[Summary] The isolated dissection of the superior mesenteric artery ( IDSMA) was once considered to be a rare disease .In recent years , a growing number of cases of IDSMA have been reported , especially by Chinese authors , because of the increasing use of contrast-enhanced computed tomography scans .To understand the real domestic status of IDSMA , the Chinese-language literatures were searched, and the clinical characteristics and treatment of IDSMA were analyzed .

Objective:To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.Methods:In the study,42 cases of renal artery stenosis were treated with 52 renal artery stent implantation.Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney,ipsilateral kidney (renal) glomerular filtration rate (GFR),renal effective renal plasma flow effective renal plasma flow (ERPF),kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.Results:The 52 cases of renal artery stent implantation were all successful.Preoperative ipsilateral GFR was significantly lower than that of normal side (t =-3.989,P =0.000);preoperative ipsilateral ERPF was significantly lower than the contralateral side (t =-4.926,P =0.000).On both sides,the overall FF values were equal (t =1.273,P =O.207).Postoperative ipsilateral renal GFR was increased,but there was no statistical difference (t =-1.411,P =0.164).Postoperative ipsilateral renal ERPF was increased significantly (t =-4.954,P =0.000),and FF lower (closer to the normal value (t =3.274,P =0.002).Postoperative side GFR was significantly reduced (t =2.569,P =0.000),the contralateral ERPF was significantly reduced (t =3.889,P =0.001),and FF had no significant change (t =-0.758,P =0.454).Postoperative side GFR was lower than that of the contralateral (t =-3.283,P =0.002) and postoperative side ERPF was still lower than that of the contralateral (t =-3.351,P =0.001),but on both sides,the FF values were equal (t =-0.361,P =0.719).Preoperative FF was relatively normal in the patients with kidney,and the postoperative FF value change was small (t =O.799,P =O.430);preoperative FF was significantly higher in the patients with kidney,and the postoperative FF value was lower than the preoperative (normal value,t =5.299,P =0.000).Postoperative overall serum creatinine was significantly decreased (t =2.505,P =0.016);but for the patients with unilateral renal artery stenosis,the changes in serum creatinine had no statistical difference (t =1.228,P =0.299);and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative,the changes were decreased significantly (t =2.518,P =0.030);postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t =8.945,P =0.000);antihypertensive drugs taken were decreased significantly compared with the preoperative (t =5.280,P =0.000).Conclusion:For the patients with renal artery stenosis,FF is a useful index to understand the pathophysiological process of renal ischemia.Whether preoperative FF is significantly increased or FF is relatively normal,should be regarded as the indications of renal artery stent implantation.

Objective:To evaluate the safety and effectiveness of neglecting superficial femoral artery (SFA) recanalization for chronic lower extremity arteriosclerosis obliterans (ASO).Methods:Thirty-six cases treated for severe stenosis or occlusion of superficial femoral artery resulted from ASO were randomly divided into 2 groups.Twenty of them were treated by endovascular reconstruction of superficial femoral artery and the other 16 cases were not treated with their superficial femoral artery,but were only treated with the accompanied iliac and/or profunda femoral artery lesion.Results:There was no significant difference between the two groups on mean age,gender,ABI before treatment,accompanied diseases,Rutherford classification and trans-atlantic inter-society consensus (TASC) classification (P ＞ 0.05).One week after operation,the reconstruction group had better marked effect and total effective rate [75.0％ vs.12.5％ (P ＜0.001);90.0％ vs.37.5％ (P =0.001)] and lower no effective rate [10.0％ vs.62.5％ (P =0.001)],There was no significant difference between the two groups on effective rate [15.0％ vs.25.0％ (P =0.675)].The deteriorate cases in both groups were zero,and there was no morbidity of complications and death in both groups during the perioperative period.In the 3-month follow up,the reconstruction group had a better marked effect rate [65.0％ vs.25.0％ (P =0.017)];There was no significant difference between the two groups on the effective rate,no effective rate and total effective rate [20.0％ vs.43.8％ (P=O.124);15.0％ vs.31.3％ (P =0.422);85.0％ vs.68.8％ (P =0.422)].The deteriorate cases and morbidity of complications and death in both groups during the perioperative period were still zero.In the 6-and 12-month follow ups,there were no significant differences between the two groups on marked effect and total effective rate [60.0％ vs.37.5％ (P =0.180),80.0％ vs.87.5％(P=0.672);60.0％ vs.43.8％(P=0.332),85.0％ vs.87.5％(P=1.000)].The deteriorate case was zero in both groups,and there was no morbidity of complications and death in both groups.The limb salvage rate in both groups was 100％ during the whole follow up period.The reconstruction group had a higher cost [(53 367.4 ± 24 518.3) yuan vs.(30 397.5 ± 15 354.4) yuan(P =0.011)].There were 8 cases of SFA restenosis/ reocclusion during the follow up,three of which accepted another endovascular treatment,and the reoperation rate was 15.0％.while in the nonreconstruction group,there was no case that needed another endovascular therapy,and the reoperation rate was zero.Conclusion:Only dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe,effective and inexpensive therapy for chronic lower extremity arteriosclerosis obliterans,and should be the preferred alternative for some patients.

Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.

Objective To evaluate the technique of selective portal vein embolization before hepatectomy and its value in the preparation of major hepatic resection for those with insufficient future remnant liver.Methods From Jan 2008 to July 2012,6 patients who suffered from hepatic tumors underwent selective ipsilateral portal vein embolization (PVE) due to insufficient future remnant liver volume (FRLV) before second-stage major hepatic resection.Results Technically,all six PVE were completed successfully with only minor liver function damages.The average FRLV increased from (474.33 ± 89.19)cm3 to (722.67 ± 151.51) cm3 (t =-5.587,P =0.003).The average tumor burden (total tumor volume)increased from (134 ± 181) cm3 to (270 ± 346) cm3 (t =-1.64,P =0.16).Five cases underwent secondstage major hepatectomy 6 weeks after PVE,while in 1 case a resection attempt was abandoned because of uncontrolled tumor growth during the period.During the follow-up period (median 37 months),1 died,4 survived,2 were tumor-free.Conclusions Selective portal vein embolization is a safe and effective method to induce hepatic hypertrophy in the appropriate clinical setting.Before PVE,hepatic tumor should be controlled beforehand with chemotherapy or TACE to ensure the scheduled second-stage hepatectomy.

Objective:To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ( trans-atlantic inter-society consensus Ⅱ) C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods:One hundred and three patients(119 limbs) accepted bypass surgery or endovascular therapy for TASCⅡC/D femoropopliteal artery lesion between January 2002 and Decem-ber 2012 at our institution were retrospectively assessed. All the patients were diagnosed with arterioscle-rosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees. Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery. We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients' latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared. Results:There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [(67. 1 ± 7. 1) years (51 to 80 years) vs. (68. 0 ± 9. 4) years (49 to 91 years),P=0. 561;(0. 41 ± 0. 23) vs. (0. 40 ± 0 . 26 ) , P=0 . 928 ] . There were more TASCⅡD patients in the bypass group than those in the endovas-cular group ( P<0 . 001 ) , and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant[(41. 7 ± 23. 6) months vs. (59. 5 ± 41. 6) months,P =0. 065]. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure. The complication rate was higher in the bypass group than that in the endovascular group [10. 4% vs. 1. 4%, P=0. 039]. And there was no death in both the groups. Compared with the endovascular group, the bypass group had a longer hospital stays [(13. 2 ± 4. 7) d vs. (6. 5 ± 3. 1) d, P<0. 001],a higher reoperation rate (58. 3% vs. 31. 0%,P =0. 003), a better short term, obvious, and effective rate (25. 0% vs. 9. 9%, P =0. 027),a worse long term deterioration rate (37. 5% vs. 18. 3%,P=0. 019) and higher 1 to 10 years primary and secondary accumulative patency rates( P =0 . 001 , P=0 . 001 ) . There was no significant difference between the two groups on the increase of ankle brachial index[(0. 34 ± 0. 28) vs. (0. 31 ± 0. 23), P=0. 371], and short term and long term total ef-fective rates (89. 6% vs. 84. 5%, P=0. 426;45. 8% vs. 56. 3%, P=0. 260), and limb salvage rate (83. 3% vs. 94. 4%,P =0. 051). Conclusion:Endovascular therapy is a safe, effective and minimally invasive therapy for TASCⅡ C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.

Objective:To evaluate the effectiveness and safety of endovascular treatment in solving symptomatic cerebral artery tandem lesions.Methods:From June 201 2 to February 201 4,1 2 cases (24 lesions)with symptomatic cerebral artery tandem lesions were accepted for the endovascular treatment. The distributions of the tandem lesions were as follows:the common carotid artery and internal carotid ar-tery (1 case),the internal carotid artery and the proximal of the carotid cavernous sinus segment (3 ca-ses),the internal carotid artery and the distal of the carotid cavernous sinus segment (4 cases),the in-tracranial segment of internal carotid artery and middle cerebral artery M1 segment (2 cases),the first segment of vertebral artery and intracranial segment of vertebral artery (2 cases).All of these cases were treated from distal lesions to proximal lesions except for tandem lesions in the internal carotid artery and the distal of the carotid cavernous sinus segment in order to obtain better support.Tandem lesions were treated in the same operation with local anesthesia or general anesthesia.The procedures of the 1 2 cases retrospectively were analyzed and the peri-operation complications and responsibility region recurrent is-chemic stroke incidents observed.Results:All tandem lesions were solved successfully all at once.There were no peri-operation complications or recurrent ischemic stroke incidents.There were no recurrent is-chemic stroke incidents or stent restenosis cases in the follow-up.Conclusion:It is safe and effective for selective endovascular treatment in solving symptomatic cerebral artery tandem lesions at the same time, but we should take careful preoperative evaluation and improve the operation plan.

Objective:To study the clinical effects of percutaneous transluminal angioplasty (PTA ) versus stent implantation (ST)after PTA for the treatment of femoral and popliteal artery lesion resulted from arteriosclerosis obliterans.Methods:One hundred and three patients (1 1 9 limbs)treated for femo-ral and popliteal artery lesion resulted from arteriosclerosis obliterans for ten years were reviewed,of whom 60 limbs were treated by PTA and the other 47 by PTA combined with stent implantation.Results:Among the 60 limbs of the PTA group,there were 22 limbs involved only in femoral and popliteal artery;1 3 limbs combined with iliac artery lesion;1 7 limbs combined with infrapopliteal artery lesion;8 limbs combined with iliac and infrapopliteal artery lesion.Among the 47 limbs of the ST group,there were 1 8 limbs involved only in femoral and popliteal artery;8 limbs combined with iliac artery lesion;1 5 limbs combined with infrapopliteal artery lesion;6 limbs combined with iliac and infrapopliteal artery lesion. There was no significant difference between the two groups on age,sex,concomitant disease,ankle bra-chial index(ABI)before treatment and Rutherford classification (P>0.05).The patients’Trans-atlantic inter-society consensus (TASC)C/D was lower in the PTA group than that in the ST group (58.3%vs. 76.6%,P=0.047).The follow-up periods were 48.0 (5.0,1 08.0)and 40.0 (3.0,96.0)months respectively (P=0.064).Compared with the PTA group,the ST group had a better short-term total effective rate (93.6% vs.80.0%,P=0.044)and a higher cost [(33 882.7 ±8 695.6)yuan vs. (1 7 754.8 ±3 654.2)yuan,P<0.001 ].The short-term marked effective rate of the ST group was higher than that of the PTA group,but the difference was not significant (31 .9% vs.21 .7%,P =0.231 ).There was no significant difference between the two groups on short-term efficiency,and compli-cation rates (58.3%vs.58.3%,P=0.724;1 .7%vs.2.1%,P=1 .000).There was no death during perioperative period and no short-term deterioration in both the groups.The long-term marked effective rate was lower and the deterioration rate was higher in the ST group than that in the PTA group,but the difference was not significant (8.5% vs.1 5.0%,P=0.381;1 4.9% vs.5.0%,P=0.081 ).There was no significant difference between the two group on long term total effective rate,accumulative limb salvage rate and reoperation rate (66.0% vs.66.7%,P=0.939;94.7% vs.94.1%,P=0.884;31 .9% vs.31 .7%,P=1 .000),and the 1 to 1 0 years primary and secondary patency rates were similar (P=0.837,P=0.622).When compared based on TASC classification,TASC A/B patients in the ST group had a higher short-term marked effective rate,a higher short-term total effective rate and a higher long-term deterioration rate than those in the PTA group,but the difference was not significant (36.4%vs.24.0%,P=0.353;1 00.0%vs.88.0%,P=0.322;1 8.2%vs.4.0%,P=0.21 6).TASC C/D patients had a similar result (30.6%vs.20.0%,P=0.307;91 .7%vs.74.3%,P=0.050;1 3.9%vs.5.7%,P=0.226).Both TASC A/B and TASC C/D patients in the ST group had a similar accumu-lative limb salvage rate with that in the PTA group (90.9% vs.90.6%,P =0.920;97.1% vs. 94.1%,P=0.796).Conclusion:Stent implantation can increase the cost and short term effective rate at the same time and is not superior to PTA on the long term effective rate and limb salvage rate for femo-ral and popliteal artery lesion resulted from arteriosclerosis obliterans.

Objective:To study the morphology of middle cerebral artery ( MCA ) M1 segment .Me-thods:We selected the MRA data of 794 MCA (400 of the left side and 394 of the right side ) from Ja-nuary 1, 2011 to June 30, 2011 consecutively and analyzed the morphology of the MCA M 1 segment in axial, anteroposterior and lateral view , measured the length of the M1 segment, and analyzed the simila-rity of the left and right side M1 segment morphology .Results:In axial, anteroposterior and lateral view , the MCA M1 segment showed C-shape >L-shape >S-shape .In axial view , it was about 373 ( 47%) M1 segment performance for the C-shape, of which 340 (42.8%) M1 segments showed bowing to the dorsal side, only 33 (4.2%) M1 segments showed bowing to the ventral side .In anteroposterior view, it was about 322 (40.6%) M1 segments of the performance of the C-shape, of which 262(33.0%) M1 segments showed a bowing to the superior , 60 (7.6%) showed bowing to the inferior .The similarity of the left and right MCA M1 segments was 27.2% (114/419) in axial view and 42.7% (179/419) in anteroposterior view.It was more similar in anteroposterior view than in axial view .Along with the increase of age, in the axial view, L-shape converted to C-shape very obviously, but only mildly elevated in S-shape .In anteroposterior view , the L-shape converted to the C-shape or S-shape along with the increase of age.Conclusion:The different morphology of MCA M1 segment in axial and anteroposterior view may be involved in the development of intracranial atherosclerosis .

Objective:To analyze correlation factors of hemodynamic damage after carotid artery stenting.Methods:In this study, 66 cases (71 lesions) who undertook carotid artery stenting were col-lected and the correlation factors of hemodynamic damage were analyzed .Results:Hemodynamic damage emerged in 23 cases (32.4%), of which, 11.3%developed hypotension.The distance between bifurca-tion and lesions (P=0.002 0), plaque distribution (P=0.000 2), plaque character (P=0.001 9), post-dilation ( P =0.002 6 ) were associated with hemodynamic damage by single factor analysis . However, only eccentric plaque (P=0.015 3) and calcified plaque (P=0.009 7) were associated with hemodynamic damage by multiple factors analysis .All the patients could reach stable circulation by drugs during operation , and no cerebral ischemic events ( transient ischemic attack or stroke ) and cardiovascu-lar ischemic events happened .Conclusion: The distance between bifurcation and lesions , eccentric plaques, calcified plaques are correlation factors of hemodynamic damage .