Multiple factors cause atherosclerosis， and its pathogenesis is complex and has not been fully elucidated. Polyunsaturated fatty acids， a member of the fatty acid family， are critical nutrients for mammalian growth and development. Types and intakes of polyunsaturated fatty acids， and fatty acid desaturase can affect the course of atherosclerotic disease. Fatty acid desaturase gene cluster can regulate fatty acid desaturase activity and further affect atherosclerosis. Based on the metabolic and genetics perspectives， this study reviewed the research progress on the effects of polyunsaturated fatty acids on atherosclerosis regulated by fatty acid desaturase and the relationship between genetic variants of the fatty acid desaturase gene cluster and atherosclerotic cardiovascular disease was summarized.

目的 分析胭动脉瘤外科及腔内治疗的策略与方法.方法 回顾性分析首都医科大学附属北京安贞医院2000年8月至2020年8月收治的19例胭动脉瘤病人临床资料.分析比较各病人的一般情况、围手术期情况及随访情况.结果 19例病人中,外科修复16例,其中行胭动脉瘤切除+间质移植术7例,行胭动脉瘤旷置+旁路移植术9例.覆膜支架腔内修复术3例.2例围手术期深静脉血栓形成予抗凝治疗,1例吻合口出血急诊再次手术.30d围手术期无心脑血管意外、死亡发生.4例失访,15例随访12～144个月,1例病人术后1年行截趾术,因感染重度性休克死亡.2例旁路移植病人出现切口周围麻木,营养神经治疗后好转.1例旁路移植病人术后1年复查桥血管再狭窄(50％),无下肢缺血症状出现.余病人下肢症状改善明确,无下肢缺血症状.结论 治疗指征明确的胭动脉瘤应积极手术.外科重建或腔内修复是安全有效的,个体化的治疗策略选择可获得更满意的治疗效果.外科重建应作为胭动脉瘤治疗的首选.腔内修复的手术选择仍需非常谨慎.

目的:对1例超声心动图表现为B型主动脉夹层及胸主动脉瘤的患者及其家系进行基因检测，明确其可能的致病变异基因。方法:对先证者进行全外显子测序，重点分析遗传性主动脉疾病相关致病基因，依据ACMG指南，判定变异的致病性。并应用Sanger测序对患者及家系成员的候选位点进行检测。结果:二代测序结果经生物信息学分析，在患者的基因组中检测到原纤维蛋白-1(Fibrillin-1, FBN1)(NM_000138.3)基因存在c．A8378G(p.Y2793C)杂合变异，该位点在公共数据库均未见频率报道；SIFT、PolyPhen2和Mutation taster软件分析预测该变异为有害变异；在该家系内，该变异位点与临床表型共分离，依据ACMG指南，该变异为可能致病性变异(PM2+PP1+PP3+PP4+PP5)。 结论:FBN1 (NM_000138.3)基因c.A8378G变异是该患者致病的原因，本研究结果丰富了家族性主动脉瘤/夹层患者 FBN1基因的变异谱，为临床诊断和遗传咨询提供理论依据。

目的:支架置入目前仍是外周动脉硬化性疾病(PAD)最主流的治疗方式,而可降解支架有可能是改善其治疗效果更好的办法.本研究拟在通过与市场现有的金属支架进行对比,评价3D打印多聚合物可降解载药支架在动物体内的安全性和整体使用性能.方法:本研究实验组支架为3D打印多聚合物可降解载药支架BRS(北京阿迈特医疗器械有限公司),对照组为镍钛合金金属裸支架BMS(商品名:SMART,生产厂家为厂家为Cordis Corporation,生产地在美国).共选取44头健康普通白猪,性别不限,分别于双侧髂股动脉置入可降解支架和金属裸支架,并于不同随访时间点采集造影、光学相干断层扫描(OCT)、病理、电镜以及降解信息.结果:手术成功率100％,无特殊不良事件.造影结果:血管内腔最小直径结果支架置入后1个月,BMS和BRS两组的MLD均有所降低,但BRS组的MLD则高于BMS组,并有车有统计学意义(P=0.01).3个月时,BRS组的MLD略大于BMS组,但差异无统计学意义(P=0.27).6个月时,BRS组的MLD略大于BMS组(4.91vs.4.49mm),但差异无统计学意义(P=0.43).12个月时,BRS和BMS两组的MLD差异无统计学意义(P=0.66),BRS接近其置入即刻的MLD值,BMS略低于其置入即刻的MLD值.24个月时,BRS和BMS两组的MLD差异无统计学意义(P=0.18),BRS和BMS两组的MLD均大于置入即刻的MLD值.OCT结果显示,与即刻的支架面积和直径相比,BRS和BMS在1个月时支架面积和直径均有所降低,随后BRS支架面积开始增大,并继续随时间增加至高于即刻的值,BMS支架面积和直径在6～12个月内逐渐增加至与即刻的值相当.降解组BRS支架置入后支架的分子量和平板压在1个月时几乎无明显变化;3个月时,分子量下降约70％,平板压下降约90％;6个月时,分子量下降约90％,平板压下降约95％;至12个月时,分子量和平板压下降约96％.两组支架损伤积分,炎症积分、内皮化积分在1、3、6、12个月时差异无统计学意义,内皮细胞覆盖率在12个月时BMS显著低于BRS,炎症积分在24个月时BMS显著高于BRS,并差异有统计学意义(P=0.003).结论:本实验所用3D打印多聚合物可降解载药支架的安全性与金属裸支架无明显差别,在抑制内膜增生改善通畅率方面可能存在一定优势,但仍需要进一步的临床试验证实.

Objective:To compare the perioperative complications of carotid endarterectomy with patch angioplasty or primary closure.Methods:The clinical data of 492 carotid endarterectomy patients at the Vascular Surgery Department of Anzhen Hospital from Mar 2003 to Dec 2016 was analyzed retrospectively.Results:There were 364 cases (74%) in the patch angioplasty group and 128 cases (26%) in the primary closure group. The incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than that in the primary closure group (0.8% vs. 3.9%, P=0.031), and there was no difference in the incidence of the remaining perioperative complications. By subgroup analysis, the incidence of perioperative ischemic stroke was significantly lower in the patch angioplasty group than in the primary closure group when the diameter of the internal carotid artery was <5 mm (0.7% vs. 6.0%, P=0.001), whereas there was no difference between the two groups when the diameter of the internal carotid artery was ≥5 mm. Conclusions:Carotid endarterectomy with patch angioplasty can reduce the incidence of perioperative cerebral infarction, especially in cases with an internal carotid artery diameter <5 mm.

目的 评价定向斑块旋切联合药物涂层球囊扩张(DAART)治疗重度钙化股腘动脉硬化闭塞性疾病的安全性和有效性.方法 研究对象为首都医科大学附属北京安贞医院2017年1月至2018年10月行DAART治疗的47例重度钙化股腘动脉硬化闭塞性疾病患者(包括41例闭塞性病变患者,6例狭窄病变患者),收集患者基本信息、手术技术成功率、手术前后踝肱指数、住院期间影像资料和术后随访信息进行回顾性分析.结果 手术全部顺利完成.46例患者的血管病变经腔内开通成功,技术成功率97.9％.术后6、12个月一期通畅率分别为95.7％(45/47)、83.0％(39/47),二期通畅率为100％(47/47),患者术后临床症状及卢瑟福分级改善明显.术后12个月复查踝肱指数明显高于术前[(0.89±0.13)比(0.42±0.17)],差异有统计学意义(P<0.05).结论 DAART治疗重度钙化的股腘动脉硬化闭塞性疾病安全且有效,术后短期随访患者缺血症状改善明显、效果满意.

目的:颅外段颈动脉瘤是极其罕见的疾病,发病率为1％- 1.5％,可导致卒中、短暂性脑缺血(TIA)等严重症状,国内外相关文献报道显示,目前颈动脉瘤治疗仍以外科手术为主.方法:对安贞医院血管科,2002年至2017年共收治颅外颈动脉瘤25例患者进行总结,男性17例,女性8例,年龄29-80岁,平均55.3岁,其中症状性病变21例,体检发现4例.其中2例为双侧病变,共27处病变,行26例手术,其中24例开放手术,2例腔内手术.结果:手术成功率100％,围术期无死亡,围术期并发症3例,1例发生急性脑梗死,1例假性动脉瘤复发,1例颅神经损伤.术后,中位随访时间为49个月,失访5例,随访率80％.随访期间无死亡病例,1例患者在术后36个月同侧脑梗塞,1例患者在术后90个月发现腹主动脉瘤并行腔内治疗.结论:颅外段颈动脉瘤外科治疗围术期和长期疗效良好,开放手术目前仍是主要治疗手段.

目的 探讨腹主动脉腔内修复(EVAR)治疗破裂性腹主动脉瘤(RAAA)的合理性、有效性和安全性.方法 回顾性分析2005年8月至2020年1月首都医科大学附属北京安贞医院收治的112例RAAA病人资料,对EVAR组和开放手术(OSR)组围手术期结果进行比较分析.结果 EVAR组和OSR组30d病死率分别为12.3％(8/65)和12.8％(6/47),两组差异无统计学意义(P=0.942),围手术期各种并发症发生率及二次手术干预率两组差异均无统计学意义.EVAR组和OSR组手术时间分别为(3.5 ±1.7)h和(7.2 ± 3.1)h,差异有统计学意义(P＜0.01);EVAR组和OSR组术中出血量分别为(267.7 ±433.9)mL和(2721.3±2112.1)mL,差异有统计学意义(P＜0.01);EVAR组和OSR组术中输红细胞量分别为(2.2 ±4.2)U和(7.2 ± 3.1)U,差异有统计学意义(P＜0.01);EVAR组和OSR组术中输血浆量分别为(147.7±324.6)mL和(1121.3±754.1)mL,差异有统计学意义(P＜0.01).EVAR组ICU时间为(6.9 ±8.0)d,低于OSR组(8.6 ±8.4)d,但差异无统计学意义(P=0.285);EVAR组住院时间为(13.3±10.4)d,低于OSR组(21.8± 11.1)d,差异有统计学意义(P＜0.01).结论 EVAR治疗RAAA有与OSR相似的30 d病死率和并发症发生率,而EVAR有更短的手术时间,更少的术中出血量和输血量、更短的住院时间.EVAR治疗RAAA是合理有效安全的.

Objective To explore surgical experiences of endovascular and open operations treating visceral artery aneurysms.Methods Twenty-three patients with visceral artery aneurysms from June 2009 to October 2016 in Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University were retrospectively enrolled.In 23 patients,there were 10 cases of splenic artery aneurysm,7 cases of renal artery aneurysm,3 cases of superior mesenteric artery aneurysm,3 cases of celiac trunk aneurysm,22 cases of nonruptured aneurysm and 1 case of aneurysm rupture.The perioperative data were analyzed.Results All cases were successfully operated;22 cases had endovascular operation;1 case had open operation.One patient who had arterial embolization died of multiple organ failure 43 d after operation.Major perioperative complications included gastrocnemius venous thrombus in 1 case and upper abdominal pain in 3 cases.No arterial recanalization or rupture,in-stent restenosis or occlusion occurred during 6-48 months of follow-up.Conclusions Endovascular operation is a safe and effective method in treating visceral artery aneurysms;open surgery can be a second choice for patients with contraindications of endovascular therapy.

Objective To evaluate retrograde transpopliteal access for femoral-popliteal artery total occlusion with blind puncture.Methods Clinical data of 22 cases admitted from Sep 2014 to June 2016 undergoing endovascular treatment of the femoral-politeal artery occlusion with transpopliteal artery retrograde access by blind puncture were analyzed.Results A total of 22 patients underwent retrograde popliteal access with blind puncture after antegrade attempts failed.Puncture above the knee was performed in 18 cases and below the knee in 4 cases.The average increase of ABI was 0.57.Hematoma of puncture site was observed in 2 patients,other complications included pneumonia in 1 case and renal insufficiency in 2 cases.The mean follow-up time was (13 ± 5)months.Restenosis occurred in 8 patiens(36.4％)during the follow-up time.The primary patency was (86.4 ± 0.07) ％ at 6 months and (70.7-± 0.12) ％ at 12 months.There was no major amputation rate and mortality during the follow-up.Conclusions Retrograde transpopliteal access for femoral-popliteal artery occlusion with blind puncture is safe and effective.

目的:探讨无名动脉及左颈总动脉起始部狭窄及闭塞的治疗方法.方法:对2006年12月至2015年9月,收治的15例无名动脉及左颈总动脉起始部狭窄及闭塞患者的临床资料进行回顾性分析.15例患者中,完全腔内技术治疗4例,杂交技术5例,工血管旁路移置术6例,对围手术期和随访结果进行分析.结果:所有病例均顺利完成手术.全组无脑血管并发症发生.围手术期并发症包括主动脉夹层1例、泌尿系感染1例,上呼吸道感染1例,均经保守治疗好转出院,无患者死亡.15例患者均进行了随访,随访时间7 ～112个月,完全腔内治疗组有1例患者于术后25个月发现无名动脉支架内再狭窄,其余患者无再狭窄及其他并发症发生.结论:无名动脉及左颈总动脉起始部的狭窄及闭塞可以根据具体情况采用腔内技术、杂交技术以及开放手术治疗,围手术期及远期效果满意,是安全、有效的治疗方法.

Objective To explore the surgical treatment of intravenous leiomyomatosis (IVL).Methods Totally 12 cases of IVL from March 2006 to June 2015 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.All patients had surgical tumor resections.Perioperative and follow-up data were analyzed.Results All patients had successful operation;operation time was (6.7 ± 1.4) h;intraoperative blood loss was (2 108 ± 1 754) ml;length of hospital stay was (32 ± 12) d;postoperative pathological examinations confirmed the diagnosis of IVL.Perioperative complications included 1 case of arrhythmia and 1 case of pneumonia.All cases were followed up for 3-103 months;1 patient suffered from a relapse 24 months after operation and he was treated at a local hospital and died of circulatory failure;there was no other relapse or death.Conclusions Surgical treatment is effective for IVL.Tumor resection and regular follow-ups are essential for improving efficacy and preventing relapse.

目的:探讨合并对侧颈动脉病变的颈动脉狭窄的治疗方法.方法:对2011年7月至2014年12月,收治的105例合并对侧颈动脉病变的颈动脉狭窄患者的临床资料进行回顾性分析.50例实施颈动脉内膜剥脱术(CEA),55例实施颈动脉支架置入术(CAS),对围手术期结果进行对比分析.结果:CEA组围手术期并发症发生率为14％ (7/50),包括局灶性脑梗塞、TIA发作、声音嘶哑、刀口血肿及泌尿系感染.CAS组围手术期并发症发生率为20％(11/55),包括局灶性脑梗塞、颈动脉窦综合征、颈内静脉血栓、肾功能不全及肺部感染.所有患者均顺利出院,围手术期无患者死亡.2组患者并发症发生率比较差异无统计学意义(P=0.415).结论:CAS和CEA均为治疗合并对侧颈动脉病变的颈动脉狭窄的安全、有效的方法.

Objective To investigate the efficacy of hybrid technique treatment for the common femoral artery(CFA)occlusion involving the external iliac artery(EIA).Methods Between May 2008 and April 2013, a retrospective analysis was carried out in 47 patients who underwent CFA endarterectomy,EIA balloon dilatation and stent implantation. Perioperative results and arterial recanalization were analyzed. Results All procedures were performed successfully. The mean amounts of stents were(1.51±0.75)for every patient. Postoperative ankle brachial index(ABI)increased 0.54,and ischemia of lower limbs was improved in all patients. The perioperative complication rate was 17.0%(8/47) and no patient died during perioperative period. The mean follow-up time was(673.6±384.4)days. In-stent occlusion was observed in 4 patients. The primary patency rates were(97.8±2.2)% and(86.3±6.7)% at 12 months and 24 months after operation,respectively,with Kaplan-Meier life-table analysis.Conclusion The perioperative and short term results of hybrid technique treatment for the CFA occlusion involving the EIA are satisfied.

Objective:The purpose of this study was to compare the outcomes of endovascular therapy to those of aorto-femoral graft bypass for patients with Transatlantic Inter-Society Consensus(TASC Ⅱ) C and D aortoiliac occlusive disease,and to provide evidence for treatment choosing of this disease and experience for other multi-center randomize clinical trials.Methods: From 2005 to 2008,77 patients of TASC C and D aortoiliac occlusive disease underwent surgical and endovascular treatment in Anzhen hospital.35 patients underwent endonvascular therapy(group A) and 42 patients underwent aorto-femoral graft bypass(group B).All clinical,perioperative and follow-up data at average(59.7±18.7) months were obtained.Results: 5 years primary and secondary patency are 68.8% and 78.1% for group A,92.1% and 94.7% for group B.The 5 years survival rate and limb salvage rate are 93.8% and 90.6% of group A,94.7% and 97.3% of group B.Conclusion: TASC C and D lesions can be treated with either endovascular therapy or aortofemoral graft bypass with satisfactory results.Compared with aortofemoral graft bypass,endovascular therapy is associated with decreased long term patency.Aortofemoral bypass should be the first choice for patients without contraindication of open surgery.

Objective:The arm of trial is to study to treat serious lower extremity ischemia by low molecule weight heparin(LMWH)cooperated with sarpogrelate.Methods: We conducted a randomized cohort trial,in which 43 patients(experimental group) were assigned to apply LMWH cooperated with sarpogrelate,40 patients(compared group) were assigned to apply cilostazol cooperated with pancreatic kallikrein.To compare their validity and security between 2 groups.Results: The excellent,productive and invalid ratio of the experimental group are respectively 38.5%(30/78),48.7%(38/78)and 12.8%(10/78).Them of the compared group are respectively 10.1%(7/69),14.5%(10/69)and 75.4%(52/69)(P0.001).There is none of bleeding in two groups.Conclusion: LMWH cooperated with sarpogrelate plays a big role in increasing distance of claudication in FontaineⅡ,eliminating or alleviating rest pain in Fontaine Ⅲ or Ⅳ,promoting to form lateral branch artery,and no in increasing blooding.These give expression to validity and security in treatment of LMWH cooperated with sarpogrelate.

Objective:To investigate and establish the methods of in vitro culturing,differentiation and identification of endothelial progenitor cells(EPCs) of rabbit.Methods: The mononuclear cells were gained separately from rabbit bone marrow and peripheral blood by density gradient centrifugation,inoculated in the culture bottle that coated with gelatin and cultured in endothelial cell basel medium-2 then induced differentiation to EPCs.We observe the growth process of both derived EPCs by inverted microscope;measure the survival rate of passaging cells by typan blue exclusion;compare the proliferation status of both derived EPCs by observing the growth curve,MTT method,and testing the cell cycle;observe the express of EPCs-related antigen CD34,CD31,CD133,and von willebrand factor(vWF) by immunofluorescence staining.Results: Both bone marrow-derived EPCs and peripheral blood-derived EPCs are completely adherent after being cultured 3～4 d,both are clone-like growth,form a similar mature vascular endothelial cell morphology after 7～9 d,the number of cells increases gradually,the cell survival rates are 95%.The growth curves of the second generation of Both derived EPCs are S-shaped,MTT method shows that the proliferation of the cells are obvious at 3～5 d,the G0-G1 phase and S + G2 + M phase proportion of peripheral blood-derived EPCs are 96.48% and 3.52%,the G0-G1 phase and S + G2 + M phase proportion of bone marrow-derived EPCs are 97.11% and 1.84%.The result of the identification of the second generation of EPCs by immunofluorescence shows: two sources of EPCs are both positively expressed CD34、CD133 and vWF,but CD31 is weakly expressed.Conclusion: Both derived EPCs could be obtained efficiently stably cultured in vitro.And compared to the traditionally achieved EPCs from bone marrow,achieved EPCs from peripheral blood is reliable and more convenient method,providing the ideal source of cells for tissue engineering.

<正>重症下肢缺血为下肢缺血发展到Fontaine 3到4期,已经出现静息痛、肢体溃疡坏疽甚至肢体丢失等表现。此时,单纯的内科治疗已无法达到治疗目的,需要外科干预治疗。