Abdominal aortic aneurysm (AAA) is a lethal yet prevalent vascular disease, featuring progressive extracellular matrix (ECM) degradation and aortic dilation. Despite its high mortality upon rupture, there are still no medical treatments with proven benefits for AAA. In the current study, we identified thrombospondin-2 (TSP2) as a critical modulator against ECM degradation in AAA. Utilizing specimens from patients undergoing open AAA repairs, we observed that both aortic and circulating TSP2 levels were significantly upregulated and positively correlated with aortic wall thickness. Single-cell RNA sequencing and immunofluorescence staining further localized TSP2 primarily to adventitial fibroblasts. Using transgenic whole-body knockout mice, TSP2 deletion accelerated elastase-induced AAA growth, heightened rupture incidence, and exacerbated collagen loss and elastin disruption. Conversely, lentivirus-mediated TSP2 re-introduction in whole-body knockout mice effectively rescued ECM integrity and aortic homeostasis. Mechanistically, chromatin-immunoprecipitation and gain-/loss-of-function studies identified Akt-dependent phosphorylation of STAT3 as a direct transcriptional driver of TSP2. Therapeutically, local delivery of exogenous TSP2 via peri-aortic hydrogel effectively mitigated ECM destruction and AAA formation. Collectively, our current study study established TSP2 as a fibroblast-derived stabilizer of vascular ECM and highlighted its therapeutic potential for AAA through targeted modulation of matrix remodeling pathways.

AimsThis multicenter retrospective study sought to compare the efficacy and safety of endovenous laser ablation (EVLA) versus radiofrequency ablation (RFA) for treating great saphenous vein (GSV) incompetence.MethodsWe performed propensity score matching (PSM) between 864 EVLA and 1009 RFA cases. Primary endpoints comprised complete venous ablation (efficacy) and incidence of deep vein thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) (safety). Secondary outcomes assessed at serial follow-ups included: Numerical Rating Scale (NRS) pain scores, cutaneous adverse events, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Questionnaire (CIVIQ-20).ResultsThe propensity-matched cohort (n = 855 per group) showed balanced baseline characteristics after exclusions (all p > .05). Primary efficacy analysis revealed significantly lower 24-month recurrence rates with EVLA versus RFA (5.6% vs 10.2%, p < .001). Primary safety outcomes demonstrated reduced thrombotic complications with RFA, including lower DVT incidence (0.7% vs 1.8%, p = .048) and decreased EHIT formation (Class 0: 93.9% vs 89.7%; grades 1-4: 6.1% vs 10.3%, p = .034). Secondary analysis showed RFA's advantages in pain profiles (p < .001), cutaneous complications (skin burns: 2.7% vs 4.7%, p = .029), and superior therapeutic improvement through 24 months (VCSS: 0.66 ± 0.15 vs 1.66 ± 0.55, p = .029; CIVIQ-20: 5.66 ± 1.10 vs 10.66 ± 2.69, p = .006).ConclusionRFA demonstrates superior perioperative safety profiles, symptom relief, and quality-of-life outcomes. However, its significantly higher long-term recurrence risk compared to EVLA necessitates risk-stratified treatment algorithms.

An 8-year-old girl was admitted to our hospital with an infected abdominal aortic aneurysm (iAAA), following heart valve lesion excision and mitral valve replacement with a mechanical valve, latter supported by extracorporeal membrane oxygenation. Blood culture identified Staphylococcus aureus infection. The aneurysm was successfully repaired using in situ replacement with an autologous femoral vein graft. This patient represents the youngest reported case of iAAA successfully treated with the neo-aortoiliac system (NAIS) technique using a femoropopliteal vein in our country. The NAIS procedure with femoropopliteal vein offers the advantages of low mortality, improved patency, and reduced risks of reinfection and amputation. It is believed that this case report can encourage the consideration of autologous vascular therapy for infantile aneurysms and broaden treatment options for similar patients with aortic infections, promoting surgical intervention for iAAA among vascular clinicians.

Background: The purpose of this trial was to assess the safety and effectiveness of a paclitaxel-coated balloon catheter in Chinese patients with de novo or nonstented restenotic femoropopliteal atherosclerotic lesions. Methods: BIOLUX P-IV China is a prospective, independently adjudicated, multicenter, single -arm trial conducted in China. Patients with Rutherford class 2e4 were eligible, excluded were patients in which predilation resulted in severe (& GE; grade D) flow-limiting dissection or residual stenosis > 70%. Follow-up assessments were conducted at 1, 6, and 12 months. The primary safety end point was 30-day major adverse event rate and the primary effectiveness end point was primary patency at 12 months. Results: We enrolled 158 patients with 158 lesions. Mean age was 67.6 & PLUSMN; 9.6 years, diabetes was present in 53.8% (n = 85), and previous peripheral intervention/surgeries in 17.1% (n = 27). Lesions were 4.1 & PLUSMN; 0.9 mm in diameter and 74 & PLUSMN; 50 mm long with a mean diameter stenosis of 91 & PLUSMN; 13%; 58.2% (n = 92) were occluded (core laboratory analysis). Device success was achieved in all patients. The rate of major adverse events was 0.6% (95% confidence interval: 0.0; 3.5) at 30 days, consisting of 1 target lesion revascularization. At 12 months, binary reste-nosis was present in 18.7% (n = 26) and target lesion revascularization was performed in 1.4% (n = 2, all clinically driven), resulting in a primary patency of 80.0% (95% confidence interval: 72.4, 85.8); no major target limb amputation occurred. Clinical improvement at 12 months,

Abdominal aortic aneurysm (AAA) is a permanent, asymptomatic segmental dilatation of the abdominal aorta, with a high mortality risk upon rupture. Identification of potential key genes and pathways may help to develop curative drugs for AAA. We conducted RNA-seq on abdominal aortic tissues from both AAA patients and normal individuals as a control group. Integrated bioinformatic analysis was subsequently performed to comprehensively reveal potential key genes and pathways. A total of 1148 differential expressed genes (DEGs) (631 up-regulated and 517 down-regulated) were identified in our study. Gene Ontology (GO) analysis revealed enrichment in terms related to extracellular matrix organization, while KEGG analysis indicated enrichment in hematopoietic cell lineage and ECM-receptor interaction. Protein-protein interaction (PPI) network analysis revealed several candidate key genes, and differential expression of 6 key genes (CXCL8, CCL2, PTGS2, SELL, CCR7, and CXCL1) was validated by Gene Expression Omnibus (GEO) datasets. Receiver operating characteristic curve (ROC) analysis demonstrated these genes' high discriminatory ability between AAA and normal tissues. Immunohistochemistry indicated that several key genes were highly expressed in AAA tissues. Single-cell RNA sequencing revealed differential distribution patterns of these identified key genes among various cell types. 26 potential drugs linked to our key genes were found through DGIdb. Overall, our study provides a comprehensive evaluation of potential key genes and pathways in AAA, which could pave the way for the development of curative pharmacological therapies.

To the Editor: Ruptured abdominal aortic aneurysm (rAAA) is a fatal disease. Emergency surgery is the only way to provide an opportunity for survival. In 1994, endovascular aortic repair (EVAR) was reported as an emergency treatment for rAAA. Compared with traditional open surgery (OS), patients could benefit from its lower perioperative mortality and minimal invasiveness. Although recent guidelines have recommended an EVAR-first approach if suitable as judged by the clinician, the standard of whether to give a priority to EVAR varies among clinicians in practical applications, because hostile aortic morphology and hemodynamic conditions were thought to weaken the benefit of EVAR. Hence, controversies still exist regarding whether EVAR as a priority is applicable to most rAAAs. In addition, a search of the literature found few population-based studies with long-term outcomes. Given this, a population-based study was conducted by Zhongshan Hospital, Fudan University. Since 2010, our center has experimentally adopted EVAR as the priority approach for patients presenting with infrarenal rAAAs based on the modified indications for EVAR, and has not conducted any open repair surgeries [Supplementary Table 1, https://links.lww.com/CM9/B439]. We modified the requirements of hemodynamic and anatomical conditions to ensure that EVAR can be conducted in a timely manner to restore blood flow. Ethical approval of this study was obtained from the Committee for the Protection of Human Subjects at Zhongshan Hospital, Fudan University (No. B2021-216). Informed consent was obtained from all patients or their family members before the operation. The patients were divided into four subgroups: Group 1: favorable aortic anatomy (proximal neck length >15 mm, infrarenal proximal angulation < 45 and minimum aortic diameter at renal artery level <28 mm) +stable hemodynamics; Group 2: favorable aortic anatomy+unstable hemodynamics (systolic blood pressure <80 mmHg or shock with systolic blood pressure <50 mmHg or organ hypoperfusion at admission); Group 3: hostile aortic anatomy (proximal neck length <15 mm, infrarenal proximal angulation >45 or minimum aortic diameter at renal artery level >28 mm) +stable hemodynamics; Group 4: hostile aortic anatomy+unstable hemodynamics. The patients were followed up by computed tomographic angiography (CTA) at 3, 6, 12 months, and yearly thereafter. Demographics, length of stay, 24-hour, in-hospital, 30-day, 1, 3, and 5-year mortality after surgery were recorded. Additional data included stent-related complications, additional interventions, detailed surgery records, and follow-up CTA. The final follow-up time was December 2020. Our primary outcomes were peri-operative, short-term, and mid-to-long-term mortality. Secondary outcomes included reintervention and stent-related complications. Categorical variables are presented as frequencies with percentages. Comparison between categorical variables was performed with the χ2 test or Fisher's exact test according to the sample size. Continuous variables are presented as mean ± standard deviation or median (Q1, Q3). One-way analysis of variance (ANOVA) test, Welch's ANOVA test or non-parametric test was used for the analysis, as appropriate. The survival data were analyzed by Kaplan–Meier analysis and the log-rank test. A P value < 0.05 was considered statistically significant. Statistical analyses were performed using SPSS 22.0 (IBM Corp, Armonk, NY, USA). From January 2010 to September 2017, 57 patients received EVAR for infrarenal rAAA. The time from admission to EVAR was 53 ± 12 min. All patients underwent EVAR in accordance with the unified treatment scheme.[1] The median follow-up time was 60.2 months, and the longest follow-up was 119.2 months. The median length of hospital stay was 11.0 days (7.8–22.3 days). The 24-hour mortality rate was 3.5% (2/57). The in-hospital mortality rate was 12.3% (7/57). The 30-day mortality rate was 18.4%. The 1-year mortality rate was 32.3%. The short-term mortality rates were in line with the existing studies.[2] The long-term mortality rates were 46.5% (3 years) and 60.0% (5 years) [Figure 1A]. At the end of the study, among patients with complete follow-up information 11 patients survived >5 years after EVAR, and they were considered to have a long-term survival benefit. We compared the survival rates of the Group 2 and 3 with that of the Group 1 and did not observe statistically significant differences (log-rank test, P1 = 0.827, P2 = 0.641, [Figure 1B]). The results suggested that compared with patients with favorable aortic anatomy and stable hemodynamics, EVAR may also provide survival benefits for rAAA patients with unstable hemodynamics or hostile aortic anatomies. There were only five patients in subgroup 4. One patient died during hospitalization. One patient survived for >5 years and did not undergo reintervention. One patient died of hemorrhagic shock caused by rerupture at 14.1 months. One patient was admitted to our center with pneumonia at 37.5 months and died of severe septic shock. The remaining patient developed a fever at 50.2 months, and was diagnosed with type Ib endoleak and died of MODS. The characteristics of patients in four group were presented in Supplementary Table 2, https://links.lww.com/CM9/B439, and there were no significant statistical differences among the groups.Figure 1: (A) Kaplan–Meier curves of all patients who underwent EVAR as the priority approach for infrarenal rAAAs. (B) Kaplan–Meier curves of different subgroups show that there were no significant differences among the subgroup with ideal aortic morphology and stable hemodynamics (Group 1), the subgroup with favorable aortic anatomy and unstable hemodynamics (Group 2), and the subgroup with hostile aortic anatomy and stable hemodynamics (Group 3). EVAR: Endovascular aortic repair; rAAA: Ruptured abdominal aortic aneurysm.A total of 13 patients had immediate endoleaks (22.8%, 13/57), including 10 (17.5%, 10/57) type Ia, 2 (3.5%, 2/57) type Ib, and 1 (1.8%, 1/57) type Ib and III. Three patients with type Ia endoleaks were treated by the proximal cuff technique. The other seven patients with type Ia endoleaks were follow-up closely because the endoleaks detected is slight; from their follow-up CTA, the endoleak in two patients disappeared at 1 year, in four patients disappeared at 2 years, and only one patient had persistent leakage but without further enlargement (during 3-year follow-up: the diameter of the aorta increased by <5 mm). Two patients with type Ib endoleaks disappeared after management by balloon dilation. The patient with type Ib and type III endoleaks was managed by relining. Among the 15 patients in Group 3, 5 (33.3%, 5/15) had immediate endoleaks. There was no significant difference in the incidence of immediate endoleaks among Group 1 (23.1%, 6/26), Group 2 (14.3%, 2/14), and Group 3 (33.3%, 5/15) (P = 0.689). All of the endoleaks were followed up closely. These immediate endoleaks did not affect the technical safety of the EVAR, and the follow-up CTA did not show further enlargement. In recent years, there are controversies surrounding the choice of optimal procedure for rAAAs. The choice between OS and EVAR is mainly based on operator preference and patient characteristics. Here, we reported the results based on clinical practice that set EVAR as a priority choice with a long-term follow-up. Our study found lower 24-hour and in-hospital mortality than other existing studies, and the 30-day, 1-year, and 3-year mortality rates were in line with the existing studies.[2] In Kontopodis et al's[3] meta-analysis, they comprehensively demonstrated that EVAR had a lower peri-operative mortality rate than OS, and our results also demonstrated that EVAR as the priority choice had a good short-term survival outcome. A lower 24-hour mortality rate could be observed in our study compared with previous study,[3] which may be related to our treatment scheme and the characteristics of EVAR itself: (1) We tried to adopt local anesthesia if possible, which had a lower effect on hemodynamic consequences in rAAA patients compared with general anesthesia,[4] and the potential benefit appears considerable. (2) Our center has a round-the-clock "fast pass" for rAAAs, which greatly shortens the rescue time. The peri-operative period was a vital time for survival; if EVAR could be performed, it is a better choice than OS from the perspective of reducing peri-operative mortality. The impact of aortic morphology on prognosis is one of the key concerns of EVAR. For patients with hostile aortic anatomy, type Ia endoleak is a common and dangerous adverse event.[5] Besides, for the immediate management for patients with rupture, open versus endovascular repair study reported that endoleak was the most common cause for reintervention.[6] In the present study, EVAR also showed clinical benefits for rAAA patients with unfavorable anatomical conditions due to advances in technology and equipment. By means of increasing the oversizing rate appropriately, cuff and balloon dilatation, the most of endoleaks could be resolved. For patients with a short infrarenal neck, Endurant endograft, which was designed for a neck length limit to 10 mm and had good compliance with the hostile aortic neck, was used for the majority of our patients. According to the follow-up CTA results, most endoleaks disappeared after one year, and the persistent leakages did not cause further enlargement, suggesting that EVAR in patients with unfavorable aortic anatomy is technically feasible and safe in experienced centers. As this is a single-center and single-arm clinical study, the sample size was small. And the patients with hostile aortic anatomy and unstable hemodynamics were not included in the final analysis to avoid a large deviation. In the future, more multicenter studies with larger sample sizes need to be conducted to confirm the results of the present study. In conclusion, our current data demonstrated that EVAR for infrarenal rAAA should be more recommended in experienced centers. EVAR as a priority choice for infrarenal rAAA in institutions with professional could achieve low peri-operative mortality. The subgroup analysis indicated that EVAR for rAAAs with unstable hemodynamics or hostile aortic anatomy is technically safe in terms of the lower short-term mortality and undifferentiated long-term survival rate. Funding This work was financially supported by the National Natural Science Foundation of China (No. 8207021027), the Shanghai Clinical Research Center for Interventional Medicine (No. 19MC1910300), and the Shanghai Science and Technology Commission (Nos. 19441906600 and 21S31904800). Conflicts of interest None.

Objectives The aim of this study was to review our management experience of ruptured abdominal aortic aneurysms (RAAAs) using an endovascular aneurysm repair (EVAR)-only strategy, and discuss the feasibility of this strategy. Materials and methods A retrospective analysis of clinical data was performed in patients with RAAAs from January 2009 to October 2020. Our strategy toward operative treatment for RAAAs evolved from an EVAR-selected (from January 2009 to April 2014) to an EVAR-only (from May 2014 to October 2020) strategy. Baseline characteristics, thirty-day mortality, perioperative complications, and long-term outcomes of patients were compared between the two periods. Results A total of 93 patients undergoing emergent RAAA repair were eventually included. The overall operation rate in RAAAs at our centre was 70.5% (93/132). In the EVAR-only period, all 53 patients underwent ruptured endovascular aneurysm repair (rEVAR). However, only 47.5% (19/40) of patients in the EVAR-selected period underwent rEVAR, and the remaining 21 patients underwent emergent open surgery. Thirty-day mortality in the EVAR-only group was 22.6% (12/53) compared with 25.0% (10/40) for the EVAR-selected group (P = 0.79). Systolic blood pressure ≤70 mmHg [adjusted odds ratio (OR) 4.99, 95% confidence interval (CI), 1.13–22.08, P = 0.03] and abdominal compartment syndrome (adjusted OR 3.72, 95% CI, 1.12–12.32, P = 0.03) were identified as independent risk factors responsible for 30-day mortality. After 5 years, 47.5% (95% CI, 32.0–63.0%) of patients in the EVAR-selected group were still alive versus 49.1% (95% CI, 32.3–65.9%) of patients in the EVAR-only group (P = 0.29). Conclusion The EVAR-only strategy has allowed rEVAR to be used in nearly all the RAAAs with similar mortality comparing with the EVAR-selected strategy. Due to the avoidance of operative modality selection, the EVAR-only strategy was associated with a more simplified algorithm, less influence on haemodynamics, and a shorter operation and recovery time.

Objective:To evaluate the safety and efficacy of carotid artery stenting (CAS) in the treatment of non-circumferential severe calcification using the distal embolic protection device.Methods:Clinical data of patients with severe calcification lesions in cervical carotid artery treated by CAS from Jan 2018 to Dec 2020 at our center was analyzed retrospectively.Results:226 consecutively admitted patients of cervical carotid artery stenosis and non-circumferential severe calcification (CR>270°) underwent CAS using the distal embolic protection device. The technical success rate was 90.26%. No death or myocardial infarction occurred during the perioperative period. Two patients had ipsilateral hemiparesis ischemic stroke during post-dilatation. The incidence of perioperative bradycardia/hypotension was 25.34%. Patients were followed up for 6-36 months, with median follow-up period of 17.3 months. The incidence of mild or moderate in-stent restenosis (<70%) was 16.59%, and the incidence of severe in-stent restenosis or occlusion (>70%) was 3.22%.Conclusions:For carotid artery stenosis with non-circumferential severe calcification in high risk for CEA patients, carotid artery stenting is safe and effective with the aggressive pre-dilation strategies, strict stent selections and implantation standards. The incidence of perioperative death, myocardial infarction or ipsilateral hemiparesis ischemic stroke was low. The patency rate of the carotid stent in the calcification lesion is satisfactory during the mid-term follow-up.

Objectives The aim of the present study was to review our institutional experience of endovascular treatment for isolated subclavian artery aneurysms and evaluate the long-term outcomes. Methods A retrospective review of all patients with isolated subclavian artery aneurysms who underwent endovascular treatment between March 2008 and March 2020 was performed. The demographics, aneurysmal characteristics, treatment strategies, and in-hospital and follow-up outcomes were recorded and then analyzed. Results From March 2008 to March 2020, 35 isolated subclavian artery aneurysms were endovascularly treated at our institution. Atherosclerosis was the most common cause of aneurysms in this series. Most aneurysms were intrathoracic (91.4%) and located at the right side (77.1%). There were 26 true aneurysms, seven pseudoaneurysms, and two ruptured isolated subclavian artery aneurysms. Five types of endovascular strategies were performed. Covered stent placement across the aneurysm was the most (54.3%) commonly used method. Technical success was achieved in all patients. The median postoperative in-hospital stay was 4.0 days (range, 1-15 days). One patient died after discharge but within 30 days of surgery due to myocardial infarction. The median follow-up time was 62.0 months (range, 3-132 months). No death, stroke, stent fractures, or severe upper limb ischemia developed during the follow-up period. The cumulative survival rate at five years was 97.1%. The overall complication rate was 25.7% and one-third of complications (8.6%) required reinterventions. Conclusions Endovascular treatment for isolated subclavian artery aneurysms is safe, effective and technically achievable in most patients. Short- and long-term outcomes are promising. Reasonable and flexible use of covered stents can also get satisfactory outcomes in some complicated lesions such as isolated subclavian artery aneurysms located at the origin of the right subclavian artery, avoiding the huge surgical trauma caused by conventional open repair.

Dysfunction of endothelial cells (ECs) contributes to restenosis after vascular reconstruction for patients with coronary artery disease (CAD). The intercellular communication between ECs and vascular smooth muscle cells (VSMCs) might be critical in the development of restenosis and can be mediated by exosomes carrying functional microRNAs. miR-185 is reported to be associated with atherosclerosis, whether it plays a similar role in restenosis is unknown. In this study, we observed an elevated level of extracellular miR-185 in platelet-derived growth factor (PDGF)-stimulated VSMCs. The medium from PDGF-stimulated VSMCs promoted miR-185 expression in rat aortic ECs and inhibited EC angiogenesis. PDGF-stimulated VSMCs transferred miR-185 into ECs via exosomes. Furthermore, we found that the CXCL12 gene, a target of miR-185, is essential for the angiogenic potential of ECs. Exosomes derived from miR-185 mimic transfected VSMCs attenuated re-endothelialization after vascular injury. Moreover, we show that exosome-mediated miR-185 transfer is modulated by hnRNPA2B1. We also observed that hnRNPA2B1 is up-regulated during neointima formation and hnRNPA2B1 inhibition accelerates re-endothelialization and attenuates neointima formation following carotid injury. Taken together, our results indicate that exosomal miR-185 transfer from VSMCs to ECs is controlled by hnRNPA2B1 and impairs re-endothelialization after vascular injury.

OBJECTIVE:The goal of the present study was to test the safety and efficacy of chemical stabilization of the arterial extracellular matrix as a novel nonoperative treatment of abdominal aortic aneurysms (AAAs) in a clinically relevant large animal model. METHODS:To achieve matrix stabilization, we used 1,2,3,4,6-pentagalloylglucose (PGG), a noncytotoxic polyphenolic agent capable of binding to and stabilizing elastin and collagen against the action of degrading enzymes. We first optimized the therapeutic PGG formulation and time of exposure by in vitro testing on porcine aortas using phenol histologic staining with iron chloride, elastic recoil assays, and PGG quantification as a function of tissue thickness. We then induced AAAs in 16 swine using sequential balloon angioplasty and elastase/collagenase and calcium chloride treatment of the infrarenal segment. We monitored AAA induction and development using digital subtraction angiography. At 2 weeks after induction, after the AAAs had reached ∼66% arterial expansion, the swine were randomly assigned to 2 groups. In the treatment group, we delivered PGG to the aneurysmal aorta endoluminally using a weeping balloon and evaluated the AAA diameters using digital subtraction angiography for another 10 weeks. The control swine did not receive any treatment. For the safety evaluation, we collected blood and performed comprehensive metabolic panels and complete blood counts every 2 to 3 weeks for all the animals. The swine were routinely monitored for neurologic and physical attributes such as behavior, inactivity, alertness, appetite, discomfort, and weight gain. After euthanasia and full necropsy, we analyzed the AAA tissue samples for PGG content, elastic recoil, and histologic features. RESULTS:In vitro, a single 2.5-minute intraluminal delivery of 0.3% PGG to the swine aorta was sufficient for PGG to diffuse through the entire thickness of the porcine arterial tissues and to bind with high affinity to the elastic lamellae, as seen by positive iron chloride staining, a reduction of elastic recoil, and an increase in PGG content. In vivo, the control swine AAA tissues were thickened and showed the typical aspects of AAA, including chronic inflammation, adventitial reactivity, smooth muscle cell proliferation, elastic lamellae degradation, and medial and adventitial calcification. Similar aspects were noted in the PGG-treated arteries, except for the lack of calcification and an apparent diminished hyperplasia. PGG treatment was effective in reducing AAA expansion and reversing the process of AAA dilation by reducing the aortic diameters to ≤30% by week 12 (P < .05). PGG was specifically localized to the aneurysmal segments as seen by histologic examination, the reduction of elastic recoil, and an increase in PGG content. PGG treatment did not affect the swine's neurologic or physical attributes, weight, blood chemistry, blood cells, or functionality of remote organs. The control, untreated swine exhibited progressive increases in AAA diameters up to a mean value of 104%. CONCLUSIONS:Localized delivery of PGG to the aneurysmal aorta attenuated AAA growth and reversed the course of the disease in the swine AAA model. Such specificity for diseased tissue is unprecedented in nonoperative AAA treatment. This novel paradigm-shifting approach has the potential to revolutionize AAA management and save thousands of lives.

下肢股浅动脉转位动静脉内瘘具有成熟率高、远期通畅率高、感染率低的特点。在上肢静脉耗竭或中心静脉闭塞的患者中，有理由将股浅静脉转位作为下肢通路的首选方案。但国内报道罕见。本文报道一例全长使用股浅静脉及腘静脉构建下肢自体动静脉内瘘用于长期维持稳定透析的病例，并做相关文献的回顾总结。

The 2019 coronavirus disease(COVID-19) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant COVID-19, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. We also hope to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with COVID-19, as a final point to limit the severe epidemic situation, and minimize the damage of COVID-19.

Background: The perfused elastase AAA model and subcutaneous Angiotensin II infusion AAA model are widely used murine AAA models. We modified these two current models and developed a new murine model to study aneurysm formation and rupture. Methods: The murine abdominal aorta was treated with elastase. Angiotensin II was infused at a dose of 1,000 ng/kg/min via an osmotic pump placed subcutaneously. A saline osmotic pump was used as the control. The aortas were harvested from the mice 4 weeks later, or earlier if mice died. The abdominal aorta was inspected using ultrasound and microscopy for aneurysm formation and/or signs of rupture. The aneurysm outcome was measured using aortic expansion and proinflammatory cytokine expression. It was also compared with the established conventional elastase perfusion and angiotensin II infusion abdominal aortic aneurysm models. Results: By day 28 after surgery, all abdominal aortas of mice treated in the modified group had dilated and progressed to abdominal aortic aneurysms with 60% ruptured aneurysms, whereas none of the control aortas treated with saline became aneurysmal. In mice treated with elastase solution alone, 100% developed aneurysms and only one had a ruptured aneurysm. In mice given angiotensin II infusion alone, 37.5% developed aneurysms and none had a ruptured aneurysm. Histological examination of the modified murine abdominal aortic aneurysm rupture model was identical to that observed in the conventional elastase model. Quantitative polymerase chain reaction analysis revealed similarly increased levels of proinflammatory cytokines. Conclusions: We modified two current murine abdominal aortic aneurysm models to develop a murine abdominal aortic aneurysm model with consistent aneurysm formation and high rupture incidence, which can be used for studying abdominal aortic aneurysm rupture and treatment.

Heading aims: Abdominal aortic aneurysm (AAA) is featured by the growth impediment and apoptosis surge of VSMCs (vascular smooth muscle cells). MicroRNAs (miRNAs) are suggested to affect cellular behaviors including cell growth and apoptosis. This study concentrated on unraveling the emerging role of miR-28-5p in abdominal aortic aneurysm. Materials and methods: Previously, miR-28-5p was reported to be highly expressed in AAA. Functional assays were utilized to determine the role of miR-28-5p in VSMC apoptosis. To narrow down the downstream mRNAs, bioinformatics methods were utilized. The interaction between miR-28-5p and GRIA4 (glutamate ionotropic receptor AMPA type subunit 4) or LYPD3 (LY6/PLAUR domain containing 3) was explored. Candidate circRNAs (circular RNAs) of miR-28-5p were identified. Rescue analyses validated function of circCBFB (core-binding factor subunit beta)/miR-28-5p/GRIA4/LYPD3 axis in VSMC apoptosis and growth. Key findings: MiR-28-5p acted as an apoptosis driver while circCBFB, GRIA4 and LYPD3 exerted anti-apoptosis effects in VSMCs. Mechanically, GRIA4 and LYPD3 were suppressed by miR-28-5p. Moreover, circCBFB served as a sponge of miR-28-5p, releasing GRIA4 and LYPD3 from miR-28-5p suppression. Functionally, GRIA4, LYPD3 and miR-28-5p were required in circCBFB-mediated VSMC apoptosis. Significance: This work unveiled an innovative axis of circCBFB/miR-28-5p/GRIA4/LYPD3 in VSMC apoptosis, exerting its potential in providing new thoughts in AAA management.

目前，新型冠状病毒肺炎疫情防控已经取得一定进展，社会生产逐步恢复。医疗机构必将是疫情警报最晚解除的单位。在今后的一段时间内，最重要的任务依然是继续加强防护和避免聚集性发病，同时又必须向各类疾病提供医疗救治。目前国内外尚缺乏针对新型冠状病毒肺炎疫情下进行外科围手术期防护的指南和共识。根据防疫原则，外科手术的开展应以急诊手术和明显影响预后的限期手术为主。血管外科作为可以较为明确地规范其手术急缓程度的外科专科，在疫情期间收治患者应首先考虑手术急迫等级。本文结合国内外相关文献，将血管外科常见手术按照急迫程度细分为：抢救手术、急救手术、急诊手术、亚急诊手术、限期手术、择期手术六大类；并对疫情防控期间血管外科手术的收治原则提出建议。

目的 探讨应用腔内修复(EVAR)完全替代开放手术治疗急性腹主动脉瘤的可行性.方法 回顾性分析复旦大学附属中山医院血管外科2009年1月至2019年12月期间收治的121例真性破裂性腹主动脉瘤的病人资料.对比"选择性EVAR(EVAR/Open)"时期(2009年1月至2014年3月)与"完全EVAR(EVAR Only)"时期(2014年4月至2019年12月)的两种治疗策略的疗效.结果 121例真性破裂性腹主动脉瘤病人中,29例于术前放弃手术或死亡.其中,在"EVAR/Open"时期,40例(19例EVAR及21例开放手术)接受外科治疗,EVAR及开放手术后30d病死率分别为26.3％及23.8％(P=0.94);而在"EVAR Only"时期共52例全部接受EVAR治疗,术后30d病死率为23.1％.两个时期病死率差异无统计学意义(P=0.83).两个时期内均未观察到不同术式在不同术前血流动力学状态及不同瘤体解剖学条件中对病死率有明显的影响.结论 基于所在中心平诊手术经验的"完全EVAR"策略可有效用于几乎所有破裂性腹主动脉瘤的急诊救治,并获得与"选择性EVAR"策略一致的疗效.

Objective To evaluate the safety and effectiveness of endovascular aortic repair (EVAR) used in ruptured abdominal aortic aneurysm ( AAA ) , and to discuss the possibility for replacement of the traditional open surgery with EVAR in this disease. Methods Cases of EVAR on noninfected ruptured AAA over recent 7-year period were reviewed, in which the treatment strategies evolved from "EVAR/OPEN"approach (2009.1～2014.3) to "EVAR-PRIMARY" approach (2014.4～2016.7) were compared. Results Over this 7 years, 80 patients with truly-ruptured AAA were admitted in the emergency room of Zhongshan hospital from March 2009 to July 2016, among which 27 (33.8％) died preoperatively. Twenty six cases ( 15 EVARs and 11 OPENs ) were treated during "EVAR/OPEN" period , and thereafter during the "EVAR-PRIMARY" period all the 27 cases were treated by EVAR. The 30-day mortality rate was 26.9％ ( 26 . 7％for EVAR and 27 . 3％ for OPEN ) for the "EVAR/OPEN" period and 25 . 9％ for the "EVAR-PRIMARY" period (P=0.93). For all patients , preoperative hemodynamic stability (OR=0.22,95％CI 0.06～0.85,P=0.03) w as found associated with lower mortality rate. As for EVAR patients, local anesthesia (OR=0.18,95％CI 0.04～0.82,P=0.03) were found associated with lower mortality rate, comparing with general anesthesia. However, any association between hemodynamic status and the prognosis in both procedures were not found. Conclusions The "EVAR-PRIMARY" approach has allowed EVAR to be used in nearly all the ruptured AAA with similar mortality comparing with "EVAR/OPEN"approach.

Background: Podocyte injury was reported to be involved in the major pathogenesis of ischemia/reperfusion (I/R)-induced ischemic acute renal failure. Our purpose was to study the mechanism of miR-187 improving I/R-induced podocytes injury. Materials and methods: The miR-187 mimics and inhibitor were transfected into the immortalized mouse podocyte (MPC-5) cells, and then transfected cells were subjected to hypoxia/reoxygenation (H/R, 3/3 h) to establish an H/R cell model. To investigate the effects of miR-187 on H/R-induced cell injury, cell viability and apoptosis were measured by Cell Counting Kit-8 (CCK-8) assay and flow cytometry. Dual-luciferase report system was used to verify whether miR-187 could directly target acetylcholinesterase (ACHE). The animal ischemia/reperfusion model was established and injected with miR-187 agomir. Kidney tissue sections were subjected to histological examination by hematoxylin and eosin staining to assess the renal injury. Real-time quantitative PCR and western blot were performed to determine gene expressions. Results: The transfection of miR-187 mimics contributed to MPC-cells resistance to H/R-induced cell injury, which was reflected by enhanced cell viability and reduced apoptosis (from 20.05% to 9.43%) in H/R + negative control group. ACHE was confirmed as a target of miR-187, and ACHE siRNA had a similar efficiency to miR-187 mimic. The injection of miR-187 agomir not only effectively protected the kidney from I/R-induced injury, but also reduced the concentrations of serum creatinine. Moreover, nephrin was noticeably increased and desmin was decreased under the effects of agomir. Conclusions: Our findings indicated that miR-187 improved I/R-induced ischemic acute renal failure through protecting glomerular filtration barrier by blocking the expression of ACHE. (C) 2019 Elsevier Inc. All rights reserved.