Background and Aims:Totally implantable venous access port(TIVAP)are widely used for chemotherapy,blood transfusion,and nutritional support in patients with malignancies.Among them,upper arm port(UAP)are increasingly recommended in clinical practice due to their advantages in avoiding thoracic complications and providing more concealed incisions.Currently,two main implantation techniques are used for UAP:the tunnel needle-transverse incision technique and the puncture point-transverse incision technique.This study aims to compare the clinical outcomes of these two techniques in patients with hematological malignancies,focusing on safety and cosmetic appearance,to provide evidence for clinical decision-making.Methods:A retrospective analysis was conducted on 412 patients with hematological malignancies who underwent UAP implantation at Xiangya Hospital of Central South University between December 2021 and December 2024.Based on the implantation method,patients were divided into the tunnel needle-transverse incision group(n=200)and the puncture point-transverse incision group(n=212).Intraoperative variables(operative time,intraoperative pain score,catheter kinking at the pocket,intraoperative blood loss)and postoperative indicators(incidence of complications and incision aesthetic satisfaction)were compared between the two groups.Results:There were no significant differences in baseline characteristics between the two groups(all P>0.05),indicating comparability.The puncture point-transverse incision group showed superior performance in operative time[(32.99±4.91)min vs.(41.42±5.35)min],catheter kinking rate(1.4％vs.8.5％),and incision aesthetic satisfaction(7.99±0.58 vs.6.26±0.86)compared with the tunnel needle-transverse incision group(all P<0.05).Although the puncture point group had slightly more intraoperative bleeding[(4.52±1.02)mL vs.(4.16±0.83)mL],the difference,while statistically significant,was of limited clinical relevance.No significant differences were observed between the two groups in intraoperative pain scores or incidence of postoperative complications(both P>0.05).Conclusion:The puncture point-transverse incision technique offers significant advantages in terms of operative efficiency,reduced catheter kinking,and improved incision aesthetics,without compromising safety.It represents a promising alternative to the traditional tunnel needle-transverse incision method and has strong potential for broader clinical adoption.The puncture point-transverse incision technique offers advantages such as shorter operative time,lower catheter kinking rate,and higher incision aesthetic satisfaction.It is a promising alternative to the traditional tunnel needle-transverse incision technique and has good potential for clinical application and promotion.

Background and Aims:Abdominal aortic aneurysm(AAA)is a common arterial dilation disease in vascular surgery,with aneurysm rupture being its most serious complication,often leading to fatal hemorrhage and posing a severe threat to patients'lives.Endovascular aneurysm repair(EVAR),due to its minimally invasive nature,safety,and rapid recovery,has become the preferred treatment for AAA.However,endoleak,a complication unique to EVAR,remains a major clinical challenge.Persistent endoleak can lead to sustained high pressure within the aneurysm sac,increasing the risk of continued expansion and rupture.It is one of the main causes of the high reintervention rate following EVAR.In particular,the treatment strategy for type Ⅱ endoleaks remains controversial.This study was conducted to evaluate the clinical value of selective sac embolization via the iliac approach combined with standard EVAR in managing intraoperative immediate endoleaks.Methods:The clinical data of AAA patients with a risk of endoleak who underwent standard EVAR at the First Hospital of China Medical University between March 2023 and September 2024 were retrospectively collected.Patients were divided into an intervention group(n=42)and a non-intervention group(n=32)based on whether selective sac embolization via the iliac approach was performed during operation.General clinical data,preoperative anatomical characteristics of the AAA,surgical details,and postoperative follow-up results were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of age,sex,anatomical features,rupture rate,or off-label use(all P>0.05).The technical success rate during surgery was 100%in both groups.One patient in the intervention group experienced transient sigmoid colon ischemia after operation,which resolved with conservative treatment.The mean follow-up period was(6.49±4.68)months.The proportions of aneurysm sac shrinkage,stability,and enlargement in the intervention group were 40.5%,57.1%,and 2.4%,respectively,compared to 59.4%,40.6%,and 0.0%in the non-intervention group,with no statistically significant differences(all P>0.05).The incidence of endoleak during follow-up was also comparable between the two groups(P>0.05).Conclusion:For intraoperative endoleaks during standard EVAR,selective sac embolization via the iliac approach is a technically simple and safe method that provides short-term outcomes comparable to those in patients without intraoperative endoleaks.Its long-term efficacy warrants further investigation through extended follow-up.

Background and Aims:Acute inferior vena cava thrombosis(IVCT)commonly occurs secondary to inferior vena cava filter(VCF)implantation.If not promptly treated,it may lead to serious complications such as bilateral lower limb swelling and pulmonary embolism and can also reduce the likelihood of successful filter retrieval.Percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)are currently the main interventional treatments for IVCT,but comparative studies evaluating their efficacy and safety remain limited.This study was to conduct a prospective randomized controlled trial to compare the clinical efficacy and safety of AngioJet mechanical thrombectomy versus conventional CDT in the treatment of acute IVCT and to explore factors influencing filter retrieval rates,thereby providing evidence-based guidance for clinical decision-making.Methods:From January 2022 to December 2024,patients diagnosed with acute IVCT following VCF implantation were prospectively enrolled at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University.Patients were randomly assigned to either the CDT group(n=46)or the PMT group(n=48)according to the interventional procedure used.The two groups were compared in terms of filter retrieval rates,thrombus clearance outcomes,operative time,thrombolytic drug dosage,and incidence of complications.Logistic regression analysis was used to identify factors associated with primary filter retrieval.Results:A total of 94 patients were enrolled,with 46 in the CDT group and 48 in the PMT group.Compared to the CDT group,the PMT group demonstrated a significantly higher primary filter retrieval rate(77.1%vs.43.5%),grade Ⅲ thrombus clearance rate(70.8%vs.37.0%),and better postoperative thrombus scores.Additionally,the PMT group required lower urokinase doses and shorter thrombolysis duration(all P<0.05).The overall filter retrieval rate and 3-month IVC patency were similar between groups,both exceeding 93%.Regarding safety,the CDT group had a higher incidence of catheter-related infections and medical adhesive-related skin injury,while vagal reflex symptoms were more frequent in the PMT group.Logistic regression analysis identified thrombus clearance rate as an independent factor significantly associated with primary filter retrieval in the PMT group(OR=190.773,P<0.05).Conclusion:Compared to CDT,AngioJet mechanical thrombectomy combined with manual aspiration achieves higher thrombus clearance and primary filter retrieval rates in the treatment of acute IVCT while also reducing thrombolysis duration and drug dosage.However,attention should be paid to the increased risk of vagal reflex symptoms.There was no significant difference between the two groups in secondary filter retrieval rates or long-term IVC patency.The choice of intervention should be based on the patient's condition,timing of filter retrieval,and individualized clinical considerations.

Background and Aims:The completeness of lymph node dissection in laparoscopic radical gastrectomy for gastric cancer directly affects postoperative patient prognosis.Indocyanine green(ICG)fluorescence-guided navigation,as an emerging auxiliary technique,enables real-time visualization of lymphatic drainage pathways and enhances surgical precision.This study was performed to evaluate the impact of ICG fluorescence navigation on lymph node dissection,positive lymph node detection,and patient prognosis during laparoscopic D2 radical gastrectomy for gastric cancer.Methods:The clinical data of 168 patients who underwent laparoscopic radical gastrectomy at Zhangzhou Affiliated Hospital of Fujian Medical University from January 2021 to December 2022 were retrospectively analyzed.Among them,51 patients received ICG-guided surgery(ICG group),and 117 underwent conventional surgery(non-ICG group).Perioperative variables,extent of lymph node dissection,positive lymph node detection efficiency,and postoperative survival outcomes were compared between the two groups.Results:There were no statistically significant differences between the two groups in baseline clinicopathologic characteristics,as well as operative time,intraoperative blood loss,postoperative recovery,and incidence of surgical complications(all P>0.05).The ICG group had a significantly higher mean number of lymph nodes dissected than the non-ICG group(48.62 vs.37.20,P<0.001),with a greater proportion of patients achieving≥30 nodes dissected(92.16％vs.69.23％,P=0.001).Stratified analysis showed a significantly higher number of dissected lymph nodes in the ICG group at D2 stations,the supra-pancreatic region(stations 7,8,9,11),in total gastrectomy,T3-4 stage,and stage Ⅲ patients(all P<0.01).In the ICG group,the number and positivity rate of fluorescent lymph nodes were significantly higher than those of non-fluorescent nodes(30.31 vs.17.36;2.03 vs.0.94,both P<0.05).The diagnostic sensitivity of ICG fluorescence imaging for positive lymph nodes was 68.4％,with a negative predictive value of 94.6％for non-fluorescent nodes.No significant differences were observed between the two groups in terms of adjuvant therapy,overall survival(HR=0.737,P=0.471),or disease-free survival(HR=0.502,P=0.089).Conclusion:ICG-guided navigation in laparoscopic radical gastrectomy for gastric cancer is safe and significantly improves lymph node yield,particularly in the supra-pancreatic region,total gastrectomy,and advanced-stage patients.It also enhances positive node detection.However,no survival benefit has been observed in the short term.Further multicenter studies with long-term follow-up are warranted to confirm its clinical value and optimize intraoperative navigation strategies.

Background and Aims:Poorly differentiated thyroid carcinoma(PDTC)is a relatively rare but highly aggressive type of thyroid malignancy.Its biological behavior lies between differentiated and undifferentiated thyroid carcinoma,and it is often characterized by early metastasis,high recurrence rates,and poor survival outcomes.At present,prognostic assessment for PDTC patients primarily relies on traditional indicators such as TNM staging,and there remains a lack of systematic,multi-factorial,and individualized predictive tools.As a visual and quantitative method,the nomogram model has been widely applied in the prognostic evaluation of various tumors;however,its use in PDTC remains limited.This study aims to identify key risk factors associated with poor prognosis in PDTC patients and to construct a risk prediction nomogram model based on multivariate analysis,in order to provide clinical support for individualized postoperative prognostic assessment.Methods:A total of 55 PDTC patients who underwent surgical treatment at our hospital from January 2015 to December 2020 were retrospectively enrolled and followed up for three years.Based on tumor recurrence,metastasis,and mortality during the follow-up period,patients were divided into a good prognosis group and a poor prognosis group.Univariate analysis was performed to screen for clinical features associated with prognosis,followed by multivariate logistic regression to identify independent risk factors.A nomogram risk prediction model was constructed using R software(version 3.5.3),and its predictive performance and calibration were evaluated by receiver operating characteristic(ROC)curve and Bootstrap validation.Results:During the 3-year follow-up,15 patients experienced tumor progression and 1 patient died,resulting in a poor prognosis rate of 29.1%.Univariate analysis showed statistically significant differences in tumor diameter,TNM stage,local invasion,surgical approach,vascular invasion,and nerve involvement between the two groups(all P<0.05).Multivariate logistic regression identified tumor diameter≥3 cm,advanced TNM stage,local invasion,subtotal thyroidectomy,vascular invasion,and nerve involvement as independent risk factors for poor prognosis(all P<0.05).The nomogram model constructed based on these variables demonstrated a C-index of 0.794(95%CI=0.725-0.846),an AUC of 0.817,sensitivity of 82.26%,and specificity of 86.35%,indicating good discriminatory ability and predictive accuracy.Conclusion:Tumor diameter,TNM stage,local invasion,surgical approach,vascular invasion,and nerve involvement are important factors influencing postoperative prognosis in PDTC patients.The nomogram model based on these variables exhibits strong predictive performance and may serve as a valuable tool for individualized risk assessment and therapeutic decision-making in clinical practice.

The incidence of chronic venous disease(CVD)is significantly higher in the elderly population compared to non-elderly individuals,with more severe disease manifestations.Additionally,elderly CVD patients often have comorbid conditions such as cardiovascular diseases,making the evaluation process more complex and increasing treatment difficulty.Currently,there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above.Against this backdrop,the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines,relevant evidence-based medical research,and the physiological and clinical characteristics of the elderly population in China.This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.

As a type of central venous access device,the totally implantable venous access port(TIVAP)is widely used in patients requiring long-term or intermittent intravenous infusion,chemotherapy,nutritional support,and other treatments.It effectively reduces the need for repeated punctures and offers advantages such as safety and convenience.However,in primary healthcare institutions,there are still inconsistencies in procedures and non-standardized practices in the maintenance and complication management of TIVAP.To enhance the safety and standardization of TIVAP usage and to ensure treatment efficacy,the Colorectal and Anorectal Surgery Branch of the Henan Medical Doctor Association convened a multidisciplinary panel of experts to develop this expert consensus on grassroots technical specifications,integrating domestic and international evidence-based findings and clinical experience.The consensus covers the assessment,maintenance,management,and prevention of complications of TIVAP,and proposes 10 expert recommendations with an emphasis on operational feasibility and suitability for primary care.It aims to provide scientific,standardized,and practical guidance for frontline healthcare workers,reduce the risk of complications,and improve clinical quality and patient safety.

Background and Aims:Aortic aneurysm,a major cardiovascular disease with high mortality and disability rates,has emerged as a critical global public health challenge.Elevated body mass index(BMI)has been confirmed as an independent risk factor for aortic aneurysm.However,the long-term trends and heterogeneity of the disease burden attributable to high BMI in China-across sex,age,and region-remain insufficiently studied.This study,based on the Global Burden of Disease(GBD)database,aimed to analyze the changes in the disease burden of high BMI-related aortic aneurysm in China from 1990 to 2021 and compare these trends with those in global and socio-demographic index(SDI)-stratified regions.Methods:Data from GBD 2021 were used to extract mortality rates and disability-adjusted life years(DALY)due to aortic aneurysm attributable to high BMI in China from 1990 to 2021.Age-standardized mortality rate(ASMR)and age-standardized DALY rate(ASDR)were calculated.Long-term trends were assessed using the estimated annual percentage change(EAPC)and Joinpoint regression models.An autoregressive integrated moving average model was applied to project trends from 2022 to 2036.Results:During the study period,deaths and DALY from aortic aneurysms attributable to high BMI in China increased nearly sevenfold.ASMR rose from 1 to 3 per 100 000 population(EAPC=3.91),and ASDR increased from 23 to 74 per 100 000(EAPC=4.11),both showing a marked upward trend.Males consistently bore a higher burden across all age groups,particularly among those aged≥65 years.Decomposition analysis revealed that the increased burden in males was mainly driven by epidemiological improvements,while that in females was primarily attributable to population aging.Compared with the United States and global trends,China exhibited a faster increase in high BMI-related aortic aneurysm burden,which is projected to remain elevated over the next 15 years.Conclusion:The disease burden of aortic aneurysm attributable to high BMI continues to rise in China,with pronounced differences across sex and age.Targeted weight management,health interventions,and early screening strategies are urgently needed for high-risk populations to curb the upward trend and optimize public health resource allocation.

Venous malformation(VM)is the most common type of congenital vascular anomaly,characterized by a lifelong progressive course that poses significant threats to patients'physical and mental health.In terms of treatment,the innovative application of radiofrequency ablation(RFA)to VM has emerged as a reliable therapeutic option,demonstrating definitive clinical efficacy while offering advantages such as safety,minimal invasiveness,shorter hospital stays,and lower cost.Nevertheless,there is still no authoritative guideline or consensus,either from domestic or international sources,that provides standardized recommendations for RFA in the treatment of VM.To fill this void,the Emergency Medicine Branch of the Chinese Medical Association and the Interventional Physicians Branch of the Chinese Medical Doctor Association convened a multidisciplinary panel of experts from various fields that include vascular tumor surgery,vascular surgery,plastic surgery,interventional radiology,diagnostic imaging,emergency medicine,general surgery,and internal medicine.Drawing upon both domestic and international research,the panel reviewed and discussed recent advances and the clinical significance of RFA in VM treatment.As a result,they developed and refined the Expert consensus on radiofrequency ablation treatment for venous malformation(2025 version).This consensus includes 20 expert recommendations covering indications,ablation strategies,perioperative management,and approaches to the prevention and management of related complications.The aim is to enhance clinicians'understanding and practical skills in the standardized application of RFA for VM,thereby ensuring its safety and effectiveness in clinical practice.

Endoleak is a major cause of poor long-term outcomes and reintervention after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysms.The prevention and management of endoleaks are critical to improving the safety and efficacy of EVAR procedures.This article aims to summarize the key challenges and strategies in managing various types of endoleaks during EVAR,providing guidance to reduce the incidence of postoperative endoleaks.