Lipid droplets (LDs) within atherosclerotic plaques are central to cardiovascular disease, yet their molecular composition remains largely unknown. More than 20 years experiences of developing LD purification method allowed us recently to successfully purify LDs from atherosclerotic plaques of patients undergoing carotid artery surgery, including three types, soft (lipid), mixed, and hard (calcified). In addition, the subpopulations of large LDs and small LDs were purified and studied, respectively. We report the first comprehensive proteo-lipidomic analysis of these LDs. Unexpectedly, about 19.3% of the plaque LD proteins belonged to cytoskeleton, while the content of lipid metabolism enzymes on plaque LDs was low. Our results show that the compositions of lipids and proteins were similar between two population LDs. Compared to soft (lipid) plaque LDs, LDs from mixed and hard (calcified) plaques had fewer metabolic enzymes and more cytoskeletal proteins. Lipidomics of the LD core uncovered an unexpected enrichment of polyunsaturated fatty acid cholesteryl esters (PUFA-CEs), which constituted 88.3% of all cholesterol esters. Notably, esters of the pro-inflammatory precursor arachidonic acid (AA) were among the most abundant species (16.5%). In addition, plaque LD were uniquely enriched in phospholipids including phosphatidic acid (PA), phosphatidylethanolamine plasmagens (PE-P), sphingomyelin (SM), and phosphatidylserine (PS). Our findings redefine the plaque LD as a dual-function “bad” organelle: a metabolically inert container for cholesterol ester, coated with cytoskeletons, and a massive reservoir for inflammatory precursors. ### Competing Interest Statement The authors have declared no competing interest.

Background: To investigate the relationship between physical activity and risk of all-cause and cardiovascular disease (CVD) mortality in patients with peripheral artery disease (PAD). Methods: We recruited 561 PAD cases of National Health and Nutrition Examination Survey from 1999 to 2004 and linked mortality data through December 31, 2019. We explored the effect of aerobic physical activity and muscle-strengthening activity on the risk of all-cause and CVD mortality employing cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) from 1999 to 2019. Results: During an average of 9.8-year follow-up, a total of 435 deaths from all causes of the 561 PAD patients were recorded including 165 CVD deaths. Meeting the guidelines about physical activity released by World Health Organization in 2020 is not related to a lower risk for mortality in PAD patients. PAD patients engaging in moderate-to-vigorous intensity aerobic physical activity (MVPA) >= 60 min/week exhibited a significantly 45% (HR- 0.55; 95% CI- 0.37-0.85; P < 0.001) lower all-cause mortality risk and 60% (HR- 0.40; 95% CI- 0.27-0.70; P < 0.001) lower CVD mortality risk. PAD patients reached their maximal survival benefit of HR at 120-239 min/week of MVPA. The survival benefit of aerobic physical activity was notably greater in men and age < 65 years. Furthermore, PAD patients with muscle-strengthening activity 1-4 times/ week had a 66% reduction risk of CVD mortality (HR- 0.34; 95% CI- 0.17-0.90; P- 0.011). Conclusions: Aerobic physical activity (MVPA >= 60 min/week) decreases the all-cause and CVD mortality risk among PAD patients. Muscle-strengthening activity (1-4 times/week) may provide survival benefits of CVD mortality in PAD patients.

OBJECTIVE:To investigate the safety and effectiveness of balloon occlusion and intra-sac thrombin injection in the endovascular repair of ruptured abdominal aortic aneurysm. METHODS:From October 2019 to October 2022, the clinical data of 16 patients with rAAA treated with balloon occlusion technique and intra-sac thrombin injection combined with EVAR were retrospectively analyzed, including 13 males and 3 females, aged 42-85 years, with a median age of 70.5 years. The time of preoperative first aid (from hospital arrival to operation start), average operation time, stay in intensive care unit (ICU), average hospitalization time, success rate of surgical treatment, perioperative (30 d) mortality rate, incidence of complications, the maximum diameter and volume change of the aneurysm were observed and recorded. RESULTS:Among the 16 patients with ruptured abdominal aortic aneurysm, the technical success rate was 100.0% (16/16). One patient died of multiple organ dysfunction 6 hours after operation. The success rate of surgical treatment was 93.8% (15/16). The preoperative first aid time was (53.3±6.2) min, the average operation time was (89.9±17.1) min, the stay in the intensive care unit (ICU) was (1.7±0.8) d, and the average hospitalization time was (7.8±1.3) d. The intraoperative balloon occlusion time was (32.4±4.1) min. The postoperative renal function of all the patients had no significant deterioration compared with that preoperative. Abdominal compartment syndrome (ACS) occurred in 1 patient after operation, which improved after CT puncture and drainage. The median follow-up time was 36 months. During the follow-up period, 1 patient died of acute myocardial infarction 2 years after operation, and the remaining 14 patients survived. Among the 14 follow-up patients, 1 type Ⅱ endoleak occurred, and no other types of endoleak occurred. By the end of the follow-up, the maximum diameter of the aneurysm sac in 14 patients was significantly lower than that before operation [(44.6±8.0) mm vs.(66.0±15.5) mm, P < 0.001], and in 12 patients with CTA, the volume of the aneurysm sac was significantly shrunk than that before operation [(311.7±170.3) mm3 vs. (168.6±68.1) mm3, P < 0.05]. CONCLUSION:Balloon occlusion during endovascular repair is safe and effective in the treatment of ruptured abdominal aortic aneurysm; intraoperative thrombin injection of the aneurysm sac can significantly reduce the incidence of intraoperative and postoperative abdominal compartment syndrome and endoleak and, to a certain extent, improve the success rate of treatment.

OBJECTIVE:To explore the feasibility and recent efficacy of iliac vein molding and stenting in daytime treatment mode in patients with iliac vein stenosis.METHODS:Medical records of iliac vein molding and stenting performed in the ipsilateral great saphenous vein approach conducted from February 2017 to March 2022 were retrospective reviewed. There were 21 cases, 6 males and 15 females. Age ranged from 37 to 79 years [(62.5 ± 10.2) years]. The stenosis in the 21 limbs simply involved the common iliac veins in 16 patients, 2 patients had the simple and external iliac veins, and both the total and external iliac veins in 3 patients. Both iliac vein molding and iliac vein stenting were performed through the ipsilateral great saphenous vein approach. The patients with simple iliac vein stenosis with great saphenous vein valve insufficiency also underwent radiofrequency closure of great saphenous vein and flexural vein sclerosis therapy simultaneously. Regular postoperative direct oral anticoagulants therapy and stress therapy were followed. All the patients were hospitalized for less than 24 h.RESULTS:All the 21 patients operations were successful (the success rate was 100%), without any intraoperative complications. Immediate postoperative complications were puncture point bleeding in 1 case. The bandage gauze was completely wet. The bleeding was stopped after 5min of recompression. All the patients were hospitalized for less than 24 h. Follow-up results: The 3-month follow-up rate after operation was 100%. Absolute effective 18 cases (18/21, 85.7%). Relatively effective(postmentation still after surgery, but with less extent) in 3 cases (3/21, 14.3%). The iliac vein stents were unobstructed, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment. The 6-month follow-up rate after operation was 71.4%(15/21). Of these, 14 cases (14/15, 93.3%) were absolutely effective. Relatively effective(postmentation still after surgery, but with less extent) in 1 case (1/15, 6.7%). The iliac vein stents were no restenosis or obstruction, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment.CONCLUSION:The interventional treatment technique of iliac vein stenosis is feasible in the daytime treatment mode, with clear advantages and satisfactory recent efficacy.

The incidence of deep vein thrombosis (DVT) is increasing with aging, which needs a screening and monitoring biomarker. This study focused on the significance of aging- and angiogenesis-related lncRNA RAMP2-AS1 (RAMP2-AS1) aiming to identify a promising biomarker for the incidence of DVT. Serum samples were collected from 63 healthy individuals and 98 patients with DVT. The serum RAMP2-AS1 level was analyzed by PCR and its significance in DVT detection and development prediction was evaluated by ROC and multivariate Cox regression analysis. The regulatory effect of RAMP2-AS1 on endothelial progenitor cells (EPCs) was evaluated by CCK8 and transwell assays. RAMP2-AS1 was significantly downregulated in patients with DVT, which could discriminate patients with DVT from healthy individuals with relatively high sensitivity and specificity. The downregulation of RAMP2-AS1 could predict poor outcomes and was associated with activities of daily living (ADL), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and monocyte to high-density lipoprotein cholesterol ratio (MHR) of patients with DVT. RAMP2-AS1 was identified as an independent prognostic factor of DVT by Cox regression analysis. In EPCs, overexpressing RAMP2-AS1 significantly suppressed cell proliferation, migration, and invasion. Downregulated serum RAMP2-AS1 could predict the incidence and progression of DVT. RAMP2-AS1 inhibited EPCs growth and motility, which provides a target for thrombolytic therapy. RAMP2-AS1 level could be included in the risk assessment model of DVT.

Purpose To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR). Materials and Methods 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality. Results The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm 3 to 202.6 ± 114.1 cm 3 , 155.6 ± 68.4 cm 3 and 129.7 ± 52.4 cm 3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research. Conclusions Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.

OBJECTIVE:To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis.METHODS:From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up.RESULTS:Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them.CONCLUSION:In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.

Objective: To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity. Methods: The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range:4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient's operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results: All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment(t=-25.160,P<0.01).The Rutherford stages decreased from (M(IQR)) 3(1) to 1(1(Z=-6.825,P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions: Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

OBJECTIVES:The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets.METHODS:Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed.RESULTS:The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively (t= 29.644, P= .000).CONCLUSIONS:In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

OBJECTIVE:To evaluate the role of Rotarex mechanical thrombectomy system in treating instent restenosis of peripheral artery disease (PAD).METHODS:The clinical data of 7 in-stent restenosis (ISR) cases of lower extremity PAD from June 2017 to Dec 2018 were retrospectively analyzed. There were 5 males and 2 females and the mean age was (70.0±7.6) years from 59.0 to 76.0 years. All the cases were treated by Rotarex mechanical thrombectomy system. In the 7 cases, time interval from the previous stent implantation to ischemia recurrence was 1.0 to 72.0 months, and the median time was 6.0 months. The period from ischemia recurrence to endovascular therapy was 3 days to 2 years, and the median time was 62 days. Rotarex mechanical debulking catheter and percutaneous transluminal angioplasty (PTA) were used in all the cases, and the stent was used only when it was necessary. Anticoagulation was used for 24 hours after procedures and then antiplatelet agents were used as usual. Doppler ultrasonography was taken during the followed-up.RESULTS:All the 7 cases were successful in technology, 3 of which were implanted with new stents for the fracture of the old ones. while for the other four cases, no new stent was implanted. The ankle-brachial index (ABI) increased from 0.31±0.08 to 0.86±0.08 after treatment (t=-12.84, P < 0.001). Thrombectomy was applied urgently in one case because of acute thrombosis in the stent, and the result was good. There was no other complications in hospital. All the patients were followed up for 5.0-22.0 months, and the median time was 14.0 months. No death and amputation occurred during the follow-up. One patient stopped antiplatelet agents because of gastrointestinal bleeding, which resulted in acute thrombosis. in-stent restenosis reappeared in 3 cases.CONCLUSION:Debulking using Rotarex catheter is safe and effective in treating in-stent restenosis of PAD, especially in reducing stents implantation, but is not good at dealing with old thrombus and proliferating intima, and can do nothing about fractured stents and hyperplasia of intima, so it needs to be combined with stents and drug coated balloons.

OBJECTIVE:To evaluate the effectiveness and safety of Rotarex mechanical thrombectomy system in treating acute lower limb ischemia.METHODS:From December 2017 to December 2019, the clinical data of 23 acute lower limb ischemia cases treated with Rotarex mechanical thrombectomy system were retrospectively analyzed. There were 14 males and 9 females from 53- to 84-year-old patients and the mean age was (69.1±9.1) years. Duration of symptoms was 6 hours to 14 days (median time 7 days). In the study, 8 acute thromboembolism cases and 15 acute thrombosis cases were included (In which, there was one thromboangiitis obliterans case and two in-stent restenosis cases). In 5 cases, the lesions were located above the groin; in 16 cases, the lesions were located below the groin, and in the other 2 cases, the lesions were located both above and below the groin. All the cases were treated with Rotarex mechanical thrombectomy system. When residual stenosis was greater than 50%, percutaneous transluminal angioplasty (PTA) was used, and stent was used only when it was necessary. Heparin was used 24 h after the procedure, and after that, antiplatelet agents were used in acute thrombosis cases, and oral anti-coagulants were used in acute thromboembolism cases. Doppler ultrasonography was taken during the follow-up.RESULTS:In all the 23 cases, there were 22 successful cases and 1 unsuccessful case, the mean procedure time was (68.2±15.6) min. Percutaneous transluminal angioplasty was used in 18 cases, 7 of which were implanted stents (3 stents were implanted in iliac artery and 4 in superficial femoral artery). There were 3 procedure related complications. The first one was arterial wall injury which resulted in contrast medium extravazation, and in this case, we solved it with prolonged balloon inflation. The second one was distal embolism. We took out the thrombus with guiding catheter. The last one was acute occlusion in a stent, and thrombectomy was applied urgently, and the result was good. Mean hospital stay were (3.6±1.7) days. The ankle brachial index (ABI) increased from 0.25±0.10 to 0.85±0.16 after treatment (t=12.901, P < 0.001). All the patients were followed up for 4.0-28.0 months, and the median time was 12.0 months. One patient stopped antiplatelet agents, which resulted in acute thrombosis 2 months later. Another percutaneous mechanical thrombectomy and PTA were taken. In the failed case, the patient suffered amputation above the knee 3 months later and in another case, the patient died of heart failure 8 months after the procedure. Two target lesion restenosis occurred during the follow-up. Because the patients' symptom was not sever, no procedure was taken.CONCLUSION:Percutaneous mechanical thrombectomy using Rotarex catheter is safe and effective in treating acute lower limb ischemia. For one side, it can restore blood flow to the affected limbs quickly, and for the other, it has the characteristics of minimally invasive and good repeatability. So it should be considered that this me-thod can be widely used for acute lower limb ischemia.

目的:探讨除因单纯大隐静脉瓣膜功能不全外,由其他浅静脉返流或大隐静脉返流合并其他静脉返流造成的下肢静脉曲张的特点及治疗体会.材料与方法:2018年5月—2019年5月接受超声引导下射频闭合联合曲张静脉局部剥脱、硬化治疗术的非单纯大隐静脉瓣膜功能不全的原发性下肢静脉曲张患者共61例、63条肢体,其中男42例,女19例,年龄23～78岁,平均(55.9±13.2)岁.统计其返流静脉种类、直径及CEAP分级.返流大隐静脉、小隐静脉、前副隐静脉及病理性穿支静脉均行射频治疗,皮下曲张浅静脉行泡沫硬化治疗.局部静脉曲张明显处行点状剥脱术.术后即刻穿医用循序减压弹力袜.结果:本组非单纯大隐静脉瓣膜功能不全造成下肢静脉曲张的类型有10种情况.非单纯大隐静脉瓣膜功能不全肢体发生重度下肢静脉曲张(C4～C6级)的比例为54.0％(34/63).病理性穿支静脉位于小腿患者中重度静脉曲张的发生率最高(81.8％,27/33).手术成功率100％.61例患者中随访44例,44条肢体,随访率72.1％.44条肢体静脉曲张完全消失15条,临床分级降级的肢体24条,有效率88.6％.结论:对于原发性下肢静脉曲张患者术前诊断过程中需要全面掌握下肢浅静脉血流动力学情况.对于非单纯大隐静脉功能不全的原发性下肢静脉曲张患者,射频闭合联合硬化治疗术是一种微创、安全、有效的治疗方法,其近期疗效满意.

给大家讲个真实病例.2017年的大年三十,两个女儿带着一个八十多岁的老妈几近崩溃地来到了医院急诊.一边哭诉老奶奶右腿疼了一个星期,一边把老人裤子脱下来.就在老人露出小腿的一瞬间,在场的所有家属都震惊了——老奶奶的小腿已经完全成了炭黑色.这就是医学上典型坏疽,用大白话讲,就是腿已经完全坏死掉了.为了保命,治疗的方法就只有将大腿截肢了.医生询问病史,发现老人既往有多年的房颤病史.

目的 探讨超声引导下腔内射频闭合术(radiofrequency endovenous obliteration,RFO)联合局部点剥治疗下肢静脉曲张的近期疗效.方法 2016年2～10月我科采用RFO联合局部点剥治疗下肢静脉曲张218例共272条肢体.术前均行下肢静脉超声检查,明确存在隐静脉返流,返流时间大于500 ms,同时除外下肢静脉血栓形成.超声引导下21G穿刺针穿刺隐静脉主干,引入7F 11 cm鞘管.经鞘管导入射频治疗导管,超声定位位置准确后固定导管.超声引导下自大隐静脉置入鞘管部位至导管末端位置行膨胀麻醉.超声探头直视导管工作段,同时加压工作段所在区域隐静脉,打开射频行腔内射频闭合术.主干静脉处理完毕后,术前标记处1％利多卡因局麻,1～2 mm小切口行局部曲张静脉点状剥脱术.术后局部切口敷料覆盖.术后即刻穿医用循序减压弹力袜.结果 手术成功率100％.术中并发症7例,其中6例为一过性心率加快、血压升高,1例为一过性心率减慢.术后2例并发症均为局部静脉剥脱切口术后活动性出血,均发生在术后1 h内.随访173例222条肢体,术后3个月复查,静脉曲张完全消失84条,临床分级降级136条,有效率99.1％(220/222).结论 超声引导下RFO联合局部点剥治疗单纯性下肢静脉曲张微创、安全、有效,近期疗效满意.

Objective To study the clinical significance of neglecting superficial femoral artery reconstruction for chronic lower extremity arteriosclerosis obliterans . Methods One hundred and fifty-five patients (220 limbs) treated for sever stenosis or occlusion of superficial femoral artery resulted by arteriosclerosis obliterans in ten years were reviewed .Among them there were 107 limbs treated by endovascular reconstruction of superficial femoral artery ( reconstruction group ) and the other 113 limbs were only treated with the accompanied iliac and/or profunda femoral artery lesion without superficial femoral artery treatment ( non-reconstruction group) . Results Compared with the non-reconstruction group , the reconstruction group had a better short-term total effective rate [70.1%(75/107) vs.46.0%(52/113), Z=-2.356, P=0.018].There were no significant differences between the two groups on long-term total effective rate [53.3%(57/107) vs.57.5%(65/113), Z=-0.633, P=0.527] and limb salvage rate [94.4%(101/107) vs.96.5%(109/113), χ2 =0.170, P=0.680].The reconstruction group had a higher re-operation rate [30.8%(33/107) vs.8.8%(10/113),χ2 =16.903, P=0.000] and a higher cost [(34 658.7 ±8322.7) yuan vs.(17 036.6 ±1603.0) yuan, t=22.082, P=0.000] as compared with the non-reconstruction group.There was no significant difference between the two groups on the morbidity of complications and death [0 vs.0.9%(1/113), Fisher’s exact test, P=1.000;1.9%(2/107) vs.1.8%(2/113), Fisher’s exact test,P=1.000]. Conclusion Dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe , effective and inexpensive therapy for lower extremity arteriosclerosis obliterans , and should be the preferred alternative for some patients .

王先生50多岁,2周前因为崴了脚,一直在家歇着.这两天觉得脚好了,于是早上多遛了一会儿弯,结果回到家里就觉得胸闷、胸痛、憋气.王先生担心自己是心脏缺血,在家吃了速效救心丸、硝酸甘油、阿司匹林,症状却越来越重了.去医院急诊,在排除冠心病的同时,医生很快确诊了病因——肺栓塞!通过介入取栓、溶栓,患者的症状很快消失.

OBJECTIVE:To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.METHODS:In the study, 42 cases of renal artery stenosis were treated with 52 renal artery stent implantation. Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney, ipsilateral kidney (renal) glomerular filtration rate (GFR), renal effective renal plasma flow effective renal plasma flow (ERPF), kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.RESULTS:The 52 cases of renal artery stent implantation were all successful. Preoperative ipsilateral GFR was significantly lower than that of normal side (t=-3.989, P=0.000); preoperative ipsilateral ERPF was significantly lower than the contralateral side (t=-4.926, P=0.000). On both sides, the overall FF values were equal (t=1.273, P=0.207). Postoperative ipsilateral renal GFR was increased, but there was no statistical difference (t=-1.411, P=0.164). Postoperative ipsilateral renal ERPF was increased significantly (t=-4.954, P=0.000), and FF lower (closer to the normal value (t=3.274, P=0.002). Postoperative side GFR was significantly reduced (t=2.569, P=0.000), the contralateral ERPF was significantly reduced (t=3.889, P=0.001), and FF had no significant change (t=-0.758, P=0.454). Postoperative side GFR was lower than that of the contralateral (t=-3.283, P=0.002) and postoperative side ERPF was still lower than that of the contralateral (t=-3.351, P=0.001), but on both sides, the FF values were equal (t=-0.361, P=0.719). Preoperative FF was relatively normal in the patients with kidney, and the postoperative FF value change was small (t=0.799, P=0.430); preoperative FF was significantly higher in the patients with kidney, and the postoperative FF value was lower than the preoperative (normal value, t=5.299, P=0.000). Postoperative overall serum creatinine was significantly decreased (t=2.505, P=0.016); but for the patients with unilateral renal artery stenosis, the changes in serum creatinine had no statistical difference (t=1.228, P=0.299); and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative, the changes were decreased significantly (t=2.518, P=0.030); postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t=8.945, P=0.000); antihypertensive drugs taken were decreased significantly compared with the preoperative (t=5.280, P=0.000).CONCLUSION:For the patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. Whether preoperative FF is significantly increased or FF is relatively normal, should be regarded as the indications of renal artery stent implantation.

Objective To investigate the effects of fraction filtration ( FF ) on endovascular treatment for patients with unilateral renal artery stenosis . Methods Percutaneous transluminal renal angioplasty and stent ( PTRAS ) was performed in 31 patients with unilateral renal artery stenosis from May 2014 to November 2015.Preoperative and postoperative glomerular filtration rate (GFR), effective renal plasma flow ( ERPF), and renal FF of healthy and diseased kidneys were compared .The blood pressure (SBP) and antihypertensive drugs use were recorded . Results The PTRAS was successfully accomplished in all the 31 cases. Preoperative ipsilateral GFR [(28.79 ±12.88) ml/min] was significantly lower than that of the contralateral [(41.72 ±14.23) ml/min, t=-3.749, P=0.000].Preoperative ipsilateral ERPF [(124.55 ±49.36) ml/min] was significantly lower than that of the contralateral [(186.92 ±43.22) ml/min, t=-5.293, P=0.000].Postoperative ipsilateral renal GFR [(30.40 ±12.85) ml/min] was significantly higher than that before operation [(28.79 ±12.88) ml/min, t=-2.236, P=0.003].Postoperative ipsilateral renal ERPF [(137.46 ±47.00) ml/min] was significantly higher than of the preoperative [(124.55 ±49.36) ml/min, t=-5.017, P=0.000].Postoperative ipsilateral FF (22.24 ±5.52)% decreased significantly as compared with the preoperative level (24.93 ±8.68)%(more close to the normal value, t=2.577, P=0.015).Postoperative ipsilateral GFR [(30.39 ±12.84) ml/min] was still significantly lower than the contralateral [(40.31 ±13.87) ml/min, t=-2.920, P =0.005].Postoperative ipsilateral ERPF [(137.46 ±47.00) ml/min] was significantly lower than that of the contralateral [(178.25 ±42.25) ml/min, t=-3.593, P=0.001].No statistical difference was seen between postoperative ipsilateral FF (22.24 ±5.52)%and contralateral FF (22.52 ±5.73)%(t=-0.195, P=0.846).In cases with relatively normal preoperative FF , postoperative FF (21.45 ±3.35)%had small changes compared with the preoperative FF [(21.77 ±3.26)%, t=0.847, P=0.407].While in cases with significantly risk-increased preoperative FF, postoperative FF (27.21 ±5.34)% decreased significantly as compared with the preoperative FF [(36.88 ±6.00)%, t=3.495, P=0.010].Preoperative creatinine [(96.97 ±25.81) μmol/L] and serum creatinine [(94.39 ± 22.45) μmol/L] levels were not statistically significant (t=0.420, P=0.676).Postoperative blood pressure [(144.4 ±11.1) mm Hg] decreased significantly as compared with preoperative level [(158.5 ±13.7) mm Hg, t=7.804, P=0.000].The number of antihypertensive drugs after operation (2.6 ±0.6) was significantly reduced as compared with before operation [(3.0 ±0.5), t=4.655, P=0.000]. Conclusions For patients with renal artery stenosis , FF is a useful index to understand the pathophysiological process of renal ischemia .For patients with unilateral renal artery stenosis , significantly increased or relatively normal preoperative FF should be regarded as indications of renal artery stent implantation .

目的 探讨介入治疗腘动脉硬化病变的治疗效果. 方法 回顾性分析2008年1月～ 2013年2月91例(96条肢体)腘动脉硬化病变行介入治疗的临床资料,病变位于P1段44条,P2段7条,P1 ～ P2段35条,P1 ～ P3段10条.狭窄性病变(狭窄率＞50％)42条,闭塞性病变54条.单纯球囊扩张成形35条,球囊扩张支架置入61条.闭塞性病变均采用球囊扩张支架置入术. 结果 介入治疗腘动脉成功率100％,出院前踝肱指数(ankle brachial index,ABI)由术前0.45±0.15升高至0.89±0.17(t=-8.522,P=0.001).84例(87条肢体)随访12 ～74个月,(39.0±10.3)月,随访率92.3％ (84/91).术后12个月腘动脉一期通畅率70.1％ (61/87),二期通畅率89.7％(78/87).腘动脉硬化狭窄性病变中,单纯球囊扩张成形32条肢体的12个月一期通畅率90.6％ (29/32),二期通畅率96.9％(31/32);球囊扩张支架置入6条肢体的12个月一期通畅率50.0％ (3/6),二期通畅率83.3％(5/6);球囊扩张成形术一期通畅率明显高于球囊扩张支架置入术(Fisher精确检验,P=0.039). 结论 介入治疗腘动脉硬化病变效果良好,腘动脉硬化狭窄性病变球囊扩张成形术近期通畅率优于球囊扩张支架置入术.

Objective To explore the safety and efficacy of interventional therapy for high-risk pulmonary embolism. Methods We retrospectively analyzed 94 cases of high-risk pulmonary embolism who received interventional therapy ( thrombectomy, rapid thrombolysis plus anticoagulation, or mechanical embolus removal) from December 2002 to September 2012.Vital signs, heart functions, and clinical outcomes were observed and compared. Results Among the 94 cases, the success rate of operation was 98.9%(1 patient died during the interventional procedure).Six patients died after operation.In the remaining 88 cases, loss of follow-up occurred in 16 cases and 72 cases were followed for an average of 23.5 months (13-130 months), the rate of follow-up being 81.8%(72/88) .The cardiac functions were classified as class Ⅰ in 68 cases, class Ⅱ in 3 cases, and class Ⅳ in 1 case. According to our criteria, there were 68 cases of complete remission (94.4%, 68/72), 3 cases of partial improvement (4.2%, 3/72), and 1 case of inefficacy (1.4%, 1/72). Conclusion Interventional treatment for high-risk pulmonary embolism is an effective procedure, which can quickly and efficiently improve the prognosis and the life quality.