Objective:To summarize the midterm to long-term outcomes and experiences of endovascular treatment (ET) of spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 31 SISMAD patients from Jan 2011 to Dec 2019 treated with ET was retrospectively analyzed.Results:Successful ET was achieved in 29 patients with a technical success rate of 93.5%. A total of 36 self-expandable bare stents were planted in 28 patients and plain old balloon angioplastry (POBA) was performed in 1 patient. Abdominal pain disappeared within 24 hours in 89.3% of the patients after stenting. The rate of perioperative complication was 3.2%. There was no SMA dissection rupture bleeding, nor perioperative death occurred. The mean follow-up time was 53.5 (range, 6 to 110) months. There was no dissecting aneurysm formation, no SMA rupture and bleeding, and no stent rupture during the follow-up. The post ET 1-year, 3-year, and 5-year free from reintervention rate were 100%, 100%, and 91.7%, respectively.Conclusions:ET for SISMAD is safe and effective with satisfactory perioperative and midterm to long-term outcomes.

In recent years, stent implantation has played an important role in solving femoropopliteal artery disease. Because part of the femoropopliteal artery is at the level of the knee joint, the deformation of this segment of the artery is greater when the lower limbs are bent, and the stent fracture rate is higher. Studies have showed that the deformation of the femoropopliteal artery mainly includes bending, twisting, axial compression and radial compression. The selection of stents with mechanical properties suitable for the deformation of artery in different sections can reduce the risk of fracture. The commonly used clinical stent designs (classic laser engraving stent, braided stent and covered stent) have large differences in mechanical properties. Braided stents with higher radial support are more suitable for treating popliteal artery disease, while covered stent has good compliance and can be used in all segments. Of course, the existing types of stents cannot meet all mechanical requirements. The design of the new stent needs to be studied, and its clinical results need to be confirmed by research.

Objective:To examine the factors influencing the false lumen remodeling of abdominal aortic segment in the midterm and longterm after thoracic endovascular aortic repair (TEVAR).Methods:The data of patients with type B aortic dissection diagnosed and underwent TEVAR at the Department of Vascular and Endovascular Surgery, the First Medical Center, People′s Liberation Army General Hospital, from November 2009 to November 2019 were analyzed retrospectively. Patients of acute or subacute long segment dissection with residual tears of abdominal but no thoracic segment and follow-up for more than one year were enrolled. Patients with operation-related complications, and dissection caused by trauma and Marfan syndrome were excluded. A total of 51 patients were enrolled, including 45 males and 6 females, with an age of (49.4±10.6) years (range: 31 to 72 years). The patients included in the analysis were divided into stable and enlarged group. The criteria for inclusion in the enlarged group were any of the following: (1) the maximum growth rate of the abdominal segment false lumen was ≥3 mm/year; (2) the maximum diameter of the abdominal aorta was ≥50 mm; (3) the diameter of the abdominal segment false lumen increased more than 10 mm. χ 2 test, t-test and nonparametric test were used for univariate analysis. The variables with P≤0.1 were included in the Logistic multivariate stepwise regression to analyze the independent correlation factors, and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of the quantitative data. Results:All patients were divided into stable group ( n=30) and enlarged group ( n=21). The follow-up time of all patients was 42(29) months (range: 12 to 115 months). There were no significant differences in baseline characteristics, endovascular treatment characteristics and postoperative medication between the two groups ( P>0.05). Compared with stable group,the number of residual tears around visceral arteries was more (2(1) vs. 1(1), Z=-2.829, P=0.005) and the number of lumbar arteries originating from false lumen was more (5(6) vs. 3(5), Z=-2.025, P=0.043) early after TEVAR in enlarged group. The number of residual tears around visceral arteries ( OR=3.966, 95% CI: 1.552 to 10.131, P=0.004) was found to be the independent influence factor for the poor remodeling of the abdominal false lumen in multivariate Logistic regression analysis. ROC curve analysis showed that the cut-off value of the number of residual tears around visceral arteries was 2 at least (area under curve: 0.718). Conclusion:The incidence of poor remodeling of the abdominal false lumen after TEVAR was high. The number of residual tears around visceral arteries (≥2) could be independent influence factor to predict the poor remodeling of abdominal false lumen, and the follow-up of such patients should be strengthened in clinic.

Objective:To examine the factors influencing the false lumen remodeling of abdominal aortic segment in the midterm and longterm after thoracic endovascular aortic repair (TEVAR).Methods:The data of patients with type B aortic dissection diagnosed and underwent TEVAR at the Department of Vascular and Endovascular Surgery, the First Medical Center, People′s Liberation Army General Hospital, from November 2009 to November 2019 were analyzed retrospectively. Patients of acute or subacute long segment dissection with residual tears of abdominal but no thoracic segment and follow-up for more than one year were enrolled. Patients with operation-related complications, and dissection caused by trauma and Marfan syndrome were excluded. A total of 51 patients were enrolled, including 45 males and 6 females, with an age of (49.4±10.6) years (range: 31 to 72 years). The patients included in the analysis were divided into stable and enlarged group. The criteria for inclusion in the enlarged group were any of the following: (1) the maximum growth rate of the abdominal segment false lumen was ≥3 mm/year; (2) the maximum diameter of the abdominal aorta was ≥50 mm; (3) the diameter of the abdominal segment false lumen increased more than 10 mm. χ 2 test, t-test and nonparametric test were used for univariate analysis. The variables with P≤0.1 were included in the Logistic multivariate stepwise regression to analyze the independent correlation factors, and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of the quantitative data. Results:All patients were divided into stable group ( n=30) and enlarged group ( n=21). The follow-up time of all patients was 42(29) months (range: 12 to 115 months). There were no significant differences in baseline characteristics, endovascular treatment characteristics and postoperative medication between the two groups ( P>0.05). Compared with stable group,the number of residual tears around visceral arteries was more (2(1) vs. 1(1), Z=-2.829, P=0.005) and the number of lumbar arteries originating from false lumen was more (5(6) vs. 3(5), Z=-2.025, P=0.043) early after TEVAR in enlarged group. The number of residual tears around visceral arteries ( OR=3.966, 95% CI: 1.552 to 10.131, P=0.004) was found to be the independent influence factor for the poor remodeling of the abdominal false lumen in multivariate Logistic regression analysis. ROC curve analysis showed that the cut-off value of the number of residual tears around visceral arteries was 2 at least (area under curve: 0.718). Conclusion:The incidence of poor remodeling of the abdominal false lumen after TEVAR was high. The number of residual tears around visceral arteries (≥2) could be independent influence factor to predict the poor remodeling of abdominal false lumen, and the follow-up of such patients should be strengthened in clinic.

In recent years, stent implantation has played an important role in solving femoropopliteal artery disease. Because part of the femoropopliteal artery is at the level of the knee joint, the deformation of this segment of the artery is greater when the lower limbs are bent, and the stent fracture rate is higher. Studies have showed that the deformation of the femoropopliteal artery mainly includes bending, twisting, axial compression and radial compression. The selection of stents with mechanical properties suitable for the deformation of artery in different sections can reduce the risk of fracture. The commonly used clinical stent designs (classic laser engraving stent, braided stent and covered stent) have large differences in mechanical properties. Braided stents with higher radial support are more suitable for treating popliteal artery disease, while covered stent has good compliance and can be used in all segments. Of course, the existing types of stents cannot meet all mechanical requirements. The design of the new stent needs to be studied, and its clinical results need to be confirmed by research.

With the development of endovascular technology for peripheral arterial diseases, paclitaxel drug-eluting stents and drug-coated balloons have been widely used in recent years. It has been proved that paclitaxel-coated devices have good clinical effects in reducing vascular restenosis. However, the clinical safety of paclitaxel devices has encountered challenges, some of the studies have shown that paclitaxel-coated devices may increase long-term mortality. In addition, some studies have confirmed the effectiveness and safety of paclitaxel devices, leading to this topic becoming the focus and hot spot of global attention. Whether paclitaxel-coated devices increase the risk of long-term death, whether paclitaxel doses are related to mortality, and the pharmacokinetics of paclitaxel devices should be examined.

With the development of endovascular technology for peripheral arterial diseases, paclitaxel drug-eluting stents and drug-coated balloons have been widely used in recent years. It has been proved that paclitaxel-coated devices have good clinical effects in reducing vascular restenosis. However, the clinical safety of paclitaxel devices has encountered challenges, some of the studies have shown that paclitaxel-coated devices may increase long-term mortality. In addition, some studies have confirmed the effectiveness and safety of paclitaxel devices, leading to this topic becoming the focus and hot spot of global attention. Whether paclitaxel-coated devices increase the risk of long-term death, whether paclitaxel doses are related to mortality, and the pharmacokinetics of paclitaxel devices should be examined.