Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.

Primary aortic mural thrombus is a rare aorta disease.It has an insidious onset,but very dangerous complications that mainly is the lower limb arterial embolism and secondly the visceral arterial embolism,which may result in severe sepsis and multiple organ dysfunction,leading to high mortality rates.Here,the authors address the diagnosis and treatment of the primary aortic mural thrombus in recent years.

Primary aortic mural thrombus is a rare aorta disease.It has an insidious onset,but very dangerous complications that mainly is the lower limb arterial embolism and secondly the visceral arterial embolism,which may result in severe sepsis and multiple organ dysfunction,leading to high mortality rates.Here,the authors address the diagnosis and treatment of the primary aortic mural thrombus in recent years.

To investigate the effectiveness of retrograde puncture of popliteal artery in lower extremity arteriosclerosis obliterans ( ASO ) patients classified as TASC ( Tans-Atlantic Inter-Society Consensus) C/D.Retrospective analysis of 35 lower extremity ASO patients, 28 male and 7 female , the mean age was 72 ±8, 23 cases of Rutherford 3, 8 cases of Rutherford 4 and 4 cases of Rutherford 5. Preoperative ABI was 0.35 ±0.14, Lesion length in CT angiography ( CTA ) was ( 18 ±5 ) cm.The technique success rate of 35 cases was 100%.The puncture time was (6 ±4) min.6 cases used 4 F sheath and 29 cases used no sheath technology at the puncture site.In 27 cases guide wires passed retrograde through the occluded superficial femoral artery lesion and returned to the true lumen.8 cases of SAFARI technology to established the guild wire track.The complication rate of retrograde puncture was 14.2%( 5/35), 2 cases of postoperative hematoma appeared at the puncture site the next day, 2 cases of pseudoaneurysms emerged and 1 case of postoperative arteriovenous fistula at the puncture site of popliteal area were found by Doppler ultrasonography before discharged.All 5 patients were recovered by conservative treatment.The retrograde puncture of popliteal artery is a safe and reliable method.

Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.

SUMMARY An involved internal iliac artery is usually embolized when performing endovascular aneu -rysm repair for aortoiliac or isolated iliac artery aneurysm .This can lead to complications such as buttock claudication ,colon ischaemia and erectile dysfunction .Iliac branch device ( IBD ) is an endograft de-signed specifically for iliac bifurcation to preserve internal iliac flow .It was performed with high technical success rates and encouraging mid-term patency .Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm , with the patient ’ s left internal ar-tery been sacrificed then .Using a handmade IBD , we excluded the aneurysm without occlusion of the ip-silateral internal iliac artery or any type of endoleak .Both the design and deployment of this IBD are dis-tinctive that we would like to share our experience with all the colleagues .

Objective To evaluate iliac artery rupture during endovascular treatment of aorto-iliac disease and treatment with covered stent.Methods From November 2008 to August 2014,iliac artery rupture happened in 8 patients of 225 patients of aorto-iliac artery disease admitted to our hospital.Clinical data of the 8 patients were analyzed retrospectively.Four were of intraoperative rupture and four were of delayed rupture.The aorto-iliac diease of all the 8 patients were TSAC D.Direct placement of a covered stent was performed in all the cases,except for one patient who refused further treatment.Results All of the procedures finally achieved technical success and all patients become hemodynamically stable.One patient was complicated with heart failure who died of multiple organ dysfunction syndrome.Another one died of aspiration.5 patients were followed up from 9-52 moths,average 9-52 moths without recurrence.Conclusions Iliac artery rupture is a serious and life-threatening complication in the endovascular treatment of aorto-iliac disease.Covered stent provided a safe and effective treatment for iliac perforations.

Objective To investigate the clinical features of spontaneous isolated superior mesenteric artery dissection (SISMAD), and to discuss its interventional therapy. Methods The clinical data of 10 patients with SISMAD, who were admitted to authors' hospital to receive interventional treatment during the period from January 2006 to June 2014, were retrospectively analyzed. All the 10 patients were males, aged 44-66 years with a mean of (53±8) years. Clinically, all patients presented with acute-onset abdominal pain or pain around umbilicus, as the effect of conservative treatment was poor, implantation of self-expandable bare stent was carried out. Results Successful implantation of self-expandable bare stent was accomplished in all 10 patients;only one stent was used in 7 patients and 2 stents were used in 3 patients. The blood in the true lumen of superior mesenteric artery (SMA) restored and the residual stenosis extent was less than 15%. The technical success rate was 100%. The abdominal pain was relieved in 8 patients on the operative day after treatment, and in 2 patients the abdominal pain was relieved in 2 days after treatment. All the patients were followed up for 7-71 months (mean of 36 months) and the follow-up rate was 100%. After the treatment patients had no symptoms of abdominal discomfort. Contrast-enhanced CT scan performed at 6, 12 and 24 months after the treatment showed that SMA and stent was patent and no aneurysmal dilatation was observed. Conclusion For the treatment of SISMAD endovascular implantation of self-expandable bare stent is clinically safe and feasible, and its long-term effect is satisfactory.

Objective:To report a rare type of aortic arch aneurysm. Methods: Three cases of aortic arch aneurysm derived from the fourth aortic arch were retrospectively analyzed. The pathogenesis and treatment of this type of aortic arch aneurysm were investigated. Results:Most of the aneurysm body was located in the Z2 zone, which was the stem from the fourth aortic arch in the embryonic development period. All of the 3 cases could not be explained by common etiology. We speculated that the cause might be developmental anomaly of the fourth aortic arch. All the 3 aortic arch aneurysms were totally ex-cluded with a covered stent. The technical success rate was 100%. Endoleak of typeⅠwas seen in one case, which was resolved in a later open surgery. During the follow-up, no type of complications was found. Conclusion:To the best of our knowledge, this is the first report of this type of aortic arch aneurysm. The cause may be developmental anomaly of the fourth aortic arch. Endovascular treatment of this type of aortic arch aneurysm is feasible.

Objective To evaluate the efficacy of ultrasound-guided sacral block in the obese patients by comparing it with the traditional positioning method.Methods Sixty obese patients,aged 25-50 yr,weighing 56-80 kg,with body mass index ≥ 30 kg/m2,scheduled for elective anorectal surgery,were randomly divided into 2 groups (n =30 each) using a random number table:ultrasound-guided sacral block group (group U) and traditional positioning method group (group T).The sacral canal puncture point was located via either ultrasonic or traditional positioning method.After successful puncture,1％ lidocaine 20 ml was injected.The number of patients in whom puncture was successful at first attempt and the number of patients in whom the time for puncture ≤ 1 min were recorded.The adverse reactions were observed.The efficacy of sacral block was evaluated.Results Compared with group T,the success rate of puncture at first attempt was significantly increased (P ＜ 0.05),and no significant changes were found in the number of patients in whom the time for puncture ≤ 1 min or efffcacy of sacral block in group U (P ＞ 0.05).No adverse reactions were found in the two groups.Conclusion Ultrasound-guided sacral block can raise the success rate of puncture at first attempt and provide similar efficacy of block in the obese patients when compared with the traditional positioning method,and thus has significant clinical value.