The infrapopliteal arteriosclerosis occlusive disease mainly involves the anterior tibial artery,posterior tibial artery and fibular artery.For the arteriosclerosis occlusive disease of larger arteries of lower extremity,such as iliac artery,femoral artery,etc.,the interventional therapy pattern has been already very mature.However,as the infrapopliteal artery is fine in diameter and the lesion is usually wide with extensive calcification,it is hard to effectively treat the infrapopliteal arteriosclerosis occlusive disease with routine interventional therapy.The therapeutic methods of infrapopliteal arteriosclerosis occlusive disease mainly include surgical treatment,endovascular treatment,drug therapy,and the autologous stem cell transplantation therapy that is still in the research stage at present.This paper aims to introduce the latest progress in interventional therapy for the treatment of infrapopliteal arteriosclerosis occlusive disease in recent years,and to make a prospect for clinical practice in future.

Endovascular aortic repair (EVAR) has been the main treatment means for abdominal aortic aneurysm.It has become an expert consensus that in the case of abdominal aortic aneurysm that is complicated by iliac aneurysm,the preservation of internal iliac artery is necessary because it can prevent the occurrence of gluteal muscle ischemnia,sigmoid ischemia,male sexual dysfunction and other complications.In recent years,with the continuous updating of the endovascular devices it has become possible to retain the internal iliac artery in the performance of EVAR.At present,the reconstruction of internal iliac artery in EVAR includes a variety of techniques,including intraluminal iliac branched device (IBD) technique,sandwich technique,common iliac artery covered-stent bell-bottom (BBT) technique,external iliac artery-internal iliac artery intraluminal shunt technique (reverse chimney technique),and spring coil embolism technique.This article aims to make a summary of all the above mentioned techniques.

Objective To investigate the clinical value of continuity nursing model in caring patients with malignant obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD).Methods A total of 120 patients with malignant obstructive jaundice treated by PTCD were enrolled in this study.The patients were divided into the control group (n=60) and the observation group (n=60).Routine discharge guidance and health education was conducted for the patients of control group,while for the patients of observation group,in addition to conventional discharge education,the continuity nursing was executed by the responsible nurse.Continuity nursing was meant to continue the service,to guide the observation of the wound and dressing change,the observation of the quantity and quality of drainage solution,to teach the knowledge of the management of PTCD catheter as well as its complications,to guide patient's diet and rest,and to establish the continuity nursing records.Results The patients of both groups were followed up for 3 months.The patients' awareness rate of the knowledge related to PTCD tube in the observation group was significantly higher than that in the control group.The wound infection rate,the rate of PTCD tube prolapse or blockage,and the tube-related re-hospitalization rate in the observation group were strikingly lower than those in the control group (P＜0.05).Conclusion The continuity nursing model can significantly improve patients' awareness rate about the knowledge related to PTCD tube,reduce the incidences of biliary tract infection,PTCD tube prolapse or blockage,wound infection,and tube-related re-hospitalization,therefore,the quality of life can be surely improved.

Objective To discuss the feasibility,safety and validity of ViabahnTM self-expanding covered stent in endovascular repair of femoral pseudoaneurysm caused by intravenous drug injection.Methods The clinical data of 9 patients with femoral pseudoaneurysm caused by intravenous drug injection,who were admitted to authors' hospital during the period from April 2014 to April 2015,were retrospectively analyzed.The pseudoaneurysms were located at the common femoral artery in 6 patients and at the superficial femoral artery in 3 patients.Endovascular repair with ViabahnTM self-expanding covered stent was performed in all the 9 patients.The intraoperative angiographic findings,the sizes of the implanted stents,and the manifestations of the angiography performed immediately after stent implantation were recorded,after operation,the patients were kept under close observation to evaluate the improvement of clinical symptoms,the effect of pseudoaneurysm repair,and the occurrence of endoleak,stent infection,in-stent stenosisand fracture of stent.Anti-infection treatment was employed both before and after the stent implantation;after the stent implantation debridement and/or drainage for soft tissue infection area of inguinal region was adopted.Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 9 patients,with a technical success rate of 100％.Angiography performed immediately after stent implantation showed that complete repair of pseudoaneurysm cavity was obtained in all 9 patients,the distal segment of the parent artery was patent,and no endoleak occurred.The patients were followed up for 6-12 months,and limb salvage was successful in all patients,no intermittent claudication or muscular atrophy occurred.CT angiographyreexamination showed that no endoleak,stent infection,stent fracture or in-stent stenosis occurred.Conclusion Under the conditions of adequate anti-infection,local debridement and drainage,the use of ViabahnTM self-expanding covered stent can promptly close the break of femoral pseudoaneurysm to save the patient's life.Because of the excellent qualities,such as flexibility,adhesion and patency,of ViabahnTM self-expanding covered stent,the postoperative occurrence of intermittent claudication,stent fracture and in-stent stenosis can be effectively reduced.It is expected that ViabahnTM self-expanding covered stent may become one of the vascular reconstruction methods for femoral pseudoaneurysm caused by intravenous drug injection,although its long-term curative effect needs to be further observed and verified.

Objective To investigate the current situation of radiation protection capability and personal protection in the clinical practice of interventional radiology in grade-Ⅲ hospital.Methods A total of 108 medical staffs including physicians,technicians and nurses,who worked in interventional room,CT/ MR room,interventional catheterization room,radiotherapy department or radiology department in a grade-Ⅲ hospital of Guangdong province during the period from June 2014 to November 2015,were enrolled in this questionnaire investigation.The contents of self-mnade questionnaire included general demographic data,personal radiation exposure and protection.By using self-made questionnaire about the radiation protection capability of interventional work (both I-CVI and S-CVI being 0.9) the interventional radiation protection capability of the hospital was evaluated.Results In a certain grade-Ⅲ hospital of Guangdong province,the protection capability in shielding facilities,operating time and distance protection was quite strong,but the health-care leave system was lack,the occupational hazard detection was insufficient,and the protection and training system was poorly executed.In aspect of personal protection,the usage rate of lead apron in interventional procedures was only 72.2％,moreover,the rate of not wearing a radiation detector was up to 4.6％,and 9.3％ of medical staff didn't know the correct wearing position of a radiation detector.Conclusion The medical institution is lack of enough attention to the personal radiation protection as well as to the occupational health of interventional medical staff.In part of the medical staff,the consciousness of radiation protection is weak and the protection knowledge is insufficient,they are lack of adequate attention to occupational protection.All these issues need to be further improved.

Objective To discuss the optimalselection of the puncture path in performing CT-guided pericardial drainage,and to evaluate its clinical feasibility and safety.Methods A total of 114 patients with pericardial effusion,who were admitted to authors' hospital during the period from May 2013 to March 2016,were enrolledin this study.The appropriate body position and suitable needle-puncturing route were selected,and CT-guided pericardial drainage with Seldinger'stechnique was performed.Results Successful puncturing and catheter drainage was obtained in all 114 patients,no any serious complication occurred.The time used for manipulation was 18-30 min.Conclusion The use of right puncture path is of great importance for the performance of CT-guided pericardial drainage for pericardial effusion,this technique is highly feasible and safe for relieving the clinical symptoms of pericardial tamponade.

Objective To evaluate the clinical effect of reduced glutathione in protecting the liver function for patients with hepatocellular carcinoma (HCC) after receiving international therapy.Methods The clinical data of 110 HCC patients,who were admitted to authors' hospital during the period from January 2010 to June 2013,were retrospectively analyzed.According to the random number table method the patients were divided into the control group (n=50) and the treatment group (n=60),and transcatheter arterial chemoembolzation (TACE) and transcatheter arterial infusion (TAI) were carried out in all patients.After the treatment,intravenous infusion of 2.0 g vitamin C,0.2 g vitamin B6,2.0 g inosine,and 250 ml branched chain amino acid was employed per day for one week for the patients of both groups,and additional intravenous dripping of 1.8 g reduced glutathione (added in 250 ml of 5％ glucose solution) was adopted for the patients of the treatment group.Various liver function indexes were tested before and one week after the treatment,the results were compared between the two groups.Results Before the treatment,no obvious differences in the hepatic functions and in the clinical condition existed between the two groups.One week after the treatment,in both groups the aminotransferase (ALT and AST) and total bilirubin (TBIL) were significantly increased when compared with the preoperative data (P＜0.05),while the serum pre-albumin (PA) was remarkably decreased when compared with the preoperative data (P＜0.05);these changes of various indexes in the treatment group were apparently better than those in the control group (P＜0.05).Conclusion The use of reduced glutathione can effectively relieve the liver function damage caused by interventional therapy in HCC patients,therefore,reduced glutathione has a very good clinical application value.

Objective To investigate the safety and effectiveness of using covered stent in endovascular isolation treatment of spontaneous peripheral artery dissection.Methods A total of 9 patients with peripheral artery dissection were collected.The dissectionwas located at iliac artery in 6 patients and at subclavian artery in 3 patients.Preoperative CT angiography was performed in all patients to determine the site and degree of the dissection,based on which the corresponding covered stents were prepared.After puncturing the femoral artery with Seldinger technique,angiography was performed to confirm the lesions in all patients,then,according to the angiographic findings the implantation of covered stent was carried out.Results Among the 9 patients,the dissections were located at the right common iliac artery in 3,at the right external iliac artery in one,at the left common iliac artery in 2 and at the left subclavian artery in 3.The length of the dissection was 0.9-3.3 cm with a mean of 1.7 cm.The distance between the initial part of arterial dissection and the target vessel opening was 0.5-5.6 cm with an average of 2.3 cm.The covered stent was successfully implanted in all patients.In one patient,the implanted stent covered the non-dominant left vertebral artery.During the procedure no obvious complications occurred.The patients were followed up for 3-32 months (mean of 18 months).No procedure-related complications were observed in all patients.Color Doppler ultrasound examination showed that all the implanted stents were unobstructed.Conclusion For peripheral artery dissection,endovascular isolation therapy by using covered stent is safe and effective.

Six spinal cord AVMs underwent intravascular embolization in our hospital between January 1993 and August 1994 were reported.All cases diagnosed by selective digital substract angiography.There were one cervical two thoracic intramedullar AVMs,and three lumbodorsal intradural perimedullary AVFs,Five cases received complete occlusion and one intramedullary AVM was partially embolized.Three perimedullary AVFs recovered markedly and partial improvement was also seen in three intramedullary AVMs during the follow-up period from 2 to 20 months.We concluded that intravascular embolization therapy is an alternative and effective manner in treating intramedullary AVM and type Ⅱ type Ⅲ perimedullary AVF.