Vascular access is the dialysis patient's lifeline. Lower extremity arteriovenous accesses are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites.The lower extremity options are including autogenous and prosthetic arteriovenous accesses.Numerous challenges including patency rates and complications are encountered in the lower extremities that are not seen in the upper extremities.In this review,we focus on the advances in lower extremity accesses.

Objective To summarize the experience of 40 patients with carotid artery stenosis treated by carotid artery stenting (CAS). Methods Endovascular plasty and stent placement were performed in 40 patients with carotid artery stenosis from October 2000 to July 2002. A total of 43 stents were placed into, comprising 39 WALLSTENT stents and 4 SMART stents. Out of the 40 cases, cerebral protection devices were used in 5 cases. Results The stent placement was completed successively in all the patients.Diameters of carotid artery all returned to 4mm or above.Mild intraoperative ischemic stroke occurred in 2 cases, and severe intraoperative ischemic stroke was found in other 2 cases: visual field loss of the left eye in 1 case, with after-effects even 3 months after surgery; loss of consciousness and right hemiplegia in 1 case, whom was cured to full consciousness subsequently. The complication rate was 10% (4 of 40) and the rate of severe ischemic stroke was 5% (2 of 40). No complications were seen in patients with cerebral protection devices. Conclusions CAS is effective in the treatment of carotid artery stenosis. Carotid stenting with cerebral protection devices may further ensure the patients' safety.

Objective To evaluate hybrid therapy in patients with complex arteriosclerosis obliterans.Methods From Sep 2006 to Oct 2011,66 patients with complex arteriosclerosis obliterans were treated by hybrid therapy.A retrospective review was performed in all cases.Primary patency rate analyses were performed using Kaplan-Meier life tables.Results The technical success rate was 100％,and no patients died in perioperative period.12.1％ patients improved 3 levels,22.7％ patients improved 2 levels,and 65.2％ patients improved 1 level in Fontaine grade after procedures.The average ABI before and after procedures were 0.38 and 0.67 (P ＜ 0.05).2 patients died and other 64 patients completed 24 months follow-up.The primary patency rates and second patency rates were 75.0％ and 92.2％ at 24 months respectively.Primary patency rates of Fontaine Ⅱ patients were better than Fontaine Ⅲ and Ⅳ patients (P ＜ 0.05),and primary patency rates of Fontaine Ⅲ patients were better than Fontaine Ⅳ patients (P ＜ 0.05).Conclusions Hybrid therapy procedures provide an effective treatment in complex arteriosclerosis obliterans patients.

Objectives To evaluate the safety and efficacy of endovascular angioplasty for extracranial vertebral artery ( VA ) stenosis caused by atherosclerosis. Methods We analyzed retrospectively data of the 24 patients with extracranial vertebral artery stenosis who had been placed endovascular angioplasty from April 2006 to March 2010. According to Mori classification, there were 21 type A and 3 type B among all cases.The artery stenosis rate was 60％ -95％ , the average was 79％ ± 10％. Results Twenty-four balloon mounted stents were placed, the successful rate was 100％. Postoperatively the stenosis rate decreased to 4％ ± 6％. Patients were followed up from 3 to 36 months, the average was 22 months. Symptomes disappeared in 15 out of 17 patients. Postoperative restenosis on the treatment site with transient brain ischemia occurred in one patient. The symptoms in another patient of multiple cerebral infarction with ataxia and episodic vertigo were not relieved, although the patient didn't suffer from apoplectic seizure after the intervention. Postoperative color Doppler ultrasound revealed an over 50％ residual stenosis in 5 patients. The postoperative restenosis rate was 20. 8％. According to Malek scoring, 22 patients were scored 1 point, 1 patient scored 2 and one scored 4. Conclusions Endovascular angioplasty with stent placement is a safe and effective treatment. The restenosis rate could be futher reduced by technology improvement.

Objectives To compare Doppler noninvasive vascular testing and computed tomographic angiography(CTA) with vascular angiography in the assessment of arteriosclerotic occlusion of the lower limbs. Methods In this study 97 lower extremities in 64 patients suffering from arteriosclerotic occlusion underwent both Doppler and CTA plus angiography. Angiogram results were taken as golden standard.The sensitivity and specificity of Doppler was calculated,the diagnostic accuracy of Doppler scanning and CTA plus angiography was calculated and compared.The statistic analysis was performed using x2 test in SPSS 16.0 format. Results Compared with CTA,Doppler scanning is equally accurate at the segments of iliac artery,common femoral artery,superficial femoral artery,dorsal pedis artery and posterior tibial artery (P ＞ 0.05).At segment of popliteal artery,Doppler scanning yields more accurate results (P ＜0.05 ). Conclusions Being noninvasive convenient and of good accuracy,Doppler examination has a role for the diagnosis of arteriosclerotic occlusion of the lower limbs.

Objective To evaluate the safety and efficacy of endovascular intervention to revise peripheral bypass problems through prosthetic approach.Methods Among 17 cases undergoing graft bypass anastomotic stenosis and graft thrombosis was identifled in 16 cases(inflow or outflow obstructive lesions in 10),inflow obstructive lessions in 1(without anastomotic and graft thrombosis).All revision procedures were taken under local anesthesia,16 patients were treated by means of surgical thrombectomy followed by endovascular intervention through prosthesis itself in addition to one who had no thrombectomy.The graft patency and clinical outcome were observed.Resuits Thirteen stents were implanted in 13patients with distal anastomotic stenosis and 1 with proximal anastomotic stenosis including 10 stentings/PTAs in iliac popliteal,posterior tibial or anterior tibial arteries.One stent was implanted in 1 patient with common femoral stenosis.Stenting were not used(abandoned)in 2 patients,of which one underwent a foot amputation and calf gangrene occurred a week later,and the other had a redo of grafting.Follow-up time is 1-35 months.with an average of 12±4 months.One had a below-knee amputation two months after intervention,the other had symptoms recurred and treated with a redo 3 months afterwards.the third died of myocardial infarction six months later.Grafts remained patent in the rest 13 patients at follow-up.Conclusions Endovascular intervention through prosthesis is a safe and effective method,which offers an alternative means to treat anastomotic stenosis.inflow or outflow obstructive lesions.

Arteriosclerotic occlussive disease of the lower extremeties has become a common disease of aging society.Interventional technique is the main method of treating this disease,however,in-stent restenosis various and will degenerate itstherapeutic effect significantly and bring big trouble to clinicians.In the last decade,prevention and treatment techniques have emerged on the underlying mechanismofin-stent restenosis.Particularly,great improvement has been made,because of the development of related devices,such as drug coated balloons,cutting balloons,viabahn stentand bioresorbable stent,all of which could reduce the incidence of in-stent restenosisto varying degrees.In this paper,the latest progress of clinical research on the mechanism and treatment of in-stent restenosis is reviewed,particularly,the clinical effects of these newdevices are analyzed and summarized.

Objective To explore the role and clinical efficacy of catheter induced thrombolysis (CDT) debulking method in the treatment of aorto-iliac artery occlusion.Methods A total of 59 patients with aorto-iliac artery occlusion who underwent endovascular treatment between June 2015 and June 2017 were enrolled.Patients were divided into PTA group and CDT group according to the treatment methods received.The PTA group received a balloon-expandable stent placement,and the CDT group underwent thrombolytic therapy for 48 to 72 hours before angiographic evaluation and further PTA treatment.Results In the CDT group,7 cases were still unable to place the stent after thrombolysis,and 20 patients successfully received stenting including 1-stent-placement in 16 patient and 2-stents-placement in 4.In PTA group 32 patients were treated with stents placement including 1-stent-placement in 19 patients,2-stents in 12,3-stents in 1.Follow-up rate was 86.3％ within 1 year,the patency rate was 84.21％ in the PTA group,and 76.92％ in the CDT group.Conclusions CDT is effective method for occlusion of the aortoiliac artery.TASC classification of aorto-iliac arterial occlusion degrades after CDT treatment,thus reducing the use of stenting.

Objective To investigate the association between HLA-DP gene polymorphism and the susceptibility to hepatitis B virus (HBV) infection in people in Buyi,Miao and Shui ethnic groups in Guizhou.Methods A total of 256 patients with HBV infection,142 HBV self-cleared patients and 135 controls were recruited from 3 ethnic groups for this case-control study.Genotypes of rs3077 and rs9277535 were determined by using real-time PCR with a TaqMan-MGB probe.Results Compared with healthy subjects and self-cleared subjects,the allele distribution of rs9277535 was significantly associated with chronic HBV infection (P＜0.05),no significant differences in rs3077 allele and genotype distributions were found among 3 groups (P＞0.05).Compared with the rs9277535 GG genotype,the AA and AG genotypes were protective factors against HBV infection in dominant model after adjustment for age and sex (OR=0.645,95％CI:0.421-0.988),and no significant difference in rs3077 locus was found in the same analysis (P＞0.05).For men,the rs3077 locus CC and CT genotypes were also protective factors against HBV infection (OR=0.493,95％CI:0.266-0.916),and there was no significant difference in rs9277535 locus compared the genotype distributions among 3 groups in dominant mode.Comparison of allele and genotype distribution in 3 ethnic groups showed that HLA-DP gene rs3077 genotype distributions had significant difference between the HBV infection group and the healthy control group in Buyi ethnic group (x2=6.726,P=0.036).Conclusions The presence of rs9277535A allele at HLA-DP gene polymorphisms might decrease the risk for HBV infection,the rs3077 C allele at HLA-DP gene polymorphisms might also confer protective effect against HBV infection in women.No significant correlation between HLA-DP gene rs3077 and rs9277535 locus polymorphism and HBV clearance was found in this study.The HLA-DP gene rs3077 genotype distribution of HBV-infected patients had significant differences among different ethnic groups.

A total of 280 patients with varicose veins of lower extremities who were prescribed stretch socks as pressure therapy in the outpatient clinic of Beijing Chaoyang Hospital from September 2019 to November 2019 were included in the study. Among 280 patients 208 were followed up for one year(74.3%), 139 cases (66.8%) gave up wearing stretch socks and 69 cases (33.2%) insisted to wear. The main reasons for giving up wearing were feeling too tight (23.1%), too much troubles (17.7%), symptom improvement (15.1%), poor effect (10.8%) and so on. The compliance of wearing stretch socks as pressure therapy in outpatients with varicose veins of lower extremities is poor with a variety of reasons, the data may provide a reference for improving clinical compliance in the future.