The incidence of the lower extremity venous disorder is high, which seriously affects the quality of life in patients. Endovascular strategy has become an important treatment for venous disease of the lower extremity. Intraoperative venography usually can not provide detailed information about intravenous or perivascular structures. In contrast, endovascular imaging such as intravascular ultrasound and optical coherence tomography can not only reduce the use of contrast agents, evaluate intravenous and perivascular structures, but also accurately measure the anatomic parameters and provide information for subsequent treatment. This article reviewed the relevant experience and summarized the mechanism, characteristics, and clinical applications of intravascular imaging.

Chronic HBV infection is an important phase in the natural history of HBV, but there are still controversies over the treatment of this stage. Traditional Chinese medicine has had unique advantages in the prevention and treatment of viral hepatitis since ancient times and plays an important role in prevention and treatment of viral hepatitis in China. Based on the pathological process of chronic HBV infection, the team of Department of Hepatology in Shenzhen Hospital of Traditional Chinese Medicine believes that the core pathogenesis of chronic HBV infection is "kidney deficiency and epidemic toxin lurking in liver blood" and established kidney-tonifying therapy for the treatment of chronic HBV infection. Under the support of the project of Prevention and Treatment of Major Infectious Diseases such as AIDS and Viral Hepatitis in The Eleventh Five Year Plan, The Twelfth Five Year Plan, and The Thirteenth Five Year Plan, the team has conducted studies on the regularity of syndromes and a series of clinical studies and investigated the clinical efficacy of kidney-tonifying therapy through multicenter, randomized, double-blind, placebo-controlled studies, thereby exploring the application and mechanism of traditional Chinese medicine treatment in patients with chronic HBV infection. However, there are still difficulties in the pathogenesis and treatment of chronic HBV infection, and with the inheritance, innovation, and modernization of traditional Chinese medicine, it is believed that traditional Chinese medicine can provide reliable regimens for the treatment of chronic HBV infection.

Humans ; May-Thurner Syndrome ; Coronary Restenosis ; Constriction, Pathologic/surgery* ; Stents/adverse effects* ; Iliac Vein ; Treatment Outcome ; Retrospective Studies

Objective:To evaluate the clinical outcomes of excimer laser atherectomy (ELA) in the treatment of diabetic foot with below-the-knee(BTK) lesions.Methods:The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI) after operation were record.Results:All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57) before operation to 0.88(range:0.68 to 1.05) after operation.At 3 months after the operation,1 limb (1/12) underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation (limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb (1/8) underwent toe amputation due to prolonged healing of ulcers of toe.Conclusion:ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

Secondary hyperparathyroidism (SHPT) is a common and serious complication in long-term dialysis patients, who often experience multiple symptoms and a poor quality of life. Parathyroidectomy (PTX) is the best choice for severe SHPT patients with poor drug treatment. At present, the follow-up after PTX has not received sufficient attention, and the assessment of patients' clinical symptoms and quality of life is not yet adequate. In view of this, we systematically combed the changes and influencing factors of patients' quality of life and related symptoms after surgery, in order to provide reference for the practice and research of symptom management of such patients in the future.

Objective:To evaluate the clinical outcomes of excimer laser atherectomy (ELA) in the treatment of diabetic foot with below-the-knee(BTK) lesions.Methods:The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI) after operation were record.Results:All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57) before operation to 0.88(range:0.68 to 1.05) after operation.At 3 months after the operation,1 limb (1/12) underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation (limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb (1/8) underwent toe amputation due to prolonged healing of ulcers of toe.Conclusion:ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

Objective:To summarize the early and intermediate outcomes of second-grade false-lumen endovascular occlusive repair (FLEVOR) for aortic dissection.Methods:The clinical data of 12 patients undergoing second-grade FLEVOR after proximal repair of aortic dissection at our center from Aug 2016 to Aug 2019 was retrospectively analyzed.Results:The mean age was (51.3±14.9) years old. Four patients received open repair due to Stanford type A aortic dissection previously, the other 8 patients underwent thoracic endovascular aortic repair for Stanford type B aortic dissection. The time to the proximal repair varied from 3 months to 16 years. The technical success rate was 100%. Visceral ischemia, early spinal cord ischemia and in-hospital death did not occur perioperatively. The mean follow-up time was 16.7 months. Persistent false lumen perfusion was found in 3 patients, complete thrombosis of false lumen was achieved in the other 8 patients. The maximum diameter of abdominal aorta decreased in 8 (72.7%) patients.Conclusions:FLEVOR could block the blood flow from the false lumen and induce the thrombosis of false lumen, which promotes the aortic remodeling. Meanwhile, FLEVOR could protect the blood supply of spinal cord and viscera, and reduce the risk of type Ⅱ endoleaks.

Objective: To compare intravascular ultrasound (IVUS) with venography in the intraoperative evaluation of iliac vein compression syndrome (IVCS). Methods: From Sep 2017 to Mar 2018, consecutive patients with suspicious iliac vein compression, underwent both venography and IVUS. The results were compared between IVUS and venography. Results: 40 patients with 48 limbs were enrolled. Venography underestimated both the diameter and area stenosis compared with IVUS (39.63%±15.48% vs. 64.97%±16.42%, P<0.001; 51.83%±18.23% vs. 59.19%±14.17%, P=0.021, respectively). The eccentricity detected by venography was lower than IVUS (0.69±0.17 vs. 0.93±0.17, P<0.001). Taking IVUS as gold standard, the sensitivity and the specificity of venography for detecting a ≥50% stenosis was 18.92% and 81.82%, and the intertechnique agreement was extremely low between venography and IVUS (κ=0.004). Conclusion Compared with IVUS, venography underestimated the degree of stenosis in IVCS. The sensitivity of venography in detecting a significant stenosis was very low.

Objective To evaluate a self-designed in-situ fenestration system to preserve left subclavian artery during thoracic endovascular aortic repair (TEVAR).Methods From June 2016 to May 2017,aortic dilatation disease patients with insufficient proximal landing zone were treated by the selfdesigned in situ fenestration system to preserve the left subclavian artery during TEVAR.The patients were regularly followed-up with CTA.Results Totally 12 patients with an average age of 65 ± 11 years were enrolled.Among them,6 patients had thoracic aortic aneurysm and the other 6 suffered from aortic dissection.The mean operating time was 145 ± 36 minutes.The perioperative procedure success rate was 100％.One patient had intraoperative type Ⅰ endoleak,1 patient had type Ⅱ endoleak.One patient had suffered from stroke and 1 patient had mild paraplegia post-operatively.All patients were followed-up for a mean time of 6.5 ± 3.0 months.The type Ⅰ endoleak in 1 patient disappeared,type Ⅱ endoleak remained in one.There was no death during perioperative and in follow up period.Conclusions This self-designed in-situ fenestration system effectively and quickly restores the blood flow of the left subclavian artery during TEVAR.

Objective To explore the effect of the cystoscope indwelling double J tube for the treatment of pregnancy with ureteral calculi,and to observe and analyze the prognosis,and provide the basis for clinical therapy. Methods 46 pregnant women with ureteral calculi were selected.All patients were treated by cystoscope indwelling double J tube.Observation indexes were the follow -up complications after a week of operation time,operation situa-tion,Visual analogue scale (VAS)was used to evaluate the degree of pain operation before and after treatment 48 h. To observe the pregnant women with double J tube placement and delivery status.Results 46 patients were success-fully catheter,the average operation time was (29.14 ±3.27)min.37 patients with lumbar cramps and fever and other symptoms were relieved after treatment.6 patients with replacement of double J tube 2 months later.After treatment, VAS score was (1.16 ±0.83)points,which was lower than (6.93 ±1.02)points before treatment,the difference was statistically significant (t =9.64,P <0.05).After treatment,the infection rates of hydronephrosis and urinary tract were 4.35% (2 /46)and 0% (0 /46),which were lower than before treatment [(15 /46,32.61%)and 19.57%(9 /46)],the differences were statistically significant (χ2 =8.33,9.05,all P <0.05);46 cases of pregnant women were smooth production,no abortion complications.The average indwelling double J tube time was (5.08 ± 1.16)months.Conclusion Cystoscope indwelling double J tube for the treatment of ureteral calculi in pregnancy has less invasion,high stone clearance rate,less postoperative complications and high safety,the prognosis was good,and it is a safe and effective method.