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.

With the development of percutaneous transluminal angioplasty, stent implantation has gradually become an important treatment for peripheral artery diseases, especially for arterial diseases of lower extremities. Due to the continuous exposure of the disadvantages of permanent metal stents and the continuous development of absorbable materials, researchers gradually pay attention to the bioresorbable stents with fewer long-term complications. At present, the application of bioresorbable stents in coronary artery disease has been relatively mature. This paper reviews the research progress of bioresorbable zinc alloy stents in peripheral artery disease.

Great progress has been made in devices and techniques for the endovascular treatment of peripheral artery diseases. The plain old balloon angioplasty, stent implantation and the emerging drug-coated balloon angioplasty have provided new means of treatment. In recent years, drug-coated balloons have been proved valuable by many clinical trials for the treatment of superficial femoral and proximal popliteal artery lesions. However, there are still insufficient evidence and much controversy about the role of drug-coated balloons in treating infrapopliteal lesions. This article will briefly review the current research status and progress of drug-coated balloons for the treatment of infrapopliteal lesions.

The incidence of iliac vein occlusion is high in clinics. Most of them are latent disease. Non-thrombotic iliac vein occlusion is an important cause of chronic venous diseases in lower limbs. Post thrombotic syndrome and iliac vein compression syndrome are two main forms non-thrombotic iliac vein occlusion. Stent implantation is the first-line treatment method for iliac vein occlusion. Reasonable stent diameter selection and accurate positioning are two key technical points to ensure high patency rate of iliac vein stent. Intravascular ultrasound plays an important role in diagnosing iliac vein occlusion and stenting. After iliac vein stent implantation, regular ultrasonic follow-up is required, and optimal postoperative drug therapy is still controversial. The development and application of new specialized iliac vein stent is expected to further improve the clinical effect of iliac vein stent implantation.

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 a new biodegradable inferior vena cava(IVC) filter by in vitro and in vivo experiments.Methods The biodegradable filter consisted of metal stent and absorbable suture,which acts as a degradable deformable switch of the filter.When the suture of the proximal metal filter degrades and lost its tension,the metal filter will change into a stent.In vitro experiments were performed to test the influence of the sterilization method and the tension of absorbable sutures to the filter's selfconvertible time,animal experiments were conducted to evaluate the effectiveness of emboli capture and to observe the in vivo self-convertible time of the filter.IVC stenosis,pulmonary embolus and intimal hyperplasia and inflammation were evaluated.Results Ethylene oxide sterilization did not have an adverse effect on the self-convertible time of the filters.The tension did not affect the degradation rates of the suture significantly.In animal experiments,the VCFs were successfully implanted via femoral vein approach.Not any tilt,migration or structural damage of the filters was found during the follow-up time.Postoperative fluoroscopy and autopsy confirmed that there was no stenosis or thrombosis,IVC perforation.After implantation large thrombi were captured.The sutures degraded and filters transformed into stents in 3 weeks.After 90 days IVC was patent with mild intimal hyperplasia and no thrombosis.Conclusions This study demonstrated the effectiveness and safety of the biodegradable filter we designed.

Objective: To investigate the effect of Gradient treatment for acute superior mesenteric venous thrombosis (ASMVT). Methods: Clinic data of 68 patients of ASMVT admitted in Department of General Surgery, Jinling Hospital, Medical School of Nanjing University from January 2009 to December 2014 were analyzed retrospectively. There were 50 male and 18 female patients with a mean age of (45±12) years. These patients were conducted by the stepwise treatment model (endovascular treatment-damage control surgery-surgical intensive care-intestinal rehabilitation treatment). Clinical outcomes and complications were compared during the follow-up period. Differences about bowel resection length of endovascular treatment and surgical procedures were evaluated with t test. Results: In the 68 cases, 24 cases were cured simply by endovascular treatment, 19 cases received surgical procedures alone (group surgery). Twenty-five patients received endovascular treatment combined with surgical procedures (group combined), including 6 cases temporary abdominal closure. The overall mortality rate was 2.9% (2/68) during hospitalization. The range of bowel resection of group combined significantly reduced compared with group surgery ((92±14) cm vs. (162±27) cm, t=-2.377, P=0.022). During 1-year follow-up period, 4 cases suffered from short bowel syndrome, whom underwent surgery alone. Conclusions Early diagnosis and treatment is the key to treatment of ASMVT, the rapid improvement of intestinal ischemia is particularly important for prognosis. Combination therapy significantly save more residual small intestine and avoid short bowel syndrome. The selection of early gradient treatment can significantly reduce the mortality and improve the prognosis of ASMVT patients.

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.

Critical lower limb ischemia(CLI) is a severe manifestation of arteriosclerosis obliterans of lower extremity,infrapopliteal artery occlusion is an important cause of CLI.Both limb salvage and life quality improvement are therapeutic targets for CLI.With the development of technology and equipment,endovascular treatment has become the main means for infrapopliteal arterial occlusive diseases.Because of the unique anatomic features of infrapopliteal artery,great therapeutic difficulty and high incidence of restenosis,a series of controversial issues have been emerged.The main controversial issues are as follows:(1) Which should be taken as first choice of treatment,endovascular therapy or traditional bypass surgery? (2) How to select target vessels in treating infrapopliteal artery occlusion? (3) How to select optimal access in performing endovascular treatment of infrapopliteal artery? (4) How to optimize the endovascular surgical method for infrapopliteal arterial occlusive disease? Based on the latest advance in evidence-based medicine and on the clinical treatment experience,this paper aims to make a detailed description concerning the above mentioned hot issues in clinical practice as well as in academic consideration about endovascular treatment of infrapopliteal arterial occlusive diseases.

Venous leg ulcers ( VLU) are open skin lesions of the lower extremities that occur in an area affected by venous hypertension .Due to the long healing time , high prevalence and recurrent rate , VLU always comes with a heavy economic burden that affects the quality of life of the patients .Currently, compression therapy is the main approach for treatment of VLU .However, which is the most effective device for compression therapy is still controversial .This article reviews the cutting-edge advances of the clinical compression therapy for VLU , which would provide a reference for clinicians to set an optimal strategy for VLU treatment.