Treatment of hypertension in the elderly is currently an important issue,but also the current social problems.Elderly hypertensive patients more special and ordinary compared to patients with essential hypertension,the risks of them are higher and the characteristics of drugs are more complex.We are mainly reviewed the hypertension situation,physical characteristics and antihypertensive treatment strategies of the elderly.

Objective To analyze the causes of inappropriate discharge of implantable cardioverter defibrillator (ICD) in elderly patients and to discuss the corresponding solutions.Methods Totally 95 elderly patients with ICD were collected.They were followed up and the inappropriate ICD discharges were recorded and analyzed.Results All patients were followed up for 235 times/year totally.There were 16 patients with inappropriate ICD discharges.The causes of inappropriate ICD discharges included ventricular oversensing in 7 patients (43.7％),supraventricular tachycardia misclassified into ventricular tachycardia in 4 patients (25.0％),electrode fracture in 2 patients (12.5％),and electromyogram (EMG) interference,electromagnetic interference and electrode fracture with EMG interference in 1 patients respectively (6.3％ each).11 inappropriate ICD discharges were reduced and avoided by reprogrammed and noninvasive treatment in 16 patients.1 patient with the underdetected ventricular fibrillation after reprogramming and the problem was solved by external defibrillation.The other 5 patients got better by the invasive treatment.Conclusions Different causes account for inappropriate discharges in patients with ICD.Reprogramming the corresponding parameters in different ICD can reduce or avoid inappropriate discharges without affecting the sensitivity of ICD.

Objective To evaluate the management of wrong coverage of the left common carotid artery ( CCA ) during interventional treatment of type Ⅲ aortic dissection by stented graft. Methods Coverage of the left CCA occurred in four cases during endovascular repair of type Ⅲ aortic dissection using stented graft. All four cases were male. The ages ranged from 37 to 45 years old with the average of 41. The first case was due to moving proximally of the first stented graft during delivery of one more cuff because of endoleak. Recanalization of the left CCA and subclavian artery ( SA) was acquired through sliding distally of the stented graft with the help of an aortic balloon. Coverage of the left CCA and SA in the second case was due to jumping-forward of stented graft during deploying, we dragged the stented graft distally through the pigtail catheter introduced from the left brachial artery with the help of a trap device. Then, the covered left CCA and SA were recanalized. The 2/3 left CCA was covered because of mislocation of the left CCA for the 3rd case. We recanalized the covered left CCA using chimney technique with the exposure of the left CCA. For the 4th case, half the innominate artery, the left CCA and SA were covered because the performer mistake the stented graft without naked stent as one with proximal naked stent. A bypass of assending aorta to bi-carotid arteries and the left axillary artery was performed using vascular graft one month after the endovascular repair. Result The proximal intimal entry was sealed successfully in all four cases. No endoleak, cerebral infarction and ischemia of the left upper limb occurred. Conclusion In cases of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection, the CCA must be recanalized as soon as possible through surgical or interventional treatment in order to avoiding cerebral ischemia.

Objective To evaluate abdominal aortic balloon occlusion during pelvic tumors surgery and mamagement of related vascular complications. Methods We retrospectively analyze the clinical data of 265 pelvic tumor cases from December 2005 to April 2010.Before pelvic tumor operation,we place a sheath by Seldinger maneuvre in common femoral artery and send a balloon catheter in the abdominal aorta below the level of renal artery.The balloon catheter occluded the blood flow below the level of renal artery totally during the time of removing the tumors.After the procedure,we pull the balloon catheter out and normally retain the sheath for 6 hours. Results The procedure was successful in all cases and the average time of abdominal aorta blockade was (66 ± 4) min.There was no abdominal aortic rupture and acute renal dysfunction.Emergency angiography was performed on the operative region to diagnose the cause of massive bleeding after the open surgery in 6 cases.Among them,3 cases underwent embolization of internal iliac artery to stop bleeding and 1 case underwent embolization of lumber artery.Small covered stent was deployed in the common iliac artery to stop bleeding in 2 cases.Thrombosis of femoral artery at the puncture site occurred in 6 cases and bilateral thrombosis developed in 1 case. Blood flow was restowed to the femoral artery by open thrombectomy.Pseudoaneurysm formation around the puncture point occured in 2 cases and they underwent open surgical repair,then recovered well. Conclusions Balloon catheter occlusion of abdominal aorta is an effective method to control the hemorrhage in the pelvic tumors' operation.

Objectives To evaluate the method and short-term result of endovascular repairing for distal tears of Debakey type Ⅲ dissecting aneurysm. Methods In this study the continously existing distal intima tears were repaired using different method in 15 Debakey type Ⅲ dissections after previous successful repair of the proximal entry.All patients have symptoms caused by unclosed distal tears or increased false lumen in abdominal aorta.7 visceral artery tears ( 1 celiac and 6 renal),4 abdominal aorta and 7 iliac artery tears were repaired (3 cases have both viscera and iliac tears).All abdominal aorta entries were repaired by bifurcation stent grafts.Blocking umbrella was used in 1 renal tear,and all other viscera and iliac tears were repaired by small covered stents. Results All endovascular procedures were successfully completed.No any endo-leak occurred in abdominal and iliac entry repairs.One near renal tear was totally blocked by an umbrella which also blocked blood flow from false lumen to right renal artery.One major endo-leak and 2 minor endo-leak occurred in visceral artery tearing repair,all other visceral tears were completely repaired.All patients were followed up from 2 to 10 months (average 5.0 ± 2.0 months).Follow-up CTA revealed false lumen thrombosis in non-endo-leak cases.Three endo-leak cases still have blood flow in false lumen with partly thrombosis. Conclusions In selected patients,salvage endovascular repair for left over distal tears in Debakey Ⅲ dissecting aneurysm after initial repair is feasible and safe.

Objective To evaluate the surgical results for patients with lower-extremity arteriosclerotic occlusive disease. Methods We performed a respective analysis of 358 patients who underwent various consecutive surgical treatments including open artery reconstruction and intervention in our hospital between 2002 and 2007.Results In this study,358 patients(mean age 66 ± 10;293 male,65female)experienced a total of 413 surgical interventions including traditional bypass,interventional surgery and amputation.Postoperatively 310 patients(86.8%)were followed up from 6 months to 64 months.The 1-year,2-year and 3-year primary patency rates of iliac balloon angioplasty and stent placement were significantly higher than that of femoropopliteal balloon angioplasty and stent placement(P＜0.01),but not higher than that of aortoiliac or aortofemoral bypass(all P＞0.05).The 2-year and 3-year primary patency rates of femoropopliteal bypass above knee were significantly higher than that of femoropopliteal bypass below knee(P＜0.01),but that was not the case in 1-year group.There is no statistical difference in 1-year primary patency rates between femoropopliteal balloon angioplasty and distal popliteal balloon angioplasty (P＞0.05).Amputation rate was 8.7%(37/358).Perioperative mortality was 3.9%(14/358).Mortality during follow-up period was 6.4%(23/358).Conclusion A satisfactory result can be obtained in most patients with the lower-extremity arteriosclerotic occlusive disease by using the appropriate surgical treatment.

Objective To investigate surgical treatment of carotid body tumors (CBT). Methods Fifty-four cases of carotid body tumor were treated by surgery from 1994. There were 39 males and 15 females with a gender ratio of 2.6: 1. The ages ranged from 22 to 53 years averaging at 31 years. All lesions were benign and unilateral. Simple resection of CBT was performed in 12 cases. Resection of CBT with external carotid artery in 5 cases. Resection of CBT with carotid reconstruction in 6 cases ( using great saphenous vein in 4 cases, using vascular graft in 2 cases). Resection of CBT under carotid artery shunt was performed in 32 cases ( including carotid reconstruction in 3 cases). Resection of CBT with breaking mandible was necessary in 2 cases because of too high tumor position. Results Complete resection of CBT without recurrence and metastasis was achieved in all 54 cases. No complication of cerebral ischemia was encountered in all cases. Nerve injury was found in 7 cases ( including injury of sympathetic nerve and superior laryngeal nerve in 2 cases respectively, injury of recurrent laryngeal nerve in 3 cases). Conclusion Carotid shunt is helpful in resection of complicated CBT, carotid reconstruction is required for cases with resection of internal carotid artery. Breaking mandible is helpful in exposing high located tumors.

Objective To summarize our experiences of endovascular treatment for abdominal aortic aneurysm (AAA) with common iliac artery aneurysm (CIAA) by using bell-bottom technique (BBT).Methods From February 2009 to June 2014,endovascular aortic repair (EVAR) was performed on 17patients with AAA with CIAA using BBT,including 16 patients with bilateral and 1 patient with unilateral CIAA.Among them,patients with common iliac artery (CIA) of less than 25 mm in diameter without involvement of the internal iliac artery and external iliac artery aneurvsm were treated with BBT.Results All procedures were successfully completed.There were 3 bilateral and 14 unilateral BBT.Type Ⅰa endoleak was noticed intraoperatively in 3 cases and balloon dilation were applied,the endoleak disappeared after dilation in 2 cases and in 1 case the diminished endoleak disappeared during the follow-up period.The median follow-up of the 17 cases was 28 months (ranging,4-68 months).During follow-up no AAA or CIAA rupture and no endoleak occurred,and no dilation of the CIAA was observed.None of them had BBT graft occlusion or buttock claudication.Conclusion AAA with CIAA can be successfully treated with EVAR and BBT,which can preserve internal iliac artery patency.

Objective To investigate the clinical features of spontaneous isolated superior mesenteric artery dissection (SISMAD), and to discuss its interventional therapy. Methods The clinical data of 10 patients with SISMAD, who were admitted to authors' hospital to receive interventional treatment during the period from January 2006 to June 2014, were retrospectively analyzed. All the 10 patients were males, aged 44-66 years with a mean of (53±8) years. Clinically, all patients presented with acute-onset abdominal pain or pain around umbilicus, as the effect of conservative treatment was poor, implantation of self-expandable bare stent was carried out. Results Successful implantation of self-expandable bare stent was accomplished in all 10 patients;only one stent was used in 7 patients and 2 stents were used in 3 patients. The blood in the true lumen of superior mesenteric artery (SMA) restored and the residual stenosis extent was less than 15%. The technical success rate was 100%. The abdominal pain was relieved in 8 patients on the operative day after treatment, and in 2 patients the abdominal pain was relieved in 2 days after treatment. All the patients were followed up for 7-71 months (mean of 36 months) and the follow-up rate was 100%. After the treatment patients had no symptoms of abdominal discomfort. Contrast-enhanced CT scan performed at 6, 12 and 24 months after the treatment showed that SMA and stent was patent and no aneurysmal dilatation was observed. Conclusion For the treatment of SISMAD endovascular implantation of self-expandable bare stent is clinically safe and feasible, and its long-term effect is satisfactory.

Objective:To compare total percutaneous access using preclose technique with femoral ar-tery cut-down in endovascular aneurysm repair (EVAR)and assess the safety and feasibility of preclose technique.Methods:In the study,81 cases undergoing EVAR from Dec.2011 to Nov.2014 in Peking University People’s Hospital were retrospectively reviewed.Preoperative CT angiography (CTA)showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases.The maximum diameter of aneurysm >4.5 cm met the indications for surgical treatment.The conditions of bi-lateral femoral artery and iliac artery CTA showed were good,and there was no moderate or severe steno-sis,nor was there any severe calcification in anterior wall of femoral artery.Not only were the cases fit for percutaneous endovascular aortic aneurysm repair (PEVAR),but also feasible with open endovascular aneurysm repair (OEVAR).According to the intention of the patients about the surgical incision,the ca-ses were divided into group PEVAR and group OEVAR.The data of the general situation,operation time,blood loss,technical success rate,length of hospital stay after procedure and wound complications were analyzed statistically.Results:In the study,44 cases (78 incisions)were enrolled in group PEVAR and 37 cases (65 incisions)in group OEVAR.There was no significant difference between the two groups in age,gender,body mass index (BMI),accompanying diseases,average number of stents and outer diameter of stent delivery system.Average operation time of group PEVAR was less than that of group OEVAR [(119.1 ±102.0)min vs.(163.6 ±61.9)min,P =0.025].The blood loss in group PEVAR was less than that in group OEVAR [(64.7 ±97.0)mL vs.(98.6 ±88.3)mL],but there was no significant difference (P =0.106).There was no difference in the technical success rate (94.9% vs. 95.4%,P =1.000).The average length of hospital stay after procedure was significantly shorter in group PEVAR [(7.8 ±2.8)d vs.(12.3 ±7.2)d,P <0.001].There were 2 cases with subcutaneous hematoma of wound in group PEVAR and 7 cases of wound complications that occurred in group OEVAR including 3 cases with lymphatic leakage,3 cases with lower limb ischemia and 1 case with subcutaneous hematoma.The analysis showed that PEVAR could reduce the wound complications (2.6%vs.10.8%), but there was no significant difference between the two groups (P =0.079).Conclusion:Using preclose technique in EVAR is safe and effective.It can shorten the operation time and length of hospital stay after procedure.