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Objective: To compare the initial clinical efficacy of extensible intramedullary rod fixation and Williams intramedullary rod fixation combined with Ilizarov external fixation and wrapped autologous iliac bone grafting in the treatment of congenital tibial pseudarthrosis in children. Methods: A retrospective analysis was conducted on the clinical data of 60 children with Crawford Ⅳtype congenital pseudarthrosis of the tibia treated with combined surgery at the Orthopedics Department of Hunan Children's Hospital from January 2013 to December 2020.According to different internal fixation methods,patients were divided into the extensible intramedullary rod group (30 cases) and the Williams intramedullary rod group (30 cases). There were 12 males and 18 females in the extendable intramedullary rod group, aged (33.6±6.3) months (range: 18 to 44 months), while there were 10 males and 20 females in the Williams intramedullary rod group, aged (47.8±8.6) months (range: 36 to 66 months). The anteroposterior and lateral views of tibia and fibula and the full length anteroposterior film of both lower limbs were examined to compare the clinical treatment effects of the two groups at 1-,3-,6-,9-, and 12-month after surgery. Independent sample t -test, χ 2 test or Fisher exact test was used for inter group comparison. Results: Both groups of children underwent surgery successfully, with postoperative follow-up time greater than 2 years. The extensible intramedullary rod group was followed up for (49.5±6.4) months, while the Williams intramedullary rod group was followed up for (53.7±10.5) months. The initial bone healing time between the broken ends of the tibial pseudarthrosis was (5.1±0.8) months in the extensible intramedullary rod group and (5.0±0.6) months in the Williams intramedullary rod group. There was no statistically significant difference between the two groups ( t =0.584, P =0.562). The initial postoperative bone healing rate of the extensible intramedullary rod group was 93.3% (28/30), while that of the Williams intramedullary rod group was 96.7% (29/30). There was no statistically significant difference between the groups ( χ 2 =0.351 P =0.554).The postoperative fracture rate of the extensible intramedullary rod group was 20.0% (6/30), while that of the Williams intramedullary rod group was 16.7% (5/30);Six cases (20.0%) in the extensible intramedullary rod group had unequal limb lengths in both lower limbs after surgery, with a limb length difference of (2.5±1.4)cm (range: 1.5 to 5.2 cm). Eight cases (26.7%) in the Williams intramedullary rod group had a limb length difference of (2.8±1.4)cm (range: 1.8 to 6.0 cm);After surgery, there were 4 (13.3%) cases of proximal tibial valgus deformity in the extensible intramedullary rod group, with an valgus angle range of (12.5±4.9)° (range: 7 °to 18°), and 3 (10.0%) cases in the Williams intramedullary rod group, with an valgus angle of (15.0±6.0)° (range: 9°to 21°). There were 2 (6.7%) cases of ankle valgus deformity in the extensible intramedullary rod group, with an valgus angle of (11.5±4.9)° (range: 8 °to 15°), and 4 (13.3%) cases in the Williams intramedullary rod group, with an valgus angle of (14.8±6.2)° (range: 6 °to 20°). The postoperative activities of the knee and ankle joints in the extensible intramedullary rod group were normal and unrestricted, with 4 cases of extensible intramedullary rod displacement.In the Williams intramedullary rod group, there were 30 cases of postoperative ankle joint stiffness and no displacement of the fixation position of the intramedullary rod.There was no statistically significant difference in postoperative complications between the two groups of children (all P >0.05). Conclusions: The use of both extensible intramedullary rods and Williams intramedullary rods in the combined surgery for congenital tibial pseudarthrosis in children can achieve effective internal fixation results. The initial postoperative bone healing rate is high, and there is no difference in the incidence of postoperative complications between groups. Both internal fixation methods have their own advantages and disadvantages, and suitable internal fixation methods can be selected based on the characteristics of the patient.

Objective: To examine the surgical method and clinical outcome of primary repair of chronic Achilles tendon rupture. Methods: From March 2012 to August 2017, clinical data of 35 consecutive patients with chronic Achilles tendon rupture who were treated with primary repair by the same doctor at Department of Sports Medicine, Peking University Third Hospital were retrospectively analyzed.There were 29 males and 6 females with age of (41.0±9.3)years(range:29-65 years), the follow-up period was (45.6±17.2) months(range:17-82 months). All the patients had unilateral tendon rupture with 22 cases on the left and 13 cases on the right.The preoperative and postoperative Visual Analogue Scale(VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score(AOFAS), the Victorian Institute of Sport Assessment-Achilles(VISA-A), the Achilles tendon Total Rupture Score(ATRS)and the Tegner Activity Score of patients were collected and compared by paired- t test. Results: Among 47 patients with chronic Achilles tendon rupture, 35 patients were followed up for (45.6 ± 17.2)months(range: 17-28 months). No serious postoperative complications such as infection or nerve damage and rerupture outcomes were reported. At the last follow-up,the VAS decreased from 1.0(2.0) ( M ( Q(R) )) preoperative to 0.0(0.8)( Z= -3.586, P= 0.00), AOFAS increased from 64.3±12.5 to 97.0±5.0( t=- 14.359, P< 0.001), VISA-A increased from 51.3± 9.8 to 87.8±18.0( t=- 17.656, P= 0.00), Tegner increased from 0.9±0.3 to 4.6±1.7( t=- 12.524, P= 0.00)and ATRS increased from 40.0±3.5 to 97.9±3.9( t=- 64.133, P= 0.00). Twenty-eight patients (80.0%) had returned to their preinjury activity levels, and 7 patients (20.0%) no longer participate in recreational sports. According to Arner-Lindholm curative effect evaluation criteria, 32 cases(91.4%)gained the excellent results, 1 case(2.9%) of good and 2 cases(5.7%) bad, and the percentage of the cases with the excellent or good results was 94.3%. All except 2 patients with bad results could perform a single-limb heel rise painlessly. Conclusions: Primary repair is an efficient approach for chronic Achilles tendon rupture. The mid-and-long curative effect is satisfactory and stable.Compared with other surgical techniques, operation is relatively simple and economical. The primary repair is considerably safe, with few serious complications such as infection or nerve damage and reruptures.

Objective: To report experiences and results of complex aortic aneurysms involving the visceral arteries treating by total endovascular repair., Methods: Seventy cases of thoracoabdominal aortic lesions treating by total endovascular repair in Department of Vascular Surgery, People's Liberation Army General Hospital from January 2011 to December 2014 were retrospectively analyzed. There were 47 cases underwent chimney technique, 6 underwent sandwich technique, 15 underwent fenestration technique and 2 underwent branched stent grafts technique., Results: The average follow-up time was 21 months, range from 3 to 47 months. Completion angiography showed that typeⅠ endoleak of chimney, sandwich, fenestration and branched stent grafts group were 9/47, 5/6, 2/15 and 0, respectively. While at 30-day typeⅠ endoleak reduced to 7/47, 2/6, 0 and 0. During follow-up, there were 3 target vessel stents occlusion in chimney group, the patency rate of target vessel stent was 95.1% (58/61). In sandwich, fenestration and branched stent grafts group, all the target vessel stents kept patent., Conclusion: In this study, chimney, sandwich, fenestration and branched stent grafts techniques show good short-term and midterm results, the long-term effects still need further studies.

Objective: To evaluate the safety and efficacy of the drug coated balloon (DCB) with paclitaxel in patients with symptomatic peripheral artery disease (PAD)., Methods: The clinical data of 18 patients, who were diagnosed as PAD and treated with DCB from October 2013 to June 2014 in Department of Vascular Surgery, People's Liberation Army General Hospital, were retrospectively analyzed.Thirteen male and 5 female patients were in the series, the mean age of the patients was (65±7) years, and the Rutherford's categories were level 3 to 5. Patients were followed up at 3- and 6-month postoperative. The main efficacy end point were late lumen loss(LLL), rate of restenosis and clinically driven target lesion revascularization (TLR). Meanwhile, the clinical events were recorded., Results: Mean lesion length, the percentage of total occlusions and the percentage of in-stent restenosis were (138±91) mm, 9/18 and 2/18, respectively. Rate of technical success was 18/18. At 6-month postoperative, LLL, rate of restenosis and TLR were (0.1±0.9) mm, 2/14 and 0, respectively. There was no deaths or no amputations., Conclusion: DCB with paclitaxel is safe in patients with PAD, and associated with reductions in LLL, restenosis and clinically driven TLR 6-month postoperative.

Objective: To evaluate the early and midterm results of covered Cheatham-Platinum (CP) stent for treatment of aortic coarctation (CoA) in adolescents and adults., Methods: From January 2007 to June 2011, 9 consecutive cases of CoA underwent covered CP stent implantation. There were 4 male and 5 female patients, aging from 13 to 44 years with a mean of (24 ± 11) years. The covered CP stent and balloon-in-balloon catheter were selected according to digital subtraction angiography measurements. The covered CP stents were expanded to appropriate diameter by inflation of the inner balloon and outer balloon successively. The systolic pressure gradient across the stenosis and narrowest degree of the stenotic vessels were compared before and after the procedure., Results: After the procedure, the systolic pressure gradient across the stenosis decreased from (66 ± 21) mmHg to (9 ± 4) mmHg (1 mmHg = 0.133 kPa, t = 9.13, P = 0.000) and the narrowest degree of CoA decreased from 79% ± 12% to 17 ± 4% (t = 16.65, P = 0.000). During a mean follow-up of (33 ± 22) months (ranging 4 to 54 months), no intrastent restenosis were found and systolic pressure gradient from upper to low extremity was not more than 15 mmHg in each case., Conclusions: Covered CP stent implantation is safe and effective for treatment of CoA in adolescents and adults. The early and midterm results are encouraging, but long term results require further follow-up and observation.

Objective: To evaluate immediate- and median-term outcomes from subintimal recanalization of superficial femoral arteries (SFA) chronic total occlusions (CTO) with the Outback LTD catheter., Methods: From January 2010 to May 2011, 35 legs in 30 patients with CTO of the SFA and proximal popliteal artery were treated by Outback LTD catheter. There were 20 male and 10 female patients. The mean age of the patients was 68 years. Clinical presentation was severe intermittent claudication (Rutherford category 3, 10/35, 28.6%), rest pain (Rutherford category 4, 13/35, 37.1%), and minor ulceration (Rutherford category 5, 12/35, 34.3%). In all cases, the true lumen could not be entered by using standard antegrade catheter and guide wire techniques. Technical success, complications, procedure times, clinical outcomes and cumulative patency rates in follow-up were evaluated., Results: Median lesion length was (210 ± 15) mm. Recanalization of the arterial occlusion was successful in 34 of 35 treated lesions (97.1%). None of the 30 patients showed any procedure-related complications during or after treatment. The mean follow-up was (7.2 ± 0.3) months. Cumulative primary patency rates after 3, 6, and 12 months were 90.9%, 84.8% and 50.6%. Three minor toe amputations and one major below-the-knee amputation were observed in patients with critical limb ischemia., Conclusions: The Outback LTD catheter is a safe and effective device to recanalize challenging superficial femoral arteries CTO. The technique could reduce radiation exposure time and raise the technique success rate.

Objective: To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients., Methods: From July 1997 to July 2011, 120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry. There were 96 male and 24 female patients, aged from 52 to 95 years with a mean of 74 years. Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3, 6, 9, 12 months, and annually thereafter. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement., Results: Mean aneurysm diameter was (57 ± 8) mm. Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five type I endoleaks, twenty-five type II endoleaks and one type III endoleak occurred during the perioperative period. The technical success rate was 95%. Operative mortality was 2.5%. The survival rates at 1-, 3- and 5-year were 92%, 75% and 43% respectively. The mean follow up was (36 ± 3) months. Primary and secondary patency rates at 3 year were respectively 97% and 100%. Secondary intervention rate was 10% (12/120) at 5 year. The reasons included endoleaks for 7 patients, stent-grafts fracture for 2 patients, stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients., Conclusions: Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.

Objectives: To review the dilatation of the proximal neck in abdominal aortic aneurysm (AAA) after endovascular repair (EVR), and to analyze the factors contributed to these changes., Methods: From January 1997 to January 2007, a total of 45 patients treated by EVR met the inclusion criteria. There were 44 male and 1 female patients, with an average age of (69 ± 17) years. The patients were all asymptomatic abdominal aortic aneurysm, combined hypertension in 37 cases, coronary heart disease in 40 cases. All the patients had the complete preoperative enhanced CT information, and accepted more than 6 months of regular enhanced CT follow-up (1, 3, 6, 12 months after surgery and annually thereafter). The proximal aneurysm neck diameter increase was determined by CT, increase over 2 mm as having change, less than 2 mm as no change., Results: The average follow-up interval was (34 ± 25) months (ranging from 9 to 100 months). The mean preoperative proximal neck diameter was (21.5 ± 2.3) mm, and (22.4 ± 2.4) mm one month after operation and (24.0 ± 2.8) mm at the latest follow-up. The increase of proximal neck diameter was detected in 71.1%. The oversizing percentage was 19% ± 6%. The incidence of proximal neck over-sizing stent-graft in diameter was 6.7%. The incidence of no dilation at proximal neck diameter was 97.4%, 68.6%, 39.3% and 3.3% at 16, 24, 36 and 96 months postoperatively respectively. The stent-graft migration was detected in 22.2% patients, and the migration distance was (7.0 ± 1.3) mm (ranging from 0 to 9.5 mm). There were no case which the migration oversized 10 mm or need to reintervention., Conclusions: The more oversizing percentage, the more dilatation in the proximal neck. The stent-graft migration and the dilatation of the proximal neck might have effect on each other.

Objective: To determine the safety and efficacy of total percutaneous endovascular abdominal aortic aneurysm repair using the Perclose ProGlide suture-mediated closure system., Methods: From May 2008 to April 2010, 36 abdominal aortic aneurysm patients were undergone total percutaneous endovascular repair. There were 30 male and 6 female patients with a mean age of 68 years. Endografts used included 3 Endurant endografts, 13 Talent endografts, and 20 Zenith endografts. Prior to insertion of the introducer sheath, two ProGlides were pre-set to 18 to 24 F access sites and one to 14 to 16 F access sites. At last, suture the arteriotomy by tying down knots of the ProGlide following removal of the sheath. Technical success, complications, and procedure and access closure times were evaluated. Follow-up protocol consisted of computed tomography angiograms performed at 3, 6, 9, 12 months, and annually thereafter., Results: Twenty patients were operated under local anesthesia and 16 patients under general anesthesia. A total of 68 femoral arteries were closed with 128 devices. Thirty-eight vessels were with 2 devices, while 8 arteries required 3 devices and 2 arteries required 4 devices for hemostasis and an additional 20 vessels only required a single device. Sixty-three (63/68, 92.6%) vessels were closed successfully. Two vessels converted to open closure. Three vessels complicated with hematomas without surgical procedure. The mean follow-up was (12±3) months. There was one asymptomatic femoral artery dissection 3 months after operation., Conclusions: Total percutaneous endovascular abdominal aortic aneurysm repair is safe and effective. But it should be performed at hybrid operating room where can convert to open procedure if necessary.

Objective: to compare the clinical outcome of foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery., Methods: as a prospective randomized controlled trial, 60 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups, treated by SFJ ligation and either foam sclerotherapy or standard stripping of the GSV. There were 26 male and 34 female with a median age of 49 years (ranging 37 to 66 years). Primary end points were patient recovery period, postoperative pain, quality of life and recurrence rate. Secondary end points were frequency of complications on the two arms of the trial., Results: all treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group than the standard stripping (43 min vs. 65 min, P < 0.01). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group compared to the surgical group (3 d vs. 6 d, P < 0.01). After 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups (P < 0.01). After 6 months, in the foam sclerotherapy group, 5 patients needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80.0%. And the short-term obliteration rate was 89.5% in the conventional surgery group., Conclusions: foam sclerotherapy combined with sapheno-femoral ligation involves a shorter treatment time, less postoperative discomfort and results in more rapid recovery compared to conventional GSV stripping.

Objective: To study the anatomical characteristics about ascending aortic and aortic arch in Chinese population by CT., Methods: From September 2006 to September 2007, 388 patients free of current known aortic pathology undergone thoracic aorta CTA. The diameter of ascending aorta, aortic arch, and branch vessels of aortic arch were measured respectively by AW4.2 work station. The data base about all the measurements was set up. The CHISS statistical software was used to analysis data., Results: The aortic diameter above coronary artery (CA), the level at origin of and brachiocephalic trunk (BCT), the halfway of the ascending aorta, the level at origin of left common carotid artery (LCCA), the level at origin of left subclavian artery (LSA) and the level at distal of origin of LSA respectively were (34 +/- 5) mm, (34 +/- 5) mm, (33 +/- 4) mm, (30 +/- 4) mm, (28 +/- 3) mm and (26 +/- 3) mm. The diameters of two level between the origin of BCT and right subclavian artery (RSA) were (13.1 +/- 1.9) mm and (12.8 +/- 2.3) mm. Diameters of two level at LCCA were (8.7 +/- 1.5) mm and (7.9 +/- 1.0) mm. The diameters of two level between the origin of LSA and left vertebral artery were (10.7 +/- 1.7) mm and (9.3 +/- 1.3) mm. The aortic lumina length between the origin of CA and BCT was (5.3 +/- 1.2) cm, the aortic lumina length between the origin of BCT and LCCA was (1.3 +/- 0.4) cm, the lumen length between origin of BCT and RSA was (4.1 +/- 0.8) cm, the lumen length between origin of LSA and left vertebral artery was (3.8 +/- 0.8) cm. The distance between the wall of BCT and LCCA was (0.4 +/- 0.2) cm, the distance between the wall of LCCA and LSA was (0.7 +/- 0.6) cm., Conclusions: Modular branched stent-graft system is fit for most part of the Chinese. The size fit for human could be got on this basic.

Objective: To investigate the treatment strategies of peripheral arterial aneurysms., Methods: Thirty-five cases were reviewed from July 1998 to December 2007, and 28 cases were male, 7 cases were female. Eleven cases were popliteal artery aneurysms, 15 cases were femoral artery aneurysms, 4 cases were extracranial carotid aneurysms and 5 cases were subclavian artery aneurysms. All cases had either open procedures or endovascular procedures., Results: Surgical open procedures were performed on 24 cases, and endovascular procedures were performed on 11 cases. The perioperative complication rate were 16.7% (4/24) and 0% for open and endovascular groups respectively. The average follow-up time was 41 months (7 months to 8 years). The accumulative five year patency were 61% and 48% for surgical grafts and stent grafts respectively. Two cases died of diseases and one had stroke during follow-up., Conclusions: Surgical open repair is still standard procedure for most peripheral arterial aneurysms and endovascular repair may have its own advantage for high risk patients.

Objective: To describe observation of availability of catheter-directed foam sclerotherapy for the great saphenous vein varicosis., Methods: A selective series of 30 patients of vein varicosis were treated with foam sclerotherapy using a standard technique for foam delivery from April 2008 to August 2008. Patients were treated with 1% polidocanol foam through a catheter, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV). All successfully treated patients were examined by colour duplex two weeks after the procedure., Results: Thirty patients with an insufficiency reflux of the GSV were treated with the catheter-directed foam sclerotherapy. Primary technical success was achieved in all the patients. The concentrations (1.0%) and doses (6 to 8 ml) of polidocanol was mainly we used. Five patients experienced transient scotomas and developed segmental phlebitis of a collateral vein. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), a closure of the GSV was found at control visits 2 weeks, 3 months after treatment., Conclusion: The use of an endovascular catheter inserted percutaneously over a guidewire is feasible in most patients and has resulted in high primary occlusion rates.

Objectives: To evaluate the 4- to 10-year results of arthroscopic reconstruction of the posterior cruciate ligament (PCL) using single-bundle bone-patella tendon-bone graft, and to find out the principle and influential factor of the isolated PCL reconstruction., Methods: From May 1998 to July 2004 the data of 29 patients with isolated PCL reconstruction retrospectively investigated, using single-bundle bone-patella tendon-bone graft. Twenty-two cases were followed up with average 7.1 years (5 - 10 years). Follow-up included the subjective knee function evaluation, KT2000, Biodex and the radiographic assessment., Results: The mean final follow-up IKDC score, Lysholm score, and Tegner score of the 22 cases were 89.4 +/- 8.1, 94.5 +/- 9.2, and 6.9 +/- 2.6 respectively. There were statistically significant improvements in them when compared with preoperative data respectively (P < 0.01). The average posterior displacement measured with KT2000 was (4.9 +/- 1.1) mm (90 degrees flexion) and (4.3 +/- 1.2) mm (30 degrees flexion) respectively. At the final follow-up, KT2000 examination revealed >or= 6 mm of posterior laxity in 6 patients (group A), and

Objective: To review the experience of hybrid conventional open and endovascular treatment of thoracoabdominal aortic aneurysm (TAAA), and evaluate the immediate and long term outcomes., Methods: From September 1998 to October 2008, 15 TAAA patients were treated by hybrid-procedures. The mean patient age was 58.7 years (ranged from 44 to 72 years). The aneurysms were Crawford type I in 2, type II in 8, type III in 2, type IV in 3. The median aneurysms diameter was (67.5 +/- 7.5) mm (ranged from 55 to 82 mm). Patients were followed up before dismissal, 3, 6, 12 months later, and annually thereafter., Results: Two patients were antegrade revascularization, the others were retrograde revascularization. Mean operation time was (8.1 +/- 1.4) h (ranged from 6.8 to 12.7 h), mean blood loss was (956.7 +/- 80.1) ml (ranged from 750 to 3,000 ml). Two patients died during perioperative time, no paraplegia. During follow up revealed shrinkage of aneurysm, no graft migration and paraplegia, but 1 died for acute myocardial infarct., Conclusions: Hybrid treatment is a safe and effective option for treatment of TAAA. Immediate and mid-term outcomes are favorable, but long-term surveillance is indefinite.

Objective: To compare the clinical results of double and single bundle anterior cruciate ligament (ACL) reconstruction., Methods: From 2005 May to December the data of 33 patients (4 lost follow) with double-bundle and 41 patients (8 lost follow) with single-bundle reconstruction of ACL using auto-hamstring tendons was retrospectively investigated. The follow-up was 14-22 months (average 18 months) of double-bundle group and 14-21 months (average 18 months) of single-bundle group. The IKDC, Lysholm and Tegner scores, KT-2000 and Biodex were used to evaluate the clinical results., Results: The IKDC, Lysholm and Tegner scores were increased significantly from 60, 66, 4 before the operation to 85, 94 and 6 respectively after the double-bundle reconstruction. The KT-2000 results showed that at 30 and 90 degree 134 N the anterior-posterior translations were significantly decreased from 5.8 and 2.4 mm to 1.2 and 1.1 mm respectively of the double-bundle group (P < 0.01). The peak torques of the extend and flex muscles of the involved knee at 60 degrees/s and 120 degrees/s were only at 81%, 87%, 76% and 85% of the contralateral knee of the double-bundle group. And the differences were statistically significant (P < 0.01). There were no differences between the two groups of any index, but the KT value at 30 degree and the extensor peak torque of the double-bundle group manifested a better tendency., Conclusions: Both double-bundle and single-bundle ACL reconstruction can restore the stability and improve the function of the knee, and the double-bundle group shows a better tendency at the 30 degree stability and the extensor strength.

Objective: To investigate the methods and effects of secondary intervention for mid-long term complications of endovascular repair (EVR) in aortic diseases., Methods: From May 1999 to Jun 2007, 21 patients with mid-long term complications after EVR were treated in our center. Of these cases, 15 cases received first EVR for abdominal aortic aneurysm (AAA), 3 cases for thoracic aortic aneurysm (TAA) and 3 cases for aortic dissection (TAD). The mid-long term complications included 11 cases of type I endoleak, 4 cases of type II endoleak, 2 cases of type III endoleak and 4 cases of migration of stent grafts. Proximal or distal extensions were used for type I and III endoleak in 9 cases. Fenestrated, scallop and bifurcated stent grafts were used to reconstruct the aortic arch in 3 cases. Emboli technique was used in treating type II endoleak. Thrombectomy and bypass technique were used in 4 cases with stent graft limb occlusion. One ruptured AAA accepted open surgery., Results: Secondary endovascular technique were undergone in 20 (95.2%) cases. One case died in 30 days after the secondary intervention and endoleak remained after the secondary operation in 5 cases. Three cases died of the secondary intervention., Conclusions: Endoleak and limb occlusion were the chief mid-long complications after EVR. Secondary endovascular technique can be used in most cases and carries great challenges in aortic arch lesions.

Objective: To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair., Methods: After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed., Results: Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and artery rupture of left subclavian respectively during operation. In the eight successful cases, two proximal type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed., Conclusion: It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.

Objective: To investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD)., Methods: In 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover., Results: DSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg., Conclusions: EVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.

Objective: To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease., Methods: To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form., Results: Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously., Conclusions: The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.

Objective: To discuss the safety, feasibility, efficacy and problem of endovascular repair (EVR) for ruptured aortic aneurysm (RAA)., Methods: Fourteen patients with RAA were obtained diagnosis and anatomic data of proximal and distal neck through magnetic resonance imaging and CT. The patients with hypotension were accepted anti-shock treatment. Stent-grafts were deployed in proper position of RAA under X-ray fluoroscopic., Results: The time from rupture to operation was 50 min to 21 d. Three cases had plenty of blood in left pleural cavity and 2 cases were done under bleeding shock condition. Five cases with RAA were fixed by bifurcated stent-grafts and others by straight stent-grafts. Follow-up term was 1 month to 38 months. One with ruptured thoracic aortic aneurysm died 4 h later after operation, another one died of left thoracic cavity infection 9 months later, and others lived well without complication., Conclusion: The EVR is a safe, efficient and feasible method. It will be a potential alternative to treat RAA in future, but more suitable for RAA with better proximal and distal landing zones.

Objective: To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection., Methods: From June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation., Results: 10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later., Conclusion: The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.

Objective: To discuss the change of blood supply pattern in visceral arteries of Stanford B dissection. The visceral arteries include celiac trunk (CA), superior mesenteric artery (SMA) and renal artery (RA)., Methods: By retrospectively analysing the clinical data of 52 cases with Stanford B dissection, the blood supply pattern of visceral arteries was confirmed by aortography and the changes before and after endovascular repair were compared., Results: After repair: the stenosis lesions disappeared in 7 cases supported by true channel completely but one. Twenty-two visceral arteries supported by true and false channel simultaneously recovered true channel chiefly but one. One recovered true channel chiefly and one had no change in 2 visceral arteries supported by false channel completely. Four recovered true channel chiefly and one had no change in 5 visceral arteries without blood support. 88.9% blood support got better and 11.1% blood support had no change in 36 damaged visceral arteries after endovascular repair., Conclusion: Blood support from true and false channel simultaneously is the chief pattern in the injured visceral arteries before repair; Endovascular repair technique is benefit to recovering the blood support of true channel.

Objective: To prevent and manage frequent complications after endovascular repair of infrarenal abdominal aortic aneurysm (AAA)., Methods: The data of 71 cases of infrarenal abdominal aortic aneurysm (AAA) treated by endovascular repair were analysed retrospectively. The reasons, managements, results and prognosis of frequent complications were investigated., Results: Seventy-one cases of infrarenal AAA were treated by endovascular repair with 100% success rate. There was no surgical conversion to open aneurysm repair. There were 8 cases of primary endoleak, 1 case of nervous complication and acute thrombosis. An average follow-up period was 26 +/- 5 months. Three persistent endoleaks and 4 secondary endoleaks were found during the follow-up period. The endoleak rate was 9.8% (7/71) within 1 month postoperatively and mortality rate was 1.3% (1/71). Total mortality rate was 4.2% (3/71). Two patients died from acute myocardial infarction and one from acute heart failure., Conclusions: Endovascular treatment of abdominal aortic aneurysm is technically feasible and can effectively exclude aortic aneurysms from the circulation. Endoleak is a chief complication after endovascular repair of infrarenal AAA.Additional procedures and follow up are very important. Endoleak with enlarged aneurysm should be treated actively.