Coverage of the left subclavian artery is often necessary to establish an adequate landing zone in patients undergoing thoracic endovascular aortic repair,which can avoids endoleaks that contribute the important aspect of technical success of thoracic endovascular aortic repair.However,there have been controversial whether the routine revascularization of left subclavian artery benefits in preventing the complications in perioperative,like cerebrovascular accident,and which approach of revascularization should be taken for more advantages.In this review,the disputes have been discussed between the routine revascularization and selective revascularization of left subclavian artery based on clinic research published in recent years,and also introduce the progress in open surgery and endovascular technique of left subclavian artery revascularization.

A vascular closure device (VCD) is a medical apparatus which is used for stopping bleeding at the puncture point after percutaneous vascular puncturing management. According to its principles , these devices can be categorized into active closure device, compression-assisted device and local hemostatic plaster. The use of these devices can shorten the time of hemostasis, the time of limb immobilization, and the time of hospitalization; it can also reduce the damage to the patient, improve patient’s comfort, and reduce the work load of the medical staff as well. But each VCD has its own applicable scope and learning curve , thus it might cause serious complications when it is improperly used. Therefore , in using VCD the interventional physicians should be familiar with the characteristics of each special VCD and have enough knowledge concerning the treatment of the common complications. This paper aims to make a comprehensive review of the closure device manufacturer data and the relevant literatures recently published so as to make a brief introduction of the principle, characteristics, scope of application and practical tips of several common vascular closure devices.

Objectives To evaluate the effect of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA).Methods There were 41 men and 7 women patients, aged at 32-78 years.46 patients presented with abdominal pain and 3 patients was asymptomatic.The SIDSMA was diagnosed by computed tomography angiography(CTA).Results In the 45 symptomatic patients, one was treated by laparotomy, SMA thrombectomy and necrotic bowel resection.44 patients underwent endovasular treatment, among them 2 patients failed endovasular procedure.The other 42 patients underwent successful intravascular remolding.3 asymptomatic patients underwwent conservative treatment.During the mean (17 ± 4)month follow-up period, computed tomography angiography showed patent true lumen in all the 42 patients.The 2 patients in which the endovascular intervention failed remain symptomatic of recurrent abdominal pain and digestive dysfunction.Conclusions The endovascular interventional therapy is safe and effective for SIDSMA.

0.05). Conclusion The value of muscular loop substitute valve of the popliteal vein in the treatment of DVI remains to be further evaluated.

Objective To evaluate the relationship between airway obstruction and peripheral arterial stiffness in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Ninetyeight elderly patients with COPD were enrolled.The patients were divided into two groups according to forced expired volume in 1 second (FEV1) percentage of predicted (FEV1 ％):mild-moderate group (FEV1 ％ ≥ 50％,62 cases) and severe group (FEV1％ ＜ 50％,36 cases).The brachium-ankle pulse wave velocity (baPWV),body mass index (BMI),24 h average heart rate,blood level of lipid,fasting blood glucose,arterial partial pressure of oxygen (PaO2) and high sensitivity C reactive protein (hs-CRP) level were compared between two groups.Results Compared with mild-moderate group,the BMI in sever group was lower:(22.9 ± 4.3) kg/m2 vs.(25.4 ± 3.3) kg/m2,24 h average heart rate was higher:(77.5 ± 12.8) times/rmin vs.(70.7 ± 9.5) times/min,PaO2 was lower:(71.7 ± 13.1) mmHg (1 mmHg =0.133 kPa) vs.(84.5 ± 13.2) mmHg,and there were statistical differences (P ＜ 0.05).The baPWV in mild-moderate group was (18.9 ± 4.2) m/s,and in sever group was (21.8 ± 3.6) m/s,and there was statistical difference (P ＜ 0.05).The hs-CRP in miid-moderate group was (6.62 ± 4.57) mg/L,and in sever group was (3.38 ± 2.13) mg/L,and there was statistical difference (P＜ 0.05).Conclusions The morbidity of peripheral arterial stiffness is increased in elderly patients with COPD.Progression of peripheral arterial stiffness is related to the severity of airway obstruction.

SUMMARY An involved internal iliac artery is usually embolized when performing endovascular aneu -rysm repair for aortoiliac or isolated iliac artery aneurysm .This can lead to complications such as buttock claudication ,colon ischaemia and erectile dysfunction .Iliac branch device ( IBD ) is an endograft de-signed specifically for iliac bifurcation to preserve internal iliac flow .It was performed with high technical success rates and encouraging mid-term patency .Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm , with the patient ’ s left internal ar-tery been sacrificed then .Using a handmade IBD , we excluded the aneurysm without occlusion of the ip-silateral internal iliac artery or any type of endoleak .Both the design and deployment of this IBD are dis-tinctive that we would like to share our experience with all the colleagues .

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.

OBJECTIVETo study the clinicopathologic characteristics, prognostic factors, response to chemotherapy, chemotherapy-caused disease-free interval and overall survival of small cell carcinoma of uterine cervix (SCCUC).

METHODSTwelve patients with SCCUC were treated from 1995 to 1999, with their clinic ophathologic data retrospectively analyzed. Their stages were I b(1) 2, I b(2) 4, II a 3, II b 1, III b 1 and IV b1. All 12 samples were assessed through immunohistochemical methods including epithelial cell markers and neuroendocrine cell markers, showing positive results in all. Nine early stage patients underwent radical hysterectomy with pelvic lymphadenectomy. Five of these 9 patients had received neoadjuvant chemotherapy (NCH) once or twice before operation, three patients received adjuvant chemotherapy (ACH) once to six times after operation. Three patients with advanced lesions received concurrent chemotherapy twice to four times.

RESULTS44.4% (4/9) of patients treated by pelvic lymphadenectomy showed positive lymph node metastasis. The average disease free intervals of patients who showed positive or negative pelvic lymph node were 16.1 and 25.7 months, overall survival of 19 and 32 months. The success rate of surgery in the NCH group was 100%, 60% of whom showed chemotherapy response pathologically. They showed overall response rates of 80% (4/5), 20% CR (1/5) and 60% PR (3/5).

CONCLUSIONPoor prognosis of small cell carcinoma of uterine cervix, even the early lesions, is due to its high incidence of pelvic lymph metastasis. The risk factor of this lesion is high sensitivity to chemotherapy, but chemotherapeutic long-term survival should be studied further with more allotted material.

Adult ; Carcinoma, Small Cell ; drug therapy ; pathology ; surgery ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Treatment Outcome ; Uterine Cervical Neoplasms ; drug therapy ; pathology ; surgery

BACKGROUND:The molecular mechanism of traumatic deep vein thrombosis is complex.Numerous studies focus on clinical observation and epidemiology,but its molecular mechanism has not been a new breakthrough.OBJECTIVE:By use of gene array technology,this study was aimed to study the expression changes of matrix metalloproteinases in rat models of traumatic deep vein thrombosis,and to explore the roles of matrix metalloproteinases in traumatic deep venous thrombosis.METHODS:A total of 150 SD rats,SPF grade,of 8-12 weeks old,body weight of 250-300 g,were divided at random into normal control group (n=10) and model group (n=140).Rat traumatic deep venous thrombosis models were set up by clamping the femoral vein and fixing the bilateral hind limbs,and the fixation of hip spica with plaster bandage was conducted in each group.Then rats were divided into 7 subgroups:post-traumatic 0.5 hours,post-traumatic 2.5 hours (initial period of thrombosis),post-traumatic 25 hours (thrombogenesis at thrombotic crest-time),post-traumatic 25 hours non-thrombogenesis at the thrombotic crest-time),post-traumatic 72 hours (thrombus resolution),post-traumatic 72 hours thrombus insolution) and post-traumatic 168 hours (nonthrombosis).At the corresponding phasess,the femoral vein tissues were incised,and total RNA of femoral vein was extracted using Trizol one-step method.Applying Genechip Rat Genome 430 2.0 genechips,the gene expressions in femoral vein were detected in different groups.The rate of traumatic deep venous thrombogenesis and non-thrombogenesis,the rate of thrombi solution and insolution were observed;the expressions of matrix metalloproteinases and tissue inhibitor of metalloproteinases at different time phases was detected by gene array data analysis.RESULTS AND CONCLUSION:Three model rats died and the remaining 147 rats were involved in the final analysis.At the post-traumatic 25 hours,the rate of thrombogenesis was 50.5% and nonthrombogenesis was 49.5%.To the post-traumatic 168 hours,the rate of thrombus solution was 56.7% and thrombus insolution was 43.3%.Both matrix metalloproteinases and tissue inhibitor of metalloproteinases exhibited differential expressions in the course of traumatic deep venous thrombosis.Under the thrombus insolution state,matrix metalloproteinases continued to show a high expression,tissue inhibitor of metalloproteinase expression was down-regulated in the thrombus formation,was significantly inhibited in the thrombus insoluUon process.In the process of traumatic deep vein thrombosis and insolution,matrix metalloproteinase was closely related to traumatic deep vein thrombosis,the matrix metalloproteinase/tissue inhibitor of metalloproteinases are likely to affect the biological state of thrombosis.

BACKGROUND:There is lack of an effective measuring means to diagnose deep venous thrombosis (DVT) in clinic.KLF2 and KLF4 are down-expressed at prethrombotic state,which may be served as predictive molecular markers to diagnose DVT.OBJECTIVE:To explore the feasibility of KLF2 and KLF4 as molecular markers to prediagnose DVT in rats.METHODS:Totally 90 rats were obtained from 100 rats to establish traumatic DVT models and divided into the prethrombotic,thrombosis crest-time and non-thrombosis groups.The remained 10 rats served as control group.Rat blood was collected at each time point,and the expressions of KLF2 and KLF4 were detected by real-time PCR.RESULTS AND CONCLUSION:The KLF2 and KLF4 mRNA expressions in the prethrombotic group and thrombosis crest-time group were lower than that of the control group.However,the KLF2 and KLF4 mRNA expressions in the non-thrombosis group was higher than that of the control group.Therefore,KLF2 and KLF4 may be candidate molecular markers for prediagnosis of DVT in rats.