Atheroselerosis and thrombangiitis obliterans are the chief factors of chronic lower extremity ischemia. Usually we utilize intervcntional treatment which includs balloon dilatation and stent implantation or surgical revascularization for the patients who have good target vessels, but those methods are not suitable for the patients who have small target vessels. The transplantation of bone marrow stem cells is the new tech-nology for chronic lower extremity isehemia, which utilize the capacity of stem cells that have multiple differ-entiation activity and high self renewal potentiality. It can direetionally differentiated into endothelial cells. It has a good perspective in chronic lower extremity isehemia.

Ischemic disease of lower extremity is a severe disease threatening human health.In the 21st century the stem cells transplantation is one of the most advanced technologies and has applied quickly to clinical therapy.The stem cells possess the potential differentiation capability and can differentiate into all kinds of tissue cells.We transplant stem cells from peripheral blood or bone marrow to isehemie appendicular muscle or obsructed vessal in order to make them differentiate into newborn blood capillary,improve and re-cover blood flow of lower limb and achieve the aim of treating lower limb ischemia.

Thoracic endovascular aortic repair (TEVAR) has been increasingly used in the treatment of Stanford type B dissection.The incidence of new entry after thoracic endovascular aortic repair has been gradually increased report including at the proximal end and at the distal end of the endograft.New entry is difficult to handle following thoracic endovascular aortic repair for aortic dissection,and associates with a high substantial mortality.It need pay more attention to prevention and treatment on new entry after thoracic endovascular aortic repair.We summary and analyze the possible causes,prevention and management of new entry after thoracic endovascular aortic repair for aortic dissection.This article review and conclusion the progress on stent graft induced new entry after thoracic endovascular aortic repair.

Objective To evaluate thoracic endovascular aortic repair for type B aortic dissection.Methods Chnical data were reviewed on 126 cases with type B aortic dissection undergoing endovascular aortic repair in our hospital from January 2006 to April 2011.There were 86 male patients and 40 female patients,age from 32 to 82 years.The stent- grafts were introduced via femoral arteriotomy.Stent-grafts were implanted to blockade tears of aortic dissection under the guidance of DSA.Postoperatively patients were followed-up by angiography and imiging for endoleak,stent migration,and fracture of stent-graft.Results In all cases,the aortic dissection tears were closed,true lumens were opened,and organ function was restored.There were not complications such as internal hemorrhage due to trauma or stent displacement on CTA from 3 to 63 months after endovascular therapy.Procedure was successful in all 126 cases,157 stents were released,2 cases died in the perioperative period,1 case died during the followed-up.A breach was found at the end of the stent in 12 cases,endovascular aortic repair redone successfully with a retrograde type A dissection found during follow-up.Conclusions Endovascular aortic repair is safe and effective for patients with Stanford type B aortic dissection with a favorable outcomes.

Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted.Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fistula occlusion were carried out from Aug.2007 to Mar.2011,comparing the success rate and long-term patency rate.Results Two hundred and fourteen cases of initial autologous arteriovenous fistula,in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox,46 cases were cephalic vein-radial artery end-toside anastomosis at proximal wrist,the success cases were 203 (94.8％),the failed cases were 11 (5.2％),limb edema in 82 cases and there was no steal syndrome and heart failure.The primary patency rate was 95.2％ at 1 year and 91.3％ at 2 years.There were 22 patients accepted treatment of arteriovenous fistula occlusion,in which,8 cases were embolectomy due to acute occlusion,8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed,5 cases were proximal anastomosis again after chronic occlusion.Conclusions Autologous arteriovenous fistula of the distal upper limb,especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula.And deal with arteriovenous fistula occlusion actively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.

Objective To explore the treatment principle of distal crevasses in aortic dissection.Methods According to the different treatment principles of distal crevasses in aortic dissection to divide the patients into two groups:following the treatment principle group:take the principle of from near to far,endovascular repair of distal crevasses,if not deal with the crevasses involving visceral arteries,do not handle the distal crevasses; unfollowing the treatment principle group:do not deal with the crevasses involving visceral arteries,endovascular repair of it's distal crevasses).Analyze the postoperative discomfort (chest and back pain,lower back pain) incidence,postoperative distal crevasses happening again and false lumen changes respectively.Results Fifty-three patients were included in the standard,in which follow the treatment principle group has 37 cases,and do not follow the treatment principle group has 16 patients.There were no significance statistically in complained of postoperative discomfort and postoperative distal crevasses happening again(P ＞ 0.05).And there was statistically significant in the false lumen (P ＜ 0.05).Conclusions The prognosis of patients in the following the principle treatment is better than that of unfollowing the principle group.To treat the distal crevasses in aortic dissection should be took the principle of from near to far,if not deal with the crevasses involving visceral arteries,don't handle the distal crevasses also.

Objective To explore the misunderstanding and comprehension of hybrid operation for treating aortic dissection involving aortic arch.Methods From March 2009 to November 2013,13 patients received hybrid operation for aortic dissection involving aortic arch in the People's Hospital of Xinjiang Urgur Autonomous Region were enrolled,including male 11 and female 2,and aged 36 ～ 60 years old with a mean age (44 ± 6.8) years old.All patients were type-B aortic dissection.All of them were not suitable to be treated with endovascular exclusion monotherapy.The ascending aorta-brachiocephalic artery bypass and left carotid artery bypass was established with median sternotomy approach and neck incision in 13 patients,and 2 patients did left subclavian artery bypass additionally,then retrograde endovascular stent graft implantation was used.Computed tomography angiography (CTA) scanning at 3-month,9-month,1-year and every-year after operation showed no stent grafts translocation and bypass graft obstruction.Results The surgical operation and stent grafts implantation were completely successful.Angiography showed 1 case had end leakage and other cases no obvious displacement or end leakage of stent grafts in operation.Blood flow in true lumen of aortic dissection was recovered and all of bypass grafts were unobstructed.No death and severe complications occurred.All patients were followed-up with 3 to 56 months [(29.0 ± 10.2) months],and all patients resumed normal life.Enhanced CT scanning after operation showed 1 case had endoleak and other cases no endoleak,stent grafts translocation and bypass graft obstmction.No signs of brain and limb ischemia were observed.Conclusions To summarize misunderstanding and experience by continuous explore feature of hybrid operation for treating disease involving aortic arch,we developed a more reasonable surgical treatment options that can improve the success rate of complex aortic dissection surgery,and ultimately achieve better surgical results.

Objective To explore the distribution characteristics and clinical typing methods in distal crevasses of Stanford B aortic dissection.Methods Review of the cases in the People's Hospital of Xinjiang Urgur Autonomous Region from 2010 January to 2013 June were diagnosis of Stanford type B aortic dissection with computed tomographic angiography data,Observed its distal crevasses distribution and statistical its number,then summarizes the distribution characteristics of the distal crevasses and further put forward a method of clinical typing.Results Refer to 115 cases with Stanford type B aortic dissection computed tomographic angiography data,including 101 cases with distal crevasses (87.83％) and a total of 240 distal crevasses,an average of 2.37 per case.Conclusions The distal crevasses more often appear in the area involving visceral artery,combined with its different in distribution characteristics and processing methods,we put forward the classification method,namely:Type Ⅰ:the distal crevasses are located in the zone of the thoracic artery; Type Ⅱ:the distal crevasses are close to the visceral artery or involvement it; Type Ⅲ:the distal crevasses are lower than the renal artery,not involving the visceral artery; Type Ⅳ:the distal crevasses are located in the zone of the iliac artery.

Objective To assess the treatment of splenic artery aneurysms(SAA) and curative effect evaluation.Methods Twelve SAA patients treated in our hospital from January 2012 to May 2014 were clinical analyzed.The male in Twelve patients was 4 man and others were female.The vagus splenic artery aneurysms are originated from the superior mesenteric artery,tumors are single,from 1.5cm to 2.8cm in diameter,an average of 2.1cm.Twelve cases were performed surgery,4 patients underwent elective surgery,interventional embolization of the splenic aneurysm in 3 patient,The others were performed interventional embolization + superior mesenteric artery covered stents.Results Technical success was achieved in all twelve patients,2 patients had adverse effects such as abdominal pain,fever,etc.There revealed no aneurysm recurrence was found.Twelve patients were followed for 6-24 months,the follow-up by examinations with electronic computer X-ray tomography or color Doppler ultrasonic as well as angiography every 3 months.One patient died of severe abdominal bleeding 1 year later after the operation and the other eleven patients remained in good condition with no occurrence of re-canalization of the lesions.Conclusions For the vagus splenic aneurysm with suitable for anatornic conditions,cavity therapy is safe and effective,for the vagus splenic aneurysm involving hepatic artery,need to open surgery for vascular remodeling.

Objective To evaluate the efficacy and safety of catheter-directed thrombolysis (CDT) combined with anticoagulant compared with traditional treatment (Anticoagulant alone A C) for deep venous thrombosis.Methods We searched Medline,Embase,Cochrane Central Register of Controlled Trials,PubMed,Chinese Biomedical Literature Data Base (CBM),Chinese Scientific Journal,Full-text Data Base (CSJD),and,added with hand searcing and other retrievals.The Cochrane Collaboration's RevMan 5.0.18 was used for Meta-analysis.Results Four randomized controlled trials were available and were included in the study.Meta-analysis showed that 6 months after treatment,iliofemoral vein patency rate of CDT group was higher than that of AC group (OR =5.13,95％ CI:2.01-13.14,P =0.0006);Major complications of CDT group compared to those of AC group were not statistically significant(OR =2.74,95％ CI:0.76-8.07,P =0.13),but the minor complications and total complications of CDT group were higher than those of AC group [(OR =7.86,95％ CI:3.10-19.90,P ＜0.0001)and(OR=5.42,95％CI:1.47-20.01,P=0.01)].Conclusions CDT is a positively effective way to treat early DVT.Application of CDT in patients without contraindications to its use can have good therapeuic effect.