The triglyceride–glucose (TyG) index, a reliable surrogate marker of insulin resistance, has been established as a predictor for various cardiovascular diseases. This study aimed to investigate its previously unexplored association with the incidence of abdominal aortic aneurysm (AAA). In this multicenter retrospective study, we analyzed data from 2513 patients (mean age 71.5 ± 6.9 years) who underwent surgical treatment for AAA between January 2018 and June 2023 (open surgery, 504 cases; endovascular aneurysm repair, 2009 cases). A control group of 6290 age-matched healthy individuals was included. Propensity score matching (1:1) yielded 1998 pairs for analysis. Patient survival was assessed through telephone interviews or outpatient visits, with a median follow-up duration of 36.4 months (interquartile range: 24.1–52.8 months). Multivariable regression was used to identify risk factors. After matching, the AAA group had a significantly higher TyG index compared to controls (7.570 ± 0.31 vs. 6.803 ± 0.28, P < 0.001). Multivariable analysis identified a high TyG index as an independent risk factor for AAA (HR = 3.344, 95

Deep vein thrombosis (DVT) remains a therapeutic challenge, primarily driven by pathological platelet adhesion at sites of vascular injury mediated by endothelial adhesion molecule overexpression. However, the molecular mechanisms underlying endothelial-dependent pathological platelet adhesion remain elusive. Here, integrating single-cell RNA sequencing (scRNA-seq) and functional validation, we identified aberrant activation of the stimulator of interferon genes (STING) as a critical driver of endothelial dysfunction and pathological platelet adhesion. Using STING knockout mice, we confirmed its central role in promoting a prothrombotic microenvironment via the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome. Targeting this pathway, we identified forsythoside A (FA) as a potent STING inhibitor and constructed artificial platelets (Pm@Fng) via photopolymerization-membrane extrusion technology. Pm@Fng, consisting of FA-loaded nanogels cloaked with activated platelet membrane vesicles (APMVs), exhibited enhanced glycoprotein Ib alpha (GPIbα) -mediated binding affinity to von Willebrand factor (vWF), competitively blocking pathological platelet adhesion. Under thrombotic microenvironment (acidic pH and high reactive oxygen species), FA was released to modulate the STING - NLRP3 pathway, suppressing adhesion molecule expression. In a mouse DVT model, Pm@Fng rapidly targeted the endothelium, noticeably reducing thrombosis by 30% (p < 0.001) and preserving endothelial integrity. By exploiting competitive adhesion principles, this study presents a novel therapeutic strategy for DVT and other endothelial injury-related diseases.

Background: Thoracoabdominal aortic pathologies involving visceral arteries pose complex challenges for endovascular repair. This study aimed to evaluate the clinical outcomes and identify risk factors for adverse events in patients with complex thoracoabdominal aortic aneurysms (CTAAA) who underwent fenestrated-branched endovascular aortic repair (f/b EVAR) using physician-modified endografts (PMEG). Methods: In this single-center retrospective case-control study, 105 patients undergoing f/b EVAR with at least one visceral artery reconstruction between January 2018 and December 2019 were analyzed. Follow-up was conducted for a median of 36 months. Baseline clinical and imaging characteristics, procedural details, and long-term follow-up data were collected. The primary outcome was patient mortality. Secondary outcomes included technical success, complications, and reinterventions. Results: The technical success rate was 94.3%, with a 30-day mortality rate of 2.86%. During follow-up, 11 patients (10.5%) died, and 15 (14.3%) required reintervention. Analysis of prognostic factors revealed that visceral artery dissection was an independent factor affecting patient survival and positive aortic remodeling, while preoperative renal failure was closely associated with reintervention. Patient age, aortic calcification, and maximum aortic diameter were significant factors influencing endoleak development. Conclusions: f/b EVAR with PMEG is a safe and effective treatment for CTAAA, with low perioperative mortality and acceptable mid- to long-term outcomes. Preoperative renal function and visceral artery dissection are important predictors of prognosis. Larger studies are needed to further validate these findings.

Primary deep venous valve insufficiency (PDVVI) is a common lower extremity venous disease in vascular surgery, distinguished from simple lower extremity varicose veins and lower extremity thrombotic diseases, and requires clinical management as a separate disease. Surgical procedures alone in the superficial venous system cannot completely correct valve reflux and venous hypertension and require surgical valve repair. In addition, the development of non-autologous prosthetic valve transplantation provides a new breakthrough point. This article summarizes the diagnostic and therapeutic advances in PDVVI for discussion.

(1) Background: Renal artery occlusion after F/B EVAR for abdominal aortic aneurysm is a serious complication that may require re-intervention, and understanding the hemodynamic mechanisms by which it occurs is essential to optimize the surgical procedure. (2) Methods: We used computational fluid dynamics (CFD) to analyze the impact of various parameters on blood flow. Theoretical vascular models were constructed based on the common dimensions and angles of aortic stents and branch arteries in clinical practice. Actual case models were constructed from CT image data of six patients treated with F/B-EVAR. Data were collected for analysis after simulation and calculation by FLUENT software. (3) Results: Theoretical model simulations showed that a larger tilt angle of the branch stent, smaller branch entry depth, and larger branch stent diameter were beneficial for blood flow. In the case models, a significant difference in the tilt angle of the renal artery stents was observed between the high- and low-flow groups, while the differences in entry depth and branch stent diameter were not significant. Occluded renal arteries had lower WSS values than patent ones. (4) Conclusions: This study offers valuable guidance for optimizing stent placement in F/B EVAR to mitigate renal artery occlusion risk.

BACKGROUND:This study aimed to evaluate the safety and efficacy of Venastent for the patients with iliac vein compression syndrome (IVCS). METHODS:A multicenter retrospective clinical trial enrolling 199 IVCS patients was conducted by the department of vascular surgery of 3 hospitals from October 2021 to January 2023. Among them, 91 were treated with a new type of iliac vein stent and defined as the experimental group, and 108 cases in the control group were using Zilver Vena venous stent (Cook Medical). Twelve-month follow-up was performed for the following primary end points: the patency rate, the venous clinical severity score (VCSS), and the Clinical, Etiology, Anatomy, and Pathology (CEAP) classification. RESULTS:To validate the role of Venastent in the prevention of thrombosis, 91 patients with Venastent versus 108 patients with control stent were compared. No difference was found in the demographic data or accompanying symptoms or disease severity scores between the 2 groups of patients. The patency rates of the contralateral deep vein at 24 months after the surgery were 100.00% vs. 94.5%, respectively (P = 0.043). Moreover, no difference was found on the VCSS score and CEAP classification of the both groups. CONCLUSION:Venastent with a large corolla-like mesh and an adequate radial force shows a good patency in the ipsilateral iliac vein and could prevent thrombosis in the contralateral iliac vein.

Purpose:Stanford Type B Aortic Dissection (TBAD), a critical aortic disease, has exhibited stable mortality rates over the past decade. However, diagnostic approaches for TBAD during routine health check-ups are currently lacking. This study focused on developing a model to improve the diagnosis in a population. Patients and Methods:Serum biomarkers were investigated in 88 participants using proteomic profiling combined with machine learning. The findings were validated using ELISA in other 80 participants. Subsequently, a diagnostic model for TBAD integrating biomarkers with clinical indicators was developed and assessed using machine learning. Results:Six differentially expressed proteins (DEPs) were identified through proteomic profiling and machine learning in discovery and derivation cohorts. Five of these (GDF-15, IL6, CD58, LY9, and Siglec-7) were further verified through ELISA validation within the validation cohort. In addition, ten blood-related indicators were selected as clinical indicators. Combining biomarkers and clinical indicators, the machine learning-based models performed well (AUC of the biomarker model = 0.865, AUC of the clinical model = 0.904, and AUC of the combined model = 0.909) using relative quantitation. The performance of the three models was verified (AUC of biomarker model = 0.866, AUC of clinical model = 0.868, and AUC of combined model = 0.886) using absolute quantitation. Crucially, the combined models outperformed individual biomarkers and clinical models, demonstrating superior efficacy. Conclusion:Using proteomic profiling, we identified serum IL-6, GDF-15, CD58, LY9, and Siglec-7 as TBAD biomarkers. The machine-learning-based diagnostic model exhibited significant potential for TBAD diagnosis using only blood samples within the population.

OBJECTIVE:This study aimed to evaluate the peri-operative and follow up results of multicentre 3D printing assisted fenestrated thoracic endovascular repair for aortic arch diseases in zones 0 and 1. METHODS:A multicentre retrospective study of patients undergoing 3D printing assisted multi-fenestrated endovascular arch repair was conducted. The primary endpoints included death, complications, and technical success. Statistical analysis was performed using SPSS version 26, and Kaplan-Meier survival analysis was employed to calculate mid to long term outcomes. RESULTS:The study included 149 patients (mean age 62 ± 13 years; 87.9% men). Diagnoses included thoracic aortic dissection (50.3%, n = 75), aortic aneurysm (46.3%, n = 69), and penetrating aortic ulcer (3.4%, n = 5). The technical success rate was 94.0% (n = 140). Two patients died during the operation. The thirty day post-operative mortality rate was 2.7% (n = 4), while the incidence of cerebral infarction was 8.8% (n = 13), and spinal ischaemia occurred in 2.7% (n = 4). The median follow up was 28 months, during which nine died, two of which were aortic related. The overall endoleak rate was 7.0% (n = 10), comprising four type Ia, four type Ic, and two type IIIa endoleaks; nine underwent re-intervention. The one, two, and three year survival rates were 93.5% (standard error [SE] 2.1%), 90.0% (SE 2.7%), and 87.5% (SE 3.1%), respectively. CONCLUSION:For patients with complex aortic arch disease unfit for open surgery, 3D printing assisted fenestrated thoracic endovascular repair in zones 0 or 1 demonstrated a technically feasible solution with high success and acceptable 30 day mortality and complication rates. Broader validation with larger cohorts and extended follow up is required to establish the durability and safety of this technique as a viable alternative for aortic arch repair.

>Cardiovascular disease(CVD) remains the leading cause of disease burden globally,and continued efforts are required in identifying new targets for CVD prevention and treatment(Vaduganathan et al.,2022). Breakthroughs in basic research are urgently needed to fully understand the CVD mechanism and improve clinical treatment modality.

Venous thromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism, is the third most common vascular disease in the world and seriously threatens the lives of patients. Currently, the effect of conventional treatments on DVT is limited. Endothelial progenitor cells (EPCs) play an important role in the resolution and recanalization of DVT, but an unfavorable microenvironment reduces EPC function. Non-coding RNAs, especially long non-coding RNAs and microRNAs, play a crucial role in improving the biological function of EPCs. Non-coding RNAs have become clinical biomarkers of diseases and are expected to serve as new targets for disease intervention. A theoretical and experimental basis for the development of new methods for preventing and treating DVT in the clinic will be provided by studies on the role and molecular mechanism of non-coding RNAs regulating EPC function in the occurrence and development of DVT. To summarize, the characteristics of venous thrombosis, the regulatory role of EPCs in venous thrombosis, and the effect of non-coding RNAs regulating EPCs on venous thrombosis are reviewed. This summary serves as a useful reference and theoretical basis for research into the diagnosis, prevention, treatment, and prognosis of venous thrombosis.

OBJECTIVES:To evaluate the efficacy and clinical outcomes of accurate embolization of endoleaks after fenestrated thoracic endovascular aortic repair (F-TEVAR) for thoracic aortic dissections. METHODS:Twenty patients with endoleaks (17 type I and 3 type II) after fenestrated thoracic endovascular aortic repair (F-TEVAR) were embolized using detachable and ordinary coils. We assessed the success rate and complications of the operation, and its effects, through clinical and CT follow-up. RESULTS:The mean clinical follow-up duration was 25.68 ± 11.07 months (3-44 months). During follow-up, all endoleaks were completely embolized and aortic remodeling was improved. Secondary endoleaks occurred in four patients who were embolized twice. No other complications or death were reported. CONCLUSION:Embolization using detachable and ordinary coils is effective and safe for the treatment of endoleaks after fenestrated thoracic endovascular aortic repair.

Angiogenesis, whether physiological or pathological, plays a pivotal role in various physiological and disease conditions. This intricate process relies on a complex and meticulously orchestrated signal transduction network that connects endothelial cells, their associated parietal cells (VSMCs and pericytes), and various other cell types, including immune cells. Given the significance of m6A and its connection to angiogenesis and vascular disease, researchers must adopt a comprehensive and ongoing approach to their investigations. This study aims to ascertain whether a common key mechanism of m6A exists in angiogenesis and vascular diseases and to elucidate the potential application of m6A in treating vascular diseases.

PURPOSE To summarize experience with and the efficacy of fenestrated/branched thoracic endovascular repair (F/B-TEVAR) using physician-modified stent-grafts (PMSGs) under 3D printing guidance in triple aortic arch branch reconstruction. MATERIALS AND METHODS From February 2018 to April 2022, 14 cases of aortic arch aneurysms and 30 cases of aortic arch dissection (22 acute aortic arch dissection and 8 long-term aortic arch dissection)were treated by F/B-TEVAR in our department, including 34 males and 10 females, with an average age of 59.84 ± 11.72 years. Three aortic arch branches were affected in all patients. A 3D-printed model was made according to computed tomography angiography images and used to guide the fabrication of PMSGs. All patients were followed up. RESULTS A total of 132 branches were successfully reconstructed with no case of conversion to open surgery. The average operation time was 4.97 ± 1.40 hours, including a mean 44.05 ± 7.72 minutes for stent-graft customization, the mean postoperative hospitalization duration was 9.91 ± 4.47 days, the average intraoperative blood loss was 480.91 mL (100-2810 mL), and the mean postoperative intensive care unit monitoring duration was 1.02 days (0-5 days). No deaths occurred within 30 days of surgery. Postoperative neurological complications occurred in 1 case (2.3%), and retrograde type A dissection occurred in 1 case (2.3%). CONCLUSION Compared with conventional surgery, triple aortic arch branch reconstruction under the guidance of 3D printing is a minimally invasive treatment method with the advantages of accurate positioning, rapid postoperative recovery, few complications, and reliable short- to mid-term effects. CLINICAL IMPACT At present the PMSG usually depend on imaging data and software calculation. With the guidance of 3D printing technology, image data could be transformed into 3D model, which has improved the accuracy of the positioning of the fenestrations. The diameter reduction technique and the internal mini cuff technique have made a complement to the slimed-down fenestration selection process and the low rate of endoleak. As reproducible study, our results may provide reference for TEVAR in different cases.

Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.

Background:Ruptured abdominal aortic aneurysms (rAAAs) are challenging for vascular surgeons because they have a high mortality rate. In many diseases, nutritional status is closely associated with prognosis. The Controlling Nutritional Status (CONUT) screening tool score is a prognostic factor in some malignant and chronic diseases; however, the impact of nutritional status on rAAA has not yet been reported. In this study, we explored the relationship between the CONUT score and the postoperative prognosis of patients with rAAA. Methods:This was a retrospective review of 39 patients with rAAA who underwent surgical treatment from March 2018 to September 2021 at one center. Patient characteristics, nutritional status (CONUT score), and postoperative status were recorded. The patients were divided into groups A and B based on the CONUT score. The baseline characteristics of the two groups were compared, and Cox proportional hazards and logistic regression analyses were used to determine independent predictors of mid-term mortality and complications, respectively. Results:The overall mid-term mortality rate was 28.21% (11/39). Compared with group A, group B had higher intraoperative (P = 0.047) and mid-term mortality (P = 0.033) rates. The univariate analysis showed that age [hazard ratio (HR), 1.098; 95% confidence interval (CI), 1.019-1.182; P = 0.014], CONUT score (HR, 1.316; 95% CI, 1.027-1.686; P = 0.03), and surgical procedure (HR, 0.127; 95% CI, 0.016-0.992; P = 0.049) were associated with mid-term mortality, whereas the multivariate analysis showed that the CONUT score (HR, 1.313; 95% CI, 1.009-1.710; P = 0.043) was an independent predictor of mid-term mortality. The multivariate logistic regression analysis did not reveal any associations with complications. The Kaplan-Meier curves showed that group B had a lower mid-term survival rate (log-rank P = 0.024). Conclusion:Malnutrition is closely associated with the prognosis of patients with rAAA, and the CONUT score can be used to predict mid-term mortality.

A 67-year-old male patient was admitted with an enormous twisted thoracoabdominal aortic aneurysm (TAAA) with multiple branch arteries stenosis and occlusion. Three-dimensional (3D) printing technology combined with mechanics was used for developing a transparent model of lesion to simulate the segment of diseased aorta. A stent graft was deployed in the 3D model to make a physician-modified stent graft (PMSGs) on table. The locations of the opening of branches were marked twice during operation. The PMSG was successfully deployed during the surgery and repaired the TAAA, with no endoleak and all the branched arteries patency in follow-up. This technique could offer precision individualized therapy and could simplify the procedure process greatly.

患者,男性,43岁,因"胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)后 3 个月,内漏2个月"于2021年1月16日收入本院治疗.患者2020年10月因Stanford B型主动脉夹层于外院行TEVAR左锁骨下动脉(left subclavian artery,LSA)单开窗术(图 1A～1C),术中行 TEVAR+LSA覆膜支架植入(图1D).

OBJECTIVE:This study aimed to evaluate the outcomes of physician-modified endografts (PMEGs) for the treatment of thoracic aortic pathologies involving the aortic arch. METHODS:A retrospective single-center study was performed on consecutive patients with thoracic aortic pathologies treated by PMEGs between February 2018 and May 2022. Data on baseline characteristics, operative procedure, and follow-up information were collected. The endpoints included technical success, complications, mortality, overall survival, re-intervention, and target vessel instability. RESULTS:This study comprised 173 patients (mean age=58±13, range=28-83, 148 men) with thoracic aortic pathologies, including 44 thoracic aortic aneurysms, 113 aortic dissections (9 type A, 4 residual type A, 75 type B, 32 non-A non-B), 3 aortic intramural hematomas, and 13 penetrating aortic ulcers. Thirty-five of the patients had PMEGs with 3 fenestrations, 32 had 2 fenestrations, and 106 had 1 single fenestration. Technical success was 98% (170/173), and the 30-day mortality was 2% (3/173). Perioperative complications included stroke (n=3, 2%), retrograde type A dissection (RTAD; n=3, 2%) and renal injury (n=3, 2%). Seven deaths (4%) were noted during a median follow-up of 11 (range=1-52) months. Eleven cases of re-intervention were stent-related. There were 5 type Ia endoleaks (3%), 2 type III endoleaks (1%) from the innominate artery (IA), and 3 type Ic endoleaks (2%) from the left subclavian arteries. One case of IA stent-graft (SG) stenosis was noted because of mural thrombus. Estimate rates of overall survival, freedom from secondary intervention, and freedom from target vessel instability at 2 years were 93.4% (95% confidence interval [CI]=88.7%-98.1%), 80.7% (95% CI=73.3%-88.1%), and 89.0% (95% CI=80.4%-97.6%), respectively. CONCLUSIONS:Physician-modified endografts showed promising immediate therapeutic results in the treatment of thoracic aortic pathologies involving the aortic arch. Our study demonstrates that the technique is feasible and produces acceptable results. Long-term outcomes are required for further refinement of this technical approach to confirm technical success and durability over time as a valuable option for endovascular aortic arch repair in specialized centers.Clinical impactOur short- and mid-term outcomes of physician-modified endografts in 173 patients showed promising results compared to other branched/fenestrated techniques and backed up the endovascular repair of the aortic arch. Meanwhile, the technical expertise pointed out in our manuscript, including preloaded guidewire, diameter-reducing wire and inner mini-cuffs, provided reference and technical guidance for our peers. Most importantly, it demonstrated that the PMEG, as a device whose components were all commercially available, might be a better option for emergency surgery and for centers who had no access to custom-made devices.

Exosomes are nanoscale endocytic vesicles, 30–150 nm in diameter, secreted by most cells. They mainly originate from multivesicular bodies formed by intracellular invagination of lysosomal microparticles, and released into the extracellular matrix after fusion of multivesicular bodies with cell membrane. Studies have shown that exosomes contain a variety of active molecules, such as proteins, lipids and RNAs (such as mRNA, miRNA, lncRNA, circRNA, etc.), which regulate the behavior of recipient cells and serve as circulating biomarkers of diseases, including thrombosis. Therefore, exosome research is important for the diagnosis, treatment, therapeutic monitoring, and prognosis of thrombosis in that it can reveal the counts, surface marker expression, protein, and miRNA cargo involved. Recent studies have shown that exosomes can be used as therapeutic vectors for tissue regeneration and as alternative vectors for drug delivery. In this review, we summarize the physiological and biochemical characteristics, isolation, and identification of exosomes. Moreover, we focus on the role of exosomes in thrombosis, specifically venous thromboembolism, and their potential clinical applications, including as biomarkers and therapeutic vectors for thrombosis.