Background:Hybrid aortic arch repair combining debranching surgery with thoracic endovascular aortic repair (TEVAR) addresses complex aortic arch lesions. This study evaluated the long-term outcomes of hybrid aortic arch repair combining debranching surgery with TEVAR. Methods:We retrospectively analyzed 41 consecutive patients (mean age 56.9±14.6 years) undergoing hybrid arch repair between January 2010 and January 2021. Lesions included aneurysms (n=17), dissections (n=21), penetrating aortic ulcers (n=2), and intramural hematomas (n=1). Patients were stratified by proximal landing zones: zone 0 (n=8), zone 1 (n=12), and zone 2 (n=21). Primary endpoints were technical success, 30-day mortality, and long-term survival. Secondary endpoints included endoleak rates, bypass patency, and major complications. All patients underwent simultaneous hybrid surgery. Results:Technical success was achieved in all cases (100%). Early complications included type I endoleaks (4.8%, managed conservatively), severe pneumonia (14.6%), and incision hematomas (9.8%). The 30-day mortality was 2.4% (1/41, myocardial infarction). During a mean follow-up of 62.6 months, bypass graft occlusion occurred in 5 patients (4/5 axillary, 1/5 subclavian grafts, 12.8%). The 1-, 3-, and 5-year survival rates were 94.9%, 92.3%, and 84.6%, respectively, with no significant differences among landing zones (P=0.72). Axillary bypasses showed inferior patency compared to carotid-based reconstructions. Conclusions:Hybrid arch repair achieves favorable long-term outcomes with low mortality and stroke rates. Anatomical landing zone selection did not affect survival, but axillary bypasses demonstrated poorer durability. These findings support hybrid strategies for high-risk patients, with preferential use of carotid-based reconstructions to optimize bypass longevity.

BACKGROUND Clinically significant portal hypertension (CSPH) drives major complications in cirrhosis. While hepatic venous pressure gradient is the gold standard for CSPH diagnosis, its invasiveness limits routine use. Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) offer non-invasive alternatives, but their utility in tracking transjugular intrahepatic portosystemic shunt (TIPS)-induced hemodynamic changes remains unclear. AIM To assess the correlation of LSM/SSM with baseline portocaval pressure gradient (PPG) and Delta PPG, and to evalutate their predictive value for hemodynamic success (post-PPG <= 10 mmHg). METHODS We retrospectively analyzed 39 patients underwent TIPS. LSM and SSM were measured via vibration-controlled transient elastography pre- and post-TIPS. PPG was recorded invasively during the procedure. Correlations between stiffness parameters and PPG were assessed using Spearman's test; diagnostic performance was evaluated by receiver operating characteristic analysis. RESULTS PPG dropped from 17.6 +/- 4.1 mmHg to 7.0 +/- 2.3 mmHg (P < 0.001). SSM decreased significantly (61.7 +/- 17.1 kPa to 26.9 +/- 11.6 kPa; P < 0.001) and correlated with baseline PPG (r = 0.41, P < 0.001) and Delta PPG (r = -0.57, P < 0.001). LSM showed no significant correlation with PPG or Delta PPG. None of the stiffness metrics reliably predicted successful TIPS response (all area under the curve < 0.7). CONCLUSION SSM dynamically reflects TIPS-induced portal pressure changes, outperforming LSM as a non-invasive marker. Despite limited predictive value here (small cohort, etiological heterogeneity), it remains valuable for TIPS monitoring when invasive measures are impractical.

Objective: We evaluated the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension complications. Methods: We retrospectively analyzed the demographics, treatment details, and outcomes data of 89 patients with portal hypertension complications treated with TIPS from March 2020 to June 2023. The etiology of portal hypertension included viral hepatitis, alcoholic liver disease, autoimmune liver disease, sinusoidal obstruction syndrome, and Budd-Chiari syndrome. Results: The final study population consisted of 89 patients, including 43 patients with viral hepatitis, 21 with alcoholic liver disease, 18 with autoimmune liver disease, 4 with sinusoidal obstruction syndrome, and 3 with Budd-Chiari syndrome. Five emergent and 84 elective TIPS procedures were carried out, and the TIPS technical procedure successful rate was 100%. The stent configuration included 5 cases with a bare metal stent, 42 cases with a multilayer bare metal stent, 32 cases with a bare and covered stent combination, and 10 cases with a stent designed for TIPS. The preprocedural and postprocedural mean portocaval pressure gradient was 27.66 ± 5.69 and 13.73 ± 3.63 cm H2O (P < .05), respectively. The 1-year recurrent variceal bleeding or refractory ascites rate was 12.36% and the 1-year TIPS shunt dysfunction rate was 13.48%. The incidence of overt encephalopathy and minimal encephalopathy was 8.99% and 21.35%, respectively. One patient suffered from hepatic coma and treated with TIPS shunt embolization. During the 1-year follow-up, seven patients were diagnosed with hepatocellular carcinoma, three patients underwent liver transplantation, and six patients died. Conclusions: TIPS is a safe and effective treatment modality for portal hypertension complications. The incidence of hepatic encephalopathy is acceptable by proper patient selection and pharmacological treatment. More attention should be paid to this technique in China to benefit the large amounts of patients with complications of portal hypertension.

Senescence contributes to the pathology of abdominal aortic aneurysm (AAA); however, the regulation of senescence in AAA remains unclear. Here, we sought to determine the role of gasdermin-E (GSDME)-dependent non-canonical pyroptosis in AAA. GSDME-dependent non-canonical pyroptosis is activated in the lesioned vascular walls of mouse models and patients with AAA. GSDME deficiency inhibits vascular senescence and AAA progression. Combined analyses of single-cell RNA sequencing (scRNA-seq), bulk RNA-seq, and multiplex flow cytometry demonstrate that GSDME is essential for the reprogramming of vascular smooth muscle cells (VSMCs) and the shift in immune statuses of macrophages, monocytes, and neutrophils in AAA. Reintroduction of GSDME in VSMCs, but not in myeloid cells, in mice with a GSDME deletion background, recapitulates the induced vascular senescence and AAA, which is abolished by senolytic therapy with dasatinib plus quercetin. These results indicate that GSDME-dependent non-canonical pyroptosis in VSMCs may be a 'master switch' in AAA and a potential therapeutic target for managing AAA.

Objective To evaluate the efficacy of a new mechanochemical ablation (MOCA) device versus endovenous laser ablation (EVLA) for primary great saphenous vein (GSV) reflux. Materials and methods Prospectively analyze the demographics, treatment detail and outcomes data of 57 primary GSV reflux patients. Patients were randomly assigned to MOCA or EVLA group with random envelope method. Primary endpoint was 6-month closure rate of GSV. Secondary endpoint including technical success rate, the venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ-20) score and visual analogue scale (VAS) for pain. Results The procedures were well tolerated according to the VAS score. The 6-month closure rate was 85.71% in MOCA and 96.55% in EVLA group ( p = .194). Significant changes were observed in regard of VCSS and CIVIQ-20 score at 6-month follow-up. Skin paresthesia occurred in 0 in MOCA and 5 in EVLA group. Conclusion The new MOCA device is safe and effective in treating primary great saphenous vein reflux. The 6-month closure rate is non-inferior compared with EVLA. However, the long-term results need further follow-up.

Torrential bleeding is a rare and life-threatening complication of arteriovenous malformations (AVMs). We report a case of head and neck AVMs present with uncontrollable torrential bleeding, which was treated with embolization and sclerotherapy. Then we explored the potential multidisciplinary handling of the procedure for this kind of case. A 25-year-old female patient was born with right face and head AVMs. The AVMs had grown gradually and ruptured spontaneously with uncontrollable torrential bleeding before admission. Emergent direct hemostasis, nasotracheal intubation, and staged embolization and sclerotherapy were carried out on this patient. Finally, the bleeding stopped and the wound healed successfully. Embolization and sclerotherapy are effective for head and neck AVMs with uncontrollable torrential bleeding. Multidisciplinary collaboration is needed to achieve a good outcome.

Atherosclerosis is a chronic inflammatory disease characterized with innate and adaptive immunity but also involves pyroptosis. Few studies have explored the role of pyroptosis in advanced atherosclerotic plaques from different vascular beds. Here we try to identify the different underlying function of pyroptosis in the progression of atherosclerosis between carotid arteries and femoral. arteries. We extracted gene expression levels from 55 advanced carotid or femoral atherosclerotic plaques. The pyroptosis score of each sample was calculated by single-sample-gene-set enrichment analysis (ssGSEA). We then divided the samples into two clusters: high pyroptosis scores cluster (PyroptosisScoreH cluster) and low pyroptosis scores cluster (PyroptosisScoreL cluster), and assessed functional enrichment and immune cell infiltration in the two clusters. Key pyroptosis related genes were identified by the intersection between results of Cytoscape and LASSO (Least Absolute Shrinkage and Selection Operator) regression analysis. Finally, all key pyroptosis related genes were validated in vitro. We found all but one of the 29 carotid plaque samples belonged to the PyroptosisScoreH cluster and the majority (19 out of 26) of femoral plaques were part of the PyroptosisScoreL cluster. Atheromatous plaque samples in the PyroptosisScoreL cluster had higher proportions of gamma delta T cells, M2 macrophages, myeloid dendritic cells (DCs), and cytotoxic lymphocytes (CTLs), but lower proportions of endothelial cells (ECs). Immune full-activation pathways (e.g., NOD-like receptor signaling pathway and NF-kappa B signaling pathway) were highly enriched in the PyroptosisScoreH cluster. The key pyroptosis related genes GSDMD, CASP1, NLRC4, AIM2, and IL18 were upregulated in advanced carotid atherosclerotic plaques. We concluded that compared to advanced femoral atheromatous plaques, advanced carotid atheromatous plaques were of higher grade of pyroptosis. GSDMD, CASP1, NLRC4, AIM2, and IL18 were the key pyroptosis related genes, which might provide a new sight in the prevention of fatal strokes in advanced carotid atherosclerosis.

Objective:To investigate the effect of carotid endarterectomy(CEA) in the treatment of symptomatic carotid artery near-occlusion(CNO).Methods:Clinical symptoms, imaging examination, treatment and prognosis of 122 symptomatic CNO patients admitted to China-Japan Friendship Hospital from Jan 2014 to Jan 2020 undergoing CEA were retrospectively analyzed. Patients were divided into two groups based on the collapse condition,full collapse group(54 cases) and non-full collapse group(68 cases).Results:The difference was insignificant between the two groups at the 30-day and 12-month occurrence rate of primary endpoints(1.85% vs. 4.41%, P=0.629;7.41% vs. 4.41%, P=0.698).Postoperative re-stenosis occurred in one case in the non-full collapse group 8 months after CEA. Conclusions:CEA can achieve good curative effect for patients with CNO with recurrent symptoms, irrelevant to the existence of distal full collapse. The shunt can prevent intraoperative hypoperfusion and postoperative hyperperfusion.

PurposeTo retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy.Materials and methodsRetrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs from January 2018 to December 2021. We embolize the dominant outflow vein with elastic coils and then use absolute ethanol or polidocanol for intravascular sclerotherapy and bleomycin for interstitial sclerotherapy.ResultsYakes type II presents in four lesions, type IIIa in six, and type IIIb in three. A total of 29 treatment episodes were conducted for the 13 patients (1 episode for 3 patients, 2 for 4 patients, and 3 for 6 patients; the repeated treatment rate was 76.9%). The mean stretched length of coils for 1 treatment episode was 95 cm. The mean absolute ethanol dosage was 6.8 ml (range 4–30 ml). In addition, 10 ml of 3% polidocanol foam was injected and interstitial sclerotherapy with 150,000 IU bleomycin was performed on every patient. The post-operative arterial-dominant outflow vein pressure index (AVI) increased in the 29 procedures (6.55 ± 1.68 vs. 9.38 ± 2.80, P < 0.05). The Mann–Whitney U test showed that the post-operative AVI was higher in patients without re-intervention (P < 0.05). Local swelling occurred after all the procedures. Blistering occurred in 6 of the patients in 13 (44.8%) of the 29 procedures. Superficial skin necrosis occurred in 3 of the patients in 5 (17.2%) of the 29 procedures. The swelling, blistering, and superficial skin necrosis recovered within 4 weeks. No finger amputation occurred. The follow-up time was 6 months. The 6-month assessment of clinical improvement after the last treatment episode showed that 2 patients were cured, 10 were improved, and 1 remained unchanged. With regard to angiographic evaluation, 9 showed partial response and 4 complete response.ConclusionEmbolo/sclerotherapy can be effective and safe for hand AVM. The AVI increased significantly after embolo/sclerotherapy, and the index may be valuable in predicting recurrence in further study.

Objective: The objective of this research was to retrospectively investigate the difference of safety and efficacy between polidocanol foam and bleomycin polidocanol foam (BPF) in the treatment of venous malformations (VMs), and provide clinical evidence for the application of BPF for VMs. Methods: Patients with VMs treated with polidocanol foam and BPF were included between July 2018 and July 2020. The VM tissue involvements and symptoms were collected. The treatment outcomes were evaluated by the clinical improvement of symptoms and the degree of devascularization on ultrasound examination or magnetic resonance imaging. Patients were followed up for 1, 3, and 6 months after the sclerotherapy. Immediate and delayed complications were closely followed and recorded. Results: A total of 51 patients were included, including 34 females and 17 males with a mean age of 26.8 years (range, 5-65 years). The most commonly involved sites were lower extremities (31/60 [51.7%]) and the most common symptom was pain (33/51 [64.7%]). Fifty-four sclerotherapies were performed with a mean of 1.06 +/- 0.24 sessions (range, 1-2 sessions) per patient. The reduction percentage of lesion volume in the BPF group was significantly higher than the polidocanol foam group (79.4 +/- 1.6% vs 55.7 +/- 6.1%; P < .001). Patient satisfaction scores in the BPF group were significantly higher than the polidocanol foam group (7.2 +/- 1.1 vs 5.7 +/- 0.8; P < .001). No major complication was observed in either group. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) grade 1 complications occurred in 5 of 21 patients in the BPF group and 7 of 30 patients in the polidocanol foam group, CIRSE grade 2 complications occurred in 5 of 21 patients in the BPF group and 4 of 30 patients in the polidocanol foam group; there were no significant differences between the two groups. Conclusions: BPF is a safe and effective sclerosant for VMs, showing better efficacy and similar safety as commonly used mild sclerosants. It could be a promising agent to treat VMs or other slow-flow vascular malformations.

The endovascular treatment of lower extremity arteriosclerosis obliterans (ASO) has flourished and become the preferred treatment option. With the advancement of devices and technology, this kind of treatment is applied in expanded indications with improving effectiveness. This article introduces some hot topics in the endovascular treatment of lower extremity ASO.

急性肠系膜静脉血栓形成(acute mesenteric venous thrombosis,AMVT)是指肠系膜静脉内急性血栓形成;通常累及肠系膜上静脉,极少累及肠系膜下静脉[1];急性期可导致肠坏死甚至坏疽,后期可导致小肠狭窄、肠梗阻及短肠综合征. AMVT临床相对少见, 约占肠缺血性疾病的 5％～15％[2],起病较隐匿, 症状不典型, 诊断困难, 致死率高.

Objective:To compare the efficacy and safety of drug-coated balloons (DCB) combined with bare metal stents (BMS) and BMS only for superficial femoral atherosclerosis obliterans.Methods:The clinical and follow-up data of 80 patients (82 limbs) who received combined treatment or BMS implantation at Cardiovascular Surgery Department of China Japan Friendship Hospital from Jan 2017 to Aug 2022 were retrospectively analyzed.Results:43 patients (43 limbs) were included in combined treatment group. 37 patients (39 limbs) were in BMS only. The average lesion length of combined group was longer than BMS group (19.54±7.04 cm vs. 16.25±6.43 cm, P=0.031). The primary patency rate of combined group at 36 months was not statistically different with BMS only group (56.9% vs. 38.5%, P=0.171). The subgroup analysis of superficial femoral artery TASC C/D (Trans-Atlantic Inter-Society Consensus) and CTO (chronic total occlusion) lesions indicated that efficacy of the combined group was superior to BMS only group. The patency rates of the combined group compared with the BMS group at 36 months were 57.6% vs. 23.8%, P=0.046, 60.2% vs. 31.4%, P=0.028, respectively. There was no significant difference in the FCD-TLR (free from clinical driven target lesion revascularization) between the two groups at 36 months (72.6% vs. 66.5%, P=0.706). There was no significant difference in major adverse events between the two groups ( P>0.05). Conclusion:Paclitaxel drug-coated balloon combined with bare metal stent is a safe and effective treatment for superficial femoral atherosclerosis obliterans, which is superior to bare metal stent, especially in TASC C/D and chronic total occlusive lesions.

At present, the treatment of aortoiliac artery occlusion is gradually changing from open surgery to endovascular treatment. Endovascular treatment can also achieve good results for some complex lesions. However, open surgery still has the advantages of a high patency rate and the avoidance of using contrast agents. Moreover, open surgery is an important guarantee against the failure of endovascular treatment or serious complications such as ruptured aortoiliac arteries. This article introduces the open surgical treatment of aortoiliac artery occlusion.

新一代紫杉醇药物洗脱支架(Eluvia支架)具有生物兼容的氟氯聚合物涂层,允许紫杉醇在12个月内随时间逐步洗脱,从而抑制支架内再狭窄的发生.国际上已有多篇研究证实了Eluvia支架治疗股浅动脉狭窄性病变的有效性及安全性,在面对长段复杂病变时,相比较于其他治疗方式(如血管成形术、金属裸支架)仍然具有优势,而Eluvia支架治疗支架断裂引发再狭窄的疗效还鲜有报道.中国自2020年7月引进Eluvia药物支架,本文分析Eluvia支架治疗金属裸支架断裂后导致股腘动脉再狭窄患者1例,现报道如下.

Background: Tunneled central venous catheters (tCVC) exchange may be difficult in some situations. We retrospectively report our preliminary experience of a novel extra-catheter guide wire technique for exchange of dysfunctional tCVC. Materials and methods: Retrospectively analyze the demographics, treatment details and outcomes data of 39 patients received tCVC exchange from January 2018 to January 2019. According to whether guide wire could pass through the catheter lumen, patients were divided into in-catheter group and extra-catheter group. The technical successful rate, peri-operative complications, 1-month and 6-month catheter flow rate was recorded and compared between the 2 groups. Results: The final study population consists of 39 patients, including 16 in-catheter group and 23 extra-catheter group. The technical successful rate was 100% in both groups. All patients achieved restoration of line patency and completed at least 1 hemodialysis section. The 1-month (267.69 ± 20.12 vs. 274.13 ± 17.69, p = 0.604) and 6-month (255.81 ± 12.93 vs. 256.97 ± 11.20, p = 0.403) catheter flow rate was comparable between the 2 groups. Conclusion: The novel extra-catheter guide wire technique was helpful for in situ exchange of dysfunctional tunneled central venous hemodialysis catheters, especially when the guide wire could not pass through the catheter lumen.

回顾性分析2020年12月至2022年8月收治的28例使用紫杉醇药物洗脱支架治疗下肢动脉硬化闭塞症患者的临床资料，中位随访时间492 d。踝肱指数由术前0.37±0.19提升到术后0.71±0.08，Kaplan-Meier分析显示患者6及12个月累积一期通畅率分别为87.3%和78.1%，1例患者术后1年发生病变侧足趾截趾。本研究显示，紫杉醇药物洗脱支架治疗股腘动脉闭塞病变具有良好的通畅性和安全性，对于长段病变、严重钙化病变以及支架内再狭窄病变均安全有效。

Objective Report our preliminary experience of carotid endarterectomy (CEA) for the treatment of carotid near-occlusion (CNO) with recurrent symptoms. Materials and Methods Retrospectively analyze the demographics, treatment detail, and outcomes data of 122 patients with CNO from 2014 to 2020. According to whether distal full collapse exists, patients were classified into the full collapse group and the non-full collapse group. The incidence of death, myocardial infarction, stroke, and other variables were compared between the two groups. Results A total of 122 patients with CNO and recurrent symptoms were enrolled. The demographics were comparable between the two groups. Thirty-day incidence of primary endpoints was 1.85% in the full collapse group and 4.41% in the non-full collapse group. Twelve-month incidence of primary endpoints was 7.41% in the full collapse group and 4.41% in the non-full collapse group. One re-stenosis occurred in the non-full collapse group 8 months after CEA. Conclusion For patients with CNO with recurrent symptoms, CEA is not worse than the results described in historical control groups, despite whether distal full collapse exists. The shunt is important to avoid intraoperative hypoperfusion and postoperative hyperperfusion. The long-term results should be further evaluated.

BACKGROUND:Acute carotid stent thrombosis (ACST) is a rare but devastating complication in the carotid artery stenting (CAS) procedure. The aim of this article is to report a case and review cases of ACST reported in the literature, and investigate risk factors and management strategies for ACST.CASE SUMMARY:We reviewed the treatment process of a patient with ACST after CAS. Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020. The demographic data, risk factors, treatment strategies, and prognosis were extracted and analyzed.CONCLUSION:The reason for ACST is multifactorial. Proper patient selection, normative anti-platelet treatment, and perfect technical detail may decrease the incidence of ACST. Several treatment strategies such as thrombolysis, mechanical thrombectomy, and open surgery may be options for the treatment of ACST. Limited data have shown that carotid endarterectomy is effective with favorable results.

Objective:To evaluate the efficacy of different carotid artery revascularization strategy in sychronous carotid and coronary artery revascularization.Methods:The clinical data of 53 patients receiving simultaneous carotid and coronary artery revascularization in China-Japan Friendship Hospital from Jan 2014 to Dec 2019 was retrospectively analyzed. The clinical characteristics, imaging examination, treatment and prognosis were collected and reviewed. Patients were divided into CEA group (42 cases) and CAS group (11 cases) according to the carotid artery revascularization method.Results:The mean operative time and blood loss of CEA group were (288.81±43.28) min and (419.05±127.33) ml, respectively. The mean operative time and blood loss of CAS group were (251.82±23.16) min and (318.18±98.16) ml, respectively. The difference of operative time and blood loss between the 2 groups were not significant (all P>0.05). Four minor strokes, 4 transient ischemic attacks (TIA), 2 pulmonary infections and 4 recurrent laryngeal nerve injury were observed in CEA group. Two TIA and 1 re-thoracotomy for hemostasis occurred in CAS group. Conclusions:Both carotid endarterectomy and carotid stenting can achieve good clinical result in synchronous carotid and coronary artery revascularization procedure. The selection of proper carotid artery revascularization method should base on the lesion characteristic and surgeon's experience.