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 study the effect of case-based learning(CBL) combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors.Methods Total 30 peripheral vascular refresher doctors were selected in department of vascular surgery,Xuanwu Hospital of Capital Medical University and were randomly divided into the observation group(n=15) and control group(n=15).Doctors in observation group were trained by CBL combined with virtual reality simulator while those in control group were taught by traditional teaching method.Theory examination,skill examination in real environment were performed after the training and achievement differences were compared between 2 groups.Questionnaires were given to the simulator CBL group,to learn refresher doctors' recognition of the teaching method and groups were compared using independent samples t test.Results Theory examination average score was (84.5 ± 7.7) in observation group,higher than the score(72.6 ± 8.7) in control group(P=0.024).Skill examination average score was(85.3 ± 9.3) in observation group,higher than the score(70.2 ± 10.2) in control group(P=0.013).Compared with control group,the mean performance errors in training group,the contrast volume,the mean angiography procedure time,the time of X-ray exposure,the total volume of X-ray exposure and the total volume of X-ray exposure every square meter all decreased significantly and the difference was statistically significant.P value＜0.05.100％ (15/15) simulator CBL group refresher doctors recognized CBL combined with vascular interventional simulator teaching method.Conclusions Teaching method of CBL combined with virtual reality simulator can stimulate the refresher doctors' interest in learning and help them master peripheral vascular interventional techniques.

Objective To establish a diabetic rat model of hindlimb ischemia, and provide a test method for dia-betic limb ischemia and diabetic foot study.Methods Twenty-five Wistar rats were divided into three groups:the model group and control group ( n=10) , and sham operated group ( n=5) .The rats of model group were induced by intraperito-neal injection of streptozotocin ( STZ, 60 mg/kg) , with the blood glucose level over 16.8 mmol/L, while the rats of control group were injected with normal saline.All the rats had the left femoral artery and its branches ligated, and then Doppler scan blood flow analysis was performed for the two hind limbs after operation at different time points.In the meantime, the changes of body weight and blood glucose were observed.The animals were sacrificed at 21days after operation.HE stai-ning was used to observe the pathological changes of gastrocnemius and femoral arteries.Capillary density and intima hyper-plasia were examined using immunostaining for CD31 and a-SMA.Results Blood glucose of the model group rats was sig-nificantly increased as well as the quantity of urine and feces,and associated with weight loss, which were maintained for more than 21 days.The blood flow of control rats was markedly decreased immediatly after operation, reached to the lowest point after surgery, and recovered from 7 -14 days after operation.In contrast to the control group, the model group showed a marked reduction in blood flow in the ischemic hind limb.Pathological examination revealed remarkable vascular atrophy and a significantly reduced number of vessels per high power field in the gastrocnemius muscle of model group rats with respect to the control group, and the femoral arteries of model rats were more narrowed than that of the control rats. Conclusions In this study, an effective, convenient diabetic rat model of hindlimb ischemia is successfully established which will facilitate the studies of drug intervention for diabetic limb ischemia and diabetic foot in the future.

The acute ischemic stroke has become the first major disability and death disease in China.With the release of the results of five trials represented by the Dutch multicenter randomized clinical trials of intravascular treatment of acute ischemic stroke, mechanical thrombectomy has become the main means to treat the acute ischemic stroke caused by the occlusion of large intracranial vessels, ushering in a new era of mechanical thrombectomy for acute cerebral infarction.At present, the main devices of mechanical thrombectomy are Merci thrombectomy device, penumbra thrombectomy device, solitairetm fr stent, revive se stent, trevo stent and aperio ® stent.According to the location and conditions of vascular embolism, different types of thrombectomy devices should be selected, and different thrombectomy technologies, such as adapt technology, solumbra Technology, advance technology, save technology, swim technology, etc So as to improve the recanalization rate and reduce complications.

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 evaluate surgical treatment of lower limb ischemia due to combination of thromboangiitis obliterans (TAO) and arteriosclerosis obliterans (ASO). Methods Clinical data of six patients suffering from lower limb ischemia due to TAO and ASO were retrospectively analyzed. All patients had a history of smoking, and complained of rest pain. Three patients had foot ulcer and one had toe gangrene. Two patients reeeived aortie artery endartereetomy combined with FIFE graft bypass to deep femoral artery and below knee popliteal artery plus saphenous vein graft bypass to tibial artery. One patient received aortic thrombectomy and endarterectomy plus aortofemoral and femoropopliteal PTFE graft bypass. One patient with a history of left graft thrombosis after aorto-bifemoral arterial bypass using PTFE graft before admission underwent left PTFE graft thrombectomy via left groin and left deep femoral artery endarterectomy followed by femoropopliteal arterial bypass. One patient received left common iliac artery endarterectomy plus left profound femoral PTFE graft-left anterior tibial arterial bypass using in situ great saphenous vein graft. One patient received right to left femorofemoral arterial bypass using PTFE graft to left posterior tibial artety bypass using reversed great saphenous vein graft. Results One patient receiving aortoiliac thrombectomy and endarterectomy with aortofemoropopliteotibial arterial bypass suffered from graft thrombosis several hours after operation and emergency thrombectomy with distal posterior tibial arteriovenous fistulization was performed. The rest pain disappeared in 5 patients and partially relieved in one. All the grafts were patent on discharge. The foot ulcer reduced in 3 patients. All the 6 patients were followed up with a mean of 6. 5 months. 3 foot ulcers healed. One patient eventually received below knee amputation due to foot gangrene three months later. Conclusion Although it is difficult to treat combined limb ischemia of TAO and ASO, satisfactory results could be achieved when proper surgical procedure is adopted.

Objective To explore the feasibility and safety of endovascular directional atherectomy angioplasty for the treatment of severe vertebral artery stenosis.Methods Directional atherectomy combined with use of drug-coating balloon (DCB) was employed to treat one patient with severe stenosis of vertebral artery in November 2017 at authors' hospital.Protective umbrella filter was placed at the distal site of V1 segment during the procedure course.Results The operation was successfully accomplished.No postoperative complications occurred.After the operation,the clinical symptom of dizziness disappeared and the patient was well recovered.Conclusion For the treatment of severe vertebral artery stenosis,directional atherectomy combined with use of DCB is safe and feasible.

Objective To investigate the clinical outcome of drug-coated balloon ( DCB) treated atherosclerosis obliterans ( ASO) in lower extremity. Methods Data of 28 patients were retrospectively an-alyzed to determine the effectiveness and characteristics of DCB treatment. Results All the 28 patients were successfully treated with endovascular intervention therapy. Lesions mainly located in the superficial femoral arteries were divided into Groups A, B, C, and D according to TransAtlantic InterSociety Consensus (TASC) Ⅱ classification. Follow-up at 6, 9, and 12 months showed 100％, 84. 6％ and 76. 9％ patency rate in treated artery. After 9 months of endovascular intervention therapy, the combined artery patency rates in Groups A and B was 92. 8％, which was significantly better than 66. 7％ in Groups C and D ( P <0. 05 ) . DCB angioplasty had an artery patency rate of 86. 7％, while DCB angioplasty plus stenting had the patency rate of 85. 7％ (P>0. 05). Artery patency rate of Simple DCB angioplasty in ten patients (Exclu-ding patients with in-stent restenosis ) was 80％ and of Atherectomy plus DCB angioplasty in 5 patients was 100％ (P<0. 05). Conclusions DCB angioplasty has superiority over conventional intervention therapy. Combined debulky and DCB angioplasty appear to be the best choice in current treatment of ASO in lower extremity.

Objective To explore the clinical effectiveness and safety of selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropo-pliteal artery disease. Methods From Jan 2014 to December 2015, 45 femoropopliteal artery atherosclerot-ic patients were treated with SilverHawk atherectomy and selective embolic protection device (EPD). The indication for EPD was instent restenosis, highly calcified lesion, suspicious of thrombosis, ulcerated le-sion, and single below-the-knee runoff. All cases who met the indication were treated with atherectomy and EPD, and those who did not meet the indication were treated with or without EPD according to the patient's choice. The embolic related complications were analyzed. Results Twenty three out of 45 patients who met the EPD indication were all treated with SilverHawk atherectomy under EPD protection, filter captured deb-ris in 17 patients (73. 9％) of the patients. The other 22 patients who did not meet the indication were di-vided into 2 groups according to the patient's choice of EPD usage, 11 were treated by atherectomy with EPD and 11 without EPD. One case out of 11 unindicated patients without EPD suffered a tibioperoneal trunk embolization and restored with catheter aspiration. For 1/11 (9. 1％) unindicated cases with EPD protec-tion, the filter captured embolization. There was a significant difference of distal embolization rate between the indicated and unindicated patients (χ2 =19. 368,P =0. 000). All filters were retrieved successfully without any distal embolization and any complications except arterial spasm occurred in 2 patients and re-stored well with nitroglycerin. Conclusions It is safe and effective for selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropopliteal artery disease.