergency protocols.Methods The clinical data of 22 patients with rAAA who underwent EVAR at Yunnan Fuwai Cardiovascular Hospital from January 2018 to October 2024 were retrospectively analyzed. The cohort included 16 males and 6 females, with a mean age of (67.2±10) years. The mean maximum aneurysm diameter was (70.6±9.2) mm, and all cases were infrarenal rAAA with a mean aneurysm neck angle of (107.9±54.3)°. All patients were diagnosed preoperatively via total aortic and coronary computed tomography angiography (CTA) and treated with EVAR under standardized emergency protocols. Perioperative clinical data, along with follow-up CTA findings at 1 week, 1 month, 6 months, 12 months, and annually thereafter, were collected. Outcome measures included aneurysm sac thrombosis rate, stent morphology, type and incidence of endoleaks, and iliac branch patency rate.Results The procedural success rate was 100%. Intraoperative angiography revealed type I endoleak in 6 cases, which were successfully managed using balloon dilation, short stent implantation, or a combination of coil embolization and biologic glue to seal the aneurysm sac. Post-treatment angiography showed resolution or significant reduction of the endoleak. The mean operative time was (162.1±63.6) min, with an average transfusion of (736.4±532.3) mL of packed red blood cells. After operation, the average stay in the SICU was (8.76±1.0) h, and the mean hospital stay was (8.1±4.5) d. There were 6 deaths within 30 d after operation. Two patients had minor type Ⅱ endoleak detected on CTA at 1 week, which required no special intervention; these endoleaks reduced by 1 month and resolved by 3-6 months. One patient developed a type Ib endoleak at 2 years after operation, which was successfully managed with reintervention. The remaining patients had no endoleaks, no iliac branch occlusions, and satisfactory aneurysm sac thrombosis.Conclusion EVAR under standardized emergency protocols is safe and effective for treating rAAA, with satisfactory short- and mid-term outcomes. Type Ⅰ endoleak can be reliably managed using techniques such as balloon dilation, short stent implantation, and coil embolization with biologic glue, demonstrating a safe and effective treatment approach.
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TIAN Chenyang, TIAN Xuan, LIU Jianlong, JIA Wei, JIANG Peng, CHENG Zhiyuan, ZHANG Yunxin, LI Jinyong, LIU Xiao, ZHOU Mi, HUA Run
2024,33(12):1983-1994, DOI: 10.7659/j.issn.1005-6947.2024.12.006
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Background and Aims Acute lower extremity deep vein thrombosis (DVT) is a common clinical condition. In the acute phase, it can lead to secondary complications such as acute pulmonary embolism (PE) and limb swelling, while in the chronic phase, it may result in post-thrombotic syndrome (PTS), posing significant health risks. Early mechanical thrombectomy can restore venous patency, alleviate symptoms, and reduce the incidence of PTS. AngioJet percutaneous mechanical thrombectomy (PMT) offers the advantages of rapid and efficient thrombectomy with fewer complications, making it widely used in clinical practice. However, there are currently no standardized guidelines at home or abroad regarding the choice of access route for PMT. This study was performed to compare the clinical outcomes and effects on venous valve function of antegrade versus retrograde AngioJet PMT for treating acute lower extremity DVT, aiming to explore the optimal surgical approach for thrombectomy.Methods A prospective, randomized controlled study was conducted, enrolling 96 patients with acute lower extremity DVT treated at the Department of Vascular Surgery, Beijing Jishuitan Hospital, Capital Medical University, from January 2022 to June 2024. Patients were divided into an antegrade group and a retrograde group based on the direction of operation and valve opening. Surgical outcomes and risks were evaluated for both groups, and factors influencing the 3-month postoperative venous patency rate were analyzed.Results A total of 92 patients were finally included, with 47 cases in the antegrade group (51.1%) and 45 cases in the retrograde group (48.9%), all treated with AngioJet PMT. Baseline characteristics showed no significant differences between the two groups (all P>0.05). In the antegrade group, 14 cases (29.8%) had thrombus interception by filters, with 7 cases (14.9%) being effective; 4 cases (8.5%) developed new or worsened PE. In the retrograde group, 18 cases (40.0%) had thrombus interception by filters, with 8 cases (17.8%) being effective; 5 cases (11.1%) developed new or worsened PE. No significant differences were observed between the two groups in these or other safety and laboratory variables (all P>0.05). The antegrade group had a higher proportion of intraoperative manual aspiration thrombectomy compared to the retrograde group (68.1% vs. 26.7%, P<0.001). However, there were no significant differences in thrombus grade Ⅲ clearance rate (61.7% vs. 68.9%), 3-month venous patency rate (93.6% vs. 91.1%), or other perioperative variables (all P>0.05). Regression analysis of factors affecting 3-month venous patency showed that immediate venous patency (OR=3.043, 95% CI=0.993-1.209) and radiation dose (OR=0.868, 95% CI=-0.001-0.000) in the antegrade group, as well as immediate venous patency (OR=2.333, 95% CI=0.655-0.980) in the retrograde group, were significantly associated with 3-month patency rate (all P<0.001). Regression analysis also showed a significant linear relationship between immediate venous patency and VCSS/Villalta scores in both groups (all P<0.001).Conclusion Both antegrade and retrograde AngioJet PMT procedures are equally safe and effective for treating acute lower extremity DVT. However, the risk of intraoperative thrombus detachment remains high, warranting the use of inferior vena cava filters to prevent fatal PE. Patients with immediate venous patency require standardized postoperative management and follow-up to prevent PTS.
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WANG Xueqing, SHAN Shuo, ZHANG Fuxian, LUO Xiaoyun, LI Xiangtao
2024,33(12):1995-2002, DOI: 10.7659/j.issn.1005-6947.2024.12.007
Abstract:
Background and Aims The Octoparms filter is a newly introduced domestically manufactured umbrella-shaped retrievable inferior vena cava (IVC) filter. A multicenter, parallel-controlled trial demonstrated its non-inferiority to the Celect filter. This study was performed to compare the clinical outcomes of the placement and retrieval of the Octoparms filter with those of the Denali filter to assess its safety and efficacy further.Methods From May 2021 to May 2024, 289 Denali filters (Denali group) and 78 Octoparms filters (Octoparms group) were placed and attempted to be retrieved at Beijing Shijitan Hospital, affiliated with Capital Medical University. After propensity score matching (PSM) of baseline characteristics, the incidence of filter tilt, wall apposition, vein wall penetration, retrieval success rates, and other relevant variables were compared between the two groups.Results After PSM, 77 patients were included in each group. Following matching, except for the significantly lower placement cost in the Octoparms group (P<0.05), all baseline characteristics (e.g., gender, age, surgical indications, filter insertion route, IVC diameter, and angle) showed no statistically significant differences between the two groups (all P>0.05). The average indwelling time of the filter was longer in the Denali group compared to the Octoparms group (58 d vs. 47 d, P=0.004). There was no significant difference in the average filter tilt angle between the two groups (4.4° vs. 4.8°, P=0.71). While wall apposition or significant tilt was more frequent in the Octoparms group, the difference was not statistically significant (P>0.05). Both groups achieved a 100.0% technical success rate for filter retrieval, with no complications such as filter fracture or vascular rupture during retrieval. Other retrieval-related variables (surgical approach, retrieval duration, retrieval techniques, and costs) also showed no significant differences between the two groups (all P>0.05).Conclusion As a newly launched domestic filter, the Octoparms filter demonstrates comparable stability and retrieval rate to the Denali filter, and it is a safe and reliable choice.
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WU Hongfei, CAI Xin, QI Youfei
2024,33(12):2003-2010, DOI: 10.7659/j.issn.1005-6947.2024.12.008
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Background and Aims Graft materials such as covered stents and artificial vascular grafts have been widely used to treat peripheral arterial disease (PAD). However, the increasing prevalence of chronic graft thrombosis and chronic lower limb arterial thrombosis has brought attention to the challenge of removing chronic thrombi. This study evaluated the feasibility of using the Rotarex mechanical thrombectomy system for treating chronic thrombosis formation in PAD patients.Methods A retrospective analysis was conducted on the clinical data of 10 PAD patients with chronic thrombosis admitted consecutively to the Department of Vascular Surgery, Hainan Provincial People's Hospital, from July 2023 to December 2023. All patients were male, with an average age of (70.4±8.6) years. The cohort included five synthetic graft cases, one with a covered stent and four with autologous arteries. The occlusion sites included the iliac artery (2 cases), superficial femoral artery (7 cases), and popliteal artery (4 cases), with a median occlusion duration of 5.5 (3-38) months. The Rotarex mechanical thrombectomy system was used in combination with balloon angioplasty or stent implantation to restore lower limb blood flow. The debulking success rate, procedural success rate, and changes in hemoglobin (Hb), and ankle-brachial index (ABI) were evaluated. Patients were followed up at 3 and 6 months after operation with ultrasound examination, Rutherford classification, and ABI assessment.Results The Rotarex mechanical thrombectomy achieved a 100% success rate in both debulking and procedural outcomes. The median operative time was 150 (120-270) min. All patients underwent percutaneous transluminal angioplasty (PTA) following thrombectomy. Nine stents were deployed in six patients: five in the distal segments of the occluded vessels, three in the proximal segments, and one fully covering the diseased segment. Preoperative Hb was (131.30±24.55) g/L, which decreased to (114.20±25.28) g/L postoperatively, showing a statistically significant difference (t=4.253, P=0.002). The preoperative ABI was 0.46±0.15, which improved to 0.95±0.19 postoperatively, also showing a significant difference (t=17.528, P<0.001). No perioperative complications, such as distal arterial embolism, arterial injury, or acute renal dysfunction, were observed. The follow-up rate was 100% at 3 months and 80% at 6 months. At 3 months, ultrasound examinations showed patent target vessels in all patients, with Rutherford classification of grade 0 in 8 cases and grade 1 in 2 cases and an ABI of 0.84±0.17. At 6 months, two patients were lost to follow-up. Among the remaining 8 patients, ultrasound revealed moderate stenosis in 2 cases and patent vessels in 6 cases, with Rutherford classification of grade 0 in 4 cases and grade 1 in 4 cases, and an ABI of 0.76±0.16.Conclusion The Rotarex mechanical thrombectomy system is a safe and feasible option for treating chronic thrombosis in PAD patients.
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XU Zhan, ZHANG Tianhua, CHEN Bo, JIANG Weiliang
2024,33(12):2011-2022, DOI: 10.7659/j.issn.1005-6947.2024.12.009
Abstract:
Background and Aims Stenting and plain old balloon angioplasty (POBA) remain the primary treatments for femoropopliteal in-stent restenosis (ISR). These approaches demonstrate good short-term patency; however, ISR frequently recurs due to continuous stimulation of the vascular intima by the stent. With advancements in endovascular technology, excimer laser ablation (ELA) combined with drug-coated balloons (DCB) offers a novel strategy for treating ISR. This study investigated the safety and efficacy of ELA combined with DCB for complex femoropopliteal ISR.Methods The clinical data of 69 patients with femoropopliteal ISR treated with interventional procedures between June 2020 and June 2022 were retrospectively analyzed. Among them, 27 patients underwent ELA combined with DCB treatment (ELA+DCB group), and 42 patients underwent POBA combined with DCB treatment (POBA+DCB group). Relevant clinical variables were compared between the two groups.Results No significant differences were observed in baseline characteristics between the two groups (all P>0.05). True lumen re-entry was achieved in all 69 patients. The procedural success rates for the ELA+DCB and POBA+DCB groups were 92.6% (25/27) and 90.5% (38/42), respectively, with no statistically significant difference (P>0.05). Intraoperative adverse events were comparable between groups (all P>0.05). Logistic regression analysis indicated that thrombus in the target lesion was an independent risk factor for distal embolization during ELA+DCB (HR=24.695, 95% CI=1.061-574.904, P=0.046). Ankle-brachial index (ABI) values immediately after the procedure and at 1 and 6 months postoperatively showed no significant differences between the two groups (all P>0.05). However, the ELA+DCB group demonstrated superior ABI outcomes at 12, 18, and 24 months postoperatively (all P<0.05). There were no significant differences in all-cause mortality or amputation rates postoperatively (both P>0.05). Kaplan-Meier analysis showed that the ELA+DCB group had higher 2-year freedom from target lesion revascularization (81.5% vs. 57.1%, P=0.044) and 2-year patency rates (77.8% vs. 52.4%, P=0.031) compared to the POBA+DCB group. ROC curve analysis identified a laser tube diameter/reference vessel diameter (TD/RVD) ratio cutoff value of 0.47 (AUC=0.825, 95% CI=0.619-1.000) for predicting 2-year patency after ELA plus DCB treatment, with a specificity of 66.7%. Cox regression analysis revealed that postoperative antithrombotic therapy (HR=0.033, 95% CI=0.002-0.661, P=0.026), ≥2 tibial arteries recanalized (HR=0.022, 95% CI=0.001-0.808, P=0.038), and TD/RVD ≥ 0.47 (HR=0.002, 95% CI=0.000-0.403, P=0.022) were independent factors associated with improved 2-year patency after ELA plus DCB treatment.Conclusion For complex femoropopliteal ISR, ELA combined with DCB does not show significant advantages in safety compared to POBA combined with DCB, but it provides superior long-term efficacy. Intraoperative management and postoperative antithrombotic therapy may influence the mid- to long-term outcomes of ELA combined with DCB for treating complex femoropopliteal ISR.
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QIU Haijun, WAN Shengyun, PAN Lisheng, FANG Canjun, NIE Zongjie, WANG Wenrui, BAI Xia
2024,33(12):2023-2029, DOI: 10.7659/j.issn.1005-6947.2024.12.010
Abstract:
Background and Aims Iliac vein compression syndrome (IVCS) is a major cause of acute lower extremity deep vein thrombosis (DVT). Without timely treatment, it can lead to thrombus detachment, resulting in pulmonary embolism and increased mortality risk. Percutaneous mechanical thrombectomy, particularly using the AngioJet thrombectomy system, is a widely used thrombectomy method. The combination of AngioJet thrombectomy with iliac vein stent placement provides a novel treatment option for DVT associated with IVCS. This study was performed to evaluate the efficacy and safety of AngioJet thrombectomy combined with iliac vein stent placement in treating DVT with IVCS.Methods The clinical data of 120 patients with DVT and IVCS treated between April 2019 and October 2022 were retrospectively analyzed. Sixty patients underwent AngioJet thrombectomy combined with iliac vein stent placement (observation group), while another 60 patients received catheter-directed thrombolysis (CDT) combined with stent placement (control group). The clinical efficacy, outcomes (thrombus clearance grade, thrombolysis duration, venous patency score, hospitalization duration, urokinase dosage, thigh circumference difference, and calf circumference difference), Villalta scores at various time points before and after treatment, and adverse events (chest tightness, mild pulmonary embolism, bleeding at the catheter insertion site, and mild renal function impairment) were compared between the two groups.Results The overall efficacy rate in the observation group was significantly higher than that in the control group (98.33% vs. 86.67%, P=0.015). While there was no significant difference in thrombus clearance grade between the two groups (P>0.05), the observation group had significantly shorter thrombolysis duration, lower urokinase dosage, and shorter hospitalization time compared to the control group (all P<0.05). Before treatment, there were no significant differences in thigh circumference difference, calf circumference difference, or venous patency score between the two groups (all P>0.05). After treatment, the observation group had significantly better venous patency score and smaller thigh and calf circumference differences than the control group (all P<0.05). There was no significant difference in Villalta score between the two groups before treatment (P>0.05). Post-treatment Villalta scores showed a significant decreasing trend over time in both groups compared to pre-treatment scores (all P<0.05), but there were no statistically significant differences in Villalta scores between the two groups at 1, 6, and 12 months after treatment (all P>0.05). The total incidence of adverse events was not significantly different between the two groups (10.00% vs. 3.33%, P=0.143).Conclusion The use of AngioJet thrombectomy combined with iliac vein stent placement for the treatment of lower extremity DVT with IVCS can shorten thrombolysis and hospitalization duration, reduce thrombolytic drug dosage, and achieve better and safer outcomes, making it worthy of clinical application.
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YAN Xin, DING Qingzhu, HONG Yupu
2024,33(12):2030-2037, DOI: 10.7659/j.issn.1005-6947.2024.12.011
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Background and Aims ATP citrate lyase (Acly) is widely expressed in various tissues and has been shown to play a crucial role in many inflammatory diseases. However, the role of Acly in acute pancreatitis (AP)-induced pancreatic injury remains unclear. This study was conducted to investigate the effect of Acly on pancreatic injury in a mouse AP model and to preliminarily explore its underlying mechanism.Methods Twelve male C57BL6/J AclycKO mice (conditional pancreatic Acly knockout) and twelve Aclywt mice (with intact pancreatic Acly expression) were randomly divided into AP groups (administered caerulein at 100 μg/kg intraperitoneally, 6 times/d, with 1-hour intervals, for 4 consecutive days) and control groups (administered saline in the same manner), with six AclycKO mice and six Aclywt mice in each group. Pancreatic tissue samples were collected 24 hours after modeling to observe pathological changes in the pancreas and to measure the expression of the macrophage marker CD68, the neutrophil marker myeloperoxidase (MPO), as well as nuclear factor NF-κB p65, Toll-like receptor 4 (TLR4), and pro-inflammatory factors TNF-α and IL-1β.Results Compared with the control group, the AP group exhibited significant pathological changes in the pancreas. The pathological damage in AclycKO mice was more severe than in that in Aclywt mice, with significantly higher inflammation and necrosis of pancreatic tissue scores in AclycKO mice (all P<0.05). In the AP group, the pancreatic expressions of CD68 and MPO were significantly higher in AclycKO mice than those in Aclywt mice (both P<0.05). Additionally, AclycKO mice showed increased nuclear positivity for NF-κB p65 and elevated expression of TLR4, TNF-α, and IL-1β compared with Aclywt mice (all P<0.05).Conclusion Acly exerts a protective effect against AP-induced pancreatic injury, possibly by inhibiting the activation of the NF-κB signaling pathway, thereby mitigating the inflammatory response.
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WANG Qianyu, ZHANG Yu, NI Yeqin, CHEN Yuying, SONG Ping, LUO Dingcun
2024,33(12):2038-2050, DOI: 10.7659/j.issn.1005-6947.2024.12.012
Abstract:
Background and Aims Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid cancer, with a 5-year survival rate of approximately 0% and a disease-specific mortality rate nearing 100%. Despite the efforts of clinicians and researchers to advance ATC treatment, there is a lack of visualized analysis on trends, leading authors, and research focuses in this field. This study was conducted to explore research hotspots and trends in ATC treatment through visualized analysis of relevant studies.Methods Relevant literature was retrieved from the Web of Science Core Collection (WoSCC) database, spanning from January 1, 2000, to October 31, 2023. Visualization analysis was conducted using CiteSpace, VOSviewer, and Pajek software, focusing on indicators such as collaborations among countries/institutions, co-cited journals, co-authorship, co-cited authors, co-cited references and timelines, co-occurring keywords, and citation bursts. Additionally, impact factors (IF) and H-indices were obtained from WoSCC and Scopus databases.Results A total of 1 434 studies were included, involving 7 408 authors from 267 countries/regions and 1 545 institutions, published in 427 journals. These articles collectively cited 36 460 papers authored by 25 724 authors from 4 032 journals. The analysis revealed that the United States led in publication output (485 articles, 33.82%), followed by China (317 articles, 22.11%) and Italy (188 articles, 13.11%). The University of Texas System was the most prolific institution. The journal Thyroid was the leading contributor in terms of publications and citations. Maria E. Cabanillas was the most prolific author, contributing 30 publications and achieving an H-index of 51 in this field. Co-cited reference analysis identified the study “Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors” by Kebebew Electron, published in Cancer, as the most cited reference, with 241 citations. The timeline of co-cited references highlighted that recent research in the past five years has primarily focused on targeted therapies, novel drug exploration, clinical trials, and guidelines. Keyword clustering analysis identified Akt signaling pathway, targeted therapy, and peptide mRNA nanoparticles as hotspots in ATC research over the past five years. Citation burst analysis showed a shift in research focus from surgery and chemotherapy in earlier years to targeted therapy (2018-2023), BRAF (2020-2023), association guidelines (2020-2023), and radioactive iodine (2020-2023). Additionally, an increasing number of studies have shown significant progress in the application of chimeric antigen receptor T-cell immunotherapy (CAR-T) and nanomaterials in the precision medicine and targeted treatment of thyroid cancer.Conclusion Research on ATC treatment is on the rise, with the United States maintaining a leading position in this field. Further exploration of molecular biomarkers and specific targets for ATC is essential. Molecular targeted therapies, immunotherapy, CAR-T, and nanomaterials are likely to be key areas of future research.
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TAN Chengpeng, RONG Dan, LIU Hao, ZHANG Zihan, HE Jian, JIANG Peng, CUI Yongpan, MEI Fei
2024,33(12):2051-2057, DOI: 10.7659/j.issn.1005-6947.2024.12.013
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Abdominal aortic aneurysm (AAA) is a type of aneurysmal aortic disease with a high mortality rate. Endovascular aneurysm repair (EVAR) is an effective treatment for this condition, but endoleaks can occur intraoperatively or years after the procedure, necessitating lifelong monitoring. Type Ⅱ endoleak (T2EL) is a major complication of EVAR, primarily caused by persistent retrograde perfusion of the aneurysm sac from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA). The occurrence of T2EL is closely related to patient anatomical factors (e.g., the diameter, number, and patency of collateral vessels), surgical factors (e.g., the degree of stent graft adherence to the arterial wall), and systemic factors such as hypertension. Persistent T2EL may lead to aneurysm sac enlargement and increased risk of rupture, thereby adversely affecting patient prognosis. In recent years, prophylactic embolization of the IMA and LA has shown certain advantages in reducing the incidence of T2EL, aneurysm sac enlargement, and reintervention rates, contributing positively to improving treatment outcomes and quality of life of the patients. Here, the authors reviewed literature published between January 2002 and July 2024 on the epidemiology of endoleaks following EVAR and the use of IMA and LA embolization during EVAR to prevent T2EL. The current research was summarized to discuss the clinical value of prophylactic IMA and LA embolization in patients at high risk of T2EL.
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GUO Qiang, SHI Xiaoxi, FANG Kun, DONG Zhihui, YANG Yi, ZHAO Jichun, SHU Chang, LI Xin
2024,33(12):2058-2061, DOI: 10.7659/j.issn.1005-6947.2024.12.014
Abstract:
Endovascular aneurysm repair (EVAR) is a key treatment for abdominal aortic aneurysms (AAA), but type Ⅱ endoleak (T2EL) is one of the most common postoperative complications. T2EL mainly arises from retrograde blood flow from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA), which continue to perfuse the aneurysm sac. Although T2EL may lead to aneurysm sac enlargement or even rupture, its overall clinical impact is relatively minor, and most cases can be effectively managed through observation or minimally invasive interventions. Currently, the efficacy of prophylactic embolization of the IMA and LA in reducing the incidence of T2EL remains uncertain and may increase operative time, radiation exposure, and the risk of associated complications. More importantly, authoritative guidelines, both domestic and international, do not recommend routine prophylactic embolization of the IMA and LA during EVAR. Whether prophylactic embolization should be performed in high-risk patients for T2EL remains controversial, with most studies in this area being small-sample or single-center retrospective analyses, offering limited evidence quality. This article analyzes the harm of T2EL, the effectiveness of prophylactic embolization, and relevant guideline recommendations based on existing research, aiming to provide a reference for the individualized management of T2EL following EVAR.
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REN Hongcheng, CHEN Zuoguan, LI Yongjun
2024,33(12):2062-2068, DOI: 10.7659/j.issn.1005-6947.2024.12.015
Abstract:
Peripheral arterial disease (PAD) is associated with a high risk of mortality and amputation. However, many PAD patients remain asymptomatic or present with atypical symptoms, leading to low awareness and diagnostic rates. With an aging population and the increasing prevalence of risk factors, the burden of PAD is expected to grow. Artificial intelligence (AI), encompassing machine learning, deep learning, natural language processing, and computer vision, refers to machines and algorithms capable of simulating human intelligence and performing human-like tasks. Although the application of AI in PAD is still in its early stages, its potential is substantial. This article reviews the current clinical applications and limitations of AI in the management of PAD patients.
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2024,33(12):2069-2076, DOI: 10.7659/j.issn.1005-6947.2024.12.016
Abstract:
Abdominal aortic aneurysm (AAA) is a prevalent condition encountered in vascular surgery, characterized by a high mortality rate upon rupture, posing a serious threat to patients' lives. The primary treatment options include endovascular aneurysm repair (EVAR) and conventional open repair (OR). With advancements in surgical instruments and techniques, EVAR has gradually become the preferred method. However, EVAR and OR differ significantly in surgical principles and associated complications. EVAR continues to follow surgical indications originally developed for OR, limiting its full realization of its advantages. As clinical evidence continues accumulating, it has become increasingly clear that quantifying and comparing AAA rupture risk and surgical risk through scoring systems significantly aids in developing more rational and individualized treatment strategies.
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WANG Yuzhu, ZHANG Shuai, ZHOU Yu, JIN Yi, ZHAO Zihe, PAN Chaohui, FU Dongsheng, HAN Yuexue, HU Jianhang, REYAGULI·Keyoumu, LIU Zhao, LI Xiaoqiang
2024,33(12):2077-2082, DOI: 10.7659/j.issn.1005-6947.2024.12.017
Abstract:
Endovascular Aneurysm Repair (EVAR) has become an important treatment method for abdominal aortic aneurysms due to its advantages of shorter operative time, faster postoperative recovery, and lower early postoperative mortality. However, the incidence of complications and the postoperative reintervention rates are higher than those of open surgery. The main complications after EVAR include access vessel injury, post-implantation syndrome, stent migration, endoleaks, visceral branch artery occlusion, lower limb ischemia, and stent infection, which are also the primary causes of reintervention. In recent years, the causes and associated risk factors of various postoperative complications of EVAR have attracted widespread attention and discussion, which are of great significance for improving surgical techniques, enhancing postoperative monitoring, and improving patient outcomes. This paper provides a review of the current complications, associated risk factors, and management strategies after EVAR.
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MA Xianlu, WANG Tianming, ZHANG Peixi, ZHAO Yongjie, SHI Huifeng
2024,33(12):2083-2090, DOI: 10.7659/j.issn.1005-6947.2024.12.018
Abstract:
Abdominal aortic aneurysm (AAA) is a life-threatening large-vessel disease closely associated with immune and inflammation-related mechanisms. During the development of AAA, innate immune cells play a pivotal role in the immune-mediated inflammatory infiltration and destruction of the aortic wall. These cells include neutrophils, monocytes, macrophages, dendritic cells, mast cells, natural killer cells, innate lymphoid cells, and invariant natural killer T cells. Although various immune cells have been progressively identified in the study of AAA, their activation mechanisms and functions remain to be further elucidated. This article summarizes the roles of innate immune cells in the progression of AAA and discusses the regulatory mechanisms of their activation in this disease, providing a theoretical basis for research on AAA progression.
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LIU Bin, GUI Liang, ZOU Junjie
2024,33(12):2091-2098, DOI: 10.7659/j.issn.1005-6947.2024.12.019
Abstract:
With the continuous advancement of peripheral vascular interventional techniques and devices, drug-coated balloons (DCBs) have emerged as a promising therapeutic tool, garnering significant attention in endovascular treatment for lower extremity arterial diseases. Lower extremity arteriosclerosis obliterans (LEASO) is the most common type of lower extremity arterial disease and one of the key indications for DCB technology. While DCBs have achieved remarkable progress in treating femoropopliteal lesions, their efficacy in specific lower extremity arterial conditions, such as chronic limb-threatening ischemia and in-stent restenosis, remains controversial and challenging. This article summarizes and analyzes relevant clinical studies to evaluate the application, safety, clinical efficacy, and future directions of DCBs in treating LEASO, providing deeper insights and guidance for clinical practice.
Volume 33,2024 Number 12
INTERPRETATION OF GUIDELINES
COMMENTARY
MONOGRAPHIC STUDY OF VASCULAR SURGERY
BASIC RESEARCH
CLINICAL RESEARCH
VIEWPOINTS AND DEBATES
REVIEW
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Hunan Provincial Clinical Research Center for the Prevention, Treatment of Biliary Diseases, Hunan Provincial Key Laboratory for the Prevention, Treatment of Biliary Diseases, Hunan Provincial Engineering Research Center for Digital Hepatobiliary Medicine, The Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange, Promotion Association, The Hunan Alliance of Hepatobiliary, Pancreatic Surgery, The Hunan Alliance for the Diagnosis, Treatment of Malignant Biliary Tumors, The Hepatopancreatobiliary Disease Research Center of Furong Laboratory
Abstract:
Hilar cholangiocarcinoma (hCCA) is a malignant tumor originating from the epithelial cells of the bile duct, characterized by high malignancy, significant surgical challenges, high mortality, and poor prognosis, making it one of the most formidable challenges in the field of surgery. In recent years, advancements in surgical concepts and diagnostic and therapeutic techniques have led to improvements in the diagnosis and treatment of hCCA. However, standardizing the management of hCCA, enhancing treatment efficacy, and improving patient outcomes remain pressing issues. To confront these challenges, the Hepatobiliary Surgery Professional Committee of Hunan Medical Association, Hunan Provincial Clinical Research Center for the Prevention and Treatment of Biliary Diseases, Hunan Provincial Key Laboratory for the Prevention and Treatment of Biliary Diseases, Hunan Provincial Engineering Research Center for Digital Hepatobiliary Medicine, the Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association, the Hunan Alliance of Hepatobiliary and Pancreatic Surgery, the Hunan Alliance for the Diagnosis and Treatment of Malignant Biliary Tumors, and the Hepatopancreatobiliary Disease Research Center of Furong Laboratory, convened a multidisciplinary panel of experts to develop the Hunan expert consensus on comprehensive diagnosis and treatment of hilar cholangiocarcinoma. This consensus aims to standardize the diagnosis and multidisciplinary treatment approach for hCCA, enhance overall diagnostic and therapeutic standards, and ultimately improve the overall prognosis of the disease.
