BACKGROUND:In-stent restenosis remains a challenge in superficial femoral artery (SFA) treatment, though a great efficacy has been shown in drug-eluting stents (DESs). The concept of "leave nothing behind" has further driven interest to bioresorbable vascular stents. Some drug-eluting resorbable scaffold (DRS) has shown promise in coronary artery and SFA. We brought a first in-human study of DRS for treatment of peripheral artery disease (PAD) involving the de novo lesions in SFA. METHODS:This DRS system is a device-drug combination consisting of a paclitaxel-eluting poly (L-lactide-co-ε-caprolactone) scaffold, using proprietary 3D multi-axis precision printing technology. Safety and performance were evaluated in 30 patients with de novo occlusion or stenosis in SFA. RESULTS:De novo lesions were located in SFA. Mean lesion length was 37.76 ± 17.45 mm. The study device was successfully deployed in 100% of cases. At 12 months, there were two unrelated deaths, and no amputations occurred in the rest cases. The binary restenosis rates were 4.35%. The ankle brachial index improved from preprocedural 0.58 ± 0.17 to 0.83 ± 0.17 at 12 months of follow-up (P < 0.0001). At 2 years, 85.71% of the patients improved in Rutherford-Becker compared to the score preprocedure. CONCLUSION:The safety of this DRS was demonstrated with no procedure or device-related deaths and amputations within 2 years. The low occurrence of revascularizations was consistent with duplex-ultrasonography showing sustained patency at 12 months. The percent of improvement in Rutherford-Becker clinical category was still high at 2 years.

Objective:Type II endoleak (T2EL) is the most common complication following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). T2EL may lead to aneurysm sac expansion and rupture. Identifying high-risk patients is crucial for prophylaxis and early intervention. Methods:This single-center retrospective study included 332 patients who underwent EVAR for infrarenal AAA. Demographic, clinical, anatomical, and medication-related data were collected. A nomogram was developed based on significant predictors. Its performance was assessed by receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results:T2EL occurred in 70 (21.08%) of 332 patients. Multivariate logistic regression revealed six independent predictors: age, smoking status, intraluminal thrombus (ILT), number of patent lumbar arteries (LA), inferior mesenteric artery (IMA) diameter, and IMA patency. The nomogram demonstrated excellent calibration and strong predictive ability, with an area under the curve (AUC) of 0.806 (training set) and 0.758 (validation set). DCA showed clinical benefit across threshold probabilities of 1%-66% and 79%-92% in the training set, and 1%-84% in the validation set. Conclusion:The proposed nomogram effectively integrates clinical and anatomical factors to assess the risk of T2EL after EVAR. It may help identify patients requiring intensified surveillance or early interventions to mitigate complications. Further multicenter, prospective studies are needed to validate the nomogram's applicability.

背景与目的:大隐静脉高位结扎剥脱术(HSL)是治疗下肢静脉曲张的经典术式,但存在创伤较大、恢复时间较长、切口瘢痕不美观等缺点.随着医疗技术的进步,以腔内热消融治疗为代表的微创治疗技术蓬勃发展.本研究旨在对比射频消融术(RFA)与传统HSL治疗下肢静脉曲张的临床疗效.方法:回顾性分析2021年5月—2022年6月期间因原发性下肢静脉曲张于首都医科大学附属北京安贞医院血管外科行手术治疗的272例患者(298条肢体)的临床与随访资料,其中96例(100条肢体)行RFA治疗(RFA组),176例(198条肢体)行HSL治疗(HSL组).比较两组患者的术前临床特征、手术情况、并发症情况、临床表现-病因学-解剖学-病理生理学(CEAP)分级、静脉临床严重程度评分(VCSS)和慢性静脉功能不全问卷-14问版(CIVIQ-14)评分的变化情况.结果:两组技术成功率均为100％,术后3 d复查超声提示大隐静脉主干缺如/闭合率为100％.共完成随访265例(290条肢体),平均随访时间(13.2±3.8)个月,随访期间超声提示大隐静脉主干缺如/闭合率为100％.两组患者的基本临床特征无明显差异(均P＞0.05);与HSL组比较,RFA组术中出血量(21.3 mLvs.46.8 mL)、术后第1天疼痛评分(3.1vs.3.3)、总并发症发生率(25.5％vs.38.0％)及皮肤感觉异常发生率(5.1％vs.24.0％)均明显降低(均P＜0.05),RFA组的深静脉血栓形成发生率升高(5.1％vs.0,P＜0.05);术后所有患者CEAP分级均较术前降级,RFA组81.7％的患肢降级为C0～C1级,HSL组83.9％的患肢降级为C0～C1级;所有患者的VCSS和CIVIQ-14评分均较术前有所改善,且HSL组的VCSS评分改善程度大于RFA组(均P＜0.05).结论:RFA短期疗效与HSL相当,相对于HSL而言,创伤更小、疼痛感更轻、并发症发生率更低,是一种下肢静脉曲张的有效治疗方案.

Objective:To explore the clinical value of one-stop endovascular treatment for acute deep vein thrombosis (DVT) combined with iliac vein compression syndrome (IVCS).Methods:The clinical data of 35 patients treated for left DVT combined with IVCS at the Department of Vascular Surgery, Beijing Anzhen Hospital, from January 2018 to Dctober 2022 were retrospectively analyzed. One-stop endovascular treatment was conducted and postoperative efficacy and complications were observed. T-test was used to compare the circumference of affected limbs and related laboratory indicators before and after surgery.Results:All 35 patients completed one-stop endovascular treatment with a 100% of surgical success rate. After treatment, the venous patency score[1.6±0.7 vs 10.9±2.8, t=9.400, P<0.01], circumference difference in the upper and lower knees of affected limbs[(1.8±0.5)cm vs (6.3±0.8)cm, t=34.908, P<0.01;(1.6±0.2)cm vs (4.6±0.7)cm, t=11.188, P<0.01], and the patient's hemoglobin [(9.9±1.0) g/L vs (12.0±0.7) g/L, t=4.795, P<0.01] and D-dimer [(1 257.3±276.7) ng/ml vs (4 652.3±1 850.7) ng/ml, t=6.073, P<0.01] were lower than before treatment. The differences were statistically significant. The creatinine level did not change significantly compared with before treatment ( P=0.836). Thirty-five patients completed the (31.7±16.4) month (range:6-63 months) follow-up, 3 patients experienced mild pain after walking, and 2 patients experienced heaviness after a long standing (all Villalta scores<5). The color ultrasound results suggested that the veins of the affected limb were unobstructed, and no post-thrombotic syndrome (PTS) occurred in the follow-up patients. Conclusions:One-stop endovascular treatment for acute DVT with IVCS is safe and effective in removing thrombus, restoring the lumen, and preventing PTS.

Background: Carotid artery stenting (CAS) has emerged as a potential alternative for treating patients with extracranial cerebrovascular diseases. Contralateral carotid artery occlusion (CCO) occurs in approximately 2.3% to 25% of patients with carotid artery stenosis. However, the association of a CCO with long-term outcomes after CAS remains unclear. Here, we aimed to evaluate the perioperative and long-term recovery and safety of patients with CCO after receiving CAS.Methods: We retrospectively collected the data of patients with CCO treated with CAS between 2010 and 2021. The primary end point was a nonfatal major stroke. The secondary end points included cerebral hemorrhage, nonfatal myocardial infarction, restenosis, acute renal insuffi-ciency, stent-related complications, and death. Long-term outcomes were analyzed by Kaplan-Meier survival analysis using the following variables: symptomatic carotid stenosis, age, stent type, collateral flow status, and postdilation.Results: Seventy one consecutive patients with CCO who underwent CAS were included in the study. Of these, 61 patients (86%) were followed up for 9-134 months, with an average of 63.3 +/- 30.4 months. In the perioperative period, 2 patients (2.8%) experienced stroke and 1 pa-tient (1.4%) died due to cerebral hemorrhage combined with cerebral hernia. During follow-up, 2 patients (3.3%) developed stroke at 4 and 6 months each after CAS and 6 patients (9.8%) died (2 patients died due to myocardial infarction and 4 patients died due to either severe liver failure, car accident, cervical fracture, or unknown cause). Kaplan-Meier survival analysis showed that symptomatic carotid stenosis, age, stent type, and postdilation were not associated with long-term stroke (P<0.05). The inadequate collateral flow group showed a higher stroke rate than the control group (P 1/4 0.009).Conclusions: CAS is a safe and effective therapy for patients with CCO. Inadequate collateral flow is associated with a higher long-term rate of stroke. Our findings revealed that symptomatic carotid stenosis, age, stent type, and postdilation had no significant effect on outcome events after CAS.

背景与目的:目前对于高危急性肺栓塞(PE)患者的治疗策略均存在增加包括颅内出血等严重出血事件的风险.AngioJet机械性血栓抽吸术(ART)在高压脉冲注射溶栓药溶解、粉碎血栓的同时,允许在段级肺动脉分支上进行抽吸,对于急性PE理论上是一种有效的措施,但其安全性需进一步评估.本研究回顾3例采用ART治疗急性PE的患者的病例资料,分析ART治疗急性PE的安全性与有效性.方法:回顾2021年6月—2021年9月于首都医科大学附属北京安贞医院血管外科3例行ART治疗的急性PE患者病例资料,比较患者生命体征变化及PE相关数据,分析ART治疗的安全与有效性.结果:ART手术成功率100％,所有患者ART后收缩期肺动脉压、三尖瓣环收缩期位移、右室内径/左室内径、血氧饱和度、B型利钠肽水平均较术前得到明显改善.3例患者均出现一过性心动过缓,对症治疗后均缓解.所有患者围术期未出现严重手术相关并发症.1例患者因"冠心病、感染中毒性休克、缺血缺氧性脑病"于术后36d死亡,2例随访3个月,期间患者肺动脉压力、右心功能均得到明显恢复.结论:ART对于急性高危和中高危PE患者是安全有效的,为了减少ART相关并发症,应在术中动作轻柔,严格把控抽吸时间,操作过程中密切关注患者血压心率变化,必要时吸栓后追加使用低剂量溶栓药物,同时围术期充分水化,减少造影剂应用,以减少肾脏负担,避免急性肾功能不全发生.

Objective:To compare the clinical efficacy of endovascular aortic aneurysm repair (EVAR) and open surgery repair (OSR) in the treatment of complex abdominal aortic aneurysm (cAAA).Methods:The clinical data of 144 patients with cAAA were retrospectively analyzed. All patients were diagnosed and treated in Beijing Anzhen Hospital Affiliated to the Capital Medical University, The First Medical Center of Chinese PLA General Hospital, Beijing Hospital, and Xuanwu Hospital of Capital Medical University from June 2016 to December 2021. They were divided into EVAR group ( n=114) and OSR group ( n=30) according to different treatments. The preoperative clinical characteristics, operation, and follow-up results of the two groups were compared. Subgroup analysis was performed in the EVAR group according to different treatments. Two independent samples t-test was used for inter-group comparison of measurement data follow the normal distribution, rank-sum test was used for non-normal data, and Chi-square test or Fisher's exact probability test was used for count data. Results:In EVAR group, the diameter of proximal aneurysm neck was wider than in OSR group, and the proportion of trapezoidal neck was higher than in OSR group, and the differences were statistically significant [(22.03±3.59) mm vs (19.40±4.28) mm, P=0.002; 36.0% vs 16.7%, P=0.044). The operation time, intraoperative bleeding volume, and perioperative blood transfusion volume in EVAR group were lower than those in OSR group. There were statistically significant differences [(158.56±93.06) min vs (368.53±95.96) min, t=-10.915, P<0.001;(92.84±168.83)ml vs (1 370.00±1 019.52) ml, t=-12.579, P<0.001; (14.91±133.85) ml vs (1 375.00±1 300.18)ml, t=-11.055, P<0.001). 144 patients were followed up for (25.6± 10.4) months. The total complication rate and perioperative complication rate in EVAR group were lower than in OSR group. The differences had statistical significance(16.7% vs 40.0%, χ2=7.654, P=0.006; 9.6% vs 40.0%, χ2=16.301, P<0.001).There was no statistically significant difference in the quality of life scores between the two groups at 1-year follow-up. Subgroup analysis showed that the endoleak rate in the conventional EVAR group was significantly higher than that in the unconventional EVAR group (11.9% vs 0%, χ2=6.035, P=0.014). When cervical angle ≥52°, the complication rate of conventional EVAR was significantly higher than that of patients with narrower angle (29.6% vs 0%, χ2=6.486, P=0.011). In the treatment of patients with trapezoidal neck, conventional EVAR group had a higher endoleak rate than unconventional EVAR group (19.0% vs 0%, χ2=6.632, P=0.010). The incidence of complications in OSR group was correlated with concomitant diseases, and the proportion of patients with complications complicated with coronary heart disease and cerebrovascular disease was significantly higher than that of patients without complications (75% vs. 27.8%, χ2=6.451, P=0.011; 25% vs. 0%, χ2=5.000, P=0.025). Conclusion:In the treatment of patients with cAAA, the total complication rate of EVAR, especially the perioperative complication rate, is lower than that of OSR. Choosing appropriate patients and correct treatment may reduce the risk of postoperative complications and endoleak of EVAR.

Objective:To investigate the correlation between Doppler plaque echogenicity and perioperative ischemic stroke after carotid artery stenting (CAS).Methods:Clinical data of 316 patients with carotid artery stenosis who underwent CAS in the Department of Vascular Surgery of Beijing Anzhen Hospital from January 2017 to August 2020 were retrospectively analyzed. According to the results of carotid color Doppler ultrasound, the patients were divided into hypoechoic plaque group ( n=50), mixed echo plaque group ( n=79), and hyperechoic plaque group ( n=187). Baseline data and perioperative complications were compared among the three groups. Risk factors for perioperative cerebral infarction were studied by multivariate Logistic regression analysis. Results:There were no statistically significant differences in age, gender, smoking and drinking status, complicating disease, bilateral lesions, left or right side of surgery, stent type and dilation among the three groups (all P>0.05), but there were statistically significant differences in symptomatic carotid artery stenosis among the three groups (56.0% vs 39.2% vs 29.4%, χ2=12.551, P=0.002). There were no statistically significant differences in perioperative death, myocardial infarction, acute renal failure and stent complications among the three groups (all P>0.05). The incidence of perioperative cerebral infarction was 10.0% (5/50) in the hypoechoic plaque group, 3.8% (3/79) in the mixed echo plaque group and 1.1% (2/187) in the hyperechoic echo plaque group, and there was a statistically significant difference ( χ2=10.405, P=0.006). Difference in the incidence of perioperative cerebral infarction between the hypoechoic plaque group and the hyperechoic plaque group had statistical significance ( P=0.005). Multivariate Logistic regression analysis showed that hypoechoic plaque was an independent risk factor for perioperative cerebral infarction after CAS ( OR=12.566, 95% CI:2.078~75.971, P=0.006). Conclusion:Patients with symptomatic carotid artery stenosis are mostly complicated by hypoechoic plaque. Carotid ultrasound suggests that patients with hypoechoic plaque have a higher incidence of perioperative cerebral infarction after CAS, and hypoechoic plaque is an independent risk factor for perioperative cerebral infarction after CAS.

目的:探讨杂交技术治疗髂股移行处闭塞性病变的临床疗效.方法:回顾分析我中心 2007年1月至2020年12月,采用股动脉内膜剥脱联合髂动脉球囊扩张支架置入治疗的72例髂股移行处闭塞性病变的临床资料.其中男性62例,女性10例,平均年龄(65.96±8.8)岁.采用Kaplan-Meier生存率分析术后12、24及60个月一期通畅率.结果:所有患者均成功完成手术,技术成功率为100％.踝臂指数(ABI)由术前0.37±0.18提高至术后0.92±0.18,P＜0.05,差异有统计学意义.手术相关并发症发生率13.9％(10/72).30d病死率为零.平均随访时间3 045.50(2052.50,4053.00)d.全因死亡率为12.5％.应用Kaplan-Meier生存率分析术后12个月一期通畅率为(94.29±2.77)％,术后24个月一期通畅率为(88.57±3.8)％,术后60个月一期通畅率为(79.71±4.84)％.结论:杂交技术治疗髂股移行处塞性病变早期结果满意,为治疗髂股移行处闭塞性病变提供了一种有效手段.

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.

Objective:To compare carotid endarterectomy (CEA) and carotid artery stenting (CAS) in perioperative, medium and long term prognosis of patients with carotid artery stenosis.Methods:A retrospective analysis was performed on 1 329 cases of carotid artery stenosis treated at Department of Vascular Surgery, Beijing Anzhen Hospital from Jan 2011 to Aug 2020, as all cases being divided into CAS group and CEA group.Results:There were significant differences in age ( t=0.098, P=0.023) and drinking habits ( χ2=8.055, P=0.005) between the two groups. There were more unstable plaques in CEA group ( χ2=4.392, P=0.038), and more bilateral lesions in CAS group ( χ2=9.673, P=0.038). In perioperative period, there were more mannitol use in CEA group ( χ2=78.614, P<0.001), more incision/puncture site complications ( χ2=5.158, P=0.035), lung infection ( χ2=6.355, P=0.013), cerebral hyperperfusion syndrome (CHS) ( χ2=5.158, P=0.035) and extracranial nerve injury ( χ2=23.760, P<0.001) in CEA group than in CAS group, and more acute renal failure in CAS group ( χ2=10.393, P=0.001). There was no significant difference in survival rate and ischemic stroke, myocardial infarction, cerebral hemorrhage and renal insufficiency between the two groups (all P>0.05). The mean survival time of CAS group was 53.195 months (95% CI: 52.040-54.350), and 54.492 months (95% CI: 53.790-55.195) in CEA group ( P=0.051). Conclusions:Patients in CEA group had more unstable plaque and a lower perioperative stroke rate. CEA group had higher risk of CHS,while CAS was with lower postoperative lung infection rate and less wound local complications. There was no significant difference in long-term survival between the two groups.

目的 探究腹主动脉瘤病人行择期腹主动脉瘤腔内修复术(EVAR)后出现并发症的可能危险因素,为并发症的出现提供预警分析.方法 回顾性分析首都医科大学附属北京安贞医院收治的286例行择期EVAR治疗的腹主动脉瘤病人资料,依据术后并发症的发生与否进行分组.比较有并发症的病人与无并发症病人在基线资料、动脉瘤解剖条件、术中情况及术前理化指标方面的差异.结果 有并发症组与无并发症组在年龄、有无肝脏病史、术前白蛋白水平等方面差异有统计学意义(P＜0.05).通过Logistic回归分析发现,肝脏病史和术前血红蛋白水平与术后并发症的发生密切相关(P＜0.05).回归方程的ROC曲线下面积为0.614(95％ CI 0.539～0.690,P=0.003).结论 既往存在肝脏病史和术前低血红蛋白水平对EVAR术后并发症的发生有预警意义.加强监测、及时纠正异常可能减少并发症的出现.

目的:探讨新型国产髂动脉分叉支架系统重建髂内动脉治疗髂总动脉瘤的临床疗效.方法:回顾性分析2016年4月至2021年2月,本中心完成的7例髂总动脉瘤及髂总动脉瘤合并腹主动脉瘤患者,应用髂动脉分叉支架系统重建髂内动脉.其中男性6例,女性1例,平均年龄(68.14±6.20)岁,腹主动脉瘤平均直径(61.82±15.18) mm,髂总动脉瘤平均直径(33.95±9.11)mm.术后1、6、12个月以及此后每年行CT血管造影随访.Kaplan—Meier法分析36个月髂动脉分叉支架系统通畅率.结果:7例患者应用髂动脉分叉支架系统重建7条髂内动脉,技术成功率为100％,随访时间(40.86±.13.68)个月,髂动脉分叉支架系统36个月通畅率为85.7％,无内漏发生,无二次干预,无患者死亡.结论:新型国产髂动脉分叉支架系统重建髂内动脉治疗髂总动脉瘤是安全有效的,为治疗髂总动脉瘤提供了一种新的理想的方法.

目的 应用肾动态显像评估单侧动脉硬化性肾动脉狭窄患者腔内治疗效果,并对可能改善分肾功能的影响因素进行分析.方法 回顾性分析北京安贞医院2016年1月-2018年4月收治的60例单侧动脉硬化性肾动脉狭窄患者,均行肾动脉支架成形术.收集患者的一般资料,术前及术后肾功能检查结果,肾动脉彩色多普勒超声(彩超)及肾动态显像结果,随访时间1年.根据术后随访肾动态显像结果中患侧肾小球滤过率是否较术前提高分为好转组及非好转组,建立线性回归模型进行影响因素分析.结果 全部患者均经肾动脉彩超及造影证实患侧肾动脉直径狭窄程度＞70％,均行患侧肾动脉支架成形术,手术即刻成功率100％,术后患侧肾动脉残存狭窄均＜20％,无围手术期严重并发症发生.术后收缩压、舒张压均较术前改善(均P＜0.01),患侧肾小球滤过率呈改善趋势(P=0.04),血肌酐水平基本稳定(P=0.25),患侧肾动脉狭窄程度明显减轻(P＜0.01).术后1年肾动脉支架Ⅰ期通畅率85％.分组后好转组40例(66.7％),非好转组20例(33.3％),建立线性回归模型进行影响因素分析,结果显示仅患侧分肾功能不全有统计学意义(B =0.50,P＜0.01),即如果患者术前患侧分肾功能不全,术后分肾小球滤过率改善.结论 肾动脉支架成形术治疗单侧肾动脉狭窄安全有效,1年Ⅰ期通畅率85％,1年内2/3患者术后分肾功能可改善,术前分肾功能不全患者能从肾动脉支架成形术中获益的可能性更大.

To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function. A retrospective analysis was made on 60 patients with >70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors. All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P < 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P < 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P < 0.01). Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

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.

Background: This study aimed to examine a quantitative method for evaluating calcification in failure in recanalization (FR) in endovascular treatment of superficial femoral artery (SFA) chronic total occlusion, and to investigate the possibility of using a formula to predict the incidence of true lumen recanalization (TR) in such cases. Methods: Patients who met the inclusion criteria were retrospectively analyzed in our center from January 2012 to September 2017. A Calcification Lesion Analyzing and Scoring System (CLASS) was established to quantify the characteristics of calcification in SFA computed tomography slices, which were ranked as grade 1-4 and class AeE. Corresponding scores were obtained, and the Cumulative Calcification Score (CCSO) of occlusive SFA was calculated on the basis of CLASS. The factors correlating to FR and the formula for predicting TR were evaluated. Results: A total of 215 patients were included in this study. There were 150 cases of TR and 65 cases of subintimal recanalization; 12 (5.6%) cases had FR. The maximum CLASS of occlusion was correlated with FR. Not only the formula including Trans-Atlantic Inter-Society Consensus II grade and CCSO but also the formula including occlusion length and CCSO predicted the incidence of TR well. Conclusions: The degree of the most severe calcification in occlusive lesions clearly affects success in recanalization. Two quantitative formulas that combine occlusion length or TransAtlantic Inter-Society Consensus II grade with CCSO can predict TR in endovascular treatment of SFA lesions with chronic total occlusion.

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.

目的:探究腔内修复治疗破裂性腹主动脉瘤后围术期并发症出现的相关特征.方法:回顾性分析自2013年10月到2019年10月期间,于首都医科大学附属北京安贞医院血管外科,住院并行腔内修复治疗的破裂性腹主动脉瘤患者53例.其中围术期未出现并发症者29例(54.7％),出现并发症者24例(45.3％).将并发症组患者分为术后介入相关并发症组8例,术后系统性并发症组13例,术中死亡3例.比较并发症患者与无并发症患者在基线资料、动脉瘤解剖条件、术中及术后理化指标方面的差异.结果:系统性并发症患者在年龄、就诊时收缩压及舒张压、有无反复搬动、近端瘤颈成角,以及术中尿量、术后24h内腹腔内压、PT、APTT、CKMB、TnI等改变较无并发症组,差异有统计学意义(P＜0.05);介入相关并发症患者在近端瘤颈成角方面较无并发症组,差异有统计学意义(P＜0.05).结论:患者年龄、就诊时血压、近端瘤颈成角以及术前多次搬动可能对破裂动脉瘤腔内治疗后系统性并发症产生影响,术中尿量和术后24 h内的腹内压、凝血功能及心肌标志物的监测,对预测系统性并发症发生十分重要.