Objective To explore effects of arterial self-expanding stents implanted in different position for treating lower limb ischemia.Methods Follow-up records of 65 patients of lower limb ischemia(71 limbs) teated by stent implantation from January 2002 to March 2006 were retrospectively reviewed.Out of the 71 patients,there were 38 patients(52.3%) of diabetic lower limb ischemia and 33 patients(47.7%) of non-diabetic ischemia.Stent implantation included 2 abdominal aortic stents in 2 patients,1 abdominal aortic and 2 iliac stents in 1 patient with the Leriche syndrome,38 iliac stents in 33 patients(35 limbs),12 stents for iliacofemoral lesions in 6 patients(6 limbs),23 femoral stents in 16 patients(19 limbs),10 stents for femoral and prioxiaml popliteal arterial lesions in 5 patients(6 limbs),and 2 stents for distal popliteal arterial lesions in 2 patients(2 limbs).Results The patients were followed for 2~50 months(mean,16.1 months).The patency rate was 100% in 3 patients with abdominal aortic stent implantation or abdominal and aortoiliac stent implantation.Iliac artery occlusion occurred in 4 patients(4 limbs),with the patency rate of iliac arterial stents being 88.6%(31/35).The patency rate of femoral arterial stents was 78.9%(15/19),and that of femoral and prioxiaml popliteal arterial stents was 83.3%(5/6).Stents in distal popliteal artery were occluded in all the 2 patients.Stents remained patent after a mean of 5.6 months postoperatively in 3 patients with 2 femoral stents in 2 limbs and 1 femoropopliteal stent in 1 limb while distal outflow arteries were blocked.Conclusions Stent implantation can be the first choice for aortoiliac stenosis or occlusive arterial diseases.It is also recommendable for stenotic or occlusive femoral and proximal popliteal arterial diseases.It is a proper option for the senile patients or those who can not stand bypass procedures.However,for tibial arterial stenosis or occlusion,it is not a favorable consideration.

Objective To investigate the safety and medium-and long-term effects of endovascular stenting,axilloaxillary bypass (AAB),carotid-subclavian bypass (CSB) in patients of subclavian arterial occlusion.Method From 2001 to 2013,311 consecutive patients with subclavian arteriosclerosis obliterans were treated with endovascular stenting (n =191),axilloaxillary bypass (n =96) or carotidsubclavian bypass(n =32).We collected patients' medical data,calculated patency of the graft or stent with life-table method and compared patency between three approaches with Log-rank.Results The incidence of perioperative complications was 4.1％ in the stenting group vs.11.5％ in AAB group vs.18.7％ in CSB group.There was significant statistical differences between the stenting group and bypass group about the incidence of perioperative complications.The primary patency rates at 1,3 and 5 years were 90.3％,84％,81.6％ in stenting group vs.95.3％,92.6％,88.9％ for AAB group vs.100％,96.4％,96.4％ for CSB group.There was significant statistical differences between the stenting group and bypass group about the primary patency rates.Conclusions Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian arteriosclerosis obliterans.However,effect of extrathoracic surgical bypass is more durable in the medium-and long-term.

Objective: To investigate the relationship between serum levels of high sensitivity cardiac troponin T (hs-cTnT) and the severity of coronary lesions in patients with stable coronary artery disease (SCAD). Methods: A total of 450 SCAD patients with coronary angiography (CAG) conifrmed diagnosis in our hospital were studied, and serum levels of hs-cTnT were examined at 3 days prior CAG in all patients. Based on tertiles of Gensini score, the patients were divided into 3 groups: Low score group,n=153 patients with Gensini score<14, Intermediate score group, n=145 patients with Gensini score at 14-28 and High score group,n=152 patients with Gensini score>28. The relationships between Gensini score and hs-cTnT levels were analyzed among 3 groups. The optimal cut-off value of hs-cTnT for predicting high Gensini score and the need of revascularization were studied by ROC curve, the relationships between hs-cTnT and high Gensini score, the need of revascularization were further detected by Logistic regression analysis. Results: The median values (25%-75%) of hs-cTnT in Low score group, Intermediate score group and High score group were 6.72 (4.20, 8.93) pg/ml, 7.90 (5.74, 12.68) pg/ml and 14.99 (10.26, 24.30) pg/ml respectively, allP<0.01. ROC curve analysis indicated that the area under curve (AUC) of hs-cTnT for predicting high Gensini score was 0.837 (95% CI 0.803-0.874), for the need of revascularization was 0.772 (95% CI 0.728-0.817); the best cut-off value of hs-TnT for predicting high Gensini score was 10.04 pg/ml and for the need of revascularization was 8.56 pg/ml. Logistic regression analysis suggested that with adjusted age, gender, the history of hypertension, diabetes, smoking, blood levels of creatinine, LDL-C and hs-CRP, hs-cTnT was still an independent predictor for high Gensini score (OR=1.13, 95% CI 1.06-1.20,P<0.001) and for the need of revascularization (OR=1.19, 95% CI 1.14-1.24,P<0.001). Conclusion: Serum level of hs-cTnT has been related to severity of coronary lesions in SCAD patients, hs-cTnT might be used as one of the pre-operative predictor for severe coronary disease and for the need of revascularization.

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.

Objective To evaluate the outcome of composite sequential bypass in treatment of chronic lower extremity ischemia.Methods The clinical data of 25 patients with chronic lower limb ischemia who underwent composite sequential bypass reconstruction,in a 3-year period,were retropectively analyzed.The composite vessel consisted of PTFE vassular prosthesis and autologous vein.The proximal end of PTFE was anastomosed to the common femoral artery,and the distal end to the isolated popliteal artery.The autologous vein exited from the lower end of PTFE vessel and was anastomosed to the tibial or peroneal artery in the leg.Results The venous reconstructions had the inflow taken from the distal PTFE artery(above knee in 5 and below knee in 20).The outflow involved the peroneal artery in 12(48%),the posterior tibial artery in 8(32%),and the anterior tibial artery in 5(20%).Primary patency,secondary patency and limb salvage were 61%,68% and 73% at 3 year,respectively.Conclusions Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction has high long-term patency rate and good effect of limb savage,it is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.

Objective To investigate the effect of arterial bypass for subclavian artery occlusive disease. MethodsIn this study, 30 patients with subclavian artery occlusive disease received arterial bypass from Jan 1994 to Jan 2004. Occlusive lesions were documented preoperatively by arteriography. Patency was determined during follow up by Duplex ultrasound. ResultAll 30 patients undergoing bypass procedure were with blood pressure differences of less than 10mmHg between the treated and the healthy arms. The ratio of healthy/diseased side of the mean blood pressure index increased from 0 66?0 11 preoperatively to 0 99?0 09 postoperatively( P

Objective To evaluate vascular surgery and interventional technique applied in Takayasu's arteritis. Methods Data of 26 patients of Takayasu's arteritis admitted between January 2006 and December 2009 were retrospectively analyzed. The sex ratio(M/F) was 1: 4. 2, age averaged at (27±15)y. There were 16 cases of type Ⅰ , 7 cases of type Ⅱ and 3 cases of type Ⅲ according to Lupi-Herrera classification. 25 patients received surgery including 16 patients undergoing pecutaneous transluminal angioplasty operations, 9 patients doing traditional bypass surgery, and one patient was treated conservatively. Results 23 case-times of percutaneous transluminal angioplasty (PTA) were performed in 16 patients, including 12 cases of balloon angioplasty and 4 cases of stent angioplasty. Four significantly stenotic and occluded carotid arteries were revascularized successfully in 5 patients. Thrombosis of the carotid artery was found in one patient after balloon angioplasty. There were 4 patients in which repeated PTA treatment up to a total of 11 times were needed to guarantee vessel patency. Open surgery succeeded in 9 patients, and clinical symptoms were relieved in all cases during peri-operative period. 22 patients were followed up for 12 -46 months,one patient died of cerebral hemorrhage 3 months post-operation, one patient was found pseudoaneurysm at anastomotic stoma, and 2 patients suffered from anastomotic restenosis.Conclusions Vascular surgery played important role in the therapy of Takayasu's arteritis. PTA can be used repeatedly. Surgical bypass operation is difficult in technology, and can be used in cases that fail to response to PTA or in patients with severe cerebral ischemia.

Objective To explore the safety and feasibility of calf arterial stent angioplasty to treat severe lower limb ischemia. Methods Clinical data of 13 patients in our hospital during recent 3 years were retrospectively analysed and all these patients were followed up after discharge.Of these patients there were 10 males and 3 females; mean age was (73 ±7) years; mean disease course was (8 ±4) months.Severe claudication was reported in 5 patients,rest pain in 4 patients,toe ulcer in 2 patients,gangrene in 2 patients.Stent was placed in the tibioperoneal trunk artery in 5 patients ; in the proximal part of peroneal artery in 3 patients; in the tibioperoneal trunk and proximal peroneal artery in 2 patients; in the anterior tibial artery in 2 patients; in the posterior tibial artery in one patient.Simultaneous endovascular treatment of femoral/popliteal arterial disease was done in 11 patients. Results All the procedures were successful and the treated arteries kept patent on discharge of patients.Claudication distance increased to be above 500 meter in 5 patients; rest pain relieved in 4 patients ; toes ulcer reduced in 2 patients,feet gangrene kept dry till discharge in 2 patients.Postoperative ABI increased in all patients.Patients were followed-up of mean (6.9 ± 2.2) months.One patient with previous toe gangrene underwent amputation due to recurrent pain while the stent in anterior tibial artery kept patent after 6 months discharge.In the other patient gangrene toe had fallen off and the wound healed.Two patients with toe ulcer had a total recovery and patients with previous rest pain had no recurrent symptoms. Conclusions Below knee arterial stent angioplasty is a safe and effective method in the treatment of severe lower limb ischemia.

Objective To evaluate the efficiency and safety of infrainguinal arterial bypass in diabetic ischemia of the lower extremities. Method Eighty-two consecutive patients undergoing lower extremity arterial reconstruction from 2002 to 2005 were divided into diabetes group (DM) and nondiabetes group ( NDM ) . Graft patency, limb salvage, and perioperative complications were compared between the two groups. Results There were 82 patients receiving 86 grafts, 44 grafts (51. 2% ) in patients with diabetes (DM group) and 42 (48. 8% ) in nondiabetic patients (NDM group). Average age of the DM group was (68?10) years, vs. (63?12) years of NDM group (P=0.025). In-hospital perioperative mortality was 3. 7% ( DM group 4. 8% vs. NDM 2. 5% ,P = 1. 000). Cumulative primary and secondary graft patency in 4 year was 44% in DM group and 64% in NDM group, P =0. 112 and 69% in DM group, 66% in NDM group, P = 0. 083) , respectively. The 4 year overall limb salvage rate was not statistically defferent ( DM group, 68%; NDM group, 66%; P =0.114). Conclusions Diabetes mellitus does not influence perioperative mortality, graft patency, or limb salvage rates after lower extremity arterial bypass.

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.