ObjectiveTo compare the therapeutic effects of a new surgical endoscopic technique, the transilluminated powered phlebectomy (TriVex System, Smith+Nephew) and pointed phlebectomy in the treatment of varicosis of the great saphenous vein of the lower limbs. Methods Thirty-nine patients (46 limbs) received TriVex operations under spinal, or epidural anesthesia. The powered vein resector and an irrigated illuminator device-a minimally invasive system was used for varicose vein surgery. During the same period, 41 patients (46 limbs) underwent pointed phlebectomy. Results The average postoperative hospital stay was 4.6 days in patients receiving TriVex, and 8.1 days for pointed phlebectomy. Compared with the pointed phlebectomy, the incision of TriVex procedure was shorter and the number less. Conclusion This new surgical device is easy to operate, minimally invasive, efficacious and time saving with satisfactory results.

Objective To evaluate the effect of preoperative localization of Adamkiewicz artery (AKA)by CT for patients undergoing endovascular descending thoracic aortic repair. Methods From May 2003 to April 2005, 12 patients received CT examination for the detection of the AKA before undergoing endovascular descending thoracic aortic repair. Eight patients were of Stanford type B dissecting aortic aneurysm, 2 of Crawford typeⅠthoracoabdominal aortic aneurysm (TAAA) , 1 of descending thoracic aortic pseudoaneurysm and 1 of descending thoracic aortic aneurysm combined with abdominal aortic aneurysm. The inclusion criterion was that the segment from T8 to L1 needed to be partially excluded. The CT assessment accentuated the identification of the level at which the aorta gave rise to the AKA-originating intercostal/lumbar artery and approval of the continuity from the origin of the intercostal/lumbar artery at the aorta to the anterior spinal artery (ASA). Results Thirteen AKAs were identified in 9 patients (75%). A single AKA was visualized in 5 cases and double in 4. Two AKAs arose from the T8 intercostal artery, 2 from T9, 3 from T10, 3 from T11 and 3 from T12. The continuity from the origin of the intercostal artery at the aorta to the ASA was identified in 8 patients. Ultimately, 10 AKAs were preserved while 3 sacrificed. More than 15-mm both proximal and distal landing distance of the stent-graft was achieved in all patients, and no paraplegia occurred perioperatively or during the follow-up raging from 3 to 19 months ( mean 12 months). Complete false lumen thrombosis of the thoracic aorta or aneurysmal thrombosis was evidenced on CT at 3 month in 11 patients while 1 patient with dissecting aneurysm caused by Marian's syndrome died for unknown cause 2 days after being discharged. Conclusion Localization of AKA by CT before stent-grafting in the descending thoracic aorta may enable us to avoid covering the origin of the AKA-originating intercostal/lumbar artery at the aorta, hence, the remaining segment from T8 to L1 could be saved for reliable landing the sten-graft.

Objective To evaluate the efficacy of endovascular repair (EVR) for aneurysms or dissection aneurysms of the aortic arch. Methods Twelve aortic dissection aneurysm (ADA) patients with the primary entry located within 15 mm beyond the origin of the left subclavian artery (LSA) and two aortic arch aneurysm patients underwent EVR from June 2003 to August 2004. EVR with intentional coverage of the LSA without any supportive bypass was employed in 8 ADA patients, and the preliminary cervical reconstruction combined with EVR in the remaining 6 cases. Results Technical success was achieved in all cases. One case died of postoperative cerebral infarction. No neurological deficits or limb ischemia developed perioperatively or during the follow up period raging from 1 to 14 months and complete thrombosis of the thoracic aortic false lumen and remarkable anenrysmal thrombosis were revealed by CT in all 12 ADA cases and the remaining aneurysm case respectively. Conclusions EVR is effective in the management of aneurysms or dissection aneurysms of the aortic arch.

Objective:To summarize the early and intermediate outcomes of second-grade false-lumen endovascular occlusive repair (FLEVOR) for aortic dissection.Methods:The clinical data of 12 patients undergoing second-grade FLEVOR after proximal repair of aortic dissection at our center from Aug 2016 to Aug 2019 was retrospectively analyzed.Results:The mean age was (51.3±14.9) years old. Four patients received open repair due to Stanford type A aortic dissection previously, the other 8 patients underwent thoracic endovascular aortic repair for Stanford type B aortic dissection. The time to the proximal repair varied from 3 months to 16 years. The technical success rate was 100%. Visceral ischemia, early spinal cord ischemia and in-hospital death did not occur perioperatively. The mean follow-up time was 16.7 months. Persistent false lumen perfusion was found in 3 patients, complete thrombosis of false lumen was achieved in the other 8 patients. The maximum diameter of abdominal aorta decreased in 8 (72.7%) patients.Conclusions:FLEVOR could block the blood flow from the false lumen and induce the thrombosis of false lumen, which promotes the aortic remodeling. Meanwhile, FLEVOR could protect the blood supply of spinal cord and viscera, and reduce the risk of type Ⅱ endoleaks.

Objective To sum up the experience in treating thoracic aortic aneurysmal disease caused by blunt injury.Methods From September 2003 to March 2009,12 Patients were admitted into our center due to thoracic aortic aneurysmal disease after blunt injury,including 8 Stanford type B aortic dissections and 4 descending aorta pseudoaneurysms.Diagnosis was established by CT angiography and re-evaluated by angiography before endovascular treatment. Once severe co-morbidity due to iniury wag stabilized,endovascular repair of the lesions Was carried out with stent-graft implantation.Follow.up was done by CTA at 3 months、6 months、1 year and then annually postoperatively.Results Eleven patients underwent endovascular surgery,while 1 died before intervention.Technical success was achieved in all patients with left subclavian artery intentionally covered in 6 cases.Endoleak Was observed in 3 cases andmanaged with balloon dilation in 2 easels.9 cases were followed up without mortality,including 6 disseetions and 3 pseudoaneurysms.No ischemic symptom of left uppar extremity or positive neurological sign or paralysis were observed,CTA revealed no newly-developed dissection or aneurysm、no endoleak or stent migration. Conclusion Thoracic aortic aneurysmal disease after blunt injury mostly locates in aortic isthmus;endovascular stent-graft implantation after stabilization of concurrent disease is effective.

Objective To evaluate the clinical characteristics and surgical treatment of renal stenosis resulting from fibromuscular dysplasia ( FMD ). Methods 16 cases from 1998 to 2011 were reviewed,the average age was (28 ± 13 ) years old. Among them, all patients suffered refractory hypertension and only one presented renal dysfunction. Aorto-renal bypass was performed in 2 cases.Resection and reconstruction was performed in 2 cases,balloon angioplasty in 10 and stent implantation in 3.Results There was 1 death peri-operatively.13 out of 15 cases were followed-up with no death.Significant decline of blood pressure [ (134 ± 14 )/( 83 ± 8 ) mm Hg vs.( 151 ± 17 )/( 96 ± 16 ) mm H g ( P ＜ 0.01 ) ]and 100％ effective rate were observed.The creatine level were preserved after surgical treatment [ (61 ±22) μmol/L vs.(69 ± 22) μmol/L,(P ＞ 0.05 ) ] with 4 cases improved and the other 9 stable.12 patients received ultrasound surveillance with only one case of 20％ restenosis. Conclusions Renal stenosis due to FMD are most common in children and the youth with hypertension as major presentation. Balloon angioplasty is the first choice of surgical treatment with positive efficacy.

Objective To retrospectively analyze the geometrical characteristics of abdominal aortic aneurysms undergoing endovascular treatment in a single medical center.The long-term effects as well as the strategies for the prevention and treatment of complications have been reviewed.Methods From January 2003 to December 2010,clinical data and geometrical parameters of 344 cases undergoing endoluminal repair of abdominal aortic aneurysms were analyzed retrospectively.Results The diameter and length of proximal neck was (23 ± 3 )mm and ( 26 ± 12) mm respectively.The angle between the neck and the abdominal aortic aneurysm was (25 ± 28) degree.The surgical success rate was 99.7％.The average follow-up time was 32.9 months (3 -84 months) with follow-up rate 81.8％ (279/341).The mortality was 1.1％ (3/279),the re-intervention rate was 10.4％ (29/279) and the overall complication rate was 12.9％ ( 36/279),including endoleak of 5.7％ ( 16/279 ),stent-graft migration of 1.1％ ( 3/279 ),aneurysm expansion or rupture of 5.4％ ( 15/279 ),and other complications like limb occlusion.Severe infrarenal aortic neck angulation ( ＞ 60 degree) was associated with type Ⅰ endoleak ( P =0.010 ).Conclusions A careful preoperative case selection and evaluation is the key for a successful endovascular aneurysm repair.Endoleak continues to be the major long-term complication of the endoluminal grafting technique,and the major cause for re-intervention.Life-long follow-up is extremely important.

Objective To evaluate the safety and efficacy of transplantation of purified CD34 + cells (PCCs) in treatment of critical limb ischemia (CLI) caused by thromboangiitis obliterans (TAO).Methods From May 2009 to June 2015,34 TAO-induced-CLI cases underwent PCCs transplantation.None of these patients were eligible for surgical or endovascular revascularization.G-CSF was subcutaneously injected for 5 days before peripheral CD34 + cells were isolated,purified and intramuscularly injected in the limbs.Patients were regularly follow-up.Results Technical success was achieved in all cases.The mean number of transplanted cells was (7.5 ± 2.4) × 105/kg.The follow-up was accomplished in 32 cases,ranging from 6 to 79 months (mean 45 ±24 months),and two patients were lost.Wong-Baker FACES pain rating scale score significantly decreased from 8.0 ±2.0(4-10)to 2.2 ±3.1 (P ＜0.05) at 1 month.The Peak pain-free walking time improved from (4.0 ± 2.0) min to (13.5 ± 5.3) min (P ＜ 0.05) at 3 months and (19.0 ± 3.1) min (P ＜ 0.05) at 6 months.The ankle-brachial index increased from 0.42 ± 0.20 to 0.50 ± 0.10 (P ＜ 0.05) at 3 months and 0.52 ± 0.11 (P ＜ 0.05) at 6 months,respectively.Transcutaneous partial oxygen pressure rose from (25 ± 11) mmHg to (48 ± 11) mmHg(P ＜ 0.05) at 3 months and (58 ± 10) mmHg (P ＜ 0.001) at 6 months,respectively.Ulcers healed in 21 out of 22 patients at (5 ± 4) months.The overall amputation-free survival rate was 94.1％ at 6 months and 91.2％ at 48 months.No major adverse events were observed perioperatively or postoperatively.Conclusions Transplantation of PCCs could yield safe,satisfactory and durable treatment outcomes in patients with TAO-induced-CLI.

OBJECTIVETo evaluate the efficacy of endovascular repair of popliteal artery aneurysm (PAA) and to summarize the clinical experience and lessons.

METHODSA clinical data of 9 PAA cases (males 8, females 1, age range 55-84) undergoing endovascular repair from October 2006 to December 2014 at Zhongshan Hospital Fudan University were retrospectively analyzed. CT angiography was made in all of the 9 cases preoperatively, and 10 PAA were included in the analysis. Of the 9 cases, 6 cases were symptomatic. The mean diameter of PAA was 3.9 cm (range, 2.1-8.2).

RESULTSThe technique successful rate of endovascular repair was 10/10. The preoperative complications were 2/10, including one case suffered hematoma in the arterial puncture site and 1 case with distal artery embolization. The mean follow-up was 33 months (range, 3-87). During the follow-up, 2 cases received the secondary intervention and drug thrombolysis because of the stent distal thrombosis. The stent-graft primary patency at 1 year was 78.8% (95% CI: 48%-91%). One case suffered stent fracture, and one case died of brainstem hemorrhage 15 months post endovascular repair of PAA.

CONCLUSIONSEndovascular treatment of PAA is safe and effective in perioperative and midterm follow-up. However, individual endovascular strategy and postoperative complications in the long-term follow-up should be payed more attention.

Aged ; Aged, 80 and over ; Aneurysm ; surgery ; Angiography ; Embolization, Therapeutic ; Endovascular Procedures ; Female ; Humans ; Male ; Middle Aged ; Popliteal Artery ; pathology ; surgery ; Postoperative Complications ; Retrospective Studies ; Stents ; Treatment Outcome ; Vascular Patency

Objective To analyze the perioperative mortality,stroke rates and late benefits of carotid artery stenting for the treatment of unilateral severe stenosis of carotid artery with contralateral obliteration in a single medical center.Methods Clinical data of 38 cases were analyzed retrospectively,including postoperative period and follow-up.Results The technical success rate was 100％ ( 38/38 )with no peri-operative 30-day mortality or ischemic stroke.The overall peri-operative complication rate was 34.2％ ( 13/38),including transient ischemic attack (TIA) in 5.3％ (2/38).The average follow-up time was ( 29 ± 13 ) months with follow-up rate of 86.8％ ( 33/38 ).The mortality was 0 and the overall complication rate was 12.1％ (4/33),including TIA in 6.1％ (2/33).No patients had recurrent stroke.Twenty-three cases underwent whole brain CT perfusion evaluation before and after the therapy.A significant improvement of the perfusion parameters was observed in the stenotic side after CAS.Conclusions CAS contralateral to an occluded carotid artery can be performed with acceptable perioperative mortality and stroke risk rates,as well as a satisfactory long-term beneficial effect in stroke prevention.