Background: Currently, there is a lack of real-world multicenter data on the use of drug-coated balloons (DCBs) in complex peripheral artery disease (PAD). Objectives: This study aims to build a real-world multicenter database to generate evidence-based data and clinical experience for drug-coated balloons (DCBs). The goal is to provide practical guidance for clinicians, ultimately improving treatment outcomes such as walking distance and long-term vessel patency. Methods: This project is a multicenter, real-world, single-arm study. The primary endpoints are the 6-month and 12-month primary patency rates and freedom from re-intervention rates. Safety assessments primarily include 30-day perioperative mortality, major and minor amputations, and major adverse events. Results: A total of 601 patients with peripheral artery disease were enrolled in this study. The present interim analysis only included 224 patients who completed at least 6 months of clinical and imaging follow-up. No patients died within the 30-day perioperative period. At 6 months, the primary patency rate for the entire cohort was 90.76%, and the freedom from re-intervention rate was 98.66%. At 12 months, the primary patency rate was 61.65%, and the freedom from re-intervention rate was 94.06% (one patient in the cohort died during this follow-up period due to advanced age). For the above-the-knee (ATK) group, the 6-month primary patency rate was 91.96% and freedom from re-intervention was 100%; at 12 months, the primary patency rate was 69.74% and freedom from re-intervention was 95.27%. For the below-the-knee (BTK) lesion group, the 6-month primary patency rate was 88.89% and freedom from re-intervention was 95.95%; at 12 months, the primary patency rate was 50.88% and freedom from re-intervention was 91.67%. The 12-month primary patency rate was significantly lower in the BTK subgroup than the ATK subgroup (p = 0.017). Conclusions: The UltraFree carrier-free pure paclitaxel DCB is safe and effective in treating complex peripheral artery disease, demonstrating high primary patency and freedom from re-intervention rates. These findings support the use of this DCB for all femoropopliteal and below-the-knee lesions in patients with peripheral artery disease.

目的 比较经肱动脉入路和经股动脉入路治疗肠系膜上动脉病变的效果.方法 回顾性分析 2020 年 6 月至 2022 年 7 月海军军医大学第一附属医院 73 例接受肠系膜上动脉支架植入术和肠系膜上动脉取栓术的肠系膜上动脉病变患者临床资料,其中肱动脉组 16 例,股动脉组 57 例.比较两组间"超选"肠系膜上动脉的时间、术后卧床时间和术后并发症等指标.结果 当肠系膜上动脉与主动脉夹角＜90°时,肱动脉组"超选"肠系膜上动脉的时间比股动脉组更短(P=0.004),且术后卧床时间短(P＜0.001).当肠系膜上动脉与主动脉夹角≥90°时,肱动脉组术后卧床时间更短(P=0.045),"超选"肠系膜上动脉的时间差异无统计学意义(P=0.682).肱动脉组和股动脉组在术后并发症的发生率方面差异无统计学意义(P＞0.05).结论 经肱动脉入路治疗肠系膜上动脉病变能缩短术后卧床时间,且当肠系膜上动脉与主动脉夹角＜90°时,经肱动脉入路"超选"肠系膜上动脉所用时间更短.

BACKGROUND:To assess the feasibility and first-in-human experience of a novel endovascular robotic system for treatment of lower extremity peripheral arterial disease (PAD).METHODS:Between November 2021 and January 2022, consecutive patients with obstructive lower extremity PAD and claudication (Rutherford 2-5) with >50% stenosis demonstrated on angiography were enrolled in this study. Lower extremity peripheral arterial intervention was performed using the endovascular robotic system, which consisted of a bedside unit and an interventional console. The primary endpoints were technical success, defined as the successful manipulation of the lower extremity peripheral arterial devices using the robotic system, and safety. The secondary endpoints were clinical success, defined as 50% residual stenosis at the completion of the robot-assisted procedure without major adverse cardiac events and radiation exposure.RESULTS:In total, 5 patients with PAD were enrolled in this study (69.2±6.0 years; 80% men). The novel endovascular robotic system successfully completed the entire procedure of endovascular treatment of lower extremity PAD. Conversion to manual operation, including advancement, retracement, rotation of the guidewires, catheters, sheaths, deployment, and release of the balloons and stent grafts, was not necessary. We achieved the criteria for clinical procedural and technical success in all patients. No deaths, myocardial infarctions, or ruptures occurred in the period up to 30 days after the procedure, and no device-related complications were observed. The robotic system operator had 97.6% less radiation exposure than that at the procedure table, with a mean of 1.40±0.49 μGy.CONCLUSIONS:This study demonstrated the safety and feasibility of the robotic system. The procedure reached technical and clinical performance metrics and resulted in significantly lower radiation exposure to the operators at the console compared with that at the procedure table.CLINICAL IMPACT:There were some reports about several robotic systems used in the peripheral arterial disease, but no robotic system was able to perform entire procedure of endovascular treatment of lower extremity peripheral arterial disease (PAD).To solve this problem, we designed a remote-control novel endovascular robotic system. It was the first robotic system that can perform entire procedure of endovascular treatment of PAD worldwide. A novelty retrieval report about this is provided in the supplementary materials.The robotic system is compatible with all commercial endovascular surgical devices currently available in the market, including guidewires, catheters and stent delivery systems. It can perform all types of motion, such as forward, backward, and rotation to meet the requirements of all types of endovascular procedures. During the operation, the robotic system can perform these operations in a fine-tuned manner, so it is easy to cross the lesions, which is the key factor influencing the success rate of the operation. In addition, the robotic system can effectively reduce the exposure time to radiation, thereby reducing the risk of occupational injury.

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".

Endovascular therapy has become the first choice for the treatment of aortoiliac occlusive disease due to its characteristics of minimally invasive, easy to tolerate, and satisfactory medium- and long-term patency rates. However, to improve the technical success rate and efficacy of endovascular surgery, attention must be paid to treatment strategies and technical details such as the approach selection, the recanalization of lesions, the vessel preparation, the reconstruction of the arteries, the protection of important branches, and the prevention of serious complications. The author has made a relatively comprehensive exposition based on the latest technological progress and personal experience, in order to provide reference and benefit to my young colleagues.

目的 探讨性别与重症糖尿病足患者(Wagner分级3～5级)的外周血管腔内治疗效果的关系.方法 纳入2019年1月至2022年1月海军军医大学第一附属医院收治的接受外周血管腔内治疗的重症糖尿病足患者168例,根据性别分为男性组(n=118)和女性组(n=50).比较两组患者下肢血管病变特点、术中处理方式,收集术后创面愈合率及截肢等资料.结果 在重症糖尿病足患者中,女性组术后3个月及6个月的创面愈合较男性组差(P=0.035,P=0.002),但两组患者截肢率差异无统计学意义.多因素回归分析结果显示,女性(OR=5.24,95％CI 1.227～22.382;P=0.025)和病变累及膝下动脉数量(OR=5.24,95％CI 1.213～14.709;P=0.024)与术后6个月创面愈合不良相关.在病变累及膝下动脉的人群中,女性患者的术后6个月创面愈合较差(P<0.001).结论 女性患者就诊时年龄大,合并症复杂,以膝下血管病变为主,且术中干预及术后创面愈合情况较差.女性糖尿病足患者应更早更积极地进行腔内治疗,这对改善女性患者的预后有积极意义.

Background In patients with acute aortic dissection (AAD), increased vascular smooth muscle cell (VSMC) apoptosis has been found. Human cytomegalovirus (HCMV)-miR-US33-5p was significantly increased in the plasma of patients with AAD. However, the roles of miR-US33-5p in human aortic VSMC (HA-VSMC) apoptosis remain to be elucidated. Methods In the current study, cell apoptosis was analyzed by flow cytometry, cell proliferation by CCK-8 assay, and differentially expressed genes by RNA sequencing. Luciferase reporter assay was used for binding analysis between miR-US33-5p and endothelial PAS domain protein 1 (EPAS1), and EPAS1 and amino acid transporter heavy chain, member 2 (SLC3A2). The enrichment degree of SLC3A2 promoter DNA was analyzed by chromatin immunoprecipitation assay. Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and immunoblotting were performed for measuring messenger RNA (mRNA) and protein levels, respectively. Results It was found that HCMV infection inhibited proliferation but promoted HA-VSMC apoptosis by upregulating HCMV-miR-US33-5p. Transfection of HCMV-miR-US33-5p mimics the significant effect on several signaling pathways including integrin signaling as shown in the RNA sequencing data. Western blotting analysis confirmed that HCMV-miR-US33-5p mimics suppression of the activity of key factors of the integrin signal pathway including FAK, AKT, CAS, and Rac. Mechanistic study showed that HCMV-miR-US33-5p bound to the 3′-untranslated region of EPAS1 to suppress its expression, leading to suppression of SLC3A2 expression, which ultimately promoted cell apoptosis and inhibited cell proliferation. This was confirmed by the findings that silencing EPAS1 significantly reduced the SLC3A2 expression and inhibited proliferation and key factors of integrin signal pathway. Conclusions HCMV-miR-US33-5p suppressed proliferation, key factors of integrin signal pathway, and EPAS1/SLC3A2 expression, but promoted HA-VSMC apoptosis. These findings highlighted the importance of HCMV-miR-US33-5p/EPAS1/SCL3A2 signaling and may provide new insights into therapeutic strategies for AAD.

目的 评估自主研发的Castor分支型主动脉覆膜支架（简称Castor支架）治疗累及左锁骨下动脉（LSA）的Stanford B型主动脉夹层的中期治疗效果。方法 选择2018年12月—2020年6月间在海军军医大学第一附属医院使用Castor支架行胸主动脉腔内修复术（TEVAR）的Stanford B型主动脉夹层患者70例，其中男64例、女6例，年龄为（60.02±13.03）岁。所有患者均于全身麻醉下行TEVAR。记录围手术期和随访期间主要观察指标和次要观察指标。主要观察指标为患者全因死亡及夹层逆撕、脑梗死等主动脉夹层相关不良事件。次要观察指标：术前测量主动脉夹层近端锚定区主动脉直径、LSA开口与主动脉夹层近端裂口距离、LSA开口与主动脉夹层近端边缘距离、LSA起始部直径、左颈总动脉（LCA）开口远端与LSA开口近端距离，手术完成情况、手术时间、术中对比剂使用量，住院时间、随访时间，内漏、支架闭塞等并发症情况，Castor支架主体近端及远端直径、分支支架直径，主动脉主体支架近端和远端放大率。结果 主要观察指标：围手术期3例患者发生主动脉夹层相关不良事件（夹层逆撕1例，脑梗死2例）,随访期间5例患者死亡（夹层逆撕破裂1例，呼吸衰竭1例，心力衰竭1例，脑出血2例）。次要观察指标：主动脉夹层近端锚定区主动脉直径为（31.63±3.16） mm, LSA开口与主动脉夹层近端裂口距离为（45.79±19.60）mm, LSA开口与主动脉夹层近端边缘距离为（8.14±14.37） mm, LSA起始部直径为（11.35±1.45） mm, LCA开口远端与LSA开口近端距离为（8.44±2.44） mm。所有患者均顺利完成手术。手术时间为（109.63±44.65） min,术中对比剂使用量为（200.79±35.11） mL,住院时间为（8.57±3.22） d,随访时间为（11.64±6.77）个月，6例患者失访。随访期间发生Ⅰb型内漏1例，分支支架闭塞1例。Castor支架主体近端直径为（32.43±3.45）mm、远端直径为（26.46±3.40）mm,分支支架直径为（10.92±4.08） mm。主动脉主体支架近端放大率为2.48%（0,3.45%）,主动脉主体支架远端放大率为0（-7.14%,4.35%）。结论 Castor分支型主动脉覆膜支架能够安全、有效地用于累及LSA的Stanford B型主动脉夹层的腔内治疗。

Background To assess the immediate effect and factors affecting the efficacy of rotational thrombectomy (RT) in patients with thrombus-containing lower-limb ischaemic lesions. Methods Patients were retrospectively divided into two groups: RT and RT+ CDT (Catheter-directed thrombolysis). The RT group included patients in whom intraoperative thrombus aspiration was successful, while the RT + CDT group included patients in whom intraoperative thrombus aspiration was less effective and remedial CDT treatment was used. The primary outcome was the immediate effect of RT on thrombus-containing lower-limb ischaemic lesions. Results From May 2015 to July 2021, 170 patients (113 men, 57 women; mean age, 74.0 years) with thrombus-containing lower-limb ischaemic lesions were treated in our centre. Of these patients, 113 received RT only, while 57 received RT + CDT. There were no significant intergroup differences in terms of age, disease duration, or comorbidities, but a higher proportion of male patients and higher preoperative plasma D-dimer levels (1.23 vs. 0.84; p = .017) was observed in the RT + CDT group. There were no significant intergroup differences in terms of diagnosis, lesion characteristics, lesion location, or lesion length. Multivariate logistic regression analysis revealed that male sex (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.098–6.410; p = .030) and poor distal runoff (OR, 2.94; 95% CI, 1.439–5.988; p = .003) were associated with higher rates of additional CDT. Male patients also had a significantly longer onset time, more thrombotic occlusions, and a greater frequency of in-stent restenosis. Conclusions RT alone or with CDT is a feasible primary treatment option for thrombus debulking. Sex significantly influences the effect of RT on thrombus-containing lower-limb ischaemic lesions.

Objectives To determine the association of pre- and postinterventional serum levels of interleukin-6 and high-sensitivity C-reactive protein at the six-month evaluation of restenosis after stenting of the femoropopliteal artery. Methods Sixty-eight consecutive patients with steno-occlusive femoropopliteal artery disease of Rutherford category III or IV who underwent stent implantation were included. Six-month patency was evaluated with color-coded duplex ultrasound. The association of in-stent restenosis with interleukin-6 and high-sensitivity C-reactive protein levels at baseline, and 24-h postintervention was assessed with a multivariate logistic regression analysis. Results In-stent restenosis was found in 15 patients (22.1%) within six months. Interleukin-6 and high-sensitivity C-reactive protein levels were significantly increased at 24-h postintervention compared to their preintervention values (p < 0.001 and p = 0.002, respectively). Interleukin-6 values at baseline (odds ratio, 1.11; 95% confidence interval: 1.00, 1.23; p = 0.044) and 24-h postintervention (odds ratio, 1.04; 95% confidence interval: 1.02, 1.06; p < 0.001) were independently associated with six-month in-stent restenosis. Twenty-four-hour postinterventional high-sensitivity C-reactive protein levels were also found to be related to restenosis (odds ratio, 1.15; 95% confidence interval: 1.04, 1.26; p = 0.006), but high-sensitivity C-reactive protein levels at baseline did not show an independent association with in-stent restenosis (odds ratio, 0.57; 95% confidence interval: 0.35, 1.80; p = 0.667). Smoking, diabetes mellitus, and cumulative stent length were other parameters associated with an increased risk for in-stent restenosis. Conclusions Femoropopliteal artery angioplasty with stent placement induces an inflammatory response. Interleukin-6 is a powerful independent predictor of intermediate-term outcomes for stenting of the femoropopliteal artery, suggesting that its predictive value may be superior to that of high-sensitivity C-reactive protein.

载药器具的出现和应用是下肢动脉腔内治疗技术发展的一个重要里程碑,包括药物涂层球囊(drug-coa-ted balloon,DCB)和药物洗脱支架(drug-eluting stent, DES)两大类.其原理是利用载药器具携载的抗增生药物(如紫杉醇、雷帕霉素等)抑制平滑肌细胞和纤维母细胞增生,以减轻动脉内膜增生所导致的血管再狭窄.紫杉醇是细胞毒性药物,作用于细胞有丝分裂周期的 M期,雷帕霉素是细胞抑制药物,可阻断 G1 期向S期的转化.强脂溶性的紫杉醇更容易被血管壁吸收,在体外实验和动物研究中都被证实有着明确的对抗平滑肌细胞增生的作用,所以应用于外周动脉的DES和 DCB大都选择了紫杉醇[1].

Objective: PGC-1 alpha achieves the protective effect of TNF-alpha-induced injury to human umbilical vein endothelial cells by inhibiting the Ca2+/NFAT pathway.Methods: Human umbilical vein endothelial cells were treated with 20, 40, and 80 ng/mL TNF-alpha to create three models with different degrees of cell injury. The human umbilical vein endothelial cells were cultured in vitro and transfected by interfering with the PGC-1 alpha RNA lentivirus. The silencing of the PGC-1 alpha gene was divided into two groups: the control group and the down-regulation of the PGC-1 alpha gene group. The effects of different concentrations of TNF-alpha on apoptosis of human umbilical vein endothelial cells were determined by flow cytometry. The expression of intracellular genes was detected by real-time quantitative PCR, and the expression of intracellular protein was measured by western blot assay. The concentrations of mtROS and Ca2+ were measured.Results: After human vein endothelial cells were treated for 24 h with different concentrations of TNF-alpha, the apoptosis rate gradually increased with the increase of TNF-alpha concentration, and the difference was statistically significant compared with the control group (P<0.05). The expression of PGC-1 alpha mRNA in each group was significantly lower than that of the control group after human venous endothelial cells were treated for 24 h of with different concentrations of TNF-alpha (P<0.05). After treatment with different concentrations of TNF-alpha, the relative expression rate of PGC-1 alpha protein in each group was remarkably lower than that in the control group (P<0.05). The expression of NFAT1 mRNA in the TNF-alpha 40 and 80 ng/mL treatment groups was significantly higher than that in the control group (P<0.05), and the expression of NFAT2 mRNA in different concentrations of the TNF-alpha treatment groups was markedly higher than that in the control group (P<0.05). The expression of NFAT1 protein in the TNF-alpha 40 and 80 ng/mL treatment groups was significantly higher than that in the control group (P<0.05), and the expression level of NFAT2 protein in different concentrations of TNF-alpha treatment group was clearly higher than that in the control group (P<0.05). The intracellular mROS and Ca2+ concentrations were significantly higher than that in the control group after the down-regulation of the PGC-1 alpha gene expression (P<0.05). After down-regulating the expression of the PGC-1 alpha gene, the levels of NFAT1, NFAT2, mRNA, and protein in the cells were significantly higher than those in the control group (P<0.05).Conclusion: 20, 40, and 80 ng/mL of TNF-alpha can induce different degrees of human umbilical vein endothelial cell injury. PGC-1 alpha has a protective effect on this kind of cell injury, and its related mechanism may be to inhibit the Ca2+/NFAT signalling pathway by reducing the intracellular mtROS concentration, and thus to protect damaged cells.

目的 总结主动脉腔内隔绝术后脊髓缺血的治疗体会.方法 2017年11月 ～2019年11月,我科收治的主动脉腔内隔绝术后发生脊髓缺血(SCI)病人7例,总结手术特点和随访结果,分析可能造成脊髓缺血的危险因素.结果 术后发生SCI的7例病人均未在术前行预防性脑脊液引流,其中6例病人为早期SCI,1例病人为延迟SCI;术前4例病人存在肾功能不全,6例病人存在血脂异常,3例病人合并慢性阻塞性肺疾病(COPD);平均手术时间为(2.5±1.35)小时;平均主动脉隔绝范围为8个椎体节段;4例病人在术中予以重建分支动脉;术后4例病人行治疗性脑脊液引流.经治疗后,2例病人症状好转,5例病人预后不良,其中4例病人死亡.结论 SCI是多种因素综合作用的结果,治疗性脑脊液引流的效果有限.

In-stent restenosis (ISR) is still a major cause of failure of endovascular stenting treatment in patients with lower extremity arterial occlusive disease (LEAOD). Sensitive and reliable biomarkers for early diagnosis to predict ISR should be considered. This study was conducted to explore the diagnostic value of microRNA in predicting ISR in patients with LEAOD after endovascular stenting treatment. From March 2014 to July 2016, 208 patients (170 males and 38 females) with LEAOD undergoing interventional treatment were enrolled in this research. Patients were divided into the restenosis and non-restenosis groups according to routine postoperative angiography. Circulating microRNAs expression were detected in 208 participants, including 78 ISR patients, 68 non-ISR patients and 62 healthy volunteers. We selected 6 microRNAs from microarray screening as candidates for further testing via qRT-PCR. A receiver operating characteristic (ROC) curve was generated to assess the diagnostic value of circulating microRNAs in predicting ISR for LEAOD patients. The results showed that circulating microRNA-320a and microRNA-572 in patients with ISR (n = 78) had significantly higher expression levels than it from non-ISR and healthy volunteers. By receiver operating characteristic curve analysis, the sensitivity was 82.1% and the specificity was 63.8% for microRNA-320a; the sensitivity was 69.2% and the specificity was 68.9% for microRNA-572, and the AUC was 0.766 and 0.690 for detection of ISR, respectively. Furthermore, 78 patients with ISR had significantly higher circulating expression levels of microRNA-3937 and microRNA-642a-3p and lower circulating expression levels of microRNA-4669 and microRNA-3138 compared with 68 non-ISR patients and 62 healthy volunteers, but they have no significant difference. We found that differential circulating microRNA expression in patients after stenting with ISR, and the data indicate that circulating microRNA-320a and microRNA-572 have promising value in diagnosing ISR in patients with LEAOD.

随着血管腔内器具的发展和技术水平的提高,腔内微创治疗已逐渐成为下肢动脉闭塞性疾病的主要治疗方式.鉴于药物涂层技术在抑制下肢动脉内膜增生中的作用,载药器械获得了高级别的临床应用推荐,包括股腘动脉长段病变、钙化病变、再狭窄病变、膝下病变等.但载药器具也有一些局限性,如可能与术后全因死亡率增高有关、药物涂层脱落导致远端肢体栓塞、过敏反应等,所以需要持续改进涂层药物质量,严格把握适应证,规范血管腔内治疗,尽可能减少涂层载药量,切实提高治疗效果.

目的 探讨AngioJet血栓抽吸技术在急性下肢深静脉血栓形成中"一站式"治疗的意义.方法 2013年10月至2015年2月上海第二军医大学附属长海医院收治的急性下肢深静脉血栓28例,予以AngioJet机械血栓抽吸术联合左髂静脉PTA术(9例术中造影见左髂静脉狭窄)完成"一站式"治疗.结果 全部28例病人,手术技术成功率为100％,病人在术中可见静脉血流恢复通畅.2例出现穿刺点周围皮下淤血,13例出现血红蛋白尿,术后无肺栓塞和死亡病例,住院日(3.9±1.1)d.结论 AngioJet血栓抽吸术在急性下肢深静脉血栓形成中"一站式"治疗中是安全、有效的,且具有卧床时间短、住院时间少、术后并发症少等优点.

Objectives:The aim of this study was to evaluate the potential of microcomputed tomography (micro-CT) using the intravascular contrast agent ExiTron nano 12000 for aorta imaging and monitoring the dynamic changing process of the aorta in mouse models with aortic aneurysm and dissection.Materials and Methods:Experiments were performed on healthy mice and mice with aortic dissection. Mice that were developing aortic dissection and healthy mice underwent micro-CT imaging after injection of ExiTron nano 12000. Time-dependent signal enhancement (at 1, 2, 3, 6, and 12 hours after intravenous injection of the contrast agent, respectively) in the aorta of healthy mice was measured to confirm the optimal imaging time of aorta. Various contrast agent doses (70, 100, and 150 μl per 25 g mouse, respectively) were investigated to determine the optimal required dose for imaging of the aorta. The mice were scanned with micro-CT at 1, 14, and 28 days after onset of aneurysm and dissection to monitor the dynamic changing process of the aorta. Mouse aortas were stained with hematoxylin and eosin staining, and the diameter of the aorta was measured and compared with those obtained by micro-CT.Results:Time-dependent signal enhancement in the aorta shows that the contrast agent has a long blood half-life of 6 hours, with a peak enhancement at 2 hours after injection. Injection of 100 μl ExiTron nano 12000 per 25 g mouse allows for effective visualization of the aorta. Micro-CT combined with contrast agent can monitor the changing process of the aorta in the mouse model of aortic aneurysm and dissection dynamically. The values of the diameter of the aortas obtained from the in vivo micro-CT imaging were compared with those obtained from histology and showed a significant correlation (R 2 = 0.96).Conclusions:These data demonstrate that in vivo micro-CT is an accurate and feasible technique to detect aortic aneurysm or dissection in a mouse model, and the micro-CT technique using the innovative contrast agent ExiTron nano 12000 allows for monitoring various processes dynamically such as aortic remodeling in longitudinal studies.

BACKGROUND:Patients with distal residual after proximal repair of aortic dissection (AD) have shown unsatisfactory long-term prognosis. However, possible mechanisms and risk factors for distal aortic segmental enlargement (DSAE) have been poorly understood.METHODS:We analyzed 962 AD patients repaired to the descending aorta between 1999 and 2014. Aortic morphological characteristics of 419 patients (including 75 DSAE and 344 non-DSAE patients) were investigated and compared. Potential risk factors associated with DSAE were explored using logistic regression analysis or natural logarithmic transformation. Logistic multi regress equations were performed to identify independent risk factors.RESULTS:Independent risk factors of DSAE are listed as follow: more tears in the thoracic descending aorta (odds ratio [OR], 1.65; 95% confidence interval [CI],1.24 to 2.19; P = .0005); fewer tears in the infra-renal abdominal aorta (OR, 3.00; 95% CI,2.04 to 4.55; P < .0001); closer distance of the first intimal tear to the left subclavian artery (OR, 1.51; 95% CI,1.28 to 1.69; P < .0001); larger average distance between tears (OR, 11.81; 95% CI,3.39 to 41.08; P = .0001); larger maximum distance between two tears (OR, 1.79; 95% CI,1.48 to 2.16; P < .0001), and larger area of remained tears (OR, 1.56; 95% CI, 1.38 to 1.76; P < .0001).CONCLUSIONS:The location and size of remained tears are the key risk factors of DSAE patients. Long-segment aortic repair and aggressive exclusion of all distal tears located on the thoracic descending aorta in their initial therapy will be an optimal strategy.

Background: To evaluate the applicability of endovascular treatment for iliofemoral vein thrombosis with composite stents. Methods: Between September 2013 and August 2016, 29 consecutive patients underwent endovascular therapy with composite stents for iliofemoral vein thrombosis and were followed up at our institution. All the patients with acute or chronic iliofemoral vein thrombosis enrolled in this study were evaluated by color Doppler ultrasonography and diagnosed by venography. Treatment measures and related complications were recorded, and cumulative stent patency was assessed with Kaplan-Meier curves. Results: Patients with acute iliofemoral vein thrombosis (n = 7) were successfully treated with catheter-directed thrombolysis treatment, balloon angioplasty, and stents, whereas patients (n = = 22) with chronic deep vein thrombosis were treated successfully by balloon angioplasty and stent only. Among all patients, 2 stents were inserted in 25 patients, whereas 3 stents were deployed in 4 patients. Endovascular treatment for iliofemoral vein thrombosis with laser-cut stents combined with Wallstents showed primary patency of treated limbs at 6, 12, and 24 months was 96.6%, 93.1% and 93.1%, respectively. Mean duration of follow-up was 23 months, and there was no occurrence of contralateral vein thrombosis during follow-up by ultrasound. Conclusions: Iliofemoral vein thrombosis was successfully recanalized by endovascular therapy with composite stents, and there was no occurrence of contralateral vein thrombosis by ultrasound during follow-up.

近10余年来,下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)的腔内治疗在技术和器械方面都经历了一个快速蓬勃发展的时代.最初的下肢动脉腔内治疗主要是以短段、狭窄性病变的单纯球囊扩张为主,金属镍钛支架的发明和应用成为下肢ASO腔内治疗领域的一个重要里程碑,球囊扩张加支架植入的治疗模式成为下肢ASO腔内治疗的主要方式.然而,尽管支架的应用和其性能的不断改善提高了下肢动脉腔内治疗的疗效,但由于腔内治疗适应证的拓展,治疗的病变越来越长,早已从泛大西洋协作组织(TASCⅡ)的A、B型病变拓展为C、D型病变[1],球囊扩张加支架植入的治疗方式因其再狭窄、再闭塞率较高而不能令人满意.因此,下肢ASO腔内治疗技术在不断地发生着变化与进展.