Objective:To investigate the safety and efficacy of excimer laser ablation (ELA) combined with drug-coated balloon (DCB) for the below-the-knee (BTK) artery lesions.Methods:From Jun 2019 to Nov 2022, 22 patients receiving ELA combined with DCB in atherosclerotic lesions of BTK artery at these two centers were retrospectively analyzed.Results:In these 22 patients there were 3 (13.6%) suffering from stenosis and 19 (86.4%) from chronic total occlusion (CTO) lesions. The mean length of lesion was (25.6±5.7) cm. The technical success rate was 95.5%. Flow-limiting dissection was found in 1 (4.5%) patient and a bailout stent was deployed. The mean ankle-brachial index (ABI) significantly improved during the follow-up period compared with that before the treatment. The median follow-up time was 21.5 months. The 1-year primary patency rate was 80.3%Conclusion:ELA combined with DCB was safe and effective in the treatment of atherosclerotic lesions of BTK artery, improving the primary patency.

随着医疗技术的不断发展，微创技术，包括腔镜和辅助机器人，在临床外科领域的应用已愈加广泛，被越来越多的医生所认可，也被诸多患者接受和推崇。然而，目前血管外科仅部分开放手术可以实现机器人辅助，而辅助血管腔内手术虽有报道但并不成熟。本综述旨在总结机器人系统在血管外科的应用与研究进展。

目的 探讨主动脉腔内修复术(endovascular aorta repair,EVAR)治疗孤立性腹主动脉夹层(isolated abdominal aortic dissection,IAAD)的临床效果.方法 回顾性分析2011年1月至2021年1月在复旦大学附属中山医院血管外科接受EVAR治疗的53例IAAD患者的临床资料,随访术后生存、并发症及二次干预情况等.用SPSS统计软件进行统计描述,应用Kaplan-Meier法计算累计生存率和免于二次干预率.结果 53例患者均成功接受EVAR治疗,其中1例术后因心包积液死亡,围手术期死亡率为1.9％.52例获得随访,平均随访(54.9±38.9)个月.随访期内死亡3例,无IAAD相关死亡.1、3、5和10年累计生存率为98.1％、98.1％、91.4％、87.1％,免于IAAD病死率均为98.1％,免于二次干预率均为91.9％.结论 EVAR治疗IAAD具有良好的安全性、有效性,远期疗效较为理想.

Objective:To discuss the strategies of distal embolic filter protection(DEFP) during excimer laser ablation (ELA) or percutaneous mechanical thrombectomy (PMT) in treatment of peripheral artery disease.Methods:Clinical data of 29 patients undergoing ELA or PMT under the DEFP from Oct 2019 to Aug 2021 were retrospectively collected to analyze the strategies of DEFP and high-risk factors of capturing clinically significant macrodebris.Results:There were 21 males and 8 females, aged (70.3±11.0) years with 32 lesions (29 limbs) including 5 in-stent restenosis (ISR), 10 thrombosis and 17 chronic total occlusion (CTO). The technical success rate of DEFP device release and recovery was 100%. The overall debris capture rate was 77.3% and the macrodebris capture rate was 36.4%. Even with DEFP the distal embolization (DE) incidence was 3.4%. When ELA for CTO with severe calcification or long-segment ISR lesions, the capture rate of macrodebris was as high as 60.0%, and the former was significantly higher than ELA for CTO without high calcification lesions ( P<0.05). Conclusion:ELA or PMT under the DEFP in treatment of peripheral artery disease appears to be of great significance in preventing DE.

Objective:To evaluate the safety and efficacy of carotid artery stenting (CAS) in the treatment of non-circumferential severe calcification using the distal embolic protection device.Methods:Clinical data of patients with severe calcification lesions in cervical carotid artery treated by CAS from Jan 2018 to Dec 2020 at our center was analyzed retrospectively.Results:226 consecutively admitted patients of cervical carotid artery stenosis and non-circumferential severe calcification (CR>270°) underwent CAS using the distal embolic protection device. The technical success rate was 90.26%. No death or myocardial infarction occurred during the perioperative period. Two patients had ipsilateral hemiparesis ischemic stroke during post-dilatation. The incidence of perioperative bradycardia/hypotension was 25.34%. Patients were followed up for 6-36 months, with median follow-up period of 17.3 months. The incidence of mild or moderate in-stent restenosis (<70%) was 16.59%, and the incidence of severe in-stent restenosis or occlusion (>70%) was 3.22%.Conclusions:For carotid artery stenosis with non-circumferential severe calcification in high risk for CEA patients, carotid artery stenting is safe and effective with the aggressive pre-dilation strategies, strict stent selections and implantation standards. The incidence of perioperative death, myocardial infarction or ipsilateral hemiparesis ischemic stroke was low. The patency rate of the carotid stent in the calcification lesion is satisfactory during the mid-term follow-up.

Objective:To investigate the effect of diabetes on the occurrence of stroke and death after carotid endarterectomy.Methods:According to the inclusion and exclusion criteria, 795 patients who were diagnosed with carotid stenosis and underwent carotid endarterectomy from January 2017 to January 2019 were included in 3 centers, Zhongshan Hospital affiliated to Fudan University, Changhai Hospital affiliated to Naval Medical University, and the Shanghai Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine. The patients were divided into diabetes mellitus (DM) group (n=215) and non-diabetes mellitus (NDM) group (n=580) according to whether they had diabetes. The clinical data of patients were collected and analyzed with univariate, multivariate, and survival analysis of stroke and death events 30 days after operation and within 3 years of follow-up. Logistic regression analysis was used for univariate analysis of categorical outcome variables. Cox regression equation was used for multivariate analysis, and survival curves were plotted by using the Kaplan-Meier method.Results:The success rate of CEA surgery is 100%. The incidence of adverse events at 30 days after surgery showed: stroke and death in 4 cases (0.5%), serious stroke and death in 3 cases (0.4%), stroke and TIA in 7 cases (0.9%), and no patient died. Adverse events at 3-year follow-up showed: 13 (1.6%) stroke and death, 6 (0.8%) serious stroke and death, 15 (1.9%) stroke or TIA, and 1 patient died (0.1%). The univariate and multivariate results of stroke and death 30 days after surgery did not significantly associated risk factors. The results of univariate analysis of adverse events during the 3-year postoperative follow-up showed that chronic obstructive pulmonary disease was a high risk factor for stroke or death after CEA (HR=13.8, 95%CI: 1.8-106.0, P=0.011). Multivariate analysis after adjusting for variables showed that age (HR: 1.0; 95%CI: 0.9-1.0; P=0.034), previous alcohol consumption (HR: 13.1; 95%CI: 1.7-100.3; P=0.013), and chronic Obstructive pulmonary disease (HR: 13.1; 95%CI: 1.7-100.3; P=0.013) were independent risk factor for stroke or death after CEA. The results of 3-year follow-up survival analysis showed that the 1-year, 2-year and 3-year survival rates of DM group were 99.5%, 99.0% and 98.3%; And that in the NDM group were 99.5%, 99.5% and 97.7%, respectively.Conclusion:The risk of stroke and death after CEA in patients with carotid artery stenosis in the diabetic group was higher than that in the non-diabetic group, but there was no significant correlation between diabetes and the occurrence of stroke and death within 3 years after CEA.

Objective:To evaluate the effect of Rotarex in peripheral arterial disease (PAD).Methods:The clinical data of 90 PAD patients treated with Rotarex from Aug 2018 to Feb 2020 were retrospectively analyzed.Results:Among the 90 patients, 45 patients had atherosclerotic obliterans complicated with acute thrombosis (ASOCAT), 27 patients had graft restenosis or reocclusion, 16 patients had primary or embolism-induced thrombosis, 2 patients had traumatic or iatrogenic arterial occlusion. Except for 2 patients undergoing hybrid surgery, 88 patients underwent endovascular treatment. Two patients died perioperatively. Within 12 months follow-up, 2 patients died, 4 patients underwent major amputation, target arteries of 10 patients were re-stenosed or re-occluded and 5 patients were lost to follow-up. Compared with the preoperative ankle-branchial index (ABI), significant increase was observed in the 12-month ABI (0.80±0.22 vs. 0.43±0.16, P<0.01). The 12-month restenosis/re-occlusion-free rate was 82.7%, and the 12-month major amputation-free survival (MAFS) was 91.6%. Conclusion:For PAD patients, acceptable outcomes can be achieved with reasonable use of Rotarex for debulking, combined with balloon, stent and other techniques to correct the residual lesions.

Objective To investigate the efficacy and safety of surgical treatment for internal carotid artery atheromatous pseudo-occlusion (APO).Methods Clinical data of patients with carotid artery stenosis treated by carotid endarterectomy from Dec.,2011 to Jun.,2016 in Zhongshan Hospital Affiliated to Fudan University were analyzed retrospectively.Carotid endarterectomy were performed in 32 patients with pseudo-occlusion of the internal carotid artery (APO group).And 124 patients with traditional severe stenosis (70％-99％) served as control group.Perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosisrate and mortality in follow-up were compared between the two groups.Results Perioperative major complications:one patient (3.1 ％) developed myocardial infarction in the APO group,no ischemic stroke,cerebral hemorrhage and death cases;2 (1.4％) ischemic stroke cases,6 (4.2％) myocardial infarction cases and 1 (0.7％)death case was found in control group.Perioperative minor complications:1 (3.1％) incision bleeding case,2 (6.3％) pulmonary infection cases,2 (6.3％) cerebral hyperperfusion syndrome cases were found in APO group;3 (2.1％) incision bleeding cases,2 (1.4％) incision infection cases,4 (2.8％)pulmonary infection cases,2 (1.4％) cranial nerve injury cases,2 (1.4％) cerebral hyperperfusion syndrome cases were found in control group.Patients were followed up for 6-60 months,with mean follow-up period of (35.3 ± 17.5) months.During follow-up,1 (3.1％) ipsilateral ischemic stroke recurrence case,4 (12.5％) restenosis cases,and 3 (9.4％) death cases were found in the APO group.And 8 (5.6％) ipsilateral ischemic stroke recurrence cases,9 (6.3％) restenosis cases,8 (5.6％)death cases were found in control group.There were no significant differences in perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosis rate and mortality between the two groups.Conclusions Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery is safe and effective.Perioperative and follow-up results are satisfactory.

目的 总结栓塞治疗腹主动脉瘤腔内修复(EVAR)术后Ⅱ型内漏的经验,并评估该方法的可行性及安全性.方法 回顾性分析笔者所在中心自2009年1月至2014年12月期间完成的14例栓塞治疗EVAR术后Ⅱ型内漏患者的临床资料,观察手术结果、围手术期及术后并发症及随访情况.结果 14例患者栓塞治疗EVAR术后Ⅱ型内漏的技术成功率为100％ (14/14),即刻临床成功率为100％ (14/14),手术时间(124.3±11) min,每例患者使用造影剂(127±15)mL,每例患者手术使用弹簧圈(7±2)个.围手术期间1例患者术后出现左下肢麻木,其余患者无穿刺导致的并发症,无死亡等严重并发症,患者均顺利出院.12例患者获得3～ 57个月(平均17.3个月)的随访,1例仅栓塞供血动脉的患者及另2例仅栓塞瘤腔的患者在术后发现内漏复发,但瘤体未明显增大,未再次接受腔内治疗,继续随访.结论 栓塞治疗EVAR术后Ⅱ型内漏的患者是安全的,能够有效地阻止动脉瘤瘤腔的进一步扩张.由于Ⅱ型内漏复发率高,术后的随访工作尤为重要.

Objective To evaluate the roles of using intravascular ultrasound during the endovascular repair of complex aortic dissection. Methods The data of 15 complex aortic dissection patients who underwent endovascular repair with the assistance of intravascular ultrasound were analyzed retrospectively. The roles of intravascular ultrasound in the identification of true and false lumen , the locations of secondary intimal tears, and the relationship between visceral arteries and the true/false lumens were analyzed. Digital subtraction angiography (DSA) during the endovascular repair of complex aortic dissection was used as a control in our study. Results Compared with DSA, the rates of finding true and false lumens (1±0 vs 0.73±0.46), intimal tearing locations (2.1±0.9 vs 1.7±0.7), and visceral blood sources (96.7% vs 85.0%) by intravascular ultrasound were higher. All these differences were statistically significant (P<0.05). Conclusion During the endovascular repair of complex aortic dissection , intravascular ultrasound is superior to conventional DSA in distinguishing true and false lumens , secondary intimal tears locations , and relationship between visceral arteries and the true / false lumen.

Objective To evaluate the safety and efficacy of percutaneous endovascular aneurysm repair(pEVAR) using the Perclose ProGlide closure system. Methods From December 2012 to July 2013,clinical data of 57 pEVAR cases were analyzed retrospectively,including perioperative complications and treatment. Results The technical success rate of pEVAR was 100%(57/57). The mean operating time was(93.5±17.8) min. Multiple ProGlide devices were used in a total of 106 femoral sites,including 20F~22 F access sites(n=36) and ≤ 18F access sites(n=70). The initial technical success rate for the ProGlide closure devices was 88.7%(94/106),and the secondary technical success rate was 91.5%(97/106). ProGlide devices failed to achieve hemostasis for 5 patients. Surgical hemostasis(n=2) and local compression(n=3) were required. For 4patients,ProGlide devices caused the stenosis or occlusion lesion in the puncture site,which were treated with surgical repair. The rate of blue toe syndrome was 5.7%(6/106). All the patients were discharged with no perioperative mortality. Conclusion Percutaneous closure technique using multiple Perclose ProGlide devices appears safe and effective in endovascular stent-graft treatment of abdominal aortic aneurysm. Local access related complications would be low in selected patients,providing that the operator has sufficient practical experience of this technique.