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.

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 .

Objective To explore the treatment of left renal entrapment syndrome. Methods A retrospective analysis was made on the treatment of left renal entrapment syndrome. Diagnosis was established with ultrasonography, magnetic resonance angiography ( MRA) and left renal venography. The transposition of the superior mesenteric artery(SMA) was performed in three cases, the transposition of left renal vein( LRV) in two, and the stent implantation of the LRV in 15. Results Ultrasonography showed that the flow velocity of the proximal end of the LRV at horizontal position accelerates remarkably, and the acceleration is more obvious after standing for 15 minutes; The inner diameter ratio of the broadest place to the narrowest of the LRV at horizontal position is 4. 4?1. 6, while it is 8. 1?1.7 after standing for 15 minutes. MRA illustrated the angle between the abdominal aorta and the SMA was (30?5)?, the control was (64?16)?. The average pressure difference between the LRV and the inferior vena cava (IVC) was ( 14?5) mmHg and (2. 9?1. 4) mmHg before and after stent implantation. The surgical and interventional therapy was successful in all 20 cases. Follow-up from 6 months to 6 years revealed that macroscopic hematuria and symptom disappeared in all patients. Conclusion Ultrasonography, MRA and renal venography are decisive for the establishment of final diagnosis of left renal entrapment syndrome. The stent implantation is the choice of therapy because of less invasion.

Objective To summarize our preliminary experience on diagnosis and treatment of aorta pseudoaneurysms due to deceleration injury. Methods Retrospective analysis was made on 8 cases of aorta pseudoaneurysms due to deceleration injury regarding its clinical findings, imagines and surgical operations or endografting treatment. Results Diagnosis was confirmed by imaging examinations. Among two cases who refused a surgery one died and the other lost follow-up after discharge. Surgery was successful in the remaining six cases including two cases treated by open surgery and four cases by intervensive endografting. Conclusions Aorta pseudoaneurysms due to deceleration injury can be correctly diagnosed by imaging examinations. Aorta pseudoaneurysms should be treated timely since spontaneous cure is almost impossible. Traditional surgical operations is effective, however, endografting is a relatively safe, less traumatic procedure.

Objective To evaluate therapeutic results of radiofrequency endovenous obliteration (RFO) for the treatment of varicose veins of the lower limbs. Methods Fifty six cases (56 limbs) of primary greater saphenous vein tributary varicose veins were randomly assigned to RFO group (n=28) and conventional stripping operation group (n=28). In RFO group, the wall of the greater saphenous vein was treated at 85℃ with the catheter to occlude the whole length of the vein. The other 28 cases underwent stripping procedure. The scattered superficial varicose veins in calf in both groups were managed by phlebectomy. The number of surgical incision, postoperative pain, average hospital days and the short-term results were compared. Results Patients in RFO group have less surgical incisions and less postoperative pain, without subcutaneous hematoma. The average hospital stay was 2.5?1.00 days in RFO group compared to 4.14?0.85 days in stripping operation group. Conclusions RFO effectively obliterates the whole length of the great saphenous vein and is of less trauma,faster recovery, and less scars.