Anticoagulants ; therapeutic use ; Humans ; Venous Thrombosis ; drug therapy

In-stent restenosis severely reduces the long-term patency rate after stent implantation, but drug-eluting stent may be possible to solve this problem. This paper mainly from two aspects of the mechanism of in-stent restenosis and clinical trials to state progress in research of drug-eluting stent in the applications of peripheral artery disease.
Constriction, Pathologic ; Drug-Eluting Stents ; Humans ; Peripheral Arterial Disease

OBJECTIVETo attempt to produce highly accurate three-dimensional (3D) printed models of aortic aneurysm models aid complicated preoperative planning in endovascular repair procedures.

METHODSFrom October 2012 to May 2014, six patients with complicated aortic aneurysms (one aortic arch aneurysms, one thoracoabdominal aortic aneurysms and four juxtarenal abdominal aortic aneurysms) accepted preoperative contrast-enhanced CT angiography (CTA) scans for procedural planning, 4 male and 2 female, average age 64 years (range 52 to 73 years). All the CTA data were processed with FitMe 3D image processing software to get the modified 3D reconstruction pictures and computer language that can be identified by the 3D printer. With the fused deposition modeling technology, the highly accurate models were got to make preoperative endovascular planning.

RESULTSAll the patients' models were printed before operations. By the guidance of models, the endovascular procedure plans were drawn up. Three patients were performed extracorporeal simulating operations with the models and four patients' endovascular operations were guided by the models during the intraoperative time. The procedure technique success rate was 100%. No serious complications and patients dead during the perioperative period.

CONCLUSIONThe technology of 3D printed highly accurate models of aortic aneurysm models is feasible and can help to make preoperative endovascular planning for improving the safety of complicated procedures.

Aged ; Aortic Aneurysm ; diagnosis ; pathology ; Aortic Aneurysm, Abdominal ; diagnosis ; pathology ; Aortic Aneurysm, Thoracic ; diagnosis ; pathology ; Aortography ; Blood Vessel Prosthesis Implantation ; methods ; Endovascular Procedures ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Preoperative Period ; Software ; Tomography, X-Ray Computed

OBJECTIVETo compare the perioperative outcome between the endovascular repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm.

METHODSFrom January 2006 to January 2013, totally 66 patients with ruptured abdominal aortic aneurysm (rAAA) treated by surgery were retrospectively analyzed in Department of vascular surgery, People's Liberation Army General Hospital. According to the repair method, all the subjects were divided into EVAR group and OSR group. EVAR group included 40 patients, 30 patients were male, 10 patients were female, aged from 47 to 78 with a mean of (71 ± 7) years. OSR group included 26 patients, 21 patients were male, aged from 45 to 87 with a mean of (72 ± 9) years. The difference of the operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate and the difference of the two intervention rate were compared between the 2 groups by χ(2) test and t test.

RESULTSThere were significant differences between the 2 groups in operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate ((183 ± 44) minutes vs. (384 ± 108) minutes, t = -10.59, P = 0.00; (0.4 ± 0.8) units vs. (1.1 ± 1.8) units, t = -2.19, P = 0.03; (3.0 ± 1.8) d vs. (8.5 ± 5.1) d, t = -6.34, P = 0.00; 20.0% (8/40) vs. 46.2% (12/26), χ(2) = 5.10, P = 0.02; 25.0% (10/40) vs. 53.8% (14/26), χ(2) = 5.67, P = 0.02). There were no significant differences in frozen plasma quantities and the two intervention rate between the 2 groups (t = -1.98, P = 0.05; χ(2) = 0.49, P = 0.48).

CONCLUSIONSEVAR decreases the perioperative mortality and adverse event of rAAA compared with OSR. More studies are necessary to compare the middle and long-outcome between EVAR and OSR of rAAA.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Endovascular Procedures ; Female ; Humans ; Male ; Middle Aged ; Perioperative Period ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures ; methods

OBJECTIVETo investigate the outcomes in overweight and obesity patients with abdominal aortic aneurysm (AAA) treated with elective open or endovascular repair (EVAR).

METHODSThe clinical data of 52 patients with AAA treated by EVAR (EVAR group, n=17) and conventional surgical repair (open group, n=54) were analyzed retrospectively. Overweight was defined as a body mass index (BMI) between 24 kg/m2 and 28 kg/m2, obesity was defined as a BMI 28 kg/m2. Patients' conditions, operative time, blood loss, function recovery and complications were compared. A two-tailed Student's t-test or rank sum test was used to compare measurement data between the two groups. χ2 test or Fisher exact probability test was used to compare quantitative data between the two groups.

RESULTSNo significant difference were observed in gender, age, other disease, anesthesia risk category, aneurysm type, the maximum aneurysm diameter, and mortality rate between the groups (P>0.05). All patients had success of surgical procedures. Compared with open group the EVAR group had significant reductions in operative time ((449±174) minuets vs. (140±36) minuets), blood loss ((1.8±1.9) L vs. (1.7±1.2) L), units of blood transfusion ((5.3±5.2) units vs. 0), intravenous fluids ((3.3±1.6) L vs. (1.6±1.6) L), need for ventilation ((26.2±10.6) hours vs. (2.3±1.4) hours), intensive care unit stay ((5.2±1.3) days vs. (1.4±0.5) days) and length of stay ((17±9) days vs. (7±3) days) (F=9.932 to 44.816, all P<0.05). Six cases of complications was observed in open group during perioperative, while 9 cases of complications were observed in EVAR group. The difference was significant (χ2=9.572, P=0.008) which open group was significantly higher than the EVAR group. Two patients died during perioperative in open group, however, the EVAR group had no deaths occurred. All complications were connected with the interventional technique. Endoleak was the chief complication after operation. After Follow-up the main complications of infection (n=2), wounds (n=2) and abdominal hernia (n=2) based for open group was observed, and the main complications for EVAR group was endoleak (1 case of type I, 3 cases of type II).

CONCLUSIONEVAR may be preferable in overweight and obesity patients with AAA in the short term.

Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis Implantation ; Body Mass Index ; Endoleak ; Humans ; Intensive Care Units ; Obesity ; Overweight ; Retrospective Studies ; Stents

OBJECTIVETo compare the perioperative outcome after endovascular repair (EVAR) of symptomatic abdominal aneurysms (S-AAAs) and elective non-symptomatic AAAs (E-AAAs).

METHODSFrom January 2008 to February 2013, a total of 230 non-ruptured AAA patients treated by EVAR met the inclusion criteria. S-AAAs were present in 43 (18.7%) patients, 40 patients were male, 3 patients were female, aged (69 ± 10) years and E-AAAs in 187 (81.3%) patients, 162 of which were male, the other 25 patients were female, aged (71 ± 9) years. Patients were followed up at 1 month after EVAR. The primary outcome of the study was perioperative mortality, secondary outcome included procedural data and major perioperative adverse events.

RESULTSAt baseline, there were no differences in age, gender, American Society of Anesthesiologists classification score, and basic diseases. S-AAA patients had larger aneurysms on average (6.00 (1.97) cm vs. 5.10 (1.7) cm, Z = 2.51, P = 0.01). S-AAA patients had shorter preoperative hospitalization (5.00 (5.0) days vs. 7.00 (4.0) days, Z = 1.86, P = 0.02). No differences in the perioperative mortality, respectively, 0 and 1.1% (P = 0.66). Technical success and clinical success were all 100% and the other procedure data was similar (P > 0.05). The occurrence of major adverse events, including mortality, within the 30-day after EVAR were similar between S-AAA and E-AAA patients (0 vs. 2.1%, P = 0.43).

CONCLUSIONSThere is no difference in perioperative outcome between S-AAA and elective E-AAA patients treated by EVAR. More study is needed to compare the middle and long-outcome between S-AAAs and E-AAAs after EVAR.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo evaluate the outcome after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in single center.

METHODSA total of 711 AAA patients treated by EVAR in Department of Vascular Surgery, People's Liberation Army General Hospital and met the inclusion criteria from January 2004 to June 2014 were followed-up and analyzed. There were 612 male and 99 female patients, with a mean age of (69±13) years in this study group. The primary outcome of the study was all-cause mortality, secondary outcome included procedural data, intervention-related morbidity and secondary therapeutic procedures. The endpoint was death. Kaplan-Meier survival analysis were used to analyze long-term survival and cumulative probability of intervention related morbidity. Cox proportional hazards regression was used to analyze factors influenced the survival. Multivariable analysis were adjusted for covariates.

RESULTSThere were 74.8% of total patients followed up. The longest follow-up period was 10.4 years (mean 3.8 years). For the primary outcome of all-cause mortality, 140 deaths occurred. Intervention related morbidity was 9.3%, secondary therapeutic procedures was 5.3%.The Kaplan-Meier survival curve showed that cumulative survival is 78% (95% CI: 74% to 82%) in 5 years, 67% (95% CI: 61% to 74%) in 10 years and the cumulative probability of intervention related morbidity is 10.5% (95% CI: 7.3% to 13.7%) in 5 years, 19.3% (95% CI: 11.9% to 26.0%) in 10 years. Cox proportional hazards regression showed that age>75 years, American Society of Anesthesiologists classification III or IV, smoking, diabetes significantly increase the risk of long-term all-cause mortality, while hypertension significantly decreases the risk.

CONCLUSIONSLong-term outcome after EVAR of AAA in the study is similar to those advanced studies.The management of risk factors would improve the prognosis of these patients.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Risk Factors ; Treatment Outcome