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.

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

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.

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.

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.

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 .

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.

BACKGROUND: Deep venous thrombosis (DVT) always occurs after orthopedic surgery. At present, clinical diagnosis of DVT has been lack of an effective measuring means for a long time. Cathepsin may be an effective biological marker of DVT. OBJECTIVE: To study the expression change of cathepsin B and cathepsin C in the rat blood cells before and after DVT and to investigate the feasibility of cathepsin B and cathepsin C as candidate molecular markers for early diagnosis of DVT. METHODS: Totally 100 Sprague Dawley rats were randomly divided into normal control group (n=10) and model group (n=90). Rat traumatic deep vein thrombosis models were established by clamping the femoral vein and fixing the bilateral hind limbs. According to observation time points and the different situations of thrombosis, rat models were assigned to three subgroups: pre-thrombosis, intra-thrombosis, and non-thrombosis. Blood RNA of each group was extracted and reverse transcribed into cDNA. The expression of cathepsin B and cathepsin C in blood cells was detected using real-time fluorescence quantitative PCR. RESULTS AND CONCLUSUON: Expression of cathepsin B and cathepsin C in the blood cells was obviously expressed in the intra-thrombosis subgroup. There was no significant difference in cathepsin B and cathepsin C expression between pre-thrombosis, non-thrombosis groups and normal control group. These findings suggest that cathepsin B and cathepsin C are closely related to DVP and they can be used as the candidate molecular markers for early diagnosis of DVT.

BACKGROUND: At present, the basic molecular etiological mechanism and core regulatory network of deep vein thrombosis (DVT) remains uncertain, and there is not an ideal measure for early diagnosis of DVT. OBJECTIVE: To study the underlying impact of cathepsin L/G in DVT rat model. METHODS: DVT rat models (n = 50) were established by clamping both femoral vein in three different positions within 3 seconds with mosquito forceps and fixing with cast. According to different observation phases and biological situations of the femoral vein thrombosis, model rats were divided into thrombogenesis group, pre-thrombogenesis group and non-thrombogenesis group. An additional 10 normal rats served as control group. Femoral vein was obtained at corresponding time points to exact total RNA. After a gene chip-based screening, the data of gene expression were further dissected by real-time PCR. RESULTS AND CONCLUSUON: Gene chip hybridization analysis results demonstrated that differential expression of cathepsin L/G gene was significant among groups, and the expression was greatest in the thrombogenesis group, followed by pre-thrombogenesis and non-thrombogenesis groups, which was significantly greater than the control group (P < 0.05). Real-time PCR analysis results were consistent with gene chip hybridization analysis results. These indicate that DVT is associated with an increase in expression of cathepsin L/G in local venous vascular wall, and they may be candidate molecular markers for early diagnosis of deep vein thrombosis.