Vascular access is the dialysis patient's lifeline. Lower extremity arteriovenous accesses are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites.The lower extremity options are including autogenous and prosthetic arteriovenous accesses.Numerous challenges including patency rates and complications are encountered in the lower extremities that are not seen in the upper extremities.In this review,we focus on the advances in lower extremity accesses.

Objective To understand treatment outcomes of patients diagnosed with type 2 diabetes aged over 30 years in Jiangninglu Neighborhood of downtown Shanghai. Methods Total 642 patients diagnosed as type 2 diabetes aged over 30 were investigated by cluster sampling in Jiangninglu Neighborhood of downtown Shanghai. Status of optimal control of diabetes in them was analyzed based on the recommendations proposed by International Diabetes Federation (IDF) for Western Pacific Region. Results and serum level of glycosylated hemoglobin Alc (HbAlc) of less than 6.5% was achieved in 37.5% (241/were achieved in 23.8% (153/642) and 18.1% (116/642) of them, respectively, and beth systolic and mmol/L was achieved in 21.7% (139/642) of all the participants investigated, triglyceride of less than 1.5 mmol/L in 46.6% (299/642), low-deusity lipoprotein-cholesterol (LDL-C) of less than 2.5 mmol/L in 23.7% (152/642) and high-density lipoprotein-cholesterol of greater than 1.1 mmol/L in 62.1% (399/of their blood glucose, blood pressure and serum LDL-C (defined as HbAlc less than 6.5%, blood pressure less than 130/80 mm Hg and LDL-C less than 2.5 retool/L). Conclusions Only 2.6% of all the patients diagnosed with diabetes aged over 30 in downtown Shanghai get optimal control of their blood glucose, blood pressure and serum lipid, so comprehensive prevention and control for diabetes shall be strengthened for them at community-level of urban areas.

Objective To introduce the experience of prophylaxis and management of the complications of carotid endarterectomy (CEA) during perioperative period because those complications can not be avoided yet.Methods During Oct 2000 to Jan 2013,318 patients were performed CEA.There were 213 men and 105 women with an average age of 74.8 years ranged from 48 to 85y.There were 186 patients in the left,120 patients in the right,and 12 patients in two sides.Simply,CEA are performed in 166 patients,CEA and patch in 140,and 12 patients were performed bypass with the autogenously great saphenous vein after the lesions removal.Results The perioperative complications were preoperative stroke in 3 cases,hypotension during operation in 16,after-operation deaths in 3,hyperperfusion syndrome in 18,postoperative severe cerebral infarction in 1,hoarseness in 14,and hematoma in 28.Conclusions Perioperative complications of CEA can be decreased by cautious surgical procedure and postoperative observation.

Objective To explore surgical experience of stenoses or occlusion of the vertebral artery .Methods In this group, there were 28 patients including 21 men and 7 females with average of 52 ~73 (68.3 ±0.03) y, duration 3 months to 4 years , and 15 lesions in the left and 13 lesions in the right .All patients were performed operation under general anesthesia .There were 16 vertebral artery endarterectomy , 10 subclavian-vertebral bypass and 2 end-side anastomosis between vertebral artery and common ca-rotid artery.Results One patient had to be performed second operation at the 7th day after endarterectomy because of anastomotic bleeding.All patients were cured.The patency rate of 6 months was 89.28%(25/28) in all patients.Conclusions Surgical man-agement of stenoses or occlusion of the vertebral artery has excellent curative effect with simply operation .However , the technique must be selected according to anatomic circumstances of vertebral artery and subclavian artery .

AIM:To observe the effect of Shexiang Baoxin Pills on pathologic changes and heart function of streptozotocin(STZ)-induced diabetic rats. METHODS:The rats were randomly divided into the control group,Shexiang Baoxin Pill group and STZ group.The rats in Shexiang Baoxin Pill group took Shexiang Baoxin Pill(50 mg/kg) to perfuse the stomach every day.The cardiac functions in 8 weeksafter treatment were determined.Meantime,the cardiac pathologic changes were observed through electron microscope and immunohistochemistry. RESULTS: Shexiang Baoxin Pills could reduce the interstitial fibrosis of myocardium in STZ rats.it could obviously improve the cardiac contraction and diastolic functions in STZ rats. CONCLUSION: Shexiang Baoxin Pills can(amendment) cardiac pathologic changes and improve cardiac function in STZ rats.

Objective To raise the level of clinical diagnosis for the patients with pituitary stalk interruption syndrome (PSIS). Methods Five patients (4 males) with PSIS were retrospectively analyzed with respects to the clinical features, endocrine status and image characteristics. Magnetic resonance imaging (MRI) scan was performed at hypothalamic-pituitary region. Results The clinical manifestations of all patients consisted of growth retardation and delayed puberty without polyuria. Deficiency of multiple anterior pituitary hormones was revealed in all patients by the evaluation of endocrine status. The features of MRI included a lack of visible pituitary stalk, absence of posterior lobe hypersignal in the sella turcica and a hyperintense spot in the region of the thalamus opticus. Conclusion The clinical characteristics of patients with PSIS are growth retardation and delayed puberty. The evaluation of anterior pituitary function is necessary. The detection of an anatomical abnormality around hypothalamic-pituitary region by MRI is important diagnostic evidence.

Objective:To evaluate the safety and efficacy of a combination of percutaneous mechanical thrombectomy (PMT) and drug coated balloon(DCB)for the treatment of in-stent restenosis(ISR) and arterial thrombosis of the lower extremity.Methods:The clinical data of 53 patients treated with PMT + DCB were analyzed retrospectively, including 38 cases of ISR and 15 cases of arterial thrombosis. 33 patients were males and the others were females , the mean age was (68.6±9.4) years . Patients were followed at 30 days, 6 months, and 12 months concerning clinical symptoms, calculation of ABIs and duplex ultrasonography.Results:Procedural success was achieved in all 53 patients. One patient died of cardiovascular event perioperatively. 6 operation-related complications occurred including 5 cases of distal embolism during the PMT managed by using 5 F angiography catheter suction and one case of artery perforation during PMT procedure, a balloon was used to cover it. 47 (88.6%) patients completed 12-month follow-up, the TLR was 10.6% (5/47). One patient had the amputation 4 months later; There were 7 cases with arterial restenosis.PMT+ DCB were performed again in 4 cases, 1 case received stent implantation and 2 cases treated by medication.Conclusion:The use of combination of PMT and DCB is a safe and effective method to treat ISR and arterial thrombosis of the lower extremity.

Objective:To evaluate the clinical efficacy of Rotarex percutaneous mechanical thrombectomy(PMT) for treatment of lower extremity arterial graft occlusion.Methods:The clinical data of 19 patients with lower extremity arterial bypass occlusion admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients were treated with Rotarex-based endovascular therapy. After 12 months follow-up, the clinical features, surgical outcomes and follow-up data were analyzed to identify effectiveness and safety of the therapy. Independent sample t test was used to analyze the measurement data of continuous normal distribution which were expressed as mean±standard deviation( ± s), enumeration data were expressed as number and percentage, and the comparison between groups were analyzed by chi-square test. Results:A technical success rate of 100% was demonstrated. Rotarex combined with catheter directed thrombolysis was performed in 2 cases, Rotarex combined with percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Rotarex combined with stent implantation was performed in 8 patients. The Ankle brachial index significantly increased (0.82±0.14 vs 0.47±0.11, P<0.05). Critical limb ischemia (Rutherford class 4 or higher) improved significantly (0 case vs 9 cases, P<0.05). Distal embolism occurred in 1 patient and acute myocardial infarction occurred in 1 patient. There was no vascular rupture, haemorrhage, infection, pseudoaneurysm, death and amputation. Kaplan-Meier survival analysis revealed 12-month primary patency rate and freedom from clinically driven target lesion revascularization was 78.9% and 89.5% respectively. Conclusion:Rotarex-based endovascular therapy is a safe and effective treatment for graft occlusion after lower extremity arterial prosthesis bypass with high patency rate and few complications.

Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.