Objective To evaluate the clinical features and curative effect of patients with Takayasu's arteritis.Methods The clinical data of fifty-eight patients,which were divided into different groups according to gender,clinical classifications,disease activity,and so on,were retrospectively analyzed,to compare whether the results of clinical features,laboratory tests or prognosis had significant differences.Results The data suggested the fact that stroke as first manifestation(2/9 vs 0/49,P =0.022) and incidence of hypertension (9/9 vs 28/49,P =0.037),as well as critical hypertension(8/9 vs 18/49,P =0.011) were more common in male patients than in female patients.The active Takayasu's arteritis patients showed that the level of erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),platelet and fibrinogen was elevated,while the level of Albumin/Globulin ratio was decreased.Electrophoresis showed that the elevation of globulin mainly based on globulin α1 and globulin α2 (P ＜ 0.05).The reduction of complement C3 is more common in inactive group than in active group.Conclusion Stroke and hypertension are more common in male Takayasu's arteritis patients than in female patients.The active Takayasu' s arteritis patients showed elevated level of ESR,CRP,platelet and fibrinogen,while the level of Albumin/Globulin ratio was reduced.

Objective To assess surgical strategies and its therapeutic effect on treating tumors invading of the great vessels. Methods 23 patients underwent tumor resection along with reconstruction of great vessels from Jan. 2001 to Dec. 2005 were retrospectively reviewed. Results 19 cases (82.6%) experienced radical resection along with reconstruction of great vessels, 4 cases (17.4%) underwent palliative resections. 20 cases (86.9%) were followed up by various imaging examination methods. 4 cases (17.4%) died perioperatively and 7 cases (30.4%) had complications in perioperative period. Up to Aug. 2005, the postoperative survival times in patients were from 1.5 to 59.0 months. 3 cases (15.0%,3/20) existed more than 48 months, 4 cases (20.0%,4/20) more than 36 months, 6 cases (30.0%,6/20) more than 24 months, 9 cases (45.0%,9/20) more than 12 months and 12 cases(55.0%,11/20)more than 6 months. No complications related to vascular graft occlusion and tumor recurrence next to grafts occurred in these patients. In 2 cases appeared partial thrombosis in grafts in perioperatively. Conclusion Combination of radical resection of tumor and reconstruction of great vessels could extend survival time and improve quality of life in selected patients with tumor invading thoracic and abdominal great vessels.

Objective To sum up our preliminary experience on radical surgery for the treatment of Budd Chiari syndrome under genuine direct vision. Method A total of 13 cases were enrolled in this study with age ranging from 17 to 48 years, and history from 3 months to 5 years. There was inferior vena cava (IVC) membranous obstruction in 3 cases, right hepatic venous membrane (HV) in 1 case, IVC membrane with distal thrombosis in 6 cases, long segment of thrombosis of IVC in 2 cases, IVC tumor thrombus extending to right atrium in 1 case of retroperitoneal tumor. Result All lesions were successfully resected. Extracorporeal circulation was used in one case, cell saver was used in 2 cases. No blood transfusion was needed except for one case receiving bank blood transfusion of 2000 ml, and the other one of 400 ml. One patient died of renal failure during perioperative period. Disappearance of the symptoms and sigh after operation was found in all the other cases. Conclusion This new radical surgery gives access to the lesions under clear direct vision facilitating the correction.

Objective To probe the etiology and management of restenosis after artificially grafting bypass for chronic ischemia of the lower extremities. Methods In this study 52 cases suffering from postoperative restenosis and obliteration were compared with 32 cases whose artificial grafts remain patent during the same postoperative follow-up period of 3～62 months.Possible risk factors that lead to restenosis were evaluated.Resuits FIB(4.48±1.68)g/L,CRP(9.5±2.6)mg/L and LDL(4.5±1.7)mmol/L were significantly higher in the restenosis group than FIB(3.50±0.72)g/L,CRP(4.0±3.2)mg/L and LDL(2.8±0.9)mmol/L in the patent group(P＜0.01).There were no significant difference between HDL(1.02±0.32)mmol/L in the restenosis group and HDL(1.12±0.28)mmol/L in the patent group (P＞0.05).Reoperation in these 52 cases found severe intima hyperplasia and secondary thrombosis within anastomosis in 42 cases and the remaining 10 cases were found with artificial vessel primary thrombosis.After reoperation,artificial graft remain patent in 28 cases,limb amputation was performed in 10 cases,the grafted bypass were removed due to infection in 3 cases. Five patients died postoperatively.Conclusion The main reason for restenosis after artificially grafting bypass is intima hyperplasia in vascular anastomosis.Higher levels of FIB,CRP and LDL maybe the major high risk factors that lead to intima hyperplasia and artificial graft obliteration.

Objective To investigate the expression of chemokine-like factor 1(CKLF1) in the balloon injured aorta of Sprague-Dawley rats.Methods Balloon expansion induced aorta injury model was established in 80 male Sprague-Dawley rats.Model rats were randomly divided into 8 groups.Rats were sacrificed at the postoperative periods of 12 hours,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks,and 8 weeks respectively.Sham injury operation was applied to 5 rats as control.The ratio of intimal area (IA) and medial area (MA) was calculated to determine the extent of neointimal hyperplasia.Expression of CKLF1 was examined at protein level with immunohistochemistry and at mRNA level with RT-PCR.Software IPP6.0 was used to examine the mean optical density of positive staining.With β-actin expression as an internal control,semi-quantity of CKLF1 expression was calculated by CKLF1/β-actin.Results Visible neointima was noticed at 1 week postoperation.Extend of intimal hyperplasia(IA/MA)was most remarkable at 4 weeks and receded afterwards. Immnohistochemistry study showed that expression of CKLF1 was stronger in the neointima than in the media(P=0.016).The expression was most obvious in the neotima at 1 week postoperation.RT-PCR showed peak expression at 3 days postoperation and declined gradually but still at a higher level than control(P<0.05).The extent of intimal hyperplasia(IA/MA)was positively correlated to the expression of CKLF1(R=0.70,P=0.188).Conclusion The expression of CKLF1 was up regulated in balloon injured rat aorta.The expression was more obvious in the neointima than in the media.CKLF1 may play a role in the development of intimal hyperplasia.

Objective To analyse the recurrence rate of patients with Budd-Chiari syndrome (BCS) after radical correction.Method We retrospectively analyzed the clinical characters and follow-up of patients who underwent radical correction and suffered recurrence.Patency rate of inferior vena cava (IVC) and hepatic veins (HVs) were examined.We present the causes of recurrence and clarify risk factors for recurrence by survival analysis.Result Among the 102 patients undergoing radical correction,34 patients suffered from postoperative recurrence,including 32 cases of IVC lesions,21 cases of HVs lesions (19 patients suffered concurrently from IVC and HVs lesions).One patient received reoperation,16 patients received balloon angioplasty of IVC or HVs,3 patients received stent implantation,and 14 patients received conservative treatment.Conclusions The recurrence rate is high after radical correction for BCS.Once the abnormal syndrome recurs,the patients can be managed by radical correction,balloon or stent angioplasty.The main causes of recurrence are thrombosis of IVC,compression of caudate lobe,scar contracture,and the risk factors for recurrence are concurrent hypercoagulation status,too short period of postoperative anticoagulation (less than 6 months).

0.05) between the two groups diluted by 100-fold and 1 000-fold supernatants.When ASMCs were treated at different concentrations of 0 and 2 ?g/L of pertussis toxin(PTX),the cell number migrated from the test and control groups diluted by 10-fold supernatants,they had statistical significance(74?4 vs 34?3,P0.05).Conclusion:CKLF1 has significant chemotactic effects on ASMCs and such a CKLF1-induced chemotaxis could be inhibiteded by PTX at concentration of 10 ?g/L.

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.

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 sum up our preliminary experience for the treatment of abdominal aortic aneurysm ( AAA) using unibody bifurcation stent-graft ( UBST). Methods This study included 42 cases, among them there were 39 AAA cases, one case of abdominal aortic pseudoanrurysm (AAPA) , one case of type C dissecting aortic aneurysm, one descending aortic aneurysm (DAA) with AAA. Five stent-grafts were deployed for the case with DAA and AAA including 4 stent-grafts were used for DAA and one UBST for AAA. For the case of type C dissecting aortic aneurysm, one straight stent-graft was used for sealing the proximal intimal tear, one UBST was deployed for sealing the distal intimal tear. A graft bypass was required in the case with AAPA through extraperitoneal incision occlusion of external iliac artery of one side, then an UBST was deployed for sealing the rupture of abdominal aorta. Results The average operative time was 50 minutes. One patient died. One more proximal cuff was required in 8 cases. One more distal cuff was required in one case, one more proximal and distal cuff respectively were required in one case. Postoperative transient slight leakage was present in 8 cases. Both internal iliac arteries were sealed in 5 cases; unilateral internal iliac artery was sealed in 20 cases. Success was reached in two cases with an angle of 90 degress between aneurismal neck and body. Conclusion The exclusion of AAA using UBST is successful and safe.