Objective To evaluate the safety and efficacy of profunda femoral vein thrombosis clearance in endovascular treatment of acute lower extremity deep venous thrombosis (DVT). Methods From January 2022 to September 2023, clinical data of acute lower extremity DVT patients who underwent percutaneous mechanical thrombectomy (PMT) for profunda femoral vein thrombosis were retrospectively analyzed. The 12-month primary patency rate of iliofemoral vein and incidence of post-thrombotic syndrome(PTS) were analyzed. Results Twenty-two patients were included in the study, and all patients underwent PMT for profunda femoral vein thrombosis. Five patients were treated through the contralateral common femoral vein via crossover approach, and 17 patients were treated through the contralateral common femoral vein combined with the ipsilateral deep vein approach. The 12-month primary patency rate of iliofemoral vein was 90.9% (20/22), and the incidence of PTS was 9.1% (2/22). Conclusions For patients with acute lower extremity DVT undergoing endovascular treatment, PMT for profunda femoral vein thrombosis is safe and effective, achieving good primary patency of iliofemoral vein and low incidence of PTS.

Objective:To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods:From Sep 2013 to Mar 2020, clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed. Patency rates, the freedom rate from clinically-driven target lesion revascularization (F-TLR), limb salvage and survival after five years were calculated.Results:A total of 65 patients (67 lower limbs) were included. 20 limbs were TASC C lesions, 47 limbs were TASC D lesions. The mean lesion length was (29.1±9.4) cm, including 48 chronic total occlusion (CTO) lesions (71.6%) with mean lesion length of (26.1±10.4) cm. Technique success rate was 98.6%. Mean length of stent graft was (31.3±10.1) cm.Major amputation was performed in 4.2% cases within 5 years. All-cause mortality in 5 years was 23.1%. Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%, Assisted primary patency rates were 88.4%, 83.4%, 83.4% and secondary patency rates were 88.4%, 85.8%, and 85.8% . F-TLR at 1, 3 and 5 year was 88.2%,76.9%,73.1% .Conclusion:Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.

Objective:To analyze the clinical efficacy and safety of endoluminal treatment of complex renal artery aneurysm (RAA).Methods:The clinical data and follow-up results of 19 patients with complex RAA admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from November 2014 to September 2021 were retrospectively analyzed. Two patients were treated with simple spring coil embolization into the aneurysmal artery, 14 patients were treated with simple spring coil embolization of the aneurysmal cavity, and 3 patients were treated with stent-assisted + spring coil embolization technique. Based on the location of the aneurysm, RAA were classified into type Ⅰ, Ⅱ, and Ⅲ. 7 patients with type Ⅰ, 10 patients with type Ⅱ, and 2 patients with type Ⅲ were studied. Variance analysis was used to compare the differences in glomerular filtration rate(GFR) of the affected side when the tumor was located at different locations, and Pearson was used to analyze the correlation between the number of coils implanted and the size of the tumor and GFR.Results:Ten of the 19 patients who were underwent successful endoluminal intervention. The average size of the patients′ aneurysms was (20.89±6.65) mm, and the average number of spring coils implanted was 8.22±3.08. The preoperative and postoperative serum creatinine were in the normal range, and no RAA tumor enlargement or recurrence was found during the follow-up period. The postoperative GFR was abnormal in patients with type Ⅰ, type Ⅱ, and type Ⅲ renal aneurysms, and the mean GFR value differed among the three types of patients( P=0.003). There was a negative correlation between the postoperative GFR values of the affected kidney and the number of spring coils implanted ( P=0.047), and no significant relationship between GFR and aneurysm size. Conclusion:The endovascular technique is an effective and safe means of treating complex RAA.

Objective:To evaluate the mid-term clinical efficacy of drug-coated balloons (DCB)in the treatment of femoro-popliteal artery TASC Ⅱ C/D de novo stenosis and in-stent restenosis.Methods:A total of 126 patients with TASC Ⅱ C/D femoro-popliteal artery stenosis treated with DCB in Renji Hospital and Pudong New Area People's Hospital from December 2016 to August 2020 were retrospectively enrolled, including 74 cases of de novo stenosis (de novo group) and 52 cases of in-stent restenosis (ISR group). The clinical data and lesion characteristics were analyzed; the primary patency rate, primary-assisted patency rate, secondary patency rate, and the freedom from target lesion revascularization (f-TLR)rate were evaluated; the perioperative complications, mortality and amputation rate were compared between two groups. Kaplan-Meier method was used to evaluate the patency rate of target vessel lesions, and Cox regression analysis was used to evaluate the relative risk factors.Results:There were 6 patients died in each group during the followup period. The lesion length of the de novo and ISR groups were (21.25±12.64) cm and (34.71±12.02) cm, respectively( t=33.74, P<0.001). The popliteal artery involvement was 33.8% (25/74) in the de novo group and 15.4% (8/52) in the ISR group (χ 2=5.35, P=0.021). The operational success rate was 100.0% in both groups, and the perioperative complication rate was 6.8% (5/74) in the de novo group and 1.9% (1/52) in ISR group. The median follow-up time was 22 month and 17 months; the mean follow-up time were(19.78 ± 11.02) months and (20.02 ± 11.32) months in the de novo group and ISR group, respectively. The primary patency rates at 6, 12 and 24 months after intervention were 89.1%, 73.4%, 50.8% in the Denovo group, and 87.8%, 68.8%, 42.0% in the ISR group, respectively; the primary assisted patency rate was 90.7%, 78.4%, 62.8% in the de novo group, and 89.3%,77.1%, 62.8% in the ISR group, respectively; the secondary patency rate was 95.1%,95.1%, 88.7% in de novo group, and 94.9%, 88.9%, 84.3% in ISR group, respectively; the f-TLR rate was 97.3%, 88.6%, 79.2% in de novo group, and 90.0%, 77.7%, 74.7% in ISR group, respectively (all P>0.05). Cox regression analysis showed that P2 and P3 segment involvement of the popliteal artery were independent factors affecting the patency rate of target lesion. Conclusions:The mid-term clinical efficacy of DCB in the treatment of TASC Ⅱ C/D femoro-popliteal artery de novo stenosis and in-stent restenosis is satisfactory.

Objective:To evaluate the efficacy and safety of drug-coated balloon (DCB) with paclitaxel in the treatment of femoropopliteal arteriosclerosis obliterans (ASO).Methods:From Dec 2016 to Dec 2018, clinical data of femoropopliteal artery disease patients treated with paclitaxel DCB in Renji Hospital, School of Medicine, Shanghai Jiaotong University were retrospectively analyzed.Results:A total of 83 patients (95 lower limbs) underwent DCB therapy. Including 50 chronic total occlusion (CTO) lesions (52.6%) with mean lesion length of (18.35±10.61) cm. Twenty-four lesions (25.3%) were moderately or severely calcified. Bail-out stent implantation was performed in 29.5% cases. The mean follow-up time was 17.5 months. Twelve months after intervention, the all-cause mortality rate was 6.0%, the major amputation rate was 4.3%, the primary patency rate was 60.6%, the primary assisted patency rate was 72.4%, the secondary patency rate was 83.4%, and the freedom rate from clinically-driven target lesion revascularization(F-TLR) was 77.0%. Moderate to severe calcification was an independent risk factor for the primary patency of DCB therapy.Conclusion:DCB is a safe and effective endovascular therapy for femoropopliteal artery disease.

Objective:To investigate whether the clinical efficacy of mechanical pharmacothrombectomy (PMT) in treatment of whole-lower-limb acute deep vein thrombosis (DVT) could be improved by the modified approach removing popliteal vein thrombosis.Methods:From Mar 2016 to Mar 2018, 31 patients with whole-lower-limb acute DVT were enrolled and treated with PMT by AngioJet. The clinical data was retrospectively analyzed, and the clinical efficacy was evaluated.Results:26 cases were treated by contralateral common femoral vein approach and the other 5 cases by ipsilateral calf deep vein. Urokinase was given in bolus in 29 patients before thrombectomy. After PMT, 7 cases combined with catheter-directed thrombolysis. 26 cases underwent iliac vein PTA, and 14 cases underwent iliac vein stenting. The average hospitalization days was (7.6±1.8) d. The thrombus clearance rate was grade Ⅱ (50%~99%) in 16 cases (51.6%) and grade Ⅲ (100%) in 15 cases (48.4%). 30 patients were followed up and the mean follow-up time was 19.7 months. The 12-month primary patency rate was 83.3%. All the 5 patients with occlusion had different degrees of post-thrombotic syndrome (PTS), and the incidence of PTS was 16.7% (5/30).Conclusions:The modified approach to treat the whole-lower-limb acute deep vein thrombosis with PMT is safe and effective. The popliteal vein thrombosis can be cleared in one stage. The blood inflow can be improved, and the incidence of PTS is relatively low.

Objective To evaluate the feasibility and safety of using bidirectional subintimal technique,i.e.subintimal arterial flossing with antegrade-retrograde intervention (SAFARI),in endovascular treatment of subclavian arterial occlusion when the guide wire cannot re-enter into the distal true cavity.Methods The clinical data of 11 patients with symptomatic subclavian artery occlusion,who were admitted to authors' hospital during the period from August 2013 to June 2016 to receive treatment,were retrospectively analyzed.The patients included 8 males and 3 females,with a mean age of 67 years old (61-74 years).Endovascular recanalization of subclavian artery with SAFARI technique and stent implantation were carried out in all patients after conventional reopening surgery of obstructed artery failed.Results Subclavian artery recanalization by using SAFARI technique together with implantation of stent (average length of 46.4 mm) was successfully accomplished in 10 patients,but in one patient the technical management failed,the technical success rate was 90.9％.No serious postoperative complications occurred.The patients were followed up for 6-36 months by telephone,and no in-stent restenosis was verified during the follow-up period.Conclusion In treating severely calcified and long-segmental subclavian artery occlusion,endovascular treatment using SAFARI technique is safe and effective,SAFARI technique can further improve the success rate of endovascular treatment.

Objective To evaluate the clinical effect of endovascular therapy with covered stent in treating aortoiliac occlusive disease. Methods The clinical data of 20 patients with aortoiliac occlusive disease, who received endovascular therapy with covered stent during the period from January 2014 to December 2016, were collected. According to Rutherford standard of clinical symptom classification, gradeⅢ, grade Ⅳ and grade V were seen in 9, 7 and 4 patients respectively. Based on the Trans-Atlantic Society Coalition (TASC) treatment guidelines Ⅱ classification, B type, C type and D type were observed in 4, 7 and 9 patients respectively. The postoperative primary patency and secondary patency of the stent as well as the clinical efficacy were analyzed. Results Endovascular treatment was successfully accomplished in all 20 patients. After the treatment, the clinical symptoms were significantly relieved. Two patients developed complications (10％). One patient developed thrombus at the distal end of stent, which was improved after thrombolytic therapy. Another patient developed hematoma at puncture site, which was absorbed after conservative therapy. No perioperative death occurred. The patients were followed up for 5-37 months, with a mean of (17±10) months. The primary patency rate was 95％ and the secondary patency rate was 100％. Conclusion For the treatment of aortoiliac occlusive disease, endovascular therapy with covered stent has excellent clinical efficacy.

Objective To investigate the protective effect of sulodexide (SDX) on oxidized low density lipoprotein (ox-LDL) induced damage to human umbilical vein endothelial cell (HUVEC),and to discuss its mechanism.Methods By using CCK-8 method,the ox-LDL intervention HUVEC dose and the concentration of SDX were determined.The reactive oxygen species (ROS) assay kit was used to verify the protective effect of SDX on HUVEC.Real time fluorescent quantitation-polymerase chain reaction (RT-PCR) was employed to test the endothelial nitric oxide synthase (eNOS) and caveolin-1 mRNA expression;immunoblot assay was adopted to check the protein expression of phosphorylated eNOS (p-eNOS) and caveolin-1.The ability of cell migration was assessed by Transwell assay.Results Stimulated by 100 μg/ml concentration of ox-LDL,the cell viability of HUVEC decreased significantly (P＜0.01).After adding 125 LRU/ml concentration of LDX,the cell viability of HUVEC was remarkably improved (P＜0.01) and the production of ROS was strikingly decreased (P＜0.01).SDX could down-regulate the expression of caveolin-1 (P＜0.05) and up-regulate the expression of eNOS mRNA and p-eNOS (P＜0.05) for ox-LDL-damaged HUVEC,and markedly improve the migration ability of damaged HUVEC (P＜0.01).Conclusion By regulating the caveolin-1/eNOS signal route,SDX can improve impaired HUVEC cell migration ability,thus,to protect endothelial cells.