Objective To estimate the security and effectiveness of double access technique to treat chronic total occlusion in lower extremity artery. Method Fifty four patients,who had lower limb arteriosclerosis and accepted failed endovascular treatment because of unable to reenter true lumen through antegrade access,were treated immediately in double access style to recanalize occluded artery (including 27 patients of dorsalis pedis artery puncture,17 patients of posterior tibial artery punctrue,5 patients of proximal anterior tibial artery puncture and 5 patients of distal superficial femoral artery puncture). Evaluate the revascularization rate,complication rate and 6-month limb salvage rate of double access technique,t test was used to compare the ABI.Results Revascularization rate was 98.2％ (53/54),average puncture frequency of every case was 6 ( the first access was 2 in every patient,the second access was 4 in every patient ),average treatment time was 167 minutes,complication rate was 5.6％ (3/54),2 patients were occlusion in puncture segment of the second access,1 patient was hematoma in the second access point. 6-month ABI after intervention increased from 0.44 ±0.13 to 0.69 ±0.15,6-month limb salvage rate was 100％. Conclusion For chronic total occlusion,double access is a feasible technique to deal with unable to reenter true lumen throughantegrade access,the complication rate is low,the primary limb salvage rate is relatively high.

Objective To evaluate a 5HT receptor antagonist sarpogrelate hydrochloride after percutaneous transluminal angioplasty (PTA) in infrapopliteal arteriosclerotic occlusive disease.Methods From June 2010 to June 2012,105 (116 limbs) patients of infrapopliteal arteriosclerosis obliterans treated by PTA were divided randomly into two groups:treatment group (58 cases,64 limbs)and control group(47 cases,52 limbs).All patients were treated with aspirin and clopidogrel for 3 months.Patients in treatment group were treated with additional sarpogrelate hydrochloride.Intermittent claudication,rest pain,amputation rate,ABI,vascular prosthesis obstructing degree were assessed.Results 95 patients were followed up for 6 months,the intermittent claudication rate in treatment group and control group were 3.8％ and 16.3％ (P ＜ 0.05); while there was not different on 1,3 months,in the intermittent claudication rate and 1,3,6 months,in rest pain rate,amputation rate,target artery patency rate and ABI between the two groups (P ＞ 0.05).There was one bleeding event in treatment group (1.7％).Conclusions 5HT receptor antagonist (sarpogrelate hydrochloride) significantly improves intermittent claudication after PTA in infrapopliteal arteriosclerotic occlusive disease,and its use is safe with aspirin and clopidogrel.

This experiment was designed to search and identify the active principle as well as the optimal proportion of water-soluble extractives of traditional Chinese medicine (water-soluble extractives) Liqi Huoxue medicinals com-patibility (Qixue Bingzhi Fang-CWQB) in the prevention and treatment of atherosclerosis (As) by optimal uniform design method. The water-soluble extractives of CWQB were divided into 6 sections (A, B, C, D, E, F) through macroporous resin. The effect intensity and step of every component were compared through its effect on blood fat level, platelet aggregation, inflammatory factors, vascular endothelial growth factor (VEGF) and so on among hyper-lipoidemia rat models. The pharmacological experimental results and statistical analysis showed that CWQB water-soluble extractives of component D (mainly is paeoniflorin, accounted for 49.12%), component E (mainly is total flavonoids, accounted for 30.0%) compatibility had better effects on decreasing blood fat and triglyceride (TG). Com-pared with the model group, there was significant difference (P < 0.01). It also had inhibiting effect on endothelin (ET) and maximum platelet aggregation rate (P < 0.01). The component F (mainly is total acids, accounted for 32.7%) had inhibiting effect on serum IL-6 and IL-8 (P< 0.01). It was concluded that different compatibility of wa-ter-soluble extractives of CWQB can be applied to different targets or steps of the body. The active principle extrac-tives include main component of paeoniflorin, flavonoids and total acids. The best proportion is about 1:1:1.

Objective To analyze the mid and long term results of endovascular procedures for diabetic below-the-knee lesions.Methods We retrospectively analyzed data of 762 patients (797 limbs in Wagner Grade 1 to 4) who suffered ischemic symptoms of diabetic below-the-knee lesions,admitted for endovascular procedures from Aug 2005 to May 2012.Technical success rate and complications,anklebrachial index,wound healing,limb salvage and survival were evaluated.Results 762 patients (797 limbs) underwent 857 endovascular procedures with immediate technical success in 805 times (success rate 93.93％).30 day complications included 33 cases (4.33％) of hematoma or pseudoaneurysm related to access site,20 cases (2.62％) of vasovagal reflex,38 cases (4.99％) of belowthe-knee arteriorrhexis,75 cases (9.84％) of inflow-limited dissection,23 cases (3.02％) of arterial embolism,4 cases (0.52％) of blue-toe sign.Postoperative mean ABI was improved significantly,from 0.33 ± 0.20 to 0.68 ± 0.17,P ＜ 0.005.722 patients (751 limbs) were followed up for more than 12 months (35 ± 23 months),wound healing rate within 3 months was 72.28％,limb salvage rate after 12 months was 85.62％,survival rate was 95.01％.Conclusions Immediate technical success rate of endovascular procedures for diabetic below-the-knee lesions is high,complications rate is low,medium and long term efficacy is satisfactory.

Objective To observe the primary clinical results of Gore （R） Viabahn endoprosthesis for atherosclerotic stenosis or occlusion in superficial femoral artery (SFA).Methods From March 2013 to November 2013,45 consecutive patients (54 limbs) who had ischemic symptom due to stenosis or occlusion of superficial femoral artery were treated by endovascular deployment of Gore （R） Viabahn endoprosthesis.We observed patency rate,improvement of Rutherford classification and ankle-brachial index,limb salvage rate and survival rate after 1,3 and 6 months.Results 43 patients (52 limbs)were followed-up,among which 32 patients(38 limbs)belonged to TASC Ⅱ type C or type D lesion.The mean (± SD) length of treated segment in 52 limbs was(19 ±4)cm.The rate of postoperative patency on duplex ultrasonography:one month,3 months and 6 months were 96.15％ (50 limbs),92.31％ (48 limbs)and 90.38％ (47 limbs) ; Ankle-brachial index increased from(0.32 ±0.20)to(0.68 ±0.18) (t =3.180,P ＜ 0.005) after 6 months ; at 6 months limb salvage rate was 96.08 percent (49 limbs),and survival rate was 97.67％ (42 patients).Conclusions Implantation of Gore （R） Viabahn endoprosthesis in atherosclerotic stenotic or occluded superficial femoral artery safely achieves a definite primary clinical effectiveness.

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.

Objective To compare the clinical results of micropuncture technique and traditional puncture technique in the treatment of lower extremity arteriosclerosis occlusion.Methods From January 2007 to February 2012,862 patients of lower extremity arteriosclerosis occlusion were treated by endovascular technology,385 patients ( 463 limbs ) by 21-G micropuncture technique and 477 patients ( 586 limbs ) by traditional 18-G puncture technique.Access sites were managed with manual pressure hemostasis or a vascular closure device.Primary endpoints included groin hematoma ( ≥ 2 cm),pseudoaneurysm,iatrogenic arteriovenous tistula,retroperitoneal hematoma,vascular perforation requiring repair and blood flow limited dissection.Results Patients assigning to undergo micropuncture technique were at higher risk,there was a significant shorter puncture time required for micropuncture technique vs.traditional puncture technique,(3.2 ± 2.3 vs.5.1 ± 3.2,P ＜ 0.05 ),the overall access site complications rate was lower in micropuncture group ( 6.2％ vs.6.7％,x2 =7.91,P ＜ 0.005 ).Conclusions In lower extremity arteriosclerosis occlusion treatment,arterial access can be completed by micropuncture which was safer and more effective than traditional puncture technique.

This study was aimed to optimize the uniform design for effective constituents in water-soluble extractives D, E, F of traditional Chinese medicine (TCM) in Qi-Xue Bing-Zhi Fang (QXBZF) for the further validation of the ratio of different compatibility. A total of 100 SD rats were used in the study. Among them, 90 rats were given high fat feeding for 7 days. Then, stratified randomization was used. The rats were divided into the all-party group; D, E original prescription group; D, E optimized compatible group; D, E between optimized and original group; D, E optimized but anti-compatibility group; all-party group adding F; optimized compatible group adding F; QXBZF with mainly paeoniflorin accounted for 49.12% as component D, total flavonoids accounted for 30.0% as component E, total acids accounted for 32.07% in component F; the positive drug control group (Xue-Zhi-Kang, 0.108 g/kg); and the high fat model group. In addition, a blank control group (with normal diet) was set. Each group was treated with gastric perfusion according to drug compatibility proportion for 14 days. Rats were sacrificed to take blood samples for the detection of serum lipid, platelet aggregation, vasoactive substance, and inflammation level. The results showed that compared with the model group, the QXBZF D, E original prescription group and D, E optimized compatible group had significant decreasing effects on TC (P< 0.05). The lowest level of TC decreased by optimized compatible group was (3.49 ± 0.86) mmol/L. The all-party group, D, E original prescription group and optimized compatible group can inhibit the platelet with maximum aggregation rate effectively(P< 0.05, P< 0.01); while the D, E optimized but anti-compatibility group (with D, E inverse proportion) had no effect on it. All-party group and the D, E original group adding F had significant inhibition on IL-6 and IL-8 (P < 0.05, P < 0.01). The D, E original prescription group, D, E optimized compatible group and D, E between optimized and original group can ascend 6-Keto-PGF1α significantly (P< 0.05). ET-1 was decreased in the D, E optimized compatible group (P< 0.05). Other groups had no obvious effect on vascular active substances. It was concluded that different effects between the QXBZF D, E original prescription group and the D, E optimized compatible group were observed in action segment and strength. When F parts added, inhibitions of inflammation levels were enhanced at certain level.

Objective To compare the short-term clinical results of paclitaxel coated balloon angioplasty (PCBA) and plain balloon angioplasty (POBA) in remedying popliteal arteriosclerosis occlusive disease.Methods From July 2013 to July 2016,56 patients of severe intermittent claudication or critical limb ischemia (CLI) due to stenosis or occlusion of popliteal artery were treated by PCBA in 30 patients (30 limbs),and by POBA in 26 patients (26 limbs).We compared clinical data of both groups at 1,3 and 6 months.Results The mean(± SD)length of treated segment in PCBA and POBA group respectively was (8.6 ± 3.3) cm and (6.9 ± 3.7) cm (t =1.817,P ＞ 0.05).According to peak systolic velocity rate (PSVR ＞ 2.4 as restenosis),l-month,3-month and 6-month restenosis rates were 0 (0 patients)in PCBA group vs.11.5％ (3 patients)in POBA group(x2 =1.74,P ＞0.05),0(0 patients)vs.24.0％ (6 patients) (x2 =5.59,P ＜ 0.05),3.6％ (1 patients)vs.65.2％ (15 patients) (x2 =22.29,P ＜ 0.01),respectively.6-month target lesion revascularization(TLR) was 3.6％ (1 patient) in PCBA group vs.60.9％ (in 14 patients) in POBA group(x2 =19.97,P ＜0.01),limb salvage rate at 6 months was 100％ (28 patients)vs.65.2％ (15 patients) (x2 =11.55,P ＜ 0.01).Conclusion In the short term,paclitaxel coated balloon angioplasty was superior to POBA for anti-restenosis of popliteal arteriosclerosis occlusive disease.