Objective:Lower extremity varicose veins (LEVV) are common chronic venous disorders. Adherence to perioperative self-care plays a vital role in managing postoperative pain and enhancing long-term quality of life (QoL). Traditional health education models often struggle with issues such as incomplete information and high cognitive load. Methods:This study utilized a single-blind, randomized controlled trial design. LEVV patients were randomly assigned to either an intervention group [checklist-enhanced multimedia interactive education (CE-MIE), n = 96] or a control group [multimedia interactive education (MIE), n = 97]. Both groups received standard perioperative care and multimedia educational resources. The intervention group also used a structured checklist for a comprehensive, bidirectional verification of educational content (including ankle pump exercises, limb elevation and discharge instructions) and key skills, with patients required to score >80 points on elastic stocking wearing skills. Primary outcomes included QoL scores, pain levels, and complication rates. Results:The CE-MIE group showed significantly better QoL scores at 1 month postoperatively compared to the MIE group (32.74 ± 4.72 vs. 35.49 ± 4.01, p < 0.001). Additionally, the CE-MIE group reported lower pain scores on the 3rd and 7th postoperative days. However, there were no significant differences in QoL scores between the two groups at the 1-year follow-up, and long-term pain assessment at 1 year was not included in the study design as the primary focus was on acute recovery. Conclusion:CE-MIE is an effective short-term intervention for improving QoL and pain management in LEVV patients. To address the challenge of long-term decay in intervention effectiveness, future studies should explore ways to extend the "in-hospital standardization" model to promote "out-of-hospital sustainability."

IntroductionProblem-based learning (PBL) has been a cornerstone of medical education since its introduction at McMaster University in the 1960s. Since the public release of ChatGPT in November 2022, artificial intelligence (AI) tools have increasingly been applied to PBL and case-based learning (CBL) contexts, yet the research landscape at this intersection remains poorly characterized. This study aimed to map the growth trajectory, thematic structure, and collaboration networks of AI-PBL/CBL research from 2019 to 2026.MethodsA comprehensive search of Scopus and Web of Science was conducted on June 2, 2026, combining AI-related terms with PBL/CBL frameworks and medical education contexts. Using a PRISMA-guided bibliometric review workflow, 1,616 records were identified; after deduplication and eligibility screening, 735 unique publications (2019–2026, original articles, reviews, conference papers, and other eligible indexed document types) were included. Bibliometric analyses employed VOSviewer for network visualization (keyword co-occurrence, co-authorship, co-citation), CiteSpace for citation burst detection, and Bibliometrix for thematic mapping, three-field plot, and factorial analysis.ResultsPublication output grew from 25 papers in 2022 to 254 in 2025, with 206 papers indexed by June 2, 2026. The United States (n = 70) and China (n = 64) led publication volume. Keyword co-occurrence analysis identified four thematic clusters: a central AI-focused cluster, a medical education and clinical reasoning cluster, a nursing and simulation-oriented cluster, and an educational technology cluster. Kung et al.'s 2023 study evaluating ChatGPT's performance on the USMLE was the most frequently co-cited reference (62 co-citations, betweenness centrality = 0.11). Thematic mapping positioned machine learning as a motor theme, while clinical reasoning, medical education, and self-directed learning appeared in the basic themes quadrant. The country/region collaboration network comprised 33 countries/regions and was led by the United States and China, although collaboration patterns remained uneven across regions.ConclusionTo our knowledge, this is the first bibliometric study specifically focused on the intersection of AI technologies with PBL/CBL in health professions education. The findings reveal rapid growth after 2023, four distinct but interconnected research clusters, and a collaboration network led by the United States and China, with uneven regional participation. These results may inform curriculum design and research priorities in AI-enhanced medical education.

This case report discussed a 43-year-old female who underwent multiple radiotherapy sessions after cervical cancer surgery and experienced serious complications due to simultaneous iliac vein stent placement immediately after thrombus aspiration without adequate evaluation of the indication for stent placement. Two months after radiotherapy, the patient developed right lower limb edema and pain, which led to the discovery of an iliac vein thrombosis. Subsequent stent placement without thorough evaluation resulted in severe complications, including infection and sepsis. Despite initial symptom relief, the patient was readmitted with high fever and severe pain, and imaging revealed gas around the stent, indicating infection. An exploratory laparotomy uncovered a large abscess and a colonic fistula. The stents were removed, and the patient underwent aggressive anti-infection treatment involving meropenem and vancomycin, along with surgical repair of the fistula. This case highlights the importance of accurate diagnosis and careful consideration of stent placement in preventing severe outcomes, including the rare but serious risk of venous stent infections requiring surgical intervention.

OBJECTIVE:To evaluate whether dexamethasone enriched tumescent local anesthesia (TLA) fluid reduces post-operative pain and improves recovery outcomes following radiofrequency ablation(RFA) for great saphenous vein (GSV) insufficiency. SUMMARY OF BACKGROUND DATA:Post-operative pain and local complications of RFA for GSV insufficiency remain significant concerns. Identifying strategies to improve patient outcomes is critical for optimizing care. METHODS:Double-blind, randomized clinical trial was conducted. Adult patients with GSV insufficiency classified as CEAP C2-C5 were included. The treatment group received dexamethasone enriched TLA fluid, while the control group received traditional TLA fluid. Standard RFA procedures were performed in both groups. The primary outcome was post-operative pain measured by the Visual Analogue Scale (VAS). Secondary outcomes included quality of life (EQ-VAS, EQ-5D), Venous Clinical Severity Score (VCSS), local complications, and GSV occlusion rates. RESULTS:A total of 136 patients were randomized (67 treatment group, 69 control group). Median pain scores on day 1 and 3 were significantly lower in the treatment group compared to the control group [1 (IQR: 0-2) vs. 2 (IQR: 1-3), P=0.010; 0 (IQR: 0-1) vs. 1 (IQR: 0-2), P=0.007]. Ecchymosis incidence was reduced in the treatment group (58.7% vs. 75.4%; P=0.042). No significant differences were observed in VCSS scores, EQ-5D scores, thrombosis incidence, or GSV occlusion rates. CONCLUSIONS:Dexamethasone enriched TLA fluid during RFA reduces early postoperative pain and ecchymosis without increasing complications. This approach offers a cost-effective enhancement to RFA protocols for non-diabetic patients.

To evaluate whether dexamethasone enriched tumescent local anesthesia (TLA) fluid reduces post-operative pain and improves recovery outcomes following radiofrequency ablation(RFA) for great saphenous vein (GSV) insufficiency. Post-operative pain and local complications of RFA for GSV insufficiency remain significant concerns. Identifying strategies to improve patient outcomes is critical for optimizing care. Double-blind, randomized clinical trial was conducted. Adult patients with GSV insufficiency classified as CEAP C2-C5 were included. The treatment group received dexamethasone enriched TLA fluid, while the control group received traditional TLA fluid. Standard RFA procedures were performed in both groups. The primary outcome was post-operative pain measured by the Visual Analogue Scale (VAS). Secondary outcomes included quality of life (EQ-VAS, EQ-5D), Venous Clinical Severity Score (VCSS), local complications, and GSV occlusion rates. A total of 136 patients were randomized (67 treatment group, 69 control group). Median pain scores on day 1 and 3 were significantly lower in the treatment group compared to the control group [1 (IQR: 0–2) vs. 2 (IQR: 1–3), P =0.010; 0 (IQR: 0–1) vs. 1 (IQR: 0–2), P =0.007]. Ecchymosis incidence was reduced in the treatment group (58.7% vs. 75.4%; P =0.042). No significant differences were observed in VCSS scores, EQ-5D scores, thrombosis incidence, or GSV occlusion rates. Dexamethasone enriched TLA fluid during RFA reduces early postoperative pain and ecchymosis without increasing complications. This approach offers a cost-effective enhancement to RFA protocols for non-diabetic patients.

Objectives Emergency treatment of patients with severe subphrenic vascular trauma often adopts resuscitative thoracotomy or endovascular balloon. This case report proposes a non-invasive method to treat patients with vascular trauma, mainly through ultrasound-guided positioning of the proximal aorta and applying pressure to occlude the aorta and limit the distal blood flow, using bedside ultrasound to achieve accurate compression, continuous monitoring of its efficacy, and early detection of the recovery of autonomic circulation in patients with cardiac arrest. Methods We introduced a case of left iliac artery injury caused by a knife wound and subsequent cardiac arrest. Results We tried to externally compress the proximal aorta under bedside US guidance to achieve and maintain the recovery of the autonomic circulation. This allowed the patient to be transferred from the emergency department to the operating room. Conclusion This case demonstrated that ultrasound-guided proximal external aortic compression can be used as a bridge for further treatment of patients with vascular trauma, such as resuscitative thoracotomy or endoaortic balloon or covered stent occlusion.

ObjectiveTo evaluate the effect of malnutrition assessed by the Geriatric Nutritional Risk Index (GNRI) on major adverse cardiac and cerebrovascular events (MACCE) in the elderly patients after endovascular aortic aneurysm repair (EVAR).Materials and methodsThis was a retrospective cohort study of elderly patients who underwent EVAR in a tertiary hospital. Malnutrition status was assessed by the GNRI. The primary outcome was MACCE. The predictive ability of the GNRI was compared with both the Revised Cardiac Risk Index (RCRI) and the modified Frailty Index (mFI) using Receiver operating characteristic (ROC) curve.ResultA total of 453 patients underwent EVAR November 2015 and January 2020 was retrospectively analyzed, equally divided into three (low/medium/high) groups according to GNRI values which ranked from low to high. Five (1.10%) patients were lost in follow-up after surgery, and the median length of follow-up was 28.00 (15.00–47.00) months. The high GNRI values reduced length of hospital stay following EVAR in comparison to patients in low GNRI values group (β 9.67, 95% CI 4.01–23.32, p = 0.0113; adjusted β −1.96, 95% CI −3.88, −0.05, p = 0.0454). GNRI status was associated with a significantly increased risk of long-term mortality after EVAR (Medium GNRI, unadjusted HR 0.40, 95%CI 0.23–0.70, p = 0.0014; adjusted HR 0.47, 95%CI 0.26–0.84, p = 0.0107; high GNRI, 0.27 95%CI 0.14–0.55; p = 0.0003; adjusted HR 0.32 95%CI 0.15–0.68, p = 0.0029). Both medium and high GNRI values were linked to significantly reduced risks of MACCE compared to low GNRI score patients (Medium GNRI, unadjusted HR 0.34, 95%CI 0.13–0.88, p = 0.00265; adjusted HR 0.37, 95%CI 0.14–0.96, p = 0.0408; High GNRI, 0.26 95%CI 0.09–0.78; p = 0.0168; adjusted HR 0.21 95%CI 0.06–0.73, p = 0.0029). Compared with the RCRI and mFI, the GNRI had better discrimination in predicting long-term MACCE. An area under the curve (AUC) for GNRI mFI, and RCRI is 0.707, 0.614 and 0.588, respectively. (Z statistic, GNRI vs. mFI, p = 0.0475; GNRI vs. RCRI, p = 0.0017).ConclusionMalnutrition assessed by the GNRI may serve as a useful predictor of long-term MACCE in elderly patients after EVAR, with preferable discrimination abilities compared with both RCRI and mFI.

Background: Intravenous lobular capillary hemangioma (IVLCH) of the neck is a kind of rare benign tumor of vein. Purpose: In this paper, we report two female patients who were hospitalized because of neck masses. Results: The tumors in the neck veins of our patients were white oval masses with pedicle, clearly defined and of different sizes. Their immunohistochemical staining results showed CD31 (+), CD34 (+), SMA (+), ERG (+). The pathological diagnosis was intravenous lobular capillary hemangioma. Conclusions: Due to the location, morphology and immunohistochemistry, This lesion needs to be distinguished from other intravascular lesions such as thrombus, hemangiosarcoma and papillary endothelial hyperplasia.

Consideration for oversizing the proximal stent graft is suggested in endovascular aortic repair. However, a special recommendation for the proximal oversizing ratio (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA) is ambiguous. This study aims to evaluate the effect of different degrees of the proximal oversizing ratio (OSR) on risk of type IA endoleak (TIAEL) in hemodynamically stable and unstable patients with rAAA undergoing emergency endovascular aortic repair (EVAR). Our study included 134 rAAA patients undergoing emergent EVAR, and we did not observe a significant association between hemodynamic instability and risk of T1AEL (HR 3.89, 95%CI 0.40–37.75, p = 0.24). All three T1AELs in the hemodynamically unstable subgroup were observed in patients with OSR ≤ 30%, but no significant difference was found regarding T1AEL between patients with OSR > 30% and OSR ≤ 30% (0.00% vs. 11.11%, p = 0.19). As for hemodynamically stable patients, OSR > 20% was associated with a significantly decreased risk of T1AEL (HR 0.03, 95%CI 0.01–0.53, p = 0.016). In conclusion, a proximal OSR > 20% is associated with a decreased risk of T1AEL in hemodynamically stable patients, while an OSR > 30% did not add an additional advantage of lowering the risk of T1AEL in hemodynamically unstable patients.

Purpose: To investigate the safety and efficacy of fast-track management of concurrent percutaneous coronary intervention (PCI) in patients with abdominal aortic aneurysm scheduled for endovascular aortic aneurysm repair (EVAR). Materials and Methods: Eligible patients with abdominal aortic aneurysm who received EVAR from January 2011 to December 2019 were included in this retrospective cohort study. Propensity score (PS)–matched analysis was used to balance the baseline between the fast-track and standard control (EVAR without significant coronary artery disease) groups. Effects of fast-track management on short-term and midterm outcomes were evaluated via Cox proportional hazard regression and logistic regression analyses with corresponding hazard ratio (HR) or odds ratio (OR) and associated 95% confidence intervals (95% CIs), respectively. Results: The study included 669 patients (73 fast-track and 596 standard control). Compared with the standard control group, no significant difference was found regarding major adverse cardiac events (HR 0.78, 95% CI [0.36, 1.68], p=0.519), overall mortality (HR 0.63, 95% CI [0.25, 1.55], p=0.315), and 30-day major hemorrhage events (OR 1.01, 95% CI [0.99, 1.03], p=0.514). The results were consistent in the PS-matched cohorts regarding major adverse cardiac events (HR 0.57, 95% CI [0.25, 1.29], p=0.176), overall mortality (HR 0.43, 95% CI [0.17, 1.11], p=0.820), and 30-day major hemorrhage events (OR 1.00, 95% CI [0.05, 10.61], p=0.999). Similar results were found in the subgroup analyses concerning fast-track management of 2-week intervals and patients with high age-adjusted Charlson comorbidity index. Conclusions: Under appropriate perioperative care, shortening the time interval between PCI and EVAR to 1 month, or even 2 weeks, seemed to be safe and effective. Short-term and midterm cardiovascular and survival outcomes were comparable with patients who underwent standard EVAR without significant coronary artery disease.

Background: The aim of this study was to compare the vascular complications of ProGlide and Prostar in percutaneous transfemoral transcatheter aortic valve replacement. Methods: Electronic databases were searched in July 2022 for studies that compared the vascular complications of ProGlide and Prostar for percutaneous closure in transcatheter aortic valve replacement. The primary outcome was major vascular complications and the secondary outcomes were minor vascular complications, types of access-site vascular complications, device failure, and additional intervention. Estimates of relative effects were pooled to generate ORs and their 95 per cent c.i. using a random-effects model. The risk of bias in non-randomized comparative studies was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions ('ROBINS-I') tool. Results: Nine studies were identified and a total of 7529 patients were included. Among them, 4144 patients received ProGlide and 3385 received Prostar. The pooled data showed that the risk of major vascular complications was significantly lower with ProGlide versus Prostar (OR 0.50, 95 per cent c.i. 0.32 to 0.78). Regarding the types of vascular complications, vascular trauma was the most common complication and the risk was similar between groups (OR 1.02, 95 per cent c.i. 0.55 to 1.91). ProGlide had a lower risk of bleeding complications (OR 0.46, 95 per cent c.i. 0.22 to 0.94), but a higher risk of ischaemia complications (OR 1.90, 95 per cent c.i. 1.10 to 3.27). The risk of device failure was lower in the ProGlide group (OR 0.45, 95 per cent c.i. 0.21 to 0.95). Both groups had a similar risk of having additional interventions for vascular complications (OR 1.02, 95 per cent c.i. 0.75 to 1.39). The use of ProGlide was associated with a lower risk of additional surgical treatments (OR 0.52, 95 per cent c.i. 0.34 to 0.80), but a higher risk of endovascular treatments (OR 2.69, 95 per cent c.i. 1.29 to 5.63). Conclusion: In percutaneous transfemoral transcatheter aortic valve replacement procedures, ProGlide has superior safety and efficacy when compared with Prostar; it is associated with fewer major vascular complications and device failures. The vascular complications of ProGlide are more likely to be dealt with using endovascular treatments than surgical treatments.

大隐静脉是下肢反流的高发部位,一直是下肢静脉疾病治疗的重点.慢性静脉疾病(CVI)的治疗具有社会效应和经济效应,目前,多种安全有效的微创方式可对功能不全的大隐静脉进行闭合,其中腔内激光治疗(EVTA)、射频消融(RFA)应用较为广泛.本综述总结了近年来大静脉曲张闭合的相关文献,以期为大隐静脉闭合技术的有效性和安全性提供指导.

Venous thrombosis has a great impact on patients' quality of life after relapse. The present study summarizes the prediction model of recurrent venous thrombosis published in recent years regarding the applicable population, evaluation index, and predictive performance. It aims to provide a reference for the construction of a more reasonable predictive model and application of venous thrombosis recurrence. A query was conducted on EBSCO, Ovid, PubMed, Wanfang, and CNKI databases using the keywords "Venous Thromboembolism", "Recurrence", and "Prediction Models" to assess the prediction model of recurrent venous thrombosis. A total of five major models related to the recurrence of venous thrombosis were included. The models differed in reliability, validity, scoring method, evaluation method, and scope of application.

To the Editor: Direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, and apixaban, are increasingly used in cardiovascular disease, including venous thromboembolism, atrial fibrillation, deficiency hemorrhagic stroke, and treatment and prevention of acute coronary syndrome.1 Compared with the traditional anticoagulant drug warfarin, DOACs are treated with fixed doses and generally do not require dose adjustment or level monitoring. However, DOAC levels have obvious advantages in judging the amount of bleeding in emergency surgery, detecting redosing after drug interruption, and evaluating bleeding risk in patients with worsening renal function and can judge patients' compliance with DOAC treatment. It is also very advantageous to detect the presence of DOACs when urgent reversal may be required to prevent severe bleeding, since DOACspecific reversal agents are also very expensive. Liquid chromatography coupled with tandem mass spectrometry is currently the standard detection method for quantitative assessment of DOAC,2 but this technology is not available in most hospitals. Currently common clinical coagulation tests (such as PT, APTT, and ACT) cannot detect DOAC due to lack of sensitivity or have large errors when judging the clinically relevant levels of DOAC. The chromogenic substrate antiFactor (F)Xa assay currently used for heparin is an acceptable assay for FXa inhibitor DOACs, while thrombin coagulation assays or venombased assays are being used for thrombin inhibitor DOACs. However, these clinical tests are not suitable for rapid bedside use, especially in emergency patients. These two tests are the biggest limitations due to the need for standardization and proofreading for a specific DOAC and interpretation by corresponding experts. A rapid test that can be reliably and remotely interpreted is currently an unmet clinical need. The DOAC test strips (DOASENSE GmbH) were developed based on the excretion of DOAC into urine.3 The DOASENSE test provides qualitative results that report the absence or presence of DOACs (FXa inhibitors and thrombin inhibitors) in urine samples from patients. The test procedure is relatively simple, similar to routine urinalysis with characteristic reaction paper, and results can be obtained within minutes, especially for emergency patients. There have been seven related studies describing the performance characteristics of the DOAC dipstick test. Evidence of clinical use of this novel test system has been published in conjunction with other clinical studies supporting the clinical utility of the DOAC dipstick test, while the current report also clarifies that heparin and lowmolecularweight heparin do not interfere with the DOAC dipstick test.4,5 DOACs have become the mainstay of anticoagulation therapy today. The DOAC laboratory assessment challenges faced by emergency departments may now be improving as various new testing modalities are researched and opened up. The DOAC dipstick test can assist emergency physicians in different clinical decisions in a variety of situations because of the rapid presentation of a patient's coagulation result report, classification of DOAC types, and above/ below threshold levels. Such a test system is of particular value for applications requiring emergency surgery, severe bleeding, and other emergencies.

Objective: This meta-analysis was conducted to investigate whether compression stockings were necessary after endovenous thermal ablation of varicose veins. Data Sources: Electronic databases, including MEDLINE, EMBASE, and the Cochrane Library database, were searched from inception to 10 March 2021 to identify all the related trials. Methods: Random or fixed effects models were used to generate pooled mean difference (MD) or standardised mean difference (SMD) for continuous data, risk ratios (RRs) for dichotomous data, and related 95% confidence intervals (95% CIs). The quality of evidence was graded with a specific tool (GRADEpro GDT) from the GRADE working group. Results: A total of seven randomised controlled trials (RCTs) comprising 1 146 patients were included in this meta-analysis. Wearing compression stockings was correlated with lower post-operative pain scores from a 0 to 100 mm visual analogue scale (MD -8.00; 95% CI -12.01 - -3.99; p < .001). No difference was observed between wearing compression stockings or not in quality of life (SMD 0.45; 95% CI 0.14 - 1.04), major complications (RR 0.64; 95% CI 0.26 -1.59), target vein occlusion rates (RR 0.99; 95% CI 0.96 - 1.02), or time to return to work (MD -0.43; 95% CI 1.06 - 0.19). Conclusion: After endovenous thermal ablation of varicose veins, wearing compression stockings was not associated with a better outcome except for mild pain relief. Post-operative compression stockings may be unnecessary after endovenous thermal ablation.

Objective:To analyze and summarize the short and long-term results of open surgical repair (OSR) of abdominal aortic aneurysm (AAA) with hostile neck.Methods:The clinical data of AAA patients with hostile neck who underwent OSR from June 2017 to September 2019 in the Division of Vascular Surgery, West China Hospital of Sichuan University were retrospectively analyzed. A total of 21 patients were included, with a mean age of (64.33±12.46) years, 12 male patients, and 10 impending ruptures. The primary outcome was 30-day mortality, secondary outcomes included 3-year overall survival and reintervention rate.Results:Among 21 patients, 15 were short neck or pararenal aneurysms, 3 were large-neck AAAs, and 9 were AAAs with severe neck angulation. The aneurysm diameter of the patients was (66.54±17.34) mm. Three underwent renal artery reconstruction, and 2 underwent renal artery angioplasty. The median length of stay was 16 (12,19) days. The 30-day postoperative mortality rate was 4.76% (1/21), and the patient died of severe pulmonary infection. During a median follow-up of 40 (40, 67) months, 2 patients died of cardiovascular events. The 3-year overall survival rate was 85.71% (18/21). No aortic-related reintervention or death was observed during follow-up.Conclusion:OSR of AAA with hostile neck is safe and effective. Although there is a short-term risk of postoperative pulmonary complications, the long-term results are stable with a low risk of reintervention and mortalit.

OBJECTIVE:The aim of our systematic review and meta-analysis was to demonstrate the clinical outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infective native aortic aneurysms (INAAs).METHODS:MEDLINE, Embase, and Cochrane Databases were searched for articles reporting OSR and/or EVAR repair of INAA. The methodological quality of included studies was assessed by the Newcastle-Ottawa scale and Moga-Score. Random-effects models were used to calculate the pooled measures.RESULTS:A total of 34 studies were included, with 22 studies reporting OSR alone, 6 studies reporting EVAR alone and 6 comparative studies for INAAs. The pooled estimates of infection-related complications (IRCs) were 8.2% (95% CI 4.9%-12.2%) in OSR cohort and 23.2% (95% CI 16.1%-31.0%) in EVAR cohort. EVAR was associated with a significantly increased risk of IRCs compared with OSR during follow-up (OR 1.9, 95% CI 1.0-3.7). As for survival outcomes, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality in OSR cohort were 11.7% (95% CI 7.7%-16.1%), 21.6% (95%CI 16.3%-27.4%) and 28.3% (95% CI 20.5%-36.7%; I2=50.47%), respectively. For EVAR cohort, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality were 4.9% (95% CI 1.1%-10.4%), 9.4% (95% CI 2.7%-18.7%) and 22.2% (95% CI 12.4%-33.7%), respectively. EVAR was associated with a significantly decreased of 30-day mortality (OR 0.2, 95% CI 0.1-0.6). However, no difference was found between EVAR and OSR in 3-month (OR 0.2, 95% CI 0-1.1), 1-year all-cause mortality (OR 0.4, 95% CI 0.1-1.1) or aneurysm-related mortality (OR 1.4, 95% CI 0.5-3.9). Moreover, no difference of incidence of reintervention was observed (OR 2.6, 95% CI 0.9-7.7; I2=53.7%) between two groups.CONCLUSIONS:EVAR could provide better short-term survival than OSR in patients with INAAs. However, patients undergoing EVAR suffered from higher risks of IRCs. EVAR could be considered as an alternative for low-risk patients with well-controlled infections or patients considered high-risk for open reconstruction.

To the Editor: Venous aneurysms are extremely rare. At present, approximately 500 cases have been reported in the literature, and the first symptom is often deep vein thrombosis (DVT) or pulmonary embolism,1 so they have become a very special disease in the emergency department (ED). Venous aneurysms can occur at any age, with the same sex distribution, and can occur in any vein, but they are most common in popliteal vein (45%), portal vein (30%), and superior mesenteric vein (10%). In the process of screening the etiology of venous thromboembolism (VTE), venous aneurysms of the lower limbs is one of the reasons, and popliteal venous aneurysms are the most common. Cystic vein aneurysm is also considered as a highrisk factor for DVT. Surprisingly, anticoagulation alone does not seem to reduce the risk of thromboembolic events (VTE), because venous aneurysms provide an environment for the formation and spread of thrombosis.2 At least 60% of portal or superior mesenteric vein aneurysms are at risk of complications, including portal hypertension, rupture and fistulation, and subsequent gastrointestinal bleeding.3 For symptomatic patients or patients with venous aneurysms with signs of thromboembolism, surgical repair is recommended. There is no consensus on the management of asymptomatic patients. The low incidence rate of venous aneurysms makes it difficult to assess the outcome of interventional therapy, longterm treatment, and the incidence of postthrombotic sequelae. At present, the management of different centers is not unified, and multiagency cooperation should be encouraged. However, since most patients appear in the ED with their first symptoms, multidisciplinary cooperation to treat this disease in the ED should be promoted. Surgery is the main treatment for venous aneurysms. Endovascular treatment of venous aneurysms has not been determined, although endovascular intervention may be suitable for anatomically challenging venous aneurysms. Cystic venous aneurysms are usually treated by resection of venous aneurysms and repair of lateral veins. Fusiform vein aneurysms can be treated by the following methods: resection and endtoend anastomosis, intermediate transplantation and bypass, and proximal and distal venous ligation.4 Superficial venous aneurysms can be treated by venous ligation. Surgical risks include hematoma, wound infection, thrombophlebitis, nerve injury, and recurrence. Individuals usually remain anticoagulant for 3– 6 months after surgery. The patency rate was estimated to be between 40% and 93%, and venous aneurysm resection and lateral vein repair were associated with the best longterm patency rate.5 The emergency intervention decision of venous aneurysm is based on the risk balance, considering the risk of rupture and the incidence rate of VTE related to the intervention. Although it may not be possible to conduct a standard randomized controlled trial in the ED, it emphasizes the need to register data and combine multicenter retrospective studies to help determine individualized treatment.

ObjectiveTo investigate the features of cardiac Doppler parameters in patients with primary lower extremity varicose veins in China.Materials and MethodsWe performed a prospective statistical analysis of cardiac Doppler parameters between 129 Chinese patients with varicose veins and normal controls. Furthermore, we evaluated the relationship between cardiac Doppler and the progress or severity of lower extremity varicose veins.ResultsCompared with normal controls, patients with primary varicose veins had significantly lower early mitral and tricuspid diastolic inflow and annular velocities (E- and e′-waves), significantly higher late mitral and tricuspid diastolic inflow and annular velocities (A- and a′-waves), significantly higher mitral systolic annular velocities (s′-wave), and significantly lower mitral and tricuspid E/A ratio. There was no significant association between deep venous reflux (DVR) of the lower extremities and cardiac Doppler parameters. The relationship between Clinical Etiological Anatomical Pathophysiological (CEAP) clinical class and cardiac Doppler parameters showed on that: In comparison with normal control, all cardiac Doppler parameters of C2 clinical class patients were basically unchanged, but the cardiac Doppler parameters of the C3 or higher CEAP class patients changed. Hence, we found a potential CEAP grade cut-off value (C3) linked to statistical changes in cardiac Doppler parameters.ConclusionCardiac Doppler parameters in patients with primary varicose veins could indeed be different from those of normal people, especially for C3 class or higher CEAP clinical class patients. Therefore, for those patients, pre-operative echocardiography can be used to evaluate cardiac hemodynamic changes, but large-scale clinical promotion requires further large sample studies.

探讨团队学习的教学方法应用在血管外科轮转住院医师显微技术培训中的效果.实践表明,应用团队学习教学方法对在血管外科轮转的住院医师进行显微技术的培训,有助于住院医师发挥主观能动性,从而增强他们学习显微外科技术的兴趣,提高他们的操作技能.