Re-use of contrast agent during endovascular treatment in patients with contrast agent allergy may lead to severe allergic reaction. For patients with localized stenosis of external iliac artery, endovascular therapy (stenting) is the first choice. Whether patients with severe iliac artery stenosis with contrast allergy can be treated with endovascular therapy is unknowed. A case of iliac artery stenting without contrast agent is reported in this paper. The successful implementation of this operation requires adequate preoperative and intraoperative preparation, and the accurate determination of the stenosis site and the presence or absence of residual stenosis during the operation.

OBJECTIVE:To provide reference for rational use of antihypertensive drugs in the clinic. METHODS:One hun-dred and eighteen primary hypertensive inpatients were selected from our hospital during Jan.2014-Oct.2015. The application of anti-hypertensive drugs and medication compliance were summarized and analyzed by reviewing the doctor’s advice and the question-naire survey method. RESULTS:Commonly used antihypertensive drugs of our hospital included diuretic,βreceptor blocker,calci-um antagonist, angiotensin converting enzyme inhibitor, angiotensinⅡreceptor antagonist and aldosterone receptor antagonist. Among 118 patients,fewer patients treated with monotherapy(10 cases,8.47%),and three-drug regimen took up the greatest pro-portion(51 cases,43.22%). The number of patients receiving antihypertensive drugs in related internal medicine departments(94 cases)was more than in related surgical departments(24 cases). 25 patients used antihypertensive drugs irrationally,mainly from internal medicine department,heart disease department,cerebropathy department,etc. Irrational medication mainly included irratio-nal frequencies(8 cases,32.00%),pharmaceutical frame structure damage(5 cases,20.00%),irrational drug selection(4 cases, 16.00%),etc. The poor medication compliance was found in 16 patients,mainly resulted from complex therapy plan (6 cases, 37.50%),forgetting to take medicine(5 cases,31.25%). CONCLUSIONS:Irrational use of antihypertensive drugs exist in prima-ry hypertensive inpatients of our hospital. Clinical pharmacists should use their own advantage to strengthen communication with medical staff,develop in pharmaceutical care and promote rational drug use in the clinic.

Objective To evaluate the feasibility of endovascular aortic repair (EVAR) under local anesthesia without using any contrast agent for abdominal aortic aneurysm in patients with high allergic risk to contrast agent.Methods Under local anesthesia and with no use of any contrast,percutaneous EVAR was performed in a patient with abdominal aortic aneurysm who carried high allergic risk to contrast agent.Results Percutaneous EVAR was successfully accomplished.Postoperative follow-up MRI examination showed that the abdominal aortic aneurysm was completely isolated with no endoleak.The blood flow was unobstructed in the covered stent,and bilateral renal arteries were well visualized.Conclusion For the treatment of abdominal aortic aneurysm in patients who are highly allergic to contrast agent and who have contraindications to general anesthesia,percutaneous EVAR performed under local anesthesia and using no contrast agent is safe and effective.Strict observation of indications and sufficient preoperative evaluation of clinical conditions is the key to ensure a successful operation.

Objective o investigate the clinical efficacy of atherectomy in the treatment of Tosaka class Ⅲ in-stent restenosis in the femoropopliteal artery. Methods From June 2013 to December 2015, 33 restenotic lesions after femoropopliteal artery stenting were retrospectively analyzed by clinical information including technical success rate, incidence of complications, improvement of postoperative symptoms and objective indicators, and target vessel patency. Results To January 2016, twenty-eight cases were followed up. The average follow-up time was 17. 9 months. Five cases were lost. The follow-up rate was 84. 9％. The technical success rate was 100％. The patency rate was 79. 9％ at 6 months and 65. 8％ at 1 year after surgery. Conclusions Atherectomy is safe and effective for treatment of Tosaka classⅢin-stent restenosis in femoropopliteal artery with good short-term and medium-term efficacy.

OBJECTIVETo analyze the trends in treatments of lower extremity peripheral arterial disease and their prognosis in the recent 10 years.

METHODSClinical data of inpatients with lower extremity peripheral arterial disease who received surgical treatments in Xuanwu Hospital from January 2002 to December 2011 were analyzed retrospectively. Patients were stratified into two groups (group 1: from 2002 to 2006, group 2: from 2007 to 2011). The demographics, risk factors, clinical presentation, lesion anatomy, therapies, limb salvage and survival were observed. χ(2) test, Fisher exact test, and t test were used to compare the data between the two groups.

RESULTSFrom 2002 to 2006, 170 limbs (47.49%) underwent conventional bypass surgery, 72 limbs (20.11%) underwent endovascular interventions and the rest 116 limbs (32.40%) received stem cell treatment. While from 2007 to 2011, the percentages were 18.49%, 68.73%, 8.27%, respectively. Furthermore, gene-based drug appeared, 67 limbs (4.51%) underwent the new treatment. Former group had decreased limb salvage rates compared with latter group (87.15% vs. 93.41%, χ(2)=15.71, P=0.000). However, survival rates did not differ from the two groups (84.67% vs. 84.31%, χ(2)=0.02, P=0.880).

CONCLUSIONWith the appearance of new medical instruments and operating methods, the percentage of the patients with lower extremity peripheral arterial disease receive endovascular interventions increases, with a improved limb salvage rates.

Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; pathology ; Peripheral Arterial Disease ; diagnosis ; surgery ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Survival Rate ; Treatment Outcome ; Vascular Grafting ; Vascular Patency

Objective To investigate the safety and feasibility of carotid endarterectomy (CEA) combined with carotid artery stent angioplasty (CASA) in treating tandem stenosis of carotid artery. Methods The clinical data of 9 patients with tandem stenosis of carotid artery, who were treated at authors' hospital during the period from January 2013 to October 2014, were retrospectively analyzed. The patients included 7 males and 2 females, with a mean age of (66.0 ±4.2) years. The disease course ranged from 2 months to 36 months, with a mean of 7 months. Clinically, all patients had cerebral ischemia symptoms. Transient ischemia attack was seen in 5 patients and history of cerebral infarction was present in 2 patients. Coronary artery disease was found in 2 patients, hypertension in 6 patients and lower limb ischemia in one patient. After receiving adequate antiplatelet therapy, CEA and CASA were carried out in all patients. Results The technical success rate was 100%, postoperative residual stenosis was less than 30%, no death occurred in perioperative period. After the treatment, the clinical symptoms were improved in all 9 patients;no new stroke or cerebral hemorrhage occurred. After the treatment, 2 patients developed cerebral hyperperfusion-related symptoms such as headache and dizziness, which were much relieved at the time of discharge. The patients were followed up for 4-19 months, with a mean of (10.5±6.2) months. No recurrence of symptoms was observed . In one patient , transcranial Doppler ultrasound performed at 6 months after treatment showed that the carotid artery became moderate restenosis (50%-70%). No death occurred. Conclusion For the treatment of tandem stenosis of carotid artery, CEA combined with CASA is safe and effective, although larger sample and long-term follow-up studies are still needed to further confirm the effect.

Objective To discuss the methods, advantages and indications of multipoint puncturing in performing endovascular therapy for complex lower extremity arterial occlusive diseases. Methods During the period from Oct. 2011 to Oct. 2013, a total of 46 patients with complex lower extremity arterial occlusive diseases were treated with endovascular therapy by using multipoint puncturing technique. The puncturing type, the advantages of multipoint puncturing technique and the success rate of this technique were analyzed. Results The multipoint puncturing was divided into three types: type Ⅰ : puncturing from the opposite direction to deal with the same target vessel; type Ⅱ: direct puncturing of the target vessel; and type Ⅲ:using the same puncturing direction to deal with different target vessels. The success rate of endovascular treatment was 80.4%. Conclusion Multipoint puncturing technique helps improve endovascular treatment success rate for lower extremity arterial occlusive diseases. Full understanding of the advantages of multipoint puncturing technique, perfect preoperative planning, precise puncturing technique and proper interventional equipments are helpful to ensure a successful treatment.

Objective To analyze the influence of diabetes mellitus (DM) on the outcomes of percutaneous transluminal angioplasty (PTA) with stenting of femoropopliteal artery,in patients with atherosclerotic occlusive disease (ASO).Method Clinical data of inpatients who successfully received PTA with stenting procedures of femoropopliteal artery in Xuanwu Hospital from January 2006 to December 2012 were analyzed retrospectively.Patients were stratified into DM and non-DM groups.Results were compared between the two groups including primary patency (PP),assisted patency (AP),limb salvage and survival using Kaplan-Meier life table and Cox regression analyses.Result Totally 291 patients underwent 332 procedures.There were 214 DM and 118 non-DM limbs.Mean follow-up was 34 months.The 5-year PP was 23.2％,AP was 35.3％,limb salvage was 89.2％,and survival was 69.6％.DM was associated with lower 5-year PP,limb salvage,and survival than non-DM.But there were no significant difference in AP between the two groups.Females were associated with decreased PP than males on Cox multivariate analysis.Hypertension and below tibial diseases were associated with lower limb salvage rate and age is the only predictor of survival rate.Conclusions DM is a risk factor for poor outcomes after PTA with stenting procedures.

BACKGROUNDTotally laparoscopic aortoiliac surgery has been newly developed in China. It is known as the most complex laparoscopic technique to learn because of its high-risk procedures. Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique.

METHODSTwelve male patients (56-70 years old) with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery (TLABS) in our institute. Clinical data and operation-related complications were retrospectively analyzed.

RESULTSOf the 12 patients, TLABS succeeded in nine and conversion to open surgery occurred in three. One of the converted patients finally died of pulmonary infection. Operation-related complications included bleeding from arterial injury, perforation from colonic injury, graft embolism, residual aortic stenosis, and hydronephrosis. Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery. Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications. Left hydronephrosis, which was thought to result from intraoperative injury and treated with ureteric intubation drainage, recovered 6 months after TLABS.

CONCLUSIONSGood understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS. Immediate conversion to open surgery is necessary for saving the patient's life in case of life-threatening complications.

Aged ; Arterial Occlusive Diseases ; surgery ; Humans ; Iliac Artery ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective To explore the indications of axillary artery approach in endovascular treatment and to analyze complications associated with axillary artery puncture.Methods In 111 cases endovaccular treatment via axillary artery approach by Seldinger technique was performed.The indications of axillary artery approach and the complications associated with axillary artery punture were respectively analyzed.Results The success rate of angiography was 100％,and the success rate of angioplasty was 90.8％ by axillary artery approach.The total incidence of complications was 10.3％.The incidence of local hematomas was 4.8％,nerve injury was 3.2％,pseudoaneurysm was 0.8％,acute thrombosis of the axillary artery was 0.8％,acute thrombosis of the axillary vein was 0.8％.The main factors affecting complications include vascular conditions,perioperative medication,anatomy of the axillary artery,location of puncture point,the success rate of first attempt,and pressure of bandage.Conclusions The axillary artery approach increases the success rate of endovascular treatment.Reasonable choice of axillary artery appruch,meticulous perioperative management and fully understanding the anatomical characteristics of the axillary artery can decrease the complications of axillary artery puncture.