Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.

Objective:To study the effect of ischemic postconditioning(I-postC)on the lung injury following ischemia-reperfusion(I/R)of skeletal muscle in the hind limbs of rats.Methods:The rat model of hind limbs I/R injury was established by subrenal abdominal aorta cross-clamping for 4 hours.Forty-eight rats were divided into 3 groups:I/R group,IPC and I-postC group.Each group received 4 hours of ischemia and then 12 or 24 hours of reperfusion respectively.The tissue morphology,wet-to-dry weight(W/D)ratio,malondialdehyde(MDA)and myeloperoxidase(MPO) of lung tissue were compared.The expression of ICAM-1 mRNA in lung was also studied by RT-PCR or in situ hybridization.The protein product was detected by Western blot.Results:In IPC and I-postC groups,all parameters decreased significantly compared with I/R ischemia group(P

Objective To summarize our experience in treating abdominal aorta saddle embolism(ASE).Methods The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other(methods) during January 2000 to July 2006 were retrospectively assessed.Results After the blood flow was restored by operation,4 died in the postoperative early stage because of sudden cardiac asystole due to(hyperkalemia);in the late stage,6 died of multiple organ dysfunction syndrome socondary from acute renal(failure)(ARF).Eleven patients were cured.Of them,bilateral lower extremites were salvaged in 5 patients;and 6 patients received amputation.Ten patients were followed up,and the blood supply of the salvaged legs was good.Conclusions Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE.The intra-operative and post-operative prevention and management of(hyperkalemia) and ARF are important for reduction of mortality.

Objective: To investigate the effect of inhibitng C-myc expression by actinomycin D on intimal hy-perplasia in vein graft. Methods: The vein graft model was established in rats. The different dises of actinomycin D (0.015 mg/kg; 0.15 mg/kg) were given just before and after operation. The vein grafts were harvested at 2 hrs and 1 week after grafting. C-myc mRNA was measured by in situ hybridization method. The intimal thickness was measured using a computerised image analysis system. Results: The expression of C-myc mRNA and the intimal thickness were both significantly reduced in large dose (0.15 mg/kg) group of actinomycin D, with 6.5%; 18.7 μm compared with control group in 12.5%; 28.5 μm respectively. Conclusion: Actinomycin D can inhibit expression of C-myc mRNA and intimal hyperplasia in graft. Expression of C-myc plays an important role in inducing proliferation of smooth muscle cell in vein graft.

Objective To assess the treatment of splenic artery aneurysms (SAA) and prognosis.Methods Clinical data of 18 SAA patients treated in our hospital from 1999 to 2011 were retrospectively analyzed. Results There were 18 patients diagnosed as SAA,including 7 males and 11 females.The average age was 53.8 ± 7.3 years.8 patients were asymptomatic found by routine physical examination,7 patients complained upper left abdominal pain,3 cases suffered from aneurysm rupture. Diagnosis was established by three-dimensional computed tomography angiography (3DCTA) in 14,Digital subtraction angiography (DSA) in 3 and magnetic resonance angiography (MRA) in 1 patient.Three patients with ruptured splenic artery aneurysm underwent emergent operations,11 patients underwent elective surgery or interventional therapy.Surgical procedures included aneurysmectomy and splenectomy in 4 patients,distal pancreatectomy in 5 cases; aneurysmectomy and splenic artery ligation in one patient; and aneurysmectomy with splenectomy and colon resection in 1 case.Interventional embolization by coils of the splenic aneurysm in 3 patients.The remaining 4 being asymptomatic and with tumor diameter less than 2 cm were put on a close follow-up.There was no perioperative mortality.Two were lost to follow-up.16 cases were followed-up for averaging 3.2 years. 1 patient died of cerebral hemorrhage after four years. Conclusions Splenic artery aneurysms was a rare disease and with usually occult symptoms,but rupture can leads to abdominal apoplexy.Open surgery and minimally invasive endovascular treatment is effective and offers a good prognosis.

Objective To evaluate surgical therapies in patients with popliteal aneurysms (PA).Method The clinical data of 25 PA patients admitted from January 1988 to January 2012 were retrospectively analyzed.There were 21 men and 4 women,the mean age was (56 ± 16)years.There were 27 PA in these 25 patients,with bilateral PA in 2 cases.The main symptoms were pulsatile mass in the popliteal fossa,limb pain,acute or chronic distal limb ischemia and limb edema.Result In this series 23out of 25 PA cases recieved operations,17 of them were treated with aneurysmectomy and saphenous vein interposition or bypass grafting,4 of them were treated with aneurysmectomy and prosthetic grafts interposition,1 was treated with aneurism ligation and 1 underwent end-to-end anastomosis after aneurysm resection.There was no perioperative mortality.One patient recieved amputation for distal anastomotic thrombosis and severe limb ischemia.The mean follow-up time is (6.5 ± 0.5) years.After 4 years,a right subclavian artery aneurysm was found in a bilateral PA case and treated surgically.Conclusions Early elective surgical treatment is recommended for patients with PA because PA may go rupture or induce dital limb ischemia and these patients may have good outcome after surgical treatment.Long-term follow-up is warranted to detect the new aneurysm formation.

Objective To investigate the expression and relationship of early growth response gene-1((Egr-1)),platelet-derived growth factor-B(PDGF-B) and tranforming growth factor(TGF-?_1) in autogenous vein graft in rats,and the role in vein graft intimal hyperplasia(IH).Methods Autogenous vein graft model was(established) in 90 wistar rats.The vein graft samples were harvested at 1,2,6,24 hours,and 3,7,14,28,42 days after surgery.Normal vein was used as control group.Egr-1、PDGF-B,TGF-?_1 mRNA was measured by reverse transcription-PCR and in situ hybridization.Western blotting and immunohistochemistry were used to detect the protein expression of Egr-1,PDGF-B and TGF-?_1. Results Expression of Egr-1,PDGF-B,TGF-?_1 mRNA and protein was not detected in normal vein.In grafting vein,expression level of Egr1mRNA reached a peak at 28days,and the positive rate of Egr-1mRNA was 45%?6%;(PDGF-BmRNA) reached a peak at 14days(48%?6%);a peak of TGF-?_1mRNA was 46%?9% reached at 7days;Egr-1 protein expression reached a peak at 28days, and the positive rate of Egr-1 protein was 40%?9%.PDGF-B protein reached a peak at 28days(45%?4%),TGF-?_1 protein reached a peak at 14days(41%?7%).Conclusions Intimal hyperplasia of vein graft is closely associated withexpression of Egr-1、PDGF-B and TGF-?_1;the activation and expression of PDGF-B and TGF-?_1 may be(modulated) by Egr-1,and they may contribute to increase expression of Egr-1 by feedback.

Objective To report our surgical experience in treating 19 cases of solitary iliac aneurysms (SIA). Methods The clinical data of 19 consecutive patients with SIA between January 1985 and January 2008 were retrospectively reviewed. There were 18 men and 1 woman, aging from 39 to 77 years ( mean 62 ± 7 years). Results There were 30 SIAs in the 19 patients, including 25 ( 83.3% ) common iliac aneurysms, 4 (13.3%) internal ihac aneurysms and 1 (3. 3% ) external iliac aneurysm. Eleven patients ( 57.9% ) had multiple ancurysms, with 9 patients ( 47.4% ) having bilateral SIA. Two patients had coexistent peripheral vascular occlusive disease. There were 2 patients suffering form ruptured SIA, one was saved by emergency operation and one died before an surgery could be attempted. Seventeen patients underwent successful open aneurysmectomy and artificial graft implantation leaving no ischemic complications of the pelvic organs. One patient with right common iliac aneurysm underwent endovascular repair without endoleak. There was no operative death during porioperative period. The surviving patients remained stable and had good patency of grafts during the follow-up period. Conclusions Early management of SIA is important, CT angiogarphy (CTA) is necessary not only to evaluate the SIAs, but also to detect multiple aneurysms or arterial occlusive disease. Close and long-term follow-up is mandatory for the early detection of the formation of new anearysms.

Objective To evaluate risk factors of the prognosis in acute arterial embolism of the upper extremities. Methods The clinical data of 62 consecutive patients admired in our hospital with the diagnosis of acute arterial embolism in the upper extremities, from July 1988 to January 2008, were retrospectively reviewed. The risk factors including age, gender, cardiac function, location of embolism, embolectomy and duration of iaehemia were analyzed by cumulative Loots regression. Results There were 62 patients, 33 men and 29 worsen, with a mean age of 63. 5 years (35～86 years). Among them, 37 patients received Fogarty embolectomy and 25 patients received medical treatment including thrombolysis, anticoagulation and antiplatelet therapy because of poor risk for surgery. The iachemic status meliorated in 55 patients (88.7%) with 2 patients receiving amputation and 2 patients dying during the peri-operative period. The result of cursulative Logits regression shewed that the duration of ischemia, cardiac function and embolectomy played the significant role on the prognosis (P < 0.01 ), but age, sex and the location of embolism did not show the significant role. In those only receiving the medical treatment, 23 patients restored blood flow to different degree. Conclusions Embolectomy with Fogarty catheter within 8 hours of onset was the most effective treatment for acute arterial embolism in the upper extremities. For peor-risk patients, early medical treatment including thrombolysis, antieoagulation and antiplatelet treatment, can also restore the blood flow in the isehemie limbs.

Objective To assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes of patients with abdominal aortic aneurysm. Methods The apoptotic pathway was triggered by anti-Fas monoclonal antibody in cultured and activated peripheral T-cells from 20 AAA patients. Control groups consisted of 15 patients with aortic atherosclerotic occlusive disease(AOD)and 25 healthy individuals. Cell survival and death rate were assessed. Results Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, while the effect on T cells was very limited from that of AAA patients. The evaluation of cell Survival rate showed a significantly higher percentage in AAA group(98.9%±10.3%)than in the AOD subjects(58.9%±15.2%)or the healthy group(59.4%±12.9%;P＜0.001＝.Apoptosis assessment by annexin V and propidium iodide staining and flow cytometry showed similar results. The defect in AAA group was not due to decreased fas expressed at normal levels. Moreover,it specifically involved the Fas system because cell death was induced in the normal way by methylprednisolone. Conclusions Fas-induced apoptosis in activated T cell from AAA patients is impaired. This may disturb the normal down-regulation of the immune response and thus provide a new insight into possible mechanisms and routes in the pathogenesis of AAA.