Abdominal aortic aneurysm (AAA) is a progressive degenerative vascular disease with a high risk of rupture and mortality. Endovascular aneurysm repair (EVAR) is a widely used minimally invasive treatment option for anatomically suitable AAA. However, postoperative endoleaks associated with EVAR can precipitate secondary aneurysm rupture. We developed an injectable nanocomposite hydrogel for embolization and local delivery of cycloastragalol (CAG). CAG-loaded aldehyde-functionalized polyurethane nanoparticles (DFPU@CAG) showed uniform morphology, favorable biocompatibility, and enhanced CAG delivery efficiency, and were incorporated into a chitosan (CS)-based dynamically crosslinked hydrogel to form CS-DFPU@CAG. The hydrogel showed suitable injectability and rheological properties for embolization with sustained local drug release. In vivo studies in animal AAA models showed that in situ administration significantly attenuated AAA expansion and reduced matrix metalloproteinase9 (MMP9) expression and enzymatic activity. CS-DFPU@CAG also demonstrated robust embolization performance in vitro and in vivo, maintaining stability under high pressure and achieving blood-flow occlusion in rabbit femoral arteries comparable to a clinical porcine fibrin sealant. These findings provide a preclinical proof-of-concept for CS-DFPU@CAG as a dual-function embolic and local therapeutic platform for AAA management.

OBJECTIVE:To investigate the effect of intraoperative blood salvage autotransfusion on local recurrence and long-term metastasis of patients after carotid body tumor resection. METHODS:We retrospectively reviewed a consecutive series of 61 patients undergoing elective carotid body tumor resection from August 2009 to December 2020. Among them, 14 received intraoperative blood salvage autotransfusion (autotrasfusion group) and 47 did not (non-autotransfusion). Data of general information, surgical status and postoperative follow-up results were collected. RESULTS:The proportion of Shamblin Ⅲ in the autotransfusion group was 85.7%, which was significantly higher than 31.9% in the non-autotransfusion group (P=0.003). The average operation time of the 14 patients in the autotransfusion group was (264±84) min, intraoperative blood loss was 1 200 (700, 2 700) mL, and autologous blood transfusion was 500 (250, 700) mL. Of these, 8 patients (57%) required concomitant allogeneic blood with 400 (260, 400) mL of allogeneic blood. The average operation time of the 47 patients in the non-autotransfusion group was (153±75) min, and the intraoperative blood loss was 300 (100, 400) mL. Of these, 6 (13%) required allogeneic blood transfusion, and 520 (400, 520) mL of allogeneic blood was used. Compared with the non-autotransfusion group, the average operation time in the autologous blood transfusion group was significantly longer (P < 0.001), and the intraoperative blood transfusion volume was larger (P=0.007). Of the 14 patients undergoing autotransfusion, 8 (57%) needed allogeneic blood at the same time; while in the 47 non-autologous transfusion patients, 6 (13%) needed allogeneic blood transfusion. The proportion of autotransfusion group using allogeneic blood at the same time was even higher (P=0.002). The incidence of nerve injury within 30 days after surgery was 29.5%, and there was no significant difference between the two groups. No early deaths occurred. The average follow-up was (76±37) months. One case of local recurrence occurred in the non-autotransfusion group. There was no distant metastasis. There were no tumor-related deaths. The estimated 5-year and 10-year overall survival rates were 96.4% and 83.8%, respectively. There was no significant difference in overall survival between the two groups (P=0.506). CONCLUSION:The use of intraoperative blood salvage autotransfusion increased no risk of local recurrence and distant metastasis in patients with carotid body tumor, which is safe and effective in carotid body tumor resection.

Aortic aneurysm and dissection (AAD) are life-threatening cardiovascular diseases with limited effective medical treatments. Protein phosphatase 2A (PP2A), the most abundant serine/threonine phosphatase in eukaryotes, is pivotal in regulating intracellular signaling. This study investigates the role of PP2A in the pathogenesis of AAD. Analysis of available datasets revealed that PP2Acα is the most significantly downregulated PP2A subunit in human and mouse aneurysm tissues. Vascular smooth muscle cell (VSMC)-specific PP2Acα knockout exacerbates β-Aminopropionitrile (BAPN)-induced aortic dissection and elastase-induced abdominal aortic aneurysm in mice. Collagen-based contraction assays, Western blot, and gelatin zymography confirmed that the deficiency of PP2Acα results in decreased contractility, contractile markers, and elevated production of matrix metallopeptidase 2 (MMP2) in VSMCs. Furthermore, PP2Acα deficiency promoted VSMC phenotypic switching through stabilizing Kruppel-like factor 4 (KLF4). Mechanistically, PP2Acα binds to and dephosphorylates protein kinase B 1 (AKT1), thereby reducing phosphorylation of the AKT1 substrate KLF4 at Thr398. The deficiency of PP2Acα diminishes KLF4 phosphorylation-dependent ubiquitination and degradation, leading to the suppression of VSMC contractile gene transcription. The findings underscore a critical role for PP2Acα in regulating VSMC phenotypic switching and AAD progression by controlling KLF4 phosphorylation and ubiquitination, offering novel insights into the molecular pathogenesis underlying AAD.

Objectives This study aimed to evaluate the incidence trend and related factors for hospital-acquired upper extremity deep vein thrombosis (HA-UEDVT) in inpatients of a large medical center in China over 13 years, and to summarize and analyze the complications and preventive treatments of HA-UEDVT. Methods We conducted a retrospective analysis on the epidemiological characteristics, related factors, and use of different prophylactic anticoagulation methods in patients with HA-UEDVT at Peking University People's Hospital from January 1, 2009, to December 31, 2021. The data of all patients were obtained through the hospital's medical record system. Results Over the 13 years, there has been 239 cases of HA-UEDVT, with a much lower incidence rate compared to HA-LEDVT (0.31 vs 2.28 per 1000 admissions). HA-UEDVT incidence peaked in 2015 and 2016 (both 0.44 per 1000 admissions). The highest HA-UEDVT incidence rates were in the respiratory and gastroenterology departments, with 1.13 and 1.22 per 1000 admissions, respectively. The top three related factors of HA-UEDVT were having a CVC, concurrent of breast cancer, and concurrent of HA-LEDVT, with the β values of 4.81, 4.68, and 3.11, respectively. Thrombosis-related preventive measures were implemented in 30.1% of patients, significantly less frequently than HA-LEDVT (30.1% vs 82.4%, p < .001). The low molecular weight heparin (LMWH) subcutaneous injection being the main thromboprophylaxis used before HA-UEDVT diagnosis. Conclusions HA-UEDVT mainly occurred in medicine departments and has shown a decreasing trend in recent years. Having CVC, breast cancer, and HA-LEDVT are highly associated with HA-UEDVT occurrence. There was no statistical difference in the incidence of pulmonary embolism between CVC-related HA-UEDVT and HA-LEDVT groups. More high-quality prospective studies are needed to guide HA-UEDVT prevention.

Background: This study aimed to evaluate the demographic characteristics and changing trends in the incidence of hospital-acquired lower extremity deep venous thrombosis (HALEDVT) in Chinese inpatients over the course of 15 years. Methods: We performed a retrospective analysis of the HA-LEDVT events in a medical center between January 1, 2007, and December 31, 2021. Results: A total of 846,347 eligible patients were analyzed. The overall incidence of HA-LEDVT was 2.53 per 1,000 admissions. The incidence was 0.22 and 4.20 per 1,000 admissions in 2007 and 2017, respectively (P < 0.01). Medical patients had a higher incidence of HA-LEDVT than surgical patients (3.19 vs. 2.14 per 1,000 admissions; P < 0.01). The incidence of HA-LEDVT increased from 0.28 to 11.90 per 1,000 admissions for those aged 17-29 years and 8089 years, respectively (P < 0.01). The increase in HA-LEDVT incidence mainly occurred in patients aged >= 60 years. The median length of stay of HA-LEDVT patients was longer than that of other eligible patients (17 vs. 7 days; P < 0.01). Most of the HA-LEDVT events (77.8%) were diagnosed between hospital day 3 and 15, and the time from admission to HA-LEDVT diagnosis decreased by year. The rate of vascular surgery consultation for diagnosed or suspected HALEDVT and HA-LEDVT-related discharge instructions both decreased by half gradually over the 15 years of this study. Isolated distal deep vein thrombosis (DVT) accounted for 83.3% of all HA-LEDVT events, and the proportion increased significantly from 62.5% in 2007 to 88.7% in 2021 (P < 0.01). Conclusion: The incidence of HA-LEDVT has been high in the Chinese population. More highquality prospective studies are needed to guide prevention of HA-LEDVTs.

Objectives: To compare drug-coated balloon (DCB) and bare metal stent (BMS) for primary lesions in femoropopliteal artery disease in Chinese population and to make subgroup analysis between the groups. Methods: Patients with primary lesions who underwent BMS or DCB treatment of a single tertiary vascular center were included and followed up for 24 months. Clinical and anatomic status were reported using the criteria recommended by the Society for Vascular Surgery. The primary endpoint included primary patency, clinically target limb revascularization, composite safety endpoint and all-cause death over 24 months assessed by Kaplan-Meier. Secondary endpoints included technical success rate and stent-related complications. Results: A total of 284 patients with 324 limbs were pooled into analysis and most of the baseline characteristics did not show significant difference. A total of 74 in BMS group and 71 in DCB group were claudicants while 83 in BMS group and 56 in DCB group suffered from chronic limb threatening ischemia (CLTI). The mean cumulative lesion length was 18.7 +/- 9.8cm in BMS group while 17.2 +/- 10.3cm in DCB group. Kaplan-Meier estimates of primary patency were 75.3% and 80.9% for BMS and DCB groups at 12 months while decreased to 63.9% and 70.2% at 24 months (log-rank P = 0.167), respectively. Freedom from clinically driven target limb revascularization was 86.8% and 92.7% for BMS and DCB groups at 12 months while dropped to 82.5% and 85.9% at 24 months (log-rank P = 0.342). Estimates of primary patency between BMS and DCB group did not show significant difference on lesions with poor runoff (58.8% vs. 67.3%, log rank P = 0.127), severe calcification (64.5% vs. 69.4%, log-rank P = 0.525) and popliteal artery involvement (59.3% vs. 60.3%, log-rank P = 0.695) at 24 months. The overall survival (92.6% for BMS, 90.3% for DCB, log-rank P = 0.391) and freedom from composite safety endpoint (79.3% for BMS, 79.2% for DCB, log-rank P = 0.941) showed no significant difference at 24 months. Conclusions: Over the 24 month follow-up, BMS and DCB showed equivalent efficacy and safety outcomes for primary femoropopliteal artery disease, which indicated the reduction of permanent metallic implant insertion might be possible.

Thoracic aortic aneurysm and dissection (TAAD) is a high-risk aortic disease. Mouse models are usually used to explore the pathological progression of TAAD. In our studies, we performed bioinformatics analysis on a microarray dataset (GSE36778) and verified experiments to define the integrated hub genes of TAAD in three different mouse models. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and protein-protein interaction (PPI) network analyses, and histological and quantitative reverse transcription-PCR (qRT-PCR) experiments were used in our study. First, differentially expressed genes (DEGs) were identified, and twelve common differentially expressed genes were found. Second, genes related to the cell cycle and inflammation were enriched by using GO and PPI. We focused on filtering and validating eighteen hub genes that were upregulated. Then, expression data from human ascending aortic tissues in the GSE153434 dataset were also used to verify our findings. These results indicated that cell cycle-related genes participate in the pathological mechanism of TAAD and provide new insight into the molecular mechanisms of TAAD.

OBJECTIVE:Thoracoabdominal aortic aneurysm is one of the most challenging aortic diseases. Open surgical repair remains constrained with considerable perioperative morbidity and mortality. The emergence of a hybrid approach utilizing visceral debranching with endovascular aneurysm repair has brought an alternative for high-risk patients. This study aimed to compare the short- and long-term outcomes between hybrid and open repairs in the treatment of thoracoabdominal aortic aneurysms. METHODS:In this retrospectively observational study, patients with thoracoabdominal aortic aneurysm treated in a single center between January 2008 and December 2019 were reviewed, of whom 11 patients with hybrid repair, and 18 patients with open repair were identified. Demographic characteristic, operative data, perioperative morbidity and mortality, freedom from reintervention, and long-term survival were compared between the two groups. RESULTS:In the hybrid repair group, the patients with dissection aneurysm, preoperative combined renal insufficiency, and American Society of Anesthesiologists (ASA) score of 3 or more were significantly overwhelming than in the open repair group. The operation time of debranching hybrid repair was (445±85) min, and the intraoperative blood loss was (955±599) mL. There were 2 cases of complications in the early 30 days after surgery, without paraplegia, and 1 case died. The 30-day complication rate was 18.2%, and the 30-day mortality was 9.1%. The operation time of the patients with open repair was (560±245) min, and the intraoperative blood loss was (6 100±4 536) mL. Twelve patients had complications in the early 30 days after surgery, including 1 paraplegia and 4 deaths within 30 days. The 30-day complication rate was 66.7%, and the 30-day mortality was 22.2%. The bleeding volume in hybrid repair was significantly reduced compared with open repair (P < 0.001). Besides, the incidence of 30-day complications in hybrid surgery was significantly reduced (P=0.011). During the follow-up period, there were 4 reinterventions and 3 deaths in hybrid repair group. The 1-year, 5-year, and 10-year all-cause survival rates were 72%, 54%, and 29%, respectively. In open repair group, reintervention was performed in 1 case and 5 cases died, and the 1-year, 5-year, and 10-year all-cause survival rates were 81%, 71%, and 35%, respectively. There was no significant difference between hybrid repair and open repair in all-cause survival and aneurysm-specific survival. CONCLUSION:Hybrid approach utilizing visceral debranching with endovascular aneurysm repair is a safe and effective surgical method for high-risk patients with thoracoabdominal aortic aneurysms. The incidence of early postoperative complications and mortality is significantly reduced compared with traditional surgery, but the efficacy in the medium and long term still needs to be improved.

New Findings What is the central question of this study? What is the relationship of chemokine (C‐C motif) ligand 8 (CCL8) to thoracic aortic aneurysm and dissection (TAAD) formation in postnatal mice with vascular smooth muscle cell (VSMC) Tgfbr2 disruption, and is dexamethasone a potential treatment? What is the main finding and its importance? CCL8 was associated with the formation of TAAD in VSMC Tgfbr2‐disrupted mice. Dexamethasone reduced TAAD formation and inhibited mitogen‐activated protein kinase (p‐p38) and nuclear factor‐κB (p‐p65) signalling pathways. CCL8 might be an important promoter of aortic inflammation. Dexamethasone provided potential therapeutic effects in TAAD treatment. AbstractAortic inflammation plays a vital role in initiation and progression of thoracic aortic aneurysm and dissection (TAAD). Disturbance of the transforming growth factor‐β (TGF‐β) signalling pathway is believed to be one of the pathogenic mechanisms of TAAD. Initially, Myh11‐CreERT2.Tgfbr2f/f male mice were used to build a TAAD mouse model, and bioinformatic analyses revealed enriched inflammatory signal pathways and upregulated chemokine (C‐C motif) ligand 8 (CCL8). So we hypothesized that vascular smooth muscle cell (VSMC) Tgfbr2 disruption in postnatal mice results in aortic inflammation associated with CCL8 secretion. Real‐time quantitative PCR and serum enzyme‐linked immunosorbent assay (ELISA) results confirmed that CCL8 expression began to increase after VSMC Tgfbr2 disruption. Next, we cultured mouse thoracic aortas ex vivo, and observed that the protein expression of CCL8 in culture supernatants was increased by ELISA. Subsequently, the co‐localization of CCL8 with α‐smooth muscle actin or CD68 was found to be significantly increased by immunofluorescence. Then, dexamethasone (DEX) was used to treat TAAD in VSMC Tgfbr2‐disrupted mice; the results of histochemical, immunofluorescence and immunohistochemical staining indicated that DEX therapy reduced CCL8 secretion, inflammatory cell recruitment, aortic medial thickening, elastic fibre fragmentation, extracellular matrix degradation and contractile apparatus impairment, and thereby ameliorated TAAD formation. Western blotting showed that mitogen‐activated protein kinase and nuclear factor‐κB signalling pathways in aorta were overactivated after VSMC Tgfbr2 disruption, but inhibited by DEX therapy. Altogether, CCL8 might be an important promoter in TAAD formation of VSMC Tgfbr2‐disrupted mice, and DEX provided potential therapeutic effects in TAAD treatment.

Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.

Objectives: To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA). Methods: The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People's Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively. Results: All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification(HR=3.804, 95%CI:2.460 to 5.883), popliteal artery involvement (HR=2.104, 95%CI:1.368 to 3.236), long lesion (HR=1.824, 95%CI:1.196 to 2.780), poor runoff(HR=1.736, 95%CI:1.025 to 2.940), chronic kidney disease(HR=1.601, 95%CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions: The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.

OBJECTIVE:The anatomic distribution of lower extremity deep venous thrombosis (LEDVT) plays an important role in its prevention and treatment. This study aimed to evaluate the anatomic distribution of hospital-acquired LEDVT (HA-LEDVT) and its probable role in the occurrence of pulmonary embolism (PE). METHODS:We retrospectively analyzed the demographic data, ultrasound results, and PE-related findings of inpatients with HA-LEDVT in 28 clinical departments at Peking University People's Hospital between January 1, 2007, and December 31, 2018. RESULTS:This study included 1431 HA-LEDVT events: 35.8%, 31%, and 33.3% were left, right, and bilateral LEDVT. Isolated distal, proximal, and blended DVT were detected in 83.4%, 7.3%, and 9.3% of the patients, respectively. The distribution of HA-LEDVT in the left and right lower extremities were not significantly different except in patients aged ≥40 years (left: 2.07 vs right: 1.88 per 1000 extremities, P = .04). For anatomic types of HA-LEDVT, isolated distal HA-LEDVT was 5.02 times more prevalent than proximal HA-LEDVT (1.24 vs 0.26 per 1000 extremities, P ＜ .01). The involvement rates of specific deep veins by HA-LEDVT were highest in the muscular calf vein (87.5%) followed by the popliteal vein (10.1%), superficial femoral vein (9.3%), and common femoral vein (9.2%). HA-LEDVT involving multiple vein segments simultaneously occurred in 338 extremities. HA-LEDVT involving the muscular calf vein and at least one of three connected axial veins of the muscular calf vein occurred most frequently. Eighty-eight patients with HA-LEDVT (6.15%) had PE. The frequency of PE among patients with proximal and distal DVT (7.89% vs 6.23% P = .275) was not significantly different. The incidence of PE was highest in patients with bilateral proximal DVT (15.4%) and lowest in patients with a single right distal DVT (4.5%). PE occurred in 6% of muscular calf vein HA-LEDVT. In isolated muscular calf vein DVT cases, PE were more likely to occur in cases with a ＞6.05-mm-diameter thrombus than in those with a ＜6.05-mm-diameter thrombus (10.3% vs 4.2%, P ＜ .0001). CONCLUSIONS:HA-LEDVT is characterized by a significantly high percentage of DVT in the muscular calf vein. Muscular calf vein thrombosis may be the primary origin of lower extremity deep vein thrombosis. The diameter of the thrombus in the muscular calf vein may be associated with the occurrence of PE. More prospective studies are needed to more fully determine the natural history of HA-LEDVT and develop prevention and treatment guidelines for HA-LEDVT.

目的 探讨通塞脉片在糖尿病下肢动脉闭塞患者接受下肢动脉介入术后的治疗效果.方法 收集78例糖尿病下肢动脉闭塞严重肢体缺血患者的临床资料,根据患者术后是否服用通塞脉片分为观察组和对照组,对照组介入术后接受抗血小板药物治疗,观察组在抗血小板药物基础上加用通塞脉片.比较2组临床治疗效果.结果 总体手术成功率94％,观察组和对照组的手术成功率、补救性支架植入率、开通的膝下动脉支数比较差异均无统计学意义(P均>0.05).随访6个月时,观察组2例(5％)患者分别死于心肌梗死和脑梗死,对照组1例(3％)患者死于心肌梗死.观察组和对照组的总体保肢率分别为81％和67％,临床症状驱动的靶血管再血管化率分别为17％和14％.2组患者总体保肢率、再血管化率和全因死亡率比较差异均无统计学意义(P均>0.05).观察组患者小截肢率低于对照组(14％vs.33％,P<0.05).对术前患者肾功能进行分层分析,肾功能正常患者中观察组的小截肢发生率低于对照组(11％vs.35％,P<0.05).结论 糖尿病下肢动脉闭塞患者接受下肢动脉介入手术效果确切,通塞脉片有助减少患者术后小截肢的风险.

Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.

Background: Although aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH. Methods: Data of 61 patients with type B IMH in Peking University People's Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture. Results: Initial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m(2) (OR, 8.726; 95% CI: 1.711- 46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322-92.258; P=0.001) were independent predictors of adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m2 and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m(2) and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone. Conclusions: Initial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.

Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening vascular disease with no effective pharmaceutical therapies currently available. Inflammation plays a key role in the progression of aneurysms. Dexamethasone (DEX), a synthetic glucocorticoid, has showed alleviating effects on cells in vitro from TAAD patients. Here we performed a study aiming at investigating the protective role of DEX in a β-aminopropionitrile monofumarate (BAPN)-induced TAAD mouse model. DEX (dose: 0.04 mg/kg/day) treatment significantly reduced the aortic diameter and inhibited TAAD formation. DEX reduced infiltration of macrophages and neutrophils, apoptosis of vascular smooth muscle cells (VSMCs), expression of metalloproteinase 2/9, and extracellular matrix degradation in BAPN-treated TAAD mice. Furthermore, DEX therapy downregulated the expression of p-p65 in macrophages and VSMCs, which suggested that DEX might ameliorate BAPN-induced TAAD by suppressing NF-κB signaling. Therefore, DEX therapy attenuates the progression of BAPN-induced TAAD murine model and could be used as an effective adjuvant therapy for treating TAAD.

To present our initial experience with Catheter-directed thrombolysis (CDT) using urokinase for the treatment of juxtarenal aortic occlusion. This was a retrospective study of 14 patients with juxtarenal aortic occlusion treated with CDT for 2-6 days between March 2012 and March 2015 at the Department of Vascular Surgery of People's Hospital of Peking University. All patients had an occlusion of the abdominal aorta adjacent to the origin of the renal arteries and were diagnosed by computed tomography. All patients were classified as TransAtlantic Inter-Society Consensus II (TASC D). Successful thrombolysis was defined as a reduction of >50% of the thrombus volume. There were nine men (64%) and five women (36%). Mean age was 58.3 +/- 9.4 years. The main symptom was claudication in eight patients (57%), rest pain in four (29%), and ulceration in two (14%). The duration of disease was 30.8 +/- 24.7 months (range, 1-72 months). CDT lasted 6 days in 12 patients, 2 and 3 days in the other 2 patients. The use of CDT was successful in all 14 patients. Three patients complained of transient pain, but it did not need intervention. No patient experienced perioperative visceral embolization. Limb ischemia was significantly relieved in all patients. At 1 year of follow-up, two patients presented asymptomatic re-occlusion. CDT could be considered in the treatment of juxtarenal aortic occlusion.

目的 探讨完全腔内技术治疗累及主动脉弓部病变的中长期随访结果. 方法 回顾性分析2010年1月.2017年12月95例应用完全腔内技术处理累及主动脉弓部病变的临床资料,其中烟囱支架技术81例,“开窗”技术8例(原位4例,体外4例),分支支架技术6例. 结果 共植入胸主动脉覆膜支架主体95枚,重建主动脉弓部分支动脉124支,其中无名动脉7支,左颈总动脉36支,左锁骨下动脉81支.2例原位开窗失败中转烟囱技术重建分支.术中Ⅰ型内漏11例(11.6％),其中5例弹簧圈栓塞后消失,6例轻微内漏随访观察.技术成功率91.6％(87/95).围术期死亡3例(3.2％),一过性截瘫1例(1.1％),脑梗死2例(2.1％),急性心肌梗死2例(2.1％),急性肺损伤1例(1.1％).存活92例中随访83例,随访率90.2％.1例术后4个月死于脑梗死,1例术后6个月因多器官功能衰竭死亡,其余81例随访时间28～106(58.9±17.9)月,其中73例＞36个月.8例因Ⅰ型内漏行二次手术栓塞,未见支架移位、狭窄、闭塞等并发症. 结论 通过多种完全腔内技术重建各主动脉弓部的分支血管,为累及主动脉弓部病变提供微创治疗机会,中长期随访结果满意.

Unicentric Castleman disease, a rare lymphoproliferative disorder, is always known as a solitary, well-defined lymph node enlargement. We reported an extraordinary case of retroperitoneal Castleman disease, which invades wall of right iliac vein and inferior vena cava, treated successfully by tumorectomy with vascular repair.