Objective:To explore the relationship between the degree of devascularization and clinical outcomes after interventional embolization and sclerotherapy for peripheral arteriovenous malformations.Method:A retrospective analysis was conducted on the data of 37 patients with peripheral arteriovenous malformations admitted at Department of Cardiovascular Surgery, China-Japan Friendship Hospital from July 2021 to June 2023. All patients received the treatment of "nidus" and/or outflow veins embolization combined with sclerotherapy injection. Two experienced physicians evaluated the degree of devascularization before and after treatment, and conducted a correlation study with clinical outcomes after follow-up.Result:All 37 patients were symptomatic. Swelling and pain accounted for 75.7% of all the cases. Twenty-six patients received only one procedure, 3 patients received re-interventional treatments. The average follow-up time was（13.3±5.0）months. Clinical symptoms were completely relieved in 14 patients, and partial relief in 22 patients. The overall effective rate was 97%. There were 6 patients with degree of de vascularization<50% during procedure, 16 patients with degree of 50%-75%, and 5 patients with degree of 75%-90%, 10 cases with degree over 90%. Patients with devascularization degrees less than 60% can not achieve clinical symptom relief.Conclusions:There is a positive correlation between the degree of devascularization and clinical outcomes in the interventional embolization and sclerotherapy of peripheral arteriovenous malformations, and 60% of the degree of devascularization can serve as the "threshold" for effectiveness of treatment.

Objective:To investigate the effect of carotid endarterectomy(CEA) in the treatment of symptomatic carotid artery near-occlusion(CNO).Methods:Clinical symptoms, imaging examination, treatment and prognosis of 122 symptomatic CNO patients admitted to China-Japan Friendship Hospital from Jan 2014 to Jan 2020 undergoing CEA were retrospectively analyzed. Patients were divided into two groups based on the collapse condition,full collapse group(54 cases) and non-full collapse group(68 cases).Results:The difference was insignificant between the two groups at the 30-day and 12-month occurrence rate of primary endpoints(1.85% vs. 4.41%, P=0.629;7.41% vs. 4.41%, P=0.698).Postoperative re-stenosis occurred in one case in the non-full collapse group 8 months after CEA. Conclusions:CEA can achieve good curative effect for patients with CNO with recurrent symptoms, irrelevant to the existence of distal full collapse. The shunt can prevent intraoperative hypoperfusion and postoperative hyperperfusion.

Objective:To evaluate the efficacy of different carotid artery revascularization strategy in sychronous carotid and coronary artery revascularization.Methods:The clinical data of 53 patients receiving simultaneous carotid and coronary artery revascularization in China-Japan Friendship Hospital from Jan 2014 to Dec 2019 was retrospectively analyzed. The clinical characteristics, imaging examination, treatment and prognosis were collected and reviewed. Patients were divided into CEA group (42 cases) and CAS group (11 cases) according to the carotid artery revascularization method.Results:The mean operative time and blood loss of CEA group were (288.81±43.28) min and (419.05±127.33) ml, respectively. The mean operative time and blood loss of CAS group were (251.82±23.16) min and (318.18±98.16) ml, respectively. The difference of operative time and blood loss between the 2 groups were not significant (all P>0.05). Four minor strokes, 4 transient ischemic attacks (TIA), 2 pulmonary infections and 4 recurrent laryngeal nerve injury were observed in CEA group. Two TIA and 1 re-thoracotomy for hemostasis occurred in CAS group. Conclusions:Both carotid endarterectomy and carotid stenting can achieve good clinical result in synchronous carotid and coronary artery revascularization procedure. The selection of proper carotid artery revascularization method should base on the lesion characteristic and surgeon's experience.

Objective:To evaluate the safety and efficacy at 1-year follow-up of the use of drug-coated balloon (DCB) for the treatment of femoropopliteal in-stent restenosis (ISR).Methods:This study enrolled 252 patients undergoing Orchid DCB angioplasty for peripheral arterial disease in the femoral-popliteal segment. The clinical data were retrospectively analyzed.Results:Forty-nine patients were eligible, including 29 (59.2%) chronic total occlusions belonging to TransAtlantic Inter-Society Consensus-Ⅱ(TASC Ⅱ) D, 7 (14.3%) thrombosis, and 14 (28.6%) moderate to severe calcifications. The mean lesion length was (215.9±97.1) mm. 69.4% were of occlusive lesions (Tosaka Ⅲ category). Only 1 provisional stent was implanted. 98% patients had severe claudication or even worse. Of these cases, 34 (73.9%) showed improvements in Rutherford category, while 11 (23.9%) did not change and 1 (2.2%) case deteriorated. The average value of ABI was 0.478±0.264 before surgery and 0.907±0.207 at the end of follow-up. The improvement in Rutherford category ( P<0.01) and ABI ( P<0.005) were both significant. The primary patency (PP) was 80.4%, and the freedom from clinically driven TLR was 84.8% at 1 year. During the follow-up period, there was no all-cause death and major limb amputation. Conclusion:This multicenter study demonstrated the effectiveness of DCB as a treatment for complicated and extensive ISR lesions within 12 months.

Objective To explore the effect of angiogenesis in carotid atherosclerotic plaque.Methods From Jan 2016 to Aug 2016,Carotid artery plaque was abtained in 52 cases after carotid endarterectomy at the Department of Cardiovascular Surgery of China-Japan Friendship Hospital.Patients were divided into symptomatic group and asymptomatic group.Specimens were stained with HE and Movat,and the density,size,distribution and morphology of neovascularization were counted.Results The density of neovascularization in the symptomatic group and the asymptomatic group were 5.27 ± 0.46 and 2.30 ±0.29,respectively (P ＜ 0.001),the average cross-sectional area of neovascularization in the symptomatic group was (2.26±0.21) mm2 and (1.00 ±0.48) mm2 in the asymptomatic group (P=0.02).In the distribution,the symptomatic group and the asymptomatic group were 3.37 ± 0.46/ mm2,1.32 ±0.16/mm2 in basal part,3.71 ±0.42/mm2,1.56 ±0.20/mm2 in the shoulder part,3.48 ±0.44/mm2,1.55 ± 0.21/ mm2 in the fibrous cap,respectively (P ＜ 0.001).Conclusion The density and cross-sectional area of neovascularization in the symptomatic group were larger than those in the asymptomatic group,irregular branching vessels were dominant.

Objective To evaluate diagnostic method and treatment strategy for free floating thrombus in carotid artery.Methods From Ju12016 to Oct 2017,7 patients with free floating thrombus in carotid artery was diagnosed at our department.The medical history,symptoms,diagnosis,treatment strategy and prognosis of those patients were analyzed retrospectively.Results Among 7 patients,4 were symptomatic;4 patients were concomitant with severe carotid artery stenosis and 3 with mild to moderate stenosis.3 received carotid endarterectomy and patch angioplasty.4 received carotid artery stenting with distal cerebral protection divice.There was no perioperative and 30-day stroke,myocardial infarction,death or hyperperfusion syndrome occurred.The 12-month follow up showed no restenosis,no free floating thrombus recurrence and no ischemic cerebrovascular event.Conclusion Free floating filling defect in carotid artery is a typical sign for unstable plaque.Both carotid endarterectomy and carotid artery stenting can be used for the treatment of free floating thrombus.

Objective To evaluate the feasibility and safety of simultaneous carotid endarterectomy (CEA) and carotid stenting (CAS) for bilateral carotid stenosis.Methods From Jan 2012 to Aug 2014,8 patients underwent simultaneous CEA and CAS.The surgical plan was based on clinical features and imaging findings.CEA before CAS was done in 5 patients,CAS before CEA was done in 3 patients.One patient also underwent simultaneous coronary artery bypass grafting due to unstable angina.Results Operation success rate was 100％.Intraoperative carotid shunts,patches and embolic protection devices were used in all patients.One patient developed post-procedural hyperperfusion syndrome and returned to normal after symptomatic treatment.The remaining patients recovered uneventfully,there were no cerebrovascular accident,nerve injury or wound complications.Follow-up period was 18-48 months,follow-up rate was 100％.During the follow-up,all patients were relatively stable,no re-stenosis,death or cardiovascular events.Conclusions Through thorough evaluation,careful preparation,and strict management,simultaneous CEA and CAS is a technically feasible and safe treatment strategy for bilateral carotid stenosis.

Objective To study the clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis.Methods The clinical data of 36 patients with 1-year follow-up who had a wrist ulnar-basilic arteriovenous fistula formed in China-Japan Friendship Hospital from January 2013 and December 2014 were retrospectively analyzed.The outcomes for this study including the surgical results,complication rate of ulnar-basilic arteriovenous fistula,immediate patency rate,average maturation time,1-year primary patency rate and true patency rate were analyzed.Results Thirty-four cases patients got successful ulnar-basilic arteriovenous fistula formed with palpable vascular thrill.There were no death cases and no severe cardio-cerebrovascular complications.No infection,heart failure,distal swelling and ischemia occurred.The immediate patency of ulnar-basilic arteriovenous fistula was 94.4%(34/36),the average maturation time was (67±4) d,1-year primary patency rate was 63.9%(23/36),and true patency rate was 67.6%(24/36).Conclusion Ulnar-basilic arteriovenous fistula with adequate 1-year primary patency and low risk of infection and complications can be a viable alternative as the hemodialysis vascular access.

Objective To compare the outcome of combined and staged approach on concomitant carotid and coronary severe stenosis.Methods From March 2013 to May 2015,27 patients with concomitant carotid and coronary severe stenosis were treated by carotid endarterectomy and coronary artery bypass grafting,15 cases received one-stage operation and 12 staged.The basic characteristics,details during surgery,complications,quality of life score,hospital stay and cost were compared.Results 27 patients received carotid endarterectomy and off-pump coronary artery bypass grafting under general anesthesia.Revascularization were performed on 27 carotid and 82 coronary artery.The characteristics of patients were similar between two groups,reflected with WIC,combined approach subgroup was (5.27 ± 0.88) and staged subgroup was (4.92 ± 1.24).The operation time was significantly decreased in the synchronous group [(295.33 ± 49.73)min vs (390.83 ± 73.45) min,P ＜ 0.001].Hospital stay days was also reduced [(30.20 ± 12.91) days vs(44.67 ± 6.34) days,P =0.002],the medical cost was lower in combined approach group,but no significant statistical difference.The complications including 1 case TIA,1 recurrent nerve injury in one-stage group and 1 case myocardial infarction,1 mediastinal bleeding post-operation and 1 pulmonary infection in stage group.No cerebral infarction and death.Quality of life scores(SF-36) of the two groups was 5.53 ± 1.30 and 5.75 ± 1.36 respectively,no significant difference.Conclusion The efficacy and safety of treatment for concomitant carotid and coronary severe stenosis patients with combined or staged approach was similar.But the combined approach program can reduce the hospital stay time and cost in some degree.

Objective To evaluate carotid endarterectomy (CEA) for bilateral moderate to severe carotid stenosis.Methods The clinical data of 59 patients with bilateral moderate to severe carotid stenosis who were treated with CEA in our hospital from October 2010 to August 2014 were retrospectively analyzed.There were 50 males and 9 females age ranging 42-80 years (mean:65 ± 9 years).48 patientsunderwent ipsilateral CEA and 11 underwent staged bilateral CEA.In patients who were confirmed to have coronary artery disease or peripheral vascular disease by preoperative angiography,6 received coronary artery bypass graft (CABG)simultaneously,1 received iliac artery balloon angioplasty and stent implantation simultaneously,and 1 received renal artery stenting simultaneously.Results A total of 70 endarterectomies were performed,shunt and patching were used in all patients,the surgical success rate was 100％.2 patients suffered from vagus nerve injury,4 patients suffered from hypoglossal nerve injury,and 3 patients presented with hyperperfusion syndrome.Follow-up period was 2-36 months (mean:19 ± 10 months).1 patient died of heart attack during the follow-up,the other patients were relatively stable with no restenosis.Conclusion CEA should be performed in patients with bilateral moderate to severe carotid stenosis,and the prognosis is good.