Acute iliofemoral deep vein thrombosis (IFDVT) often leads to femoral vein valve incompetence and post-thrombotic syndrome (PTS). This study evaluated whether thrombus volume reduction surgery (TVRS) is associated with better valve function preservation compared with simple anticoagulation (SA) in patients with acute IFDVT. A combined retrospective and prospective cohort study involving 504 patients with acute IFDVT compared TVRS (n = 238) and SA (n = 266). The primary outcome was the femoral vein valve preservation rate at 12 months. Secondary outcomes included PTS incidence and quality of life. Subgroup analysis compared two pharmacomechanical thrombectomy devices: AngioJet and Acostream. Propensity score matching (1:1 nearest neighbor, caliper 0.05), inverse probability of treatment weighting, and E-value sensitivity analysis were employed to address confounding. An exploratory mediation analysis (hypothesis-generating) examined whether valve preservation potentially mediates the association between TVRS and PTS reduction. The TVRS group showed a significantly higher valve preservation rate (75.8

BACKGROUND:In-stent restenosis remains a challenge in superficial femoral artery (SFA) treatment, though a great efficacy has been shown in drug-eluting stents (DESs). The concept of "leave nothing behind" has further driven interest to bioresorbable vascular stents. Some drug-eluting resorbable scaffold (DRS) has shown promise in coronary artery and SFA. We brought a first in-human study of DRS for treatment of peripheral artery disease (PAD) involving the de novo lesions in SFA. METHODS:This DRS system is a device-drug combination consisting of a paclitaxel-eluting poly (L-lactide-co-ε-caprolactone) scaffold, using proprietary 3D multi-axis precision printing technology. Safety and performance were evaluated in 30 patients with de novo occlusion or stenosis in SFA. RESULTS:De novo lesions were located in SFA. Mean lesion length was 37.76 ± 17.45 mm. The study device was successfully deployed in 100% of cases. At 12 months, there were two unrelated deaths, and no amputations occurred in the rest cases. The binary restenosis rates were 4.35%. The ankle brachial index improved from preprocedural 0.58 ± 0.17 to 0.83 ± 0.17 at 12 months of follow-up (P < 0.0001). At 2 years, 85.71% of the patients improved in Rutherford-Becker compared to the score preprocedure. CONCLUSION:The safety of this DRS was demonstrated with no procedure or device-related deaths and amputations within 2 years. The low occurrence of revascularizations was consistent with duplex-ultrasonography showing sustained patency at 12 months. The percent of improvement in Rutherford-Becker clinical category was still high at 2 years.

Background: This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). Methods: This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into 2 groups: those receiving anticoagulation alone with no pharmacomechanical catheter-directed thrombolysis applied (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into 3 subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both PMT and catheter-directed thrombolysis (PMT + CDT group). The incidence of postthrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. Results: The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT + CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale >5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; odds ratio [OR], 0.446; 95% confidence interval [CI], 0.2530.787; P- 0.005; and VCSS > 4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P- 0.042). Among the 3 subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale > 5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P- 0.010; and VCSS > 4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P- 0.017). The PMT + CDT group also demonstrated a reduced incidence of PTS (18% PMT + CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P- 0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT + CDT vs. 36% CDT; P- 0.121). Compared to the PMT group, the PMT + CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT + CDT; P- 0.504) or the rate of high VCSS (12% PMT vs. 20% PMT + CDT; P- 0.343). Conclusions: In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT + CDT in reducing both the incidence of PTS and the risk of high VCSS.

BACKGROUND:This study aimed to assess the clinical outcomes of combined interventional therapy (CIT) for below-the-knee (BTK) arterial lesions in individuals with diabetic foot (DF). METHODS:A prospective cohort study was conducted involving 138 patients with DF and BTK arterial lesions who underwent BTK arterial revascularization. Participants were assigned to one of 2 treatment groups: the control group received percutaneous transluminal angioplasty (PTA) with a drug-coated balloon (DCB), while the experimental group underwent excimer laser atherectomy (ELA) followed by DCB-PTA. All participants were followed for 12 months. Outcomes compared between groups included primary patency rate (PPR), target lesion revascularization rate (TLRR), primary wound healing rate (PWHR), secondary wound healing rate (SWHR), primary wound healing rate without revascularization (PWHRR), wound healing time (WHT), major amputation rate, and mortality rate. RESULTS:The overall PPR was 63.80%, with a higher rate in the experimental group (74.10%) compared with the control group (56.30%) (χ2 = 4.657, P = 0.031). The overall TLRR was 20.30%, with a lower rate in the experimental group (8.60%) compared with the control group (28.70%) (χ2 = 8.424, P = 0.004). The overall PWHR was 77.50%, with the experimental group demonstrating a higher rate (89.70%) compared with the control group (68.80%) (χ2 = 8.436, P = 0.004). The median WHT was 108.50 days; the experimental group achieved a shorter healing time (82.00 days) compared with the control group (128.00 days) (Z = 6.680, P < 0.001). CONCLUSION:CIT demonstrated safety and efficacy in the management of BTK arterial lesions in individuals with DF, yielding improved vessel patency, lower revascularization rates, higher wound healing rates, and reduced healing times compared with drug-coated balloon PTA alone.

Background Great saphenous vein (GSV) valve incompetence is one of the most common manifestations of chronic venous insufficiency (CVI) in the lower limbs. There have been no reported attempts to repair the valve prior to the appearance of varicose morphology. Method We describe two cases. Before surgery, the male patient had obvious pigmentation in the ankle area, and the female patient had obvious pain and swelling in the lower limbs after prolonged standing. Neither patient has obvious varicose veins. After retrograde venography, both patients were found to have severe reflux of the GSV valves (Kinster IV). We performed internal valvuloplasty and sleeve wrapping in two patients. Results After surgery, both patients had a significant improvement in symptoms and no particular complaints. Vascular ultrasound also suggested a good outcome. Conclusion This surgery is safe and feasible in the treatment of early GSV incompetence, with good short-term results; long-term results remain to be seen.

Aim:To evaluate the advantages and problems in the diagnosis and treatment of diabetic foot (DF) patients by analyzing the results of a 5-year follow-up of the organ system based (TOSF) treatment model. Methods:A retrospective study was conducted in 229 patients with diabetic foot. Chi-square test and rank-sum test were used to analyze the effects of patients' general condition, behavioral and nutritional status, degree of infection (inflammatory markers), comorbidity, diabetic foot grade/classification, and revascularization on readmission rate, amputation rate, all-cause mortality, incidence of other complications, and wound healing time. Logistic regression was used to analyze the risk factors affecting the prognosis of diabetic foot. Kaplan-Meier survival curve was used to analyze the differences in amputation rate and mortality rate at each time point. Results:This study showed that nutritional status, degree of infection, and revascularization influenced readmission rates. General condition, behavior and nutritional status, degree of infection, Wagner grade and revascularization affect the amputation rate. General conditions, behavioral and nutritional status, degree of infection, comorbidities, classification and revascularization affect the mortality of patients. Age and white blood cell(WBC) count affected the incidence of other complications. Influence of infection degree and Wagner grade and revascularization in patients with wound healing time. Revascularization was an independent protective factor for readmission, amputation, and mortality.Elevated serum inflammatory markers are an independent risk factor for amputation. Hypoproteinemia is an independent risk factor for mortality. Conclusion:In the "TOSF" diagnosis and treatment pattern, diabetic foot patients have a good prognosis. Special attention should be paid to the screening and revascularization of lower extremity vascular disease in patients with diabetic foot.

背景与目的:大隐静脉高位结扎剥脱术(HSL)是治疗下肢静脉曲张的经典术式,但存在创伤较大、恢复时间较长、切口瘢痕不美观等缺点.随着医疗技术的进步,以腔内热消融治疗为代表的微创治疗技术蓬勃发展.本研究旨在对比射频消融术(RFA)与传统HSL治疗下肢静脉曲张的临床疗效.方法:回顾性分析2021年5月—2022年6月期间因原发性下肢静脉曲张于首都医科大学附属北京安贞医院血管外科行手术治疗的272例患者(298条肢体)的临床与随访资料,其中96例(100条肢体)行RFA治疗(RFA组),176例(198条肢体)行HSL治疗(HSL组).比较两组患者的术前临床特征、手术情况、并发症情况、临床表现-病因学-解剖学-病理生理学(CEAP)分级、静脉临床严重程度评分(VCSS)和慢性静脉功能不全问卷-14问版(CIVIQ-14)评分的变化情况.结果:两组技术成功率均为100％,术后3 d复查超声提示大隐静脉主干缺如/闭合率为100％.共完成随访265例(290条肢体),平均随访时间(13.2±3.8)个月,随访期间超声提示大隐静脉主干缺如/闭合率为100％.两组患者的基本临床特征无明显差异(均P＞0.05);与HSL组比较,RFA组术中出血量(21.3 mLvs.46.8 mL)、术后第1天疼痛评分(3.1vs.3.3)、总并发症发生率(25.5％vs.38.0％)及皮肤感觉异常发生率(5.1％vs.24.0％)均明显降低(均P＜0.05),RFA组的深静脉血栓形成发生率升高(5.1％vs.0,P＜0.05);术后所有患者CEAP分级均较术前降级,RFA组81.7％的患肢降级为C0～C1级,HSL组83.9％的患肢降级为C0～C1级;所有患者的VCSS和CIVIQ-14评分均较术前有所改善,且HSL组的VCSS评分改善程度大于RFA组(均P＜0.05).结论:RFA短期疗效与HSL相当,相对于HSL而言,创伤更小、疼痛感更轻、并发症发生率更低,是一种下肢静脉曲张的有效治疗方案.

Background Lower extremity deep venous insufficiency (DVI) occurs secondary to structural or functional abnormalities of deep venous valves in the affected extremities. The effectiveness of surgical treatment for improvement of the hemodynamic status in these patients remains controversial in clinical practice. Method In this case report, we describe a patient who presented with severe right lower extremity edema and liposclerosis and underwent venography, which suggested a variation in the number of femoral veins. The valve within the duplicated femoral vein was significantly incompetent; however, the valve of the main trunk of the femoral vein showed normal function. We performed embolization of the duplicated femoral vein. Results The patient tolerated the procedure well without recurrent symptoms. Conclusions Individualized assessment based on venography findings is useful to establish the therapeutic approach in patients with DVI.

Objective:To compare the clinical efficacy of endovascular aortic aneurysm repair (EVAR) and open surgery repair (OSR) in the treatment of complex abdominal aortic aneurysm (cAAA).Methods:The clinical data of 144 patients with cAAA were retrospectively analyzed. All patients were diagnosed and treated in Beijing Anzhen Hospital Affiliated to the Capital Medical University, The First Medical Center of Chinese PLA General Hospital, Beijing Hospital, and Xuanwu Hospital of Capital Medical University from June 2016 to December 2021. They were divided into EVAR group ( n=114) and OSR group ( n=30) according to different treatments. The preoperative clinical characteristics, operation, and follow-up results of the two groups were compared. Subgroup analysis was performed in the EVAR group according to different treatments. Two independent samples t-test was used for inter-group comparison of measurement data follow the normal distribution, rank-sum test was used for non-normal data, and Chi-square test or Fisher's exact probability test was used for count data. Results:In EVAR group, the diameter of proximal aneurysm neck was wider than in OSR group, and the proportion of trapezoidal neck was higher than in OSR group, and the differences were statistically significant [(22.03±3.59) mm vs (19.40±4.28) mm, P=0.002; 36.0% vs 16.7%, P=0.044). The operation time, intraoperative bleeding volume, and perioperative blood transfusion volume in EVAR group were lower than those in OSR group. There were statistically significant differences [(158.56±93.06) min vs (368.53±95.96) min, t=-10.915, P<0.001;(92.84±168.83)ml vs (1 370.00±1 019.52) ml, t=-12.579, P<0.001; (14.91±133.85) ml vs (1 375.00±1 300.18)ml, t=-11.055, P<0.001). 144 patients were followed up for (25.6± 10.4) months. The total complication rate and perioperative complication rate in EVAR group were lower than in OSR group. The differences had statistical significance(16.7% vs 40.0%, χ2=7.654, P=0.006; 9.6% vs 40.0%, χ2=16.301, P<0.001).There was no statistically significant difference in the quality of life scores between the two groups at 1-year follow-up. Subgroup analysis showed that the endoleak rate in the conventional EVAR group was significantly higher than that in the unconventional EVAR group (11.9% vs 0%, χ2=6.035, P=0.014). When cervical angle ≥52°, the complication rate of conventional EVAR was significantly higher than that of patients with narrower angle (29.6% vs 0%, χ2=6.486, P=0.011). In the treatment of patients with trapezoidal neck, conventional EVAR group had a higher endoleak rate than unconventional EVAR group (19.0% vs 0%, χ2=6.632, P=0.010). The incidence of complications in OSR group was correlated with concomitant diseases, and the proportion of patients with complications complicated with coronary heart disease and cerebrovascular disease was significantly higher than that of patients without complications (75% vs. 27.8%, χ2=6.451, P=0.011; 25% vs. 0%, χ2=5.000, P=0.025). Conclusion:In the treatment of patients with cAAA, the total complication rate of EVAR, especially the perioperative complication rate, is lower than that of OSR. Choosing appropriate patients and correct treatment may reduce the risk of postoperative complications and endoleak of EVAR.

目的:探讨杂交技术治疗髂股移行处闭塞性病变的临床疗效.方法:回顾分析我中心 2007年1月至2020年12月,采用股动脉内膜剥脱联合髂动脉球囊扩张支架置入治疗的72例髂股移行处闭塞性病变的临床资料.其中男性62例,女性10例,平均年龄(65.96±8.8)岁.采用Kaplan-Meier生存率分析术后12、24及60个月一期通畅率.结果:所有患者均成功完成手术,技术成功率为100％.踝臂指数(ABI)由术前0.37±0.18提高至术后0.92±0.18,P＜0.05,差异有统计学意义.手术相关并发症发生率13.9％(10/72).30d病死率为零.平均随访时间3 045.50(2052.50,4053.00)d.全因死亡率为12.5％.应用Kaplan-Meier生存率分析术后12个月一期通畅率为(94.29±2.77)％,术后24个月一期通畅率为(88.57±3.8)％,术后60个月一期通畅率为(79.71±4.84)％.结论:杂交技术治疗髂股移行处塞性病变早期结果满意,为治疗髂股移行处闭塞性病变提供了一种有效手段.

目的 分析胭动脉瘤外科及腔内治疗的策略与方法.方法 回顾性分析首都医科大学附属北京安贞医院2000年8月至2020年8月收治的19例胭动脉瘤病人临床资料.分析比较各病人的一般情况、围手术期情况及随访情况.结果 19例病人中,外科修复16例,其中行胭动脉瘤切除+间质移植术7例,行胭动脉瘤旷置+旁路移植术9例.覆膜支架腔内修复术3例.2例围手术期深静脉血栓形成予抗凝治疗,1例吻合口出血急诊再次手术.30d围手术期无心脑血管意外、死亡发生.4例失访,15例随访12～144个月,1例病人术后1年行截趾术,因感染重度性休克死亡.2例旁路移植病人出现切口周围麻木,营养神经治疗后好转.1例旁路移植病人术后1年复查桥血管再狭窄(50％),无下肢缺血症状出现.余病人下肢症状改善明确,无下肢缺血症状.结论 治疗指征明确的胭动脉瘤应积极手术.外科重建或腔内修复是安全有效的,个体化的治疗策略选择可获得更满意的治疗效果.外科重建应作为胭动脉瘤治疗的首选.腔内修复的手术选择仍需非常谨慎.

Objective:To compare carotid endarterectomy (CEA) and carotid artery stenting (CAS) in perioperative, medium and long term prognosis of patients with carotid artery stenosis.Methods:A retrospective analysis was performed on 1 329 cases of carotid artery stenosis treated at Department of Vascular Surgery, Beijing Anzhen Hospital from Jan 2011 to Aug 2020, as all cases being divided into CAS group and CEA group.Results:There were significant differences in age ( t=0.098, P=0.023) and drinking habits ( χ2=8.055, P=0.005) between the two groups. There were more unstable plaques in CEA group ( χ2=4.392, P=0.038), and more bilateral lesions in CAS group ( χ2=9.673, P=0.038). In perioperative period, there were more mannitol use in CEA group ( χ2=78.614, P<0.001), more incision/puncture site complications ( χ2=5.158, P=0.035), lung infection ( χ2=6.355, P=0.013), cerebral hyperperfusion syndrome (CHS) ( χ2=5.158, P=0.035) and extracranial nerve injury ( χ2=23.760, P<0.001) in CEA group than in CAS group, and more acute renal failure in CAS group ( χ2=10.393, P=0.001). There was no significant difference in survival rate and ischemic stroke, myocardial infarction, cerebral hemorrhage and renal insufficiency between the two groups (all P>0.05). The mean survival time of CAS group was 53.195 months (95% CI: 52.040-54.350), and 54.492 months (95% CI: 53.790-55.195) in CEA group ( P=0.051). Conclusions:Patients in CEA group had more unstable plaque and a lower perioperative stroke rate. CEA group had higher risk of CHS,while CAS was with lower postoperative lung infection rate and less wound local complications. There was no significant difference in long-term survival between the two groups.

目的:对1例超声心动图表现为B型主动脉夹层及胸主动脉瘤的患者及其家系进行基因检测，明确其可能的致病变异基因。方法:对先证者进行全外显子测序，重点分析遗传性主动脉疾病相关致病基因，依据ACMG指南，判定变异的致病性。并应用Sanger测序对患者及家系成员的候选位点进行检测。结果:二代测序结果经生物信息学分析，在患者的基因组中检测到原纤维蛋白-1(Fibrillin-1, FBN1)(NM_000138.3)基因存在c．A8378G(p.Y2793C)杂合变异，该位点在公共数据库均未见频率报道；SIFT、PolyPhen2和Mutation taster软件分析预测该变异为有害变异；在该家系内，该变异位点与临床表型共分离，依据ACMG指南，该变异为可能致病性变异(PM2+PP1+PP3+PP4+PP5)。 结论:FBN1 (NM_000138.3)基因c.A8378G变异是该患者致病的原因，本研究结果丰富了家族性主动脉瘤/夹层患者 FBN1基因的变异谱，为临床诊断和遗传咨询提供理论依据。

复杂腹主动脉瘤（cAAA）因其解剖特点常不能采取常规EVAR进行治疗，以往更多依赖开放手术（OSR）解决。随着腔内治疗技术和理念的不断发展，腔内治疗技术包括烟囱支架技术、开窗支架技术和分支支架技术等成为治疗cAAA的研究热点。从现有的研究结果来看，EVAR和OSR在治疗cAAA方面的优劣比较尚无明确定论。目前普遍认为EVAR在围术期并发症发生率和死亡率方面有更好的结果，但其术后内漏、重建分支血管术后闭塞等情况仍有待探索及改进，远期效果相对于OSR而言尚存在争议。对于瘤颈严重扭曲、分支血管解剖异常等特殊情况，传统OSR仍然无可取代。随着技术和新器材的探索和进步，腔内治疗将继续是研究的热点，cAAA的治疗理念亦会不断更新。

目的 探究腹主动脉瘤病人行择期腹主动脉瘤腔内修复术(EVAR)后出现并发症的可能危险因素,为并发症的出现提供预警分析.方法 回顾性分析首都医科大学附属北京安贞医院收治的286例行择期EVAR治疗的腹主动脉瘤病人资料,依据术后并发症的发生与否进行分组.比较有并发症的病人与无并发症病人在基线资料、动脉瘤解剖条件、术中情况及术前理化指标方面的差异.结果 有并发症组与无并发症组在年龄、有无肝脏病史、术前白蛋白水平等方面差异有统计学意义(P＜0.05).通过Logistic回归分析发现,肝脏病史和术前血红蛋白水平与术后并发症的发生密切相关(P＜0.05).回归方程的ROC曲线下面积为0.614(95％ CI 0.539～0.690,P=0.003).结论 既往存在肝脏病史和术前低血红蛋白水平对EVAR术后并发症的发生有预警意义.加强监测、及时纠正异常可能减少并发症的出现.

目的 应用肾动态显像评估单侧动脉硬化性肾动脉狭窄患者腔内治疗效果,并对可能改善分肾功能的影响因素进行分析.方法 回顾性分析北京安贞医院2016年1月-2018年4月收治的60例单侧动脉硬化性肾动脉狭窄患者,均行肾动脉支架成形术.收集患者的一般资料,术前及术后肾功能检查结果,肾动脉彩色多普勒超声(彩超)及肾动态显像结果,随访时间1年.根据术后随访肾动态显像结果中患侧肾小球滤过率是否较术前提高分为好转组及非好转组,建立线性回归模型进行影响因素分析.结果 全部患者均经肾动脉彩超及造影证实患侧肾动脉直径狭窄程度＞70％,均行患侧肾动脉支架成形术,手术即刻成功率100％,术后患侧肾动脉残存狭窄均＜20％,无围手术期严重并发症发生.术后收缩压、舒张压均较术前改善(均P＜0.01),患侧肾小球滤过率呈改善趋势(P=0.04),血肌酐水平基本稳定(P=0.25),患侧肾动脉狭窄程度明显减轻(P＜0.01).术后1年肾动脉支架Ⅰ期通畅率85％.分组后好转组40例(66.7％),非好转组20例(33.3％),建立线性回归模型进行影响因素分析,结果显示仅患侧分肾功能不全有统计学意义(B =0.50,P＜0.01),即如果患者术前患侧分肾功能不全,术后分肾小球滤过率改善.结论 肾动脉支架成形术治疗单侧肾动脉狭窄安全有效,1年Ⅰ期通畅率85％,1年内2/3患者术后分肾功能可改善,术前分肾功能不全患者能从肾动脉支架成形术中获益的可能性更大.

To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function. A retrospective analysis was made on 60 patients with >70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors. All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P < 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P < 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P < 0.01). Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

Objective:To compare the perioperative complications of carotid endarterectomy with patch angioplasty or primary closure.Methods:The clinical data of 492 carotid endarterectomy patients at the Vascular Surgery Department of Anzhen Hospital from Mar 2003 to Dec 2016 was analyzed retrospectively.Results:There were 364 cases (74%) in the patch angioplasty group and 128 cases (26%) in the primary closure group. The incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than that in the primary closure group (0.8% vs. 3.9%, P=0.031), and there was no difference in the incidence of the remaining perioperative complications. By subgroup analysis, the incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than in the primary closure group when the diameter of the internal carotid artery was <5 mm (0.7% vs. 6.0%, P=0.001), whereas there was no difference between the two groups when the diameter of the internal carotid artery was ≥5 mm. Conclusions:Carotid endarterectomy with patch angioplasty can reduce the incidence of perioperative cerebral infarction, especially in cases with an internal carotid artery diameter <5 mm.

腹主动脉瘤(AAA)是血管外科的常见疾病,发病率高,一旦破裂,预后凶险.1951年,Charles Dubost完成了首例AAA切除及移植物替换[1].不久,Michael DeBakey完成了AAA切除并使用涤纶血管进行替换[2],很快就成为AAA开放手术(OSR)的标准术式.1991年Parodi等[3]完成了首例AAA的腔内修复(EVAR),经过30年的发展,EVAR已经成为主流术式,越来越多的AAA患者选择EVAR治疗.相对于开放手术,EVAR具有创伤小,恢复快的优点,易被患者和医生接受.另外,随着腔内技术的进步和器材的改良,部分过去认为不适合腔内治疗的AAA也可以采用腔内技术来治疗,EVAR的治疗指征逐渐拓宽,使众多不能耐受开放手术的AAA患者得以救治.但随着EVAR数量的增加和随访时间的延长,中远期并发症逐渐显现,越来越多的患者需要再次干预,其中部分患者与治疗不够规范相关,因此,合理把握AAA的适应证,重视AAA治疗的规范化,是降低并发症发生率、提高中远期预后的关键.

腹主动脉瘤(AAA)是血管外科常见疾病,随着血管腔内技术发展,腔内修复术(EVAR)已经逐渐取代开放手术成为AAA的主要治疗手段.而EVAR数量逐年增加,新技术、新器材不断应用于临床,更多的复杂AAA患者也可以采用腔内技术来救治,取得显著的临床疗效.但在提升数量的同时,要注重质量的提高,严格把握腔内治疗的指征,重视术前评估、术中操作及术后随访的规范化,改善EVAR的远期预后,提高AAA患者的治疗效果.