Objective To investigate the safety and feasibility of carotid endarterectomy (CEA) combined with carotid artery stent angioplasty (CASA) in treating tandem stenosis of carotid artery. Methods The clinical data of 9 patients with tandem stenosis of carotid artery, who were treated at authors' hospital during the period from January 2013 to October 2014, were retrospectively analyzed. The patients included 7 males and 2 females, with a mean age of (66.0 ±4.2) years. The disease course ranged from 2 months to 36 months, with a mean of 7 months. Clinically, all patients had cerebral ischemia symptoms. Transient ischemia attack was seen in 5 patients and history of cerebral infarction was present in 2 patients. Coronary artery disease was found in 2 patients, hypertension in 6 patients and lower limb ischemia in one patient. After receiving adequate antiplatelet therapy, CEA and CASA were carried out in all patients. Results The technical success rate was 100%, postoperative residual stenosis was less than 30%, no death occurred in perioperative period. After the treatment, the clinical symptoms were improved in all 9 patients;no new stroke or cerebral hemorrhage occurred. After the treatment, 2 patients developed cerebral hyperperfusion-related symptoms such as headache and dizziness, which were much relieved at the time of discharge. The patients were followed up for 4-19 months, with a mean of (10.5±6.2) months. No recurrence of symptoms was observed . In one patient , transcranial Doppler ultrasound performed at 6 months after treatment showed that the carotid artery became moderate restenosis (50%-70%). No death occurred. Conclusion For the treatment of tandem stenosis of carotid artery, CEA combined with CASA is safe and effective, although larger sample and long-term follow-up studies are still needed to further confirm the effect.

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 construct expression vectors of human ribosomal protein S 3(RPS3) and RPS3Ser209 mutant in orcler to investigate the effect of RPS3Ser209 mutant on NF-κB signaling pathway and DNA binding capacity .Methods The vector RPS3-myc was amplified by polymerase chain reaction ( PCR) from the human liver cDNA and subcloned into pcDNA-3.1myc-HisB.RPS3S209A represented mutant RPS3 expression vectors, in which the designated amino acid was mutated to an alanine residue .Dual luciferase reporter gene assay was used to detect the NF-κB transcription activity in HEK293 cells,immunofluorescence to detect RPS3 location, and EMSA to examine NF-κB DNA-binding activity.Results The expression vectors of RPS3-myc and RPS3S209A-myc were constructed.Compared with wild-type RPS3,the nucleus translocation, transactivation activity of NF-κB and DNA binding ability of RPS3S290A were reduced significantly .Conclu-sion The impact of RPS3 on NF-κB signaling pathway depend on its serine 209.

Objective To evaluate the POSSUM scoring system as preoperative risk assessment approaches for lower extremity arteriosclerosis obliterans (LEASO).Methods A retrospective study was undertaken in 108 patients ( 120 limbs) diagnosed as long segment LEASO from January 2008 to October 2010,in which,67 patients (74 limbs) receiving percutaneous transluminal stent (PTS) treatment were included into PTS group,and 41 patients (46 limbs) undergoing femoral artery to popliteal artery bypass treatment into bypass group.Rutherford classification was used to evaluate degree of chronic ischemia for lower limb and ankle/brachial index (ABI) for the treatment results in these two groups.The score of POSSUM,physiological score and physiological score without age interference were calculated respectively to estimate the risks for operations in two groups.Results The chronic ischemia conditions for two groups were similar (P =0.543 ).Postoperative follow-up was done for 9 - 15 months,there were no difference between two groups for limb salvage ( P =0.556 ) and patency rate ( P =0.632 ).Risk evaluation for patients: POSSUM score for the PTS group (33 ± 7 ) was similar with that of bypass group ( 32 ± 6 ) ( P =0.369 ) ; Physiological score of POSSUM for PTS group ( 24 ± 7 ) was more than that of bypass group ( 22 ±7) (P =0.033) ; Physiological score without age interference in PTS group (22 ±6)was higher than that of bypass group ( 19 ± 6) (P =0.035).Condusious The physiological score of POSSUM could assess the health status of patients with LEASO,which is more useful for pre-vascular surgery evaluations.

Objective To investigate the effect and safety of autologons bone margow-mononuclear cell (BM-MNC)transplantation after the bone marrow stimulation in patients with thromboangiitis obliterans (TAO).Methods The bone marrows of 12 patients were stimulated by an injection of the recombinant human granuloeyte-macmphage colony-stimulatory factor(GCSF)for 3-5 days.150-200 ml bone marrow was drown from the iliac spine and the autologous BM-MNC were obtained in each patients.Fifteen lower limbs of 12 patients received implantation of the autologous BM-MNC by an intramuscular iniecdon.A series of subjective indexes(including improvement of pain and cold sensation)and objeetive indexes [including increase of ankle braehial index(ABI),transcutaneons oxygen pressure(TcPO2)and improvement of foot skin ulcer] were used to evaluate the effects.Results The outcomes were evaluated after 2 months of transplantation.The pain-relief rate and the cold feeling improvement rate were 86.7%(13/15)and 93.3%(14/15)respectively.The ABI were 0.38 ±0.05 vs.0.61 ±0.14(P<0.05)before transplantation and 2 months after transplantation respectively.increased in 66.7%(10/15)limbs.The TcPO2 of the ischemic legs increased from(27.47±2.85)mm Hg to(43.53 ±8.38)mm Hg(t=-7.03,P<0.05)after the transplantation,and the improvement rate of TcPO2 was 93.3%(14/15).Skin ulcers in improved in 8/9 limbs.Twelve patients were followed up for all average period of 10 months.The patients'symptoms improved in 80.0%(12/15)limbs,as to the objective index the ABI was0.57±0.13,TcPO2 was(42.07 ±7.81)mm Hg,which improved significandy compared to before treatment(t=-5.33,-7.80,Ps<0.05).skin ulcer healing rate was 66.7%(6/9).The ischemic symptoms in 2 patients were not relieved.There WBS no mortality and high level amputation in all subjects.The complications,such as proliferative retinopathy,malitpmnt tumor,myocardial infarction,stroke or hemangioma were not found in any patients.Conclusion In patients with TAO,intramuscular transplantation of autologous BM-MNC after the bone marrow stimulation has advantages of less bone marrow aspiration,more mononuclear cell content and relatively high safety.It may be a new and effective method to alleviate symptoms and accelerate the healing of skin ulcer.

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 the role of transcranial Doppler (TCD) in carotid endarterectomy and the effect of carotid endarterectomy on extracranial carotid artery stenosis.Methods From January 2002 to December 2008, fifty eight patients (40 males and 18 females)with mean age of 64.5 years were treated in our hospital. Of these patients, forty had symptoms of cerebral ischemia, eighteen were asymptomatic. All the patients had 70% and up carotid artery stenosis. Forty one patients underwent simple suture closure of the arterial incision while nine patients had angioplasty with arterial patch (polyester) and eight with autologous great saphenous vein. TCD monitoring was used in the surgery of 32 patients excluding two patients using arterial shunt. Results Surgery was successful in all 58 cases except for deflected tongue-protrusion in five patients after operation, of which three recovered conservatively and two recovered after administration of cortical steroids for two weeks. Cerebral ischemic symptoms improved to a certain degree in all the 40 preoperative symptomatic patients. Cerebral hyperperfusion occurred in five of no TCD-monitoring patients ( 19.2% ), no hyperperfusion was found in TCD-monitored patients. Fifty three patients were followed up for a mean time of 42.5 months. Five patients died and three patients had carotid artery restenosis, of which two underwent PTA and stenting, one is still under surveillance.Conclusions Carotid endarterectomy is a safe and effective procedure for treating extracranial carotid artery stenosis. TCD monitoring is valuable for determining the use of arterial shunt and preventing postoperative cerebral hyperperfusion.

Objective To compare the long term outcome between traditional arterial bypass and interventional therapy for chronic lower limb ischemia according to the TASC classification. Method A retrospective study was undertaken on 201 cases receiving graft bypass or interventional therapy for CLI (chronic limb ischemia) from December 2005 to December 2008. Result The patency rate at 6 month. 12 month and 24 month after operation by femoral artery stent angioplasty in therapy group (100%, 89.8%, 75%) is higher than that of angioplasty group(82.4%, 62.5%, 35.7%), P <0.05. The 2nd term patency rate(88%) of operation group (24 months after operation) is higher than that of interventional group (70.7%), P<0.05. Conclusion Arterial bypass has higher long term patency rate and is applicable for femoral artery long segment obliterate classified as TASC C, D, while for the short segment femoral artery obliterate classified as TASC A, B interventional therapy especially stenting is an alternative despite of low patency rate.

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.

50%) rate of 11.6%.Conclusions Endovascular stent placement is a safe and effective procedure and may be selected as the first choice for severe subclavian arterial occlusion.Short-term follow-up shows a satisfactory clinical outcome.