Growing evidence has supported the potential method of umbilical cord mesenchymal stem cell (UCMSC) therapy for diabetic foot and lower extremity peripheral artery disease (PAD), but their results are not consistent. Thus, the authors conducted the first meta-analysis concerning the safety and efficacy of UCMSC treatment in diabetic foot patients. 8 English and Chinese databases were searched to identify randomized controlled trials regarding UCMSC therapy in diabetic foot patients. Two independent investigators carried out literature inclusion, data extraction, and quality assessment. Meta-analysis was performed using ReviewManager 5.4.1., 6 RCT studies involving 380 patients were included. Primary endpoints included ulcer healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), and intermittent claudication. Compared with conventional treatment, patients who accepted UCMSC therapy had a better ulcer healing rate (Odds Ratio (OR) = 2.88 [1.20-6.91]), TcPO2 (standardized mean difference (SMD) = 1.39, [0.01-2.77]), and ABI improvement (SMD=1.22 [0.30-2.13]). Moreover, they also experienced significantly better improvements in pain amelioration, skin temperature, and ulcer area reduction. Whereas, intermittent claudication cannot be ameliorated by UCMSC therapy (SMD=0.83 [-0.45-2.10]). Additionally, neovascularization, examined by angiography, was significantly promoted after UCMSC administration. Moreover, two studies recorded adverse events during follow-up, which were considered to be transient, minor, and regional. The present meta-analysis validated that UCMSC treatment enhances diabetic foot ulcer healing and circulation recovery, and has a promising safety profile, though limited by incomplete reporting. Larger-sample multicenter randomized controlled trials and longer-term follow-up are urgently needed to further explore the safety and efficacy of UCMSC treatment in diabetic foot patients. The meta-analysis was prospectively registered on PROSPERO.

Three-layered biomimetic vascular grafts (VG) based on poly(carbonate-urethane) (PCU) have been developed and used in clinical trials in China. The durability of PCU and VG during preclinical animal implantation and artificial oxidation tests is of top consideration for the long-term service of implantable devices. After being removed from the sheep after 1 month of implantation, the changes in the microstructures of VG were analyzed and compared using SEM, FTIR, tensile tests, and in situ Wide-angle X-ray diffraction (WAXD) to evaluate the performance of PCU in resisting biodegradation in implantation and blood contact scenarios. Polyester fabrics on the VG could be degraded, while the PCU structures remained largely intact. The micropores on the inner membrane of the VG facilitate endothelialization. During artificial oxidation tests, CoCl2 and H2O2 solution can erode the surface of the hot-pressed film of PCU after 2 weeks of immersion, and the soft segment was partially destroyed by hydrolytic cleavage, which was confirmed by the decrease in the FTIR band at 1256 cm(-1). However, the surface deterioration did not lead to a decrease in the tensile strength or elongation at break, even for PCU after four weeks of immersion.

The importance of management strategies for subclavian artery aneurysms (SAAs) is underscored by the risks of aneurysm rupture and distal ischemia. However, there is no consensus on the optimal timing or strategies for treatment due to their low incidence. The existing literature primarily comprises case reports and small retrospective studies, providing limited high-quality evidence. The preservation of the vertebral artery (VA) is critical to the prognosis of SAA repair, particularly when a dominant ipsilateral VA exists and the circle of Willis is incomplete. In this review, we integrate published literature together with our center’s experience to classify SAAs into four types based on the anatomical relationship between the VA and the aneurysm, and we outline the treatment strategies for each type. Furthermore, given the substantial influence of diverse etiologies on disease progression, we address the clinical features and management approaches for SAAs based on distinct etiologies.

Aortic dissection (AD) is a catastrophic cardiovascular emergency, yet the mechanisms underlying early endothelial barrier dysfunction in AD remain poorly understood. This study investigated the role of the tight junction protein Occludin in AD pathogenesis. Single-cell RNA sequencing of human ascending aortas, along with molecular analyses of human and mouse AD tissues, revealed a significant downregulation in endothelial Occludin. To determine causality, we generated endothelial-specific ocln knockout and adeno-associated virus-mediated overexpression mouse models and subsequently subjected them to a β-aminopropionitrile (BAPN)-induced AD model. Aortic pathologies were assessed via echocardiography, Evans blue extravasation, and histological staining, while in vitro permeability was evaluated using human aortic endothelial cells (HAECs) with fluorescein isothiocyanate-dextran. In vivo, endothelial ocln deficiency severely compromised the aortic endothelial barrier, accelerated BAPN-induced aortic dilation, and significantly exacerbated AD rupture mortality. Conversely, targeted overexpression of ocln in endothelial cells preserved vascular wall integrity, decreased vascular permeability, reduced inflammatory macrophage infiltration, mitigated elastic fiber degradation, and significantly improved survival in mice. In vitro, OCLN knockdown directly increased HAEC monolayer permeability, whereas its overexpression successfully rescued transforming growth factor-β-induced barrier dysfunction. In conclusion, our findings demonstrate that the downregulation of endothelial Occludin acts as a critical initiating factor in AD, driving pathological vascular permeability and further medial destruction. Preserving endothelial barrier integrity by targeting Occludin represents a promising novel therapeutic strategy to prevent AD progression and catastrophic rupture.

Background:Reliable radiographic indicators to assess the severity and prognosis of acute type A aortic dissection (ATAAD) are lacking. This study investigates whether renal artery involvement (RAI) on preoperative imaging serves as a marker of extensive branch vessel compromise and malperfusion. Methods:This retrospective study analyzed 471 consecutive patients who underwent open surgical repair for ATAAD between January 2020 and June 2022. RAI was defined on computed tomography angiography (CTA) as dissection membrane extension to the renal artery ostium. Patients were divided into RAI (n=289) and non-RAI (n=182) groups. Propensity score matching (PSM) minimized baseline differences. Multivariable ordered logistic regression assessed the association between RAI and the number of malperfused organ systems. Cox regression identified risk factors for mortality. Results:The RAI group exhibited more extensive aortic branch involvement (P<0.05), required more concomitant branch procedures, and had a higher incidence of end-organ malperfusion (P=0.006) and serious adverse events (SAEs) (P=0.009), consistent after PSM. Ordered logistic regression showed that RAI was associated with malperfusion [odds ratio (OR) =2.00, 95% confidence interval (CI): 1.25-3.27, P=0.005]. Cox regression identified RAI as an independent risk factor for overall mortality [hazard ratio (HR) =3.48, 95% CI: 1.15-10.47, P=0.03] and mid-term mortality (HR =3.42, 95% CI: 1.14-10.31, P=0.03). Long-term follow-up recorded 11 deaths among hospital survivors; no significant association was observed between RAI and permanent dialysis dependence (log-rank P=0.18). Conclusions:RAI on preoperative CTA is a simple, objective indicator of extensive aortic branch compromise and higher malperfusion burden in ATAAD, identifying a high-risk cohort with worse perioperative outcomes and reduced mid-term survival.

BACKGROUND:We aimed to compare the technical success rates and long-term patency of endovascular repair, subclavian-carotid bypass (SCB), and subclavian-carotid transposition (SCT) for subclavian artery occlusion. METHODS:A retrospective analysis was conducted on 181 patients at Fuwai Hospital (2015-2024). Primary endpoint was the primary patency rate. Secondary endpoints included technical success, secondary patency and freedom from target lesion revascularization (TLR) rates. Kaplan-Meier analyses were applied. RESULTS:One hundred and eighty-one patients [median age: 60 years, interquartile range (IQR) 54.00-65.00; 76.2% male) underwent 192 procedures, with 111 endovascular repairs, 38 SCBs, and 43 SCTs. Indications included vertebrobasilar insufficiency (39.2%), arm ischemia (28.7%), both (29.3%), cardiac causes (2.2%), and combined arm and cardiac indications (0.6%). The endovascular group had a lower technical success rate than SCB and SCT (86.5% vs 97.4% vs 100.0%). SCT had the longest lesion-to-vertebral artery (VA) length among the 3 groups. Ostial occlusion was more frequent and lesion length was longer in failed cases compared to successful cases (33.3% vs 6.3%, 14.50 vs 22.00 mm). After a median follow-up of 44 months (IQR 22.00-70.00), SCT had the highest primary patency rate (100% at 1, 3, and 5 years) compared to endovascular repair (93.4%, 88.2%, 77.6%) and SCB (94.1%, 86.8%, 72.3%; p=0.12). Endovascular group had primary patency, secondary patency, and freedom from TLR rates comparable to open surgery (SCB and SCT). SCB had lower primary patency than SCT. CONCLUSIONS:Endovascular repair offers good long-term patency but requires careful patient selection due to higher technical failure rates. SCT is recommended for patients at high risk of endovascular failure, while SCB remains suitable for multi-segment, distal occlusions or lesions with a short lesion-to-VA length.Clinical ImpactTo our knowledge, this is the largest study comparing outcomes of endovascular repair, subclavian-carotid bypass (SCB), and transposition (SCT) for SA occlusion. We found that endovascular repair provides midterm patency comparable to open surgery and may serve as the preferred option in carefully selected patients-contrary to prior reports, possibly due to optimized antiplatelet therapy. Technical failure was more frequent in cases with ostial involvement or longer lesion length. Although SCB showed inferior patency to SCT, it remains preferable for complex, distal lesions, or those with short lesion-to-vertebral artery (VA) length. Our anatomical analysis may offer guidance for individualized treatment selection.

Objective: The objective of this study was to introduce our institutional experience of treatment strategies (endovascular treatment and open surgical treatment) for the common carotid artery occlusion (CCAO). Methods: We retrospectively analyzed 28 consecutive patients with CCAO treated by different treatment strategies (endovascular treatment and open surgical treatment) in our institution from September 2015 to August 2023. Baseline data, surgery-related data, postoperative information and long-term follow-up were assessed. Results: A total of 29 CCAOs in 28 consecutive patients were treated in our institution. The baseline data of common carotid artery reconstruction in the endovascular treatment group and the open surgical treatment group was no statistically significant difference.The success rates of common carotid artery reconstruction in the endovascular treatment group and the open surgical treatment group were 77.8% and 100% (p=0.265). The contrast agent volume of the endovascular treatment group was significantly more than that of the open surgical treatment group, which were 160.00（115.00-190.00）ml and 0.00（0.00-0.00）ml, respectively (p<0.05). Postoperative drainage volume, drainage duration, and hospital stay were all significantly lower in the endovascular treatment group compared with the open surgical treatment group (p < 0.05). All patients in the open surgical treatment group achieved complete resolution of preoperative symptoms, whereas only 22.22% of patients in the endovascular treatment group had complete symptom resolution (p < 0.05). In the endovascular treatment group, the rates of freedom from re-occlusion and reintervention at 1, 3, 6, 12, 36, 60 and 84 months postoperatively were 100.00%, 90.91%, 63.64%, 60.00%, 37.50%, 16.67% and16.67%. In the open surgical treatment group, the rates of freedom from re-occlusion and reintervention at 1, 3, 6, 12, 36, 60 and 84 months postoperatively were 90.00%, 90.00%, 90.00%, 75.00%, 75.00%, 66.70% and 66.70%. Conclusions: For patients with CCAOs, the advantage of endovascular treatment is that it is minimally invasive and suitable for patients with Takayasu arteritis. The advantage of open surgical treatment is that it has a high success rate, and the long-term rate of freedom from reocclusion and reintervention is significantly better than that of endovascular treatment.

Background: Reliable indicators to assess the severity and extent of type A aortic dissection (TAAD) remain lacking. This study aimed to evaluate the role of renal artery involvement in this context. Methods: From January 2020 to June 2022, a total of 471 patients with TAAD who underwent open surgical repair were retrospectively analyzed. Based on computed tomography angiography, patients were categorized into two groups: those with renal involvement (RAI, n=289) and those without (non-RAI, n=182). To further validate the results, propensity score matching (PSM) was performed to minimize bias. A multivariate ordered logistic regression model was used to evaluate the association between renal involvement and the number of end-organ malperfusion. The incidence of dialysis dependence was calculated using the Kaplan-Meier method. Cox regression models were utilized to determine factors of overall and mid-term mortality. Results: The RAI group exhibited more extensive aortic branch involvement (all P<0.05) and required more concomitant branch procedures, with a higher incidence of end-organ malperfusion (P=0.006), as well as increased serious adverse events (P=0.009), which remain consistent after PSM matching. The multivariate ordered logistic regression model indicated that renal involvement was associated with malperfusion [Odds ratio=2.00, 95% confidence interval (CI):1.25-3.27]. Multivariable Cox regression analysis identified renal involvement as an independent risk factor for overall mortality [hazard ratio (HR)=3.48, 95%CI:1.15-10.47, P=0.027] and mid-term mortality (HR=3.42, 95%CI:1.14-10.31, P=0.029). Kaplan-Meier analysis revealed no significant difference in dialysis dependence. Conclusions: Renal artery involvement signifies more severe aortic branch compromise and malperfusion, and worse prognosis.

Background and Objective: Kommerell's diverticulum is a special type of proximal subclavian artery aneurysm that is associated with the aberrant subclavian artery. Although most patients are asymptomatic, there is a high risk of aortic rupture and aortic dissection. This study aimed to investigate the clinical characteristics, treatment strategies, and long-term prognosis of this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) through a single-center retrospective study, providing valuable support for clinical decision-making. Methods: Patient data were collected from the medical records system from February 2011 to April 2022 for patients who had computer tomography scan reports indicating Kommerell's diverticulum and underwent intervention at our institution. A total of 76 adult patients aged 18 years and above with Kommerell's diverticulum were included in this study, of which 48 had concomitant aortic dissection and 28 without. Results: The overall early postoperative mortality rate for the included cases in this study was 9.2% (7/76 cases), with a 30-day mortality rate of 12.5% (6/48 cases) for the group with concomitant aortic dissection and 3.6% (1/28 cases) for the non-aortic dissection group. The median follow-up time for all included patients in this study was 4.0 years. Preoperative coronary artery atherosclerotic heart disease was identified as a risk factor associated with surgical mortality (OR=3.15, P=0.0163). Central nervous system complications occurred in 10 patients (13.2%), and respiratory system complications occurred in 4 patients (5.3%), with both cases in the group with concomitant aortic dissection resulting in postoperative death within 30 days due to compression of the right main bronchus by the aneurysm, leading to lung infection and respiratory failure. The 3-year, 5-year, and 7-year survival rates for the group with concomitant aortic dissection were 82.5%, 79.7%, and 75.1%, respectively, while the survival rates for the non-aortic dissection group were all 88.9%. Conclusion: The treatment approach for patients with this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) should be based on comprehensive evaluation including age, symptoms, and imaging findings. Attention should be paid to the relationship and compression of the aortic dissection with the right main bronchus in patients with Kommerell's diverticulum and a right-sided aortic arch.

Abdominal aortic aneurysm refers to a serious medical condition that can cause the irreversible expansion of the abdominal aorta, which can lead to ruptures that are associated with up to 80

To better understand the pathogenesis of acute type A aortic dissection, high-sensitivity liquid chromatography-tandem mass spectrometry/mass spectrometry (LC-MS/MS)-based proteomics and phosphoproteomics approaches were used to identify differential proteins. Heat shock protein family B (small) member 6 (HSPB6) in aortic dissection was significantly reduced in human and mouse aortic dissection samples by real-time PCR, western blotting, and immunohistochemical staining techniques. Using an HSPB6-knockout mouse, we investigated the potential role of HSPB6 in β-aminopropionitrile monofumarate-induced aortic dissection. We found increased mortality and increased probability of ascending aortic dissection after HSPB6 knockout compared with wild-type mice. Mechanistically, our data suggest that HSPB6 deletion promoted vascular smooth muscle cell apoptosis. More importantly, HSPB6 deletion attenuated cofilin activity, leading to excessive smooth muscle cell stiffness and eventually resulting in the development of aortic dissection and rupture. Our data suggest that excessive stiffness of vascular smooth muscle cells caused by HSPB6 deficiency is a new pathogenetic mechanism leading to aortic dissection.

Background Pretricuspid shunts have been associated with poorer survival rates in patients with Eisenmenger syndrome compared with postricuspid shunts and complex lesions. However, the risk stratification for persistent pulmonary hypertension (PH) in this population remains uncertain. Methods and Results We retrospectively enrolled 103 patients with pretricuspid shunts with high total pulmonary resistance >4.5 Wood units (estimated pulmonary vascular resistance ≥3 Wood units). During a mean±SD follow‐up of 20.95±24.84 months, 32 patients developed postoperative persistent PH after shunt correction. We identified 3 significant predictors of postoperative persistent PH, including mean pulmonary artery pressure after inhaled oxygen ≥40.5 mm Hg (odds ratio [OR], 7.78 [95% CI, 2.02–30.03]; P <0.01), total pulmonary resistance after inhaled oxygen ≥6.5 Wood units (estimated pulmonary vascular resistance ≥5 Wood units; OR, 12.23 [95% CI, 2.12–70.46]; P <0.01), and artery oxygen saturation at rest <95% (OR, 3.34 [95% CI, 1.07–10.44]; P =0.04). We established the prediction model with the C‐statistics of 0.85 (95% CI, 0.77–0.93; P <0.01), and the C‐statistic was 0.83 (95% CI, 0.80–0.86) after bootstrapping 10 000 times with a good performance of the nomogram calibration curve for predicting persistent PH. Conclusions Our study presents a multivariable risk stratification model for persistent PH after shunt correction in adults with pretricuspid shunts. This model, based on 3 hemodynamic predictors after inhaled oxygen, may assist in identifying individuals at higher risk of persistent PH after shunt correction.

OBJECTIVE:The objective of this study was to compare the perioperative performance of the novel large-diameter composite polycarbonate polyurethane graft and the polyester graft. METHODS:In this study, we retrospectively analyzed 14 patients with thoracic aortic prosthesis replacement from 2016 to 2021. The preoperative, intraoperative, and postoperative data of the 2 groups were assessed in detail. RESULTS:We defined the patients with polyester grafts as the control group and the patients with polycarbonate polyurethane grafts as the experimental group. The total operation time of the experimental group was significantly shorter than that of the control group, which were 159.29±38.13 minutes and 252.57±64.40 minutes, respectively (p<0.001). The length of time from aortic opening to the end of operation in the experimental group was significantly shorter than that in the control group, which were 70.43±8.08 minutes and 124.71±37.59 minutes, respectively (p<0.001). The mean total drainage of pleural fluid was lower in the experimental group than in the control group (383.43±139.68 mL vs. 828.00±457.27 mL; p<0.05). The mean postoperative in-hospital time was shorter in the experimental group than in the control group (6.71±0.75 days vs. 9.43±2.82 days; p<0.05). CONCLUSIONS:This study provides preliminary evidence that the novel artificial blood vessel has good mechanical properties, histocompatibility, hemocompatibility, and anti-seepage function in the human body. A multicenter randomized controlled trial is needed for further validation.Clinical ImpactThe novel hybrid polycarbonate polyurethane (PCU)/polyester three-layered large-diameter artificial blood vessel simulates the internal, middle, and external layers of the human blood vessels. The inner and outer layer are made of PCU, and the middle reinforcing layer is woven by polyester. Because of the three-layered structure, this artificial blood vessel has excellent anti-seepage and anti-infection functions. the inner and outer layers of the blood vessel made of PCU let this artificial blood vessel has excellent blood compatibility, outstanding biocompatibility, high endothelialization rate, and 100% patency. By comparing the perioperative outcomes with the polyester artificial blood vessel, we find it has good mechanical properties, histocompatibility, hemocompatibility and anti-seepage function in the human body.

AIMS:Growing preclinical and clinical evidence has suggested the potential method of umbilical cord mesenchymal stem cell (UCMSC) therapy for diabetic foot. Thus, the authors provided an outline of the application of UCMSCs in the treatment of diabetic foot and further summarized the roles and mechanisms of this therapy.DATA SYNTHESIS:With no time limitations, the authors searched the Web of Science, Cochrane Central Register of Controlled Trials, and PubMed (MEDLINE) databases. 14 studies were included, including 9 preclinical experiments and 5 clinical trials (3 RCTs and 2 single-arm trials).CONCLUSIONS:The UCMSCs are of great efficacy and safety, and function mainly by reducing inflammation, regulating immunity, promoting growth factors, and enhancing the functions of vascular endothelial cells, fibroblasts, and keratinocytes. As a result, ulcer healing-related biological processes ensue, which finally lead to diabetic foot ulcer healing and clinical symptom improvement. UCMSC treatment enhances diabetic foot ulcer healing and has a safety profile. They function mainly by modulating immunity, promoting growth factor secretion, and enhancing cellular functions. More well-designed preclinical and clinical studies are needed to provide the most optimal protocol, the comprehensive molecular mechanisms, as well as to further evaluate the efficiency and safety profile of UCMSC treatment in diabetic foot patients.

PURPOSE:The aberrant subclavian artery (aSA) is a rare anomaly of the aortic branches. Approximately 20-60% of patients with an aSA are associated with Kommerell's diverticulum (KD). These vascular anomalies have been reported to increase the risk of aortic rupture (4-19%) and aortic dissection. However, limited studies have investigated the treatment of aortic dissection in patients with aSA and KD. This study aims to investigate clinical characteristics and midterm follow-up outcomes of patients with aortic dissection associated with aSA. MATERIALS AND METHODS:Between 2011 and 2021, a total of 48 patients with aSA anomalies underwent aortic dissection surgical intervention. Surgical interventions include open surgery, hybrid surgery, and endovascular therapy. Among them, 20 (41.7%) had Stanford type A dissection, 9 (18.8%) had Stanford type B dissection, and 19 (39.6%) had non-A non-B dissection. We report the early and midterm clinical outcomes including mortality, central nervous system complication and respiratory complication, and other operative outcomes including reintervention rates and endoleak. A subgroup analysis of the surgical and postoperative conditions was performed on Stanford type B and non-A non-B aortic dissection patients. RESULTS:The mean age of the patient population was 48.81±9.65 years. The 30-day mortality rate was 12.5%. The overall mortality rate was 20.8%, with a median follow-up time of 4.5 years (interquartile range [IQR]: 2-8.75 years). Central nervous system complications occurred in 8 patients (16.7%), subclavian steal syndrome in 6 patients (12.5%), and respiratory complications in 3 patients (6.2%). The estimated Kaplan-Meier survival rates at 1 year, 3 years, 5 years, and 7 years after surgery were, respectively, 87.0%, 82.5%, 79.7%, and 75.1%. For Stanford type B and non-A non-B aortic dissection patients, the 30-day mortality rate between the open surgery group and the minimally invasive group had no statistically significant differences (18.3% vs 8.3%, p=0.815). CONCLUSIONS:Surgical intervention for aSA patients with aortic dissection has poor outcomes. Early intervention might be considered for patients with aSA and KD to prevent the occurrence of aortic dissection.Clinical ImpactAberrant subclavian artery (aSA) and Kommerell's diverticulum (KD) have been reported to increase the risk of aortic rupture and aortic dissection. This study is currently the largest single-center retrospective study on aSA combined with aortic dissection, providing standardized data reporting and midterm follow-up of patients with this rare vascular anomaly.

AIMS:This study aimed to explore the association between glycemic variability (GV) and postoperative atrial fibrillation (POAF) incidence. METHODS:In this retrospective study, we included patients undergoing cardiac surgeries. GV was calculated as the coefficient of variation of blood glucose and categorized into tertiles based on its distribution. The primary endpoint was the incidence of POAF. Logistic regression and restricted cubic splines were used to assess the relationship between GV and POAF. RESULTS:5365 patients were included, with a median age of 68.3 years, and 25.5 % were female. 1056 (19.7 %) patients developed new-onset POAF. Compared with the low GV group, moderate GV group (odds ratio [OR], 1.82; 95 % confidence interval [CI]: 1.49-2.22) and high GV group (OR, 2.25; 95 % CI, 1.80-2.82) were significantly associated with a higher incidence of POAF. The area under the receiver operating characteristic curve of GV in predicting POAF incidence was 0.77 (95 % CI: 0.76-0.79). There is a threshold-based nonlinear relationship between GV and the incidence of POAF: when GV was < 24 %, the likelihood of POAF increases with higher GV, whereas when GV ≥ 24 %, further increases did not significantly affect the risk of POAF. CONCLUSIONS:Increased GV is associated with higher incidence of POAF.

OBJECTIVE:The objective of this study was to introduce our institutional experience of treatment strategies (cervical subclavian artery reconstruction, thoracotomy subclavian artery reconstruction and endovascular treatment) for proximal isolated subclavian artery aneurysms (PISAAs). METHODS:we retrospectively analyzed 15 consecutive patients with PISAAs treated by different treatment strategies (cervical reconstruction, thoracotomy reconstruction and endovascular treatment) in our institution from May 2016 to May 2022. Baseline data, surgery-related data, postoperative information and long-term follow-up were assessed. RESULTS:A total of 17 PISAAs in 15 consecutive patients were treated in our institution. The success rates of subclavian artery reconstruction in the cervical reconstruction, the thoracotomy reconstruction and the endovascular treatment were 100%, 100 and 83.33%, respectively. About the involved vertebral artery, the reconstruction rates in the cervical reconstruction, the thoracotomy reconstruction, and the endovascular treatment were 80%, 75%, and 0, respectively. The intraoperative blood loss in the thoracotomy reconstruction was significantly higher than that in the cervical reconstruction and the endovascular treatment (p<0.05). The total operation time of the thoracotomy reconstruction was significantly longer than that of the cervical reconstruction and the endovascular treatment (p<0.05). In terms of postoperative ventilator use time, total postoperative drainage fluid, total postoperative drainage time, and ICU duration, both the thoracotomy reconstruction and the cervical reconstruction were significantly more than the endovascular treatment (p<0.05). During the follow-up, one patient in the endovascular treatment underwent re-intervention 22 months after surgery due to in-stent occlusion. CONCLUSIONS:For patients with PISAAs, different treatment strategies are recommended depending on the size of the aneurysms and whether the involved vertebral arteries require reconstruction.Clinical impactThis article is the largest study on the treatment strategies of PISAAs. By comparing the prognosis and complications of endovascular treatment with those of open surgery, it provides a certain reference basis for the choice of treatment for patients with PISAAs. For patients with aneurysms' diameter of >50 mm, the thoracotomy subclavian artery reconstruction is recommended; for patients with aneurysms' diameter of <30 mm requiring reconstruction of the involved vertebral arteries, the cervical subclavian artery reconstruction is recommended; for patients with aneurysms' diameter of <30 mm not requiring reconstruction of the involved vertebral arteries, the endovascular treatment is recommended.

Objective To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results Finally 12 patients were enrolled, including 10males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to24.9%±14.3%（P＜0.001）. The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0%（P＜0.001）.Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes.Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients’ symptoms and has high promotion value.

BackgroundThe recommendation of the European Society for Vascular Surgery (ESVS) is that vertebral revascularization combined with ipsilateral CEA (carotid endarterectomy) should not be performed in the same operation. ESVS believes that vertebral revascularization combined with ipsilateral CEA increases perioperative death/stroke rates. In our opinion, revascularization of the first segment of vertebral artery (V1) combined with ipsilateral CEA is safe compared to vertebral V1 revascularization in the perioperative period. The purpose of this study is to prove that revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is secure in the perioperative period.MethodsWe describe our experience with homochronous revascularization of V1 segment of vertebral artery with ipsilateral CEA (group B) and simple revascularization of V1 segment of vertebral artery (group A) in 48 consecutive patients during a 5-year period. O.Y. (Ouyang) incisions were used in both groups. We compare the results of the 2 procedures with aspects of mortality, stroke, morbidity, incident rates of complications, and so on.ResultsThere was no significant difference between patients in group A and group B in terms of red blood cell reduction, postoperative ventilator using time, postoperative drainage volume, postoperative drainage days, postoperative hospitalize duration, and incident rates of postoperative complications. The postoperative complications include death, stroke, Horner syndrome, vocal paralysis, hypoglossal nerve paralysis, wound hematomas, and lymphatic leakage.ConclusionsRevascularization of vertebral artery combined with ipsilateral CEA should be divided into revascularization of V1 segment of vertebral artery combined with ipsilateral CEA and revascularization of V3 segment of vertebral artery with ipsilateral CEA. Revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is safe; it can be performed for suitable patients who are fit for indications. O.Y. incisions can fully expose the target blood vessels and simplify the procedures without transecting the sternocleidomastoid muscles in operations.

(1) Background: the indications for transcatheter closure of large patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) are still unclear, and scholars have not fully elucidated the factors that affect PH prognosis. (2) Methods: we retrospectively enrolled 134 consecutive patients with a PDA diameter ≥10 mm or a ratio of PDA and aortic >0.5. We collected clinical data to explore the factors affecting follow-up PH. (3) Results: 134 patients (mean age 35.04 ± 10.23 years; 98 women) successfully underwent a transcatheter closure, and all patients had a mean pulmonary artery pressure (mPAP) >50 mmHg. Five procedures were deemed to have failed because their mPAP did not decrease, and the patients experienced uncomfortable symptoms after the trial occlusion. The average occluder (pulmonary end) size was almost twice the PDA diameter (22.33 ± 4.81 mm vs. 11.69 ± 2.18 mm). Left ventricular end-diastolic dimension (LVEDD), mPAP, and left ventricular ejection fraction (LVEF) significantly reduced after the occlusion, and LVEF recovered during the follow-up period. In total, 42 of the 78 patients with total pulmonary resistance >4 Wood Units experienced clinical outcomes, and all of them had PH in the follow-up, while 10 of them had heart failure, and 4 were hospitalized again because of PH. The results of a logistic regression analysis revealed that the postoperative mPAP had an independent risk factor (odds ratio = 1.069, 95% confidence interval: 1.003 to 1.140, p = 0.040) with a receiver operating characteristic curve cut-off value of 35.5 mmHg (p < 0.001). (4) Conclusions: performing a transcatheter closure of large patent ductus arteriosus is feasible, and postoperative mPAP was a risk factor that affected the follow-up PH. Patients with a postoperative mPAP >35.5 mmHg should be considered for targeted medical therapy or should undergo right heart catheterization again after the occlusion.