Objective To evaluate the cause and management of intraoperative stent-graft migration during endovascular repaire of aortic dissection (AD). Method During the period between May 2001 and Dec 2007 intraoperative stent-graft migration occurred in 17 cases ( 14 males and 3 females) including 15 acute AD cases and 2 chronic AD cases. Backward migration was noticed in 11 cases including the 2 cases found during balloon extention, in 1 case the migration found during the removal of the releasing sheath which scratched the stent-graft, in 2 cases the migration occurred when the grafts were half released. Forward migration occurred in 6 cases resulting in left subclavian artery (LSA) occlusion in 3 cases and left common carotid artery (LCCA) occlusion in the other 3 cases. For the 3 cases of LCCA occlusion, the backward migrated stent-graft was pushed forward by the cuff releasing system and consequently occluded the LCCA in 1 case, and the cuff jumped forward during release and occluded the LCCA in 1 case. Result Backward migration of stent-grafts can be treated by pushing forward the graft with the sheath or additional placement of a cuff. Intraoperative complication may be less life threatening and no perioperative death occurred in this group. Occlusion of LSA in 3 cases by forward migration of stent-grafts were left untreated and 1 case died of leter cerebellar infarction. For the LCCA occlusion in 3 cases, 2 were treated by drawing back the graft with a balloon, and in the remaining 1 case the migrated graft was pushed back with the catheter in the LSA captured by a snare. Conclusion Stent-graft migration during endovascular repair may be related with poor experience of the operator, specific anatomical condition of the patient and the design drawback of the stent-graft. Forward migration of stent-graft is less common but may be more harmful for the patient. Beside back drawing with a balloon, the captured catheter with a snare may be helpful in the management of forward migration of the released stent graft.

SUMMARY Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma ( NPC ) . In this article , we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery (CCA) . A 44-year-old man with NPC was treated with external radiotherapy 19 years ago, and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago. The patient was admitted to our hospital for massive bleeding. Conservative therapy including routine medication, blood transfusion and local compression showed almost no effect. Emergency carotid angiography revealed bleeding from the left CCA, and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach. After the placement of the covered stent , angiography showed the bleeding was successfully controlled. So self-expanding covered stenting may be a safe, effective and minimal-invasive option for bleeding of the carotid artery . Longterm follow-up is required for further evaluation.

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Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external radiotherapy 19 years ago,and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago.The patient was admitted to our hospital for massive bleeding.Conservative therapy including routine medication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleeding from the left CCA,and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach.After the placement of the co-vered stent,angiography showed the bleeding was successfully controlled.So self-expanding covered stenting may be a safe,effective and minimal-invasive option for bleeding of the carotid artery.Long-term follow-up is required for further evaluation.Abstract:SUMM ARY B leed ing is a rare but fatal complication after rad iotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with rad iotherapy complicated with bleed ing of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external rad iotherapy 19 years ago,and a second course of treatment to the same field was adm inistrated because of local nasopa-ryngeal recurrence 4 years ago.The patientwas adm itted to our hospital formassive bleed ing.Conserva-tive therapy includ ing routine med ication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleed ing from the leftCCA,and a self-expand ing covered stentwas deployed through percutaneous translum inal femoral approach.After the placement of the co-vered stent,angiography showed the bleed ing was successfully controlled.So self-expand ing covered stenting may be a safe,effective and m inimal-invasive option for bleed ing of the carotid artery.Long-term follow-up is required for further evaluation.

Intravenous leiomyomatosis is characterized by a proliferation of benign smooth muscular tissue growing into uterine with malignant appearance.On extremely rare occasions,the tumor may grow out of the pelvis and extend into the inferior vena cava and the right atrium.We report a case of intravenous leiomyomatosis extending into the right atrium.A 41-year-old woman complained of 20 days of intermittent abdominal pain and lower limbs swell.Medical history of the patient revealed a previous hysterctomy operation 3 years ago due to uterine leomyoma.Echocardiography showed a homogenous mass extending from the inferior vena cava to the right atrium,without evidence of adherence to the right atrial wall,the left ventricular ejection fraction was only 60%.Computer tomography showed that a large mass arising from the left internal iliac vein and extending into the right chambers.Pelvic vascular ultrasound revealed the thrombotic material in the inferior vena cava and the left common iliac vein,and confirmed the presence of a complex mass in the left annex region.Based on the findings,the initial diagnosis was intracardiac and intravenous tumor.An operation was performed through a sternotomy and laparotomy to remove the whole tumor from the left common iliac vein to the right atrium,ligate left internal iliac vein meanwile.No hormonal therapy was administrated after the operation.Immunohistochemical studies revealed that the tumor cells were fusiform shape,there was no karyokinesis and necrosis,and the tumor cells were positive for smooth muscle antigen and desmin,as well as estrogen receptor and progesterone receptor.Six months postoperation follow-up revealed no signs of recurrence.The differential diagnosis of the disease compared with primary cardiovascular sarcomas and thrombus was difficult.The final diagnosis relied on immunohistochemical analysis,however,the short-term result of operation was acceptable.

Objective To summarize the experience and efficiency of coils in endovascular aortic repair.Methods From September 2008 to December 2013,48 patients received endovascular aortic repair in combination of coil embolization including abdominal aortic aneurysm in 32 patients, and aortic dissection in 16.Results Coils were successfully implanted in all cases.One patient with ruptured abdominal aortic aneurism (AAA) underwent emergency endovascular aortic repair and died of multiple organ failure the day after surgery.One patient died of pulmonary artery embolization 3 hours after TEVAR.44 patients were followed up ranging from 7 to 60 months.In AAA group, 25 patients received endovascular exclusion in combination with internal iliac artery embolization, four of them had claudication due to gluteal ischemia but without other severe complications.Post-operative CTA found endovascular thrombosis in aneurysm.In the aortic dissection group, one patient died of pulmonary infection.During the follow up, there was no AAA dissection, and AAA rupture.Post-operative CT confirmed thrombus in cavity.There were no scaffold and coil translocation and surrounding tissue injury.Conclusions Endovascular aortic repair in combination with coil embolization is a complementary treatment to aortic diseases.

Objective To establish technique skills and evaluate complications of carotid artery stenting with the use of Filter. Methods In this study, 38 carotid lesions in 35 patients (with an asymptomatic stenosis exceeding 70% or a symptomatic stenosis exceeding 50% ) received stenting with the use of protective filter. The skills, complication and outcomes were evaluated. Follow-up surveillance included ultrasound examination, CTA, or MRA. Results The technique was successful in all 38 lesions. Angiography after stenting showed that the treated vessels were all patent (remained stenosis was less than 20% ). Sclerotic debris was found in 21 (55.3%) filters, 3 of which were full filled with debris. Complications included 1 (2.6%) stroke and hemiplegia, and I (2.6%) cerebral bleeding, 2 (5.3%) TIA after stenting and recovered after withdrawing the filter, 10 (26.3% ) suffered from perioperative transient decrease of heart rate and blood pressure. In a follow-up of 6 to 54 months (mean 32 months), all treated vessels were patent except 1 with stent-graft for carotid ulcer, no new TIA and stroke was found. Conclusion Meticulous technique and the use of carotid fiter permits carotid stenting in a safe and effective manner and prevents complications.

Objective To analyse the recurrence rate of patients with Budd-Chiari syndrome (BCS) after radical correction.Method We retrospectively analyzed the clinical characters and follow-up of patients who underwent radical correction and suffered recurrence.Patency rate of inferior vena cava (IVC) and hepatic veins (HVs) were examined.We present the causes of recurrence and clarify risk factors for recurrence by survival analysis.Result Among the 102 patients undergoing radical correction,34 patients suffered from postoperative recurrence,including 32 cases of IVC lesions,21 cases of HVs lesions (19 patients suffered concurrently from IVC and HVs lesions).One patient received reoperation,16 patients received balloon angioplasty of IVC or HVs,3 patients received stent implantation,and 14 patients received conservative treatment.Conclusions The recurrence rate is high after radical correction for BCS.Once the abnormal syndrome recurs,the patients can be managed by radical correction,balloon or stent angioplasty.The main causes of recurrence are thrombosis of IVC,compression of caudate lobe,scar contracture,and the risk factors for recurrence are concurrent hypercoagulation status,too short period of postoperative anticoagulation (less than 6 months).

Objective To analyze the laboratory results and chest CT appearances of novel recombinant avian-origin influenza A (H7N9) in discharged patients for understanding the imaging changes.Methods The clinical and imaging data of 4 patients with novel recombinant avian-origin influenza A (H7N9) were collected.The imaging changes and laboratory results were analyzed.Results All patients underwent chest CT examination 2 to 5 times from admission to discharge.The lesions primarily presented as ground-glass opacity (GGO) and mainly located in the inferior lobe of the left lung in 3 cases,in the inferior lobe of the right lung in 1 case,alternating between absorption and progress.GGO was absorbed obviously in about 3 days after treatment and consolidation was progressed after treatment.Consolidation absorption was observed with continue treatment in 1 case.The pulmonary lesions were absorbed obviously in 1 case 7 days after discharge.Synchronous reduction of the absolute values of CD3,CD8,CD4,CD45 were observed in 3 cases and the ratio of CD4/CD8 was normal.Conclusions (1) The areas of pulmonary involvement are large and variable in H7N9.The lesion area and imaging patterns are important for disease prognosis.(2) H7N9 virus infection may causes immunosuppression,decrease of CRP value can predict the improvement of the disease.

Objective To investigate the expression of chemokine-like factor 1(CKLF1) in the balloon injured aorta of Sprague-Dawley rats.Methods Balloon expansion induced aorta injury model was established in 80 male Sprague-Dawley rats.Model rats were randomly divided into 8 groups.Rats were sacrificed at the postoperative periods of 12 hours,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks,and 8 weeks respectively.Sham injury operation was applied to 5 rats as control.The ratio of intimal area (IA) and medial area (MA) was calculated to determine the extent of neointimal hyperplasia.Expression of CKLF1 was examined at protein level with immunohistochemistry and at mRNA level with RT-PCR.Software IPP6.0 was used to examine the mean optical density of positive staining.With β-actin expression as an internal control,semi-quantity of CKLF1 expression was calculated by CKLF1/β-actin.Results Visible neointima was noticed at 1 week postoperation.Extend of intimal hyperplasia(IA/MA)was most remarkable at 4 weeks and receded afterwards. Immnohistochemistry study showed that expression of CKLF1 was stronger in the neointima than in the media(P=0.016).The expression was most obvious in the neotima at 1 week postoperation.RT-PCR showed peak expression at 3 days postoperation and declined gradually but still at a higher level than control(P<0.05).The extent of intimal hyperplasia(IA/MA)was positively correlated to the expression of CKLF1(R=0.70,P=0.188).Conclusion The expression of CKLF1 was up regulated in balloon injured rat aorta.The expression was more obvious in the neointima than in the media.CKLF1 may play a role in the development of intimal hyperplasia.