Objective:To investigate the mid- to long-term outcomes of endovascular treatment with Supera interwoven nitinol stents in patients with chronic limb-threatening ischemia (CLTI).Methods:From April 2017 to December 2020, clinical data from 303 CLTI patients aged over 50 years and treated with Supera stent were collected and analyzed retrospectively at three centers including Department of Vascular Surgery of Zhongshan Hospital of Fudan University, Department of Vascular Diseases of Shanghai TCM-Integrated Hospital, and Department of Vascular Surgery of Wenling Hospital of Traditional Chinese Medicine of Zhejiang Province. Among them, there were 205 males and 98 females, with an age of (74.0±10.1) years. Telephone follow-up and collected the overall survival, clinically driven target lesion revascularization (CD-TLR), major amputation, and wound healing. The Kaplan-Meier method was used to draw survival curves and the Log rank test was used to compare the survival differences between the two groups of patients.Results:Follow-up was obtained in 296 patients, with a follow-up duration of (23.6± 2.9) months. Kaplan-Meier survival curves showed that the overall survival rates at 6, 12, 24, and 36 months were 99.0%, 96.2%, 86.1%, and 77.4%, respectively. The proportions of patients without CD-TLR at 12, 24, and 36 months were 94.2%, 91.1%, and 89.6%, respectively. During the follow-up period, 15 patients underwent major amputations, with a total limb salvage rate of 92.7% (281/303) and an effective limb salvage rate of 94.9% (281/296). Among 268 patients with preoperative wounds, 203 healed, with a wound healing rate of 75.7%. The Kaplan-Meier survival curve indicated that patients with wounds healed had a higher survival rate compared to those whose wounds did not heal, with a statistically significant difference (Log-rank χ2=32.894, P<0.01). Meanwhile, in terms of diabetes, Meggitt Wagner classification, Rutherford classification, the number of lesions and the number of preoperative outflow tracts, there were statistically significant differences between the wound healing group and the non-healing group ( P values were 0.025, 0.007, 0.005, 0.049 and 0.004, respectively). Conclusions:The utilization of Supera interwoven nitinol stents in CLTI patients demonstrates clinical benefits in improving wound healing rates and limb preservation.
To improve the efficacy of endovascular treatment of arteriosclerosis obliterans of the lower extremities, it is first necessary to correctly evaluate and distinguish the nature of the lesion, select the appropriate vascular preparation method and make a correct evaluation of its results. On this basis, it can be decided whether to use a drug-coated balloon or implant a stent. If the latter option is chosen, it is necessary to understand the performance and characteristics of each stent and select the most suitable one according to the nature of the lesion. This follows the idea of "leave the right thing behind".
Objective:To investigate the clinical outcomes of endovascular treatment of complex aortoiliac artery occlusion (AIOD).Method:The data of 71 AIOD patients admitted to the Department of Vascular Surgery of Fuwai Hospital from January 2016 to December 2022 were retrospectively analyzed. All of them, 66 males and 5 females with a age of (64.4±8.9) years(range: 39-38 years), were identified as grade D in the second edition of Trans-Alantic Inter-Society Consensus (TASC-II). All patients underwent aortoiliac artery endovascular intervention and their follow-up results were obtained. Univariate and multivariate logistic regression analysis was applied to screen the risk factors affecting post-operative patency rate, and Kaplan-Meier curve was used to analyze the survival rates.Results:Sixty patients received first-stage stent implantation and 11 patients received second-stage stent implantation after catheter-directed thrombolysis with a technical success rate of 100%. Among them, 51 patients received kissing stent implantation,7 bare metal stent implantation,2 iliac artery stent implantation combined with fermoral endarerectomy, and 11 covered stent combined with bare metal stent implantation. The average preoperative ankle-brachial index(ABI) was 0.53 ± 0.26, and the postoperative ABI was 0.92 ± 0.21, which was significantly improved ( t=27.305, P<0.01). Among the 71 patients, acute stent thrombosis occurred in 2 cases, puncture complications in 3 cases and external iliac artery ruputure in 1 case. A number of 65 cases were followed (91.5%). The median follow-up time was (42.5±21.8) months, during which in-stent restenosis occurred in 12 cases and 1 patient underwent above-knee amputation 1 month after the surgery. The primary patency rate was 81.5% (53/65), the secondary patency rate was 100% and the limb salvage rate was 99% (64/65). Multivariate logistic regression analysis showed that severe calcification was an independent factor affecting postoperative patency rate ( OR=9.56,95% CI:1.76~51.77, P=0.01). Kaplan-Meier survival curve showed that the patency rate of patients with severe calcification was lower than that of patients without severe calcification, and the difference was statistically significant (Log-rank χ2=10.038, P=0.01). Conclusion:Endovascular treatment of complex AIOD has a high long-term patency rate. Long-term patency rate can be affected by severe calcification.
The endovascular treatment of lower extremity arteriosclerosis obliterans (ASO) has flourished and become the preferred treatment option. With the advancement of devices and technology, this kind of treatment is applied in expanded indications with improving effectiveness. This article introduces some hot topics in the endovascular treatment of lower extremity ASO.
Objective:To evaluate the efficacy and safety of low-dose novel oral anticoagulant rivaroxaban for the treatment of acute isolated distal deep vein thrombosis (IDDVT).Methods:A retrospective analysis was conducted on clinical records of 113 patients diagnosed with acute IDDVT from January to October 2021 at the Department of Vascular Surgery of Shanxi Bethune Hospital. The patients underwent color Doppler ultrasound for DVT diagnosis as well as routine blood tests, liver and kidney function tests, and tests of coagulation indicators. After the diagnosis was confirmed, all patients received treatment with rivaroxaban. The patients were divided into two groups according to doses: a low-dose anticoagulant group (54 cases) and a standard-dose anticoagulant group (59 cases). Thrombus regression, progression rate of proximal thrombus, all-cause mortality, and anticoagulant-related bleeding complications were evaluated between the two groups after treatment.Results:There was no significant difference in the incidence of proximal deep venous thrombosis (PDVT),pulmonary embolism (PE), and PDVT/PE between the low-dose anticoagulant group and the standard-dose anticoagulant group (all P>0.05). Regarding thrombus regression, there was no statistically significant difference between the two groups, but the standard-dose group had slightly better performance than the low-dose group (27.1% vs. 22.2%, P=0.211). However, the incidence of non-major bleeding events in the low-dose anticoagulant group was lower than that in the standard-dose group, demonstrating a statistically significant difference between the two groups (1.9% vs. 15.3%, χ2=6.278， P=0.032). No statistically significant difference in the incidence of major bleeding events was found between the two groups ( P=0.485). Conclusion:Low-dose anticoagulant therapy for acute IDDVT has comparable efficacy to standard-dose anticoagulant therapy, but with fewer bleeding events and higher safety.
下肢静脉曲张的主要病理生理变化是瓣膜单向开放功能受损、深静脉高压或穿静脉功能不全导致的浅静脉反流，因此用超声探寻下肢静脉的反流来源在术前评估中具有重要意义。本文阐述了下肢静脉曲张的反流来源及血流动力学变化，为下肢静脉曲张的个性化治疗提供参考。
The incidence and disability rate of lower extremity atherosclerotic obliterans are increasing year by year, which seriously jeopardizes the quality of life of patients and imposes a significant burden on the socio-economic development. The advantages of endovascular treatments, such as less trauma and faster recovery have rendered endovascular treatments the first choice for lower extremity atherosclerotic obliterans. However, there are still problems such as restenosis and a high rate of target lesion reintervention after endovascular treatments. This article briefly introduces how to use the existing endovascular treatments in perioperative preparation and intraoperative blood vessel preparation, so as to effectively improve the long-term patency rate of target lesion vessels.
Objective:To analyze real-world clinical data and efficacy on endovascular interventions for moderate to severe calcification in femoropopliteal arteriosclerosis obliterans based on the database VASCBASE.Methods:From January 2021 to December 2022, clinical data on patients enrolled in the Evolusion program (NCT04716361) at the Department of Vascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine were collected. All patients, baseline condition gathered, were followed through May 1, 2023. Observations included the rate of technical success, the freedom from clinically driven target lesion revascularization(CD-TLR), the patency rate of target lesion, and the improvement in quality of life.Results:A total of 281 patients were enrolled, with 194 (69%) being male and the age being (73.8±10.7) years. Among them, 216 cases were diagnosed with total occlusion. Of all participants, 6 cases were classified as Rutherford category 2; 148 cases were classified as category 3; 51 cases, category 4; 73 cases, category 5; and 3 cases, category 6. The ankle-brachial index (ABI) was 0.32 (0.07,0.52) with an average lesion length of (17.5±8.1) cm. Vascular-targeted therapy was applied for the treatment of mere superficial femoral artery (140 cases; 49.8%), popliteal artery together with superficial femoral artery (118 cases, 42.0%), and other arteries (23 cases, 8.2%). Full stent coverage, drug-coated balloon (DCB)dilation, and local stent implantation following DCB pre-dilation or conventional balloon dilation were the most frequently used surgical techniques, accounting for 37.4%(105/281), 29.5%(83/281), 9.6%(27/281), and 8.2%(23/281) of cases, respectively. The rate of technical success was 100% with one postoperative complication (hematoma at the puncture site). Following surgery, the patients were followed up via mobile phone and outpatient services. The follow-up rate via mobile phone was 89.0%, 89.0%, 87.9%, and 78.3% at 1, 3, 6, and 12 months, respectively. The follow-up rate via outpationt service was 87.5%, 81.8%,66.9% and 30.9% at 1,3,6 and 12 months,respectively.At 1, 3, 6, and 12 months, the Vasc-QOL score was 5.56±1.18, 5.89±0.8, 6.09±0.82 and 6.19±0.93, respectively and the EQ-5D-5L score was 20 (18, 20), 20 (19, 20), 20 (20, 20) and 20 (20, 20), respectively, the difference was statistically significant ( F=13.91, P=0.001; H=0.005, P=0.001). At 1, 3, 6, and 12 months, 96.4% (241/250), 92.8% (232/250), 91.9% (227/247), and 89.1% (196/220), respectively, of patients were exempted from CD-TLR. Meanwhile, the primary patency rates were 87.8% (216/246), 73.9% (170/230), 61.7% (116/188), and 44.8% (39/87), respectively. Conclusions:Moderate to severe calcification of the femoropopliteal occlusive sclerosis primarily affects elderly men; risk factors include diabetes, hypertension, obesity, and smoking. Interventional procedures for the lower limbs have a high rate of efficacy and few complications. At one year, the rate of freedom from CD-TLR was greater, whereas the rate of primary patency was lower.
The prevalence of chronic limb-threatening ischemia (CLTI) is increasing year by year with the aging population, and the life quality and life expectancy of patients are severely affected. Effective revascularization is an essential treatment for symptomatic relief and ulcer healing in patients with CLTI, but the rate of restenosis in diseased vessels remains high as well as the efficacy of reoperation is not as good as it should be. Therefore, the strategy of the first treatment for CLTI is particularly important for its prognosis.However,the treatment for CLTI is still controversial, especially in terms of the timing of intervention, strategy of intervention, and means of intervention. This article briefly describes the current strategies of revascularization in chronic limb-threatening ischemia and its clinical controversies.
Objective:To establish a three-dimensional model of lower extremity arteriosclerosis obliterans (LEASO) using Mimics with data from computed tomography angiography (CTA) and digital subtraction angiography (DSA) and to evaluate the safety, effectiveness and accuracy of the diagnosis and treatment of the disease based on the established model.Methods:From January 2020 to March 2023, the data of 70 patients with LEASO who underwent enhanced thin-slice CT and DSA examination of lower extremity arteries in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Henan University were collected, and three-dimensional modeling of lower extremity arteries and plaques was performed by Mimics. The stenosis grading in artery segments, diagnostic agreement rate of diseased arteries, lesion length, stent diameter, and peripheral artery calification scoring system (PACSS) grade were compared between Mimics and DSA. The calcified plaque volume and the calcified proportion of mixed plaques were compared between Mimics and CTA.Results:The diagnostic coincidence rate of Mimics was 94.29% (792/840) with 3.81% (32/840) of overestimation and 1.90% (16/840) of underestimation. For the arterial segments with a stenosis of at least 50%, the sensitivity (97.19%,311/320), specificity (98.08%,510/520), false positive rate (1.92%,10/520), false negative rate (2.81%,9/320), and accuracy (97.74%,821/840) were obtained. The Kappa coefficient was 0.952, suggesting almost perfect agreement. There was no significant difference in the measurement of lesion length and stent diameter between Mimics and DSA (both P>0.05). There was no significant difference in the measurement of calcified plaque volume and the calcified proportion of mixed plaques between Mimics and CTA (both P>0.05). The coincidence rate of Mimics in PACSS grading was 95.07% (135/142) with 1.41% (2/142) of overestimation and 3.52% (5/142) of underestimation. Conclusion:The three-dimensional reconstruction model based on Mimics can visually display the location of lower extremity arterial lesions, and accurately measure the degree of stenosis, lesion length, vessel diameter, plaque volume, etc., which are significant in accurate preoperative diagnosis and treatment of LEASO.
非复杂型Stanford B型主动脉夹层适宜的胸主动脉腔内修复术（TEVAR）时机目前仍存争议，亚急性期（14~90 d）行TEVAR手术的患者具有更低的再次干预率与严重并发症发生率，而急性期（48 h~14 d）的手术可减少动脉瘤发生与破裂风险，提高术后主动脉重塑率。临床上仍需通过综合评估患者的影像学特征，并结合高级别的临床试验证据，寻找最佳的TEVAR手术时间窗。
Compression therapy plays a crucial role in the treatment of lower extremity venous diseases. It can effectively alleviate the discomfort of the affected limb and delay the progression of the disease, making it widely applied in clinical practice.Given the diversity of available compression therapy products,clinical outcomes can vary significantly. A comprehensive understanding of the relevant knowledge and clinical application of compression therapy is of great significance for improving patient compliance and clinical effectiveness. Therefore, this article mainly introduces the mechanism, contraindications, compliance and clinical application of compression therapy in lower extremity venous diseases.
本文从血管超声造影、血管内超声成像、三维及四维超声血管成像技术三个角度分别介绍其原理、安全性及目前的临床应用情况，并简要介绍超声血管成像技术的前沿进展，包括设备更新、多技术联合及对未来发展方向的展望。
四维血流磁共振成像（4D flow MRI）技术的快速发展使得更多的临床工作者开始关注其在血管疾病中的应用价值。4D flow MRI可以同时获取血管解剖学与血流动力学信息，并且动态展示血流动力学的变化，包括血流速度、血流量、剪切力及动能等，亦可通过流线图、迹线图等形式直观显示血流方向和血流状态，对血管进行定性与定量分析，可帮助探究血管疾病的病因及影响疾病进展的因素。本文就4D flow MRI的原理及其获得的血流动力学指标进行概述并讨论其临床应用。
静脉血栓栓塞症（VTE）是由多种因素相互作用的复杂性慢性多病程疾病，抗凝治疗为现今公认的一线治疗手段，但无论使用何种抗凝药物，均不可避免地增加了出血风险，且部分患者存在抗凝禁忌证。非抗凝治疗或替代治疗为当前研究的热点内容，随着血栓形成及炎性反应之间关系的逐渐清晰，具有抗炎特性的药物（如他汀类药物、静脉活性药物等）在VTE中的应用也得到了大量数据的支持，本文就近年来具有抗炎作用的药物在VTE中治疗的应用与进展进行综述。
海南省属热带海洋性季风气候，全年温差小，气候稳定，对动脉疾病的常见诱因如高血压病、高血脂病及糖尿病等疾病的治疗有所帮助；也因其独特的气候和地理环境，每年吸引大量候鸟人群前来过冬，仅2017年海南省候鸟人口总量便达130.98万人，其中大多来自中国东北、华北及华中地区，65%以上为60岁以上人群，且多伴随高血压、糖尿病及其他基础疾病。这类人群往往也伴随不同程度血管病变，对全岛血管外科诊治工作提出重大考验。本文结合海南省气候条件、地理环境、当地居民生活习惯以及特有致病菌等，通过国内外文献综合分析海南省内动脉疾病较内陆地区在发病及诊疗方面的区别与特点，对海南省内居民动脉疾病的预防和治疗提出思考。
Venous thrombosis is a common vascular disease, which can lead to severe complication such as pulmonary embolism and post-thrombotic syndrome. So both domestic and overseas academy emphasize the diagnosis and treatment of venous thrombosis. "European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis" is the latest guideline which provide recommendation about the diagnosis, anticoagulation, compression therapy and thrombus removal of venous thrombosis based on the latest evidences. Besides, it also included the diagnosis and treatment of infrequent location and special population. This paper will introduce and explain some important contents of the guideline in order to provide reference to our clinical practice of venous thrombosis management.
急性主动脉夹层（AD）是一种高度致命性的血管外科急症。尽管过去的20多年对急性AD的外科及腔内治疗取得了巨大进展，但其发病机制目前尚不清楚。研究显示急性AD最主要的病理特征主要包括内皮细胞损伤，平滑肌细胞耗竭，炎症细胞浸润和细胞外基质降解等。在此基础上，突发的高血压状态下，血流冲击、撕裂内膜进入主动脉中层，导致急性AD的形成。本文系统回顾了近年急性AD的分子生物学机制研究成果，并进行了分析、归纳和总结，显示多因素、多信号通路的共同作用导致了急性AD的形成。
