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Objectives: To examine the prognosis factors for readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients in the Chinese population. Methods: A total of 1 129 AAA patients who underwent EVAR at Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2010 to December 2017 were enrolled. There were 948 males and 181 females, with an age of (71.2±9.6) years (range: 18 to 93 years). Comorbidities included primary hypertension found in 630 patients, diabetes mellitus in 129 patients and coronary heart disease in 163 patients. A total of 214 patients had a history of smoking, and 11 patients had a history of previous aortic intervention.Clinical data including baseline information, laboratory examinations and follow-up data before December 31, 2019 were retrospectively collected. The primary end point was readmission. Cox regression analysis was used to analyze the prognosis factors for the end point. Results: All patients completed at least one follow-up with a follow-up time of 22.7(42.6) months (range: 1 to 120 months). The readmission rate of 1 year post-operation was 4.52% (51/1 129). The overall readmission rate was 11.34% (128/1 129) during the whole follow-up duration. The main reasons of readmission included endoleak in 60 patients with readmission, iliac limb occlusion in 25 patients and distal iliac aneurysm in 12 patients. Age ( HR =0.972, 95 %CI : 0.956 to 0.987, P< 0.01) and elevated pre-operative fibrinogen level ( HR =2.213, 95 %CI : 1.185 to 4.134, P= 0.013) were found to be the prognosis factors for the survival time free from aortic-related readmission in univariate Cox regression analysis. Elevated pre-operative fibrinogen level ( HR =2.542, 95 %CI : 1.353 to 4.776, P= 0.004) was found to be the prognosis factor for the survival time free from aortic-related readmission in multivariate Cox regression analysis. Conclusions: The most common reason for readmission was endoleak, followed by iliac limb occlusion and distal iliac aneurysm. Elevated pre-operative fibri nogen level was the risk factor for the survival time free from aortic-related readmission, though further researches were warranted for exploring the underlying mechanism.

Objective: Using two antithrombotic treatment (clopidogrel vs. clopidogrel combined warfarin) strategies after femoral-popliteal artery angioplasty prospectively, to evaluate which strategy is more effective for the restenosis prevention., Methods: Totally 50 patients referred for endovascular treatment (including the percutaneous transluminal angioplasty (PTA) and stent implantation) of the superficial femoral artery and popliteal artery from January 2008 to May 2009 were randomly divided into clopidogrel group (group A, 25 cases, 30 limbs) and clopidogrel plus warfarin group (group B, 25 cases, 33 limbs) before operation. Clinical outcomes and restenosis rate of the target lesions were evaluated at 3, 6 and 12 months after operation., Results: Totally 88 patients were screened for participation in the study, 56 patients were included after the follow-up of 12 months. At 3 months, the rates of restenosis were 16.7% in group A and 18.2% in group B (χ² = 0.025, P = 0.874). At 6 months, the accumulated restenosis rates were 36.7% in group A and 36.4% in group B (χ² = 0.001, P = 0.98). At 12 months, the accumulated restenosis rates were 53.3% in group A and 42.4% in group B (χ² = 0.75, P = 0.387). Analysis for the critical limb ischemia sub-group showed that follow-up of 12 months, the accumulated restenosis rate was 8/10 in group A and 6/12 in group B (χ² = 1.023, P = 0.312)., Conclusion: The clopidogrel alone treatment for PTA or PTA plus stent implantation of femoral popliteal artery has no statistically significant difference in comparison with the clopidogrel combined warfarin treatment in terms of the cumulative vascular restenosis rate at 3, 6, 12 months postoperatively.

Objective: To evaluate the Digital Subtract Arteriography (DSA) characteristics of lower limb arterial diseases in patients with diabetic feet and to explore the correlation between DSA and Ankle-brachial index (ABI)., Methods: Fifty-two patients with diabetic feet were recruited in this study. ABI and DSA of bilateral lower extremities were examined to assess the severity of vasculopathy. The relationship between ABI and DSA was analyzed., Results: ABI values for 91 lower extremities were obtained, with a mean of 0.73 +/- 10.43 (0.15-1.97), among which 19.8% ranged from 0.9 to 1.3, 69.2% were less than 0.9, and 11% were more than 1.3. Based on the integrated angiographic images, the arteries with < or = 50% degree of stenosis, 50%-99% degree of stenosis and occlusion comprised 49.5%, 22%, and 28.5% for femoral artery; 79.1%, 14.3%, and 6.6% for popliteal artery; 25.3%, 8.8%, and 65.9% for anterior tibial artery; 29.7%, 14.3%, and 56% for posterior tibial artery; 25.3%, 20.9%, and 53.8% for peroneal artery; and 54.9%, 14.3%, and 30.8% for dorsal pedis artery. Forty (50.5%) limbs had three or more above-mentioned arteries occluded simultaneously. The average vascular score was 8.5 +/- 4.3 with a range between 0 and 18. The spearman correlation analysis showed that ABI inversely correlated with artery stenosis score (r = -0. 588, P < 0.05)., Conclusion: Arterial diseases of lower extremities in patients with diabetic feet are wide-spread, ranging from femoral artery to the dorsal pedis artery. Multiple segments of arteries are involved. Severe stenosis and occlusion are more common in anterior and posterial tibial arteries, and peroneal artery.

Objective: To evaluate the etiology, diagnosis, and treatment of lower limb arterial occlusion in patients below 45 years old., Methods: The clinical data of 58 patients with lower limb arterial occlusion (except for Buerger's disease) below 45 years old admitted to PUMC Hospital from July 1997 to November 2007 were retrospectively analyzed., Results: Among these 58 patients, 31 patients (53.4%) had confirmed thrombophilic risk factors, including 12 patients had two or more thrombophilic risk factors. Follow-up (ranged 2-43 months, mean 10 months) showed higher rates of revascularization and amputation in patients with thrombophilic risk factors (22.6% and 22.6%, respectively) than in those without thrombophilic risk factors (14.8% and 11.1%, respectively) (P > 0.05). Among patients with two or more thrombophilic risk factors, the rates of revascularization and amputation were 25.0% and 33.3%, respectively., Conclusions: Lower limb arterial occlusion in young adults is often caused by thrombophilic risk factors. Attention should be taken to identify these etiologies before surgical treatment.

Objective: To evaluate the correlation between hyperlipidemia and lower limb arterial disease in elderly diabetic patients with color Doppler ultrasonography., Methods: Two hundred and sixty elderly diabetic patients and 206 normal subjects were enrolled in the study. Doppler ultrasonographic manifestations of lower limb arterial disease, blood pressure and blood biochemistry parameters including fasting plasma glucose (FPG), postprandial plasma glucose (PPG), TC, TG, HLD-C, LDL-C, apoprotein B (apoB), very low density lipoprotein cholesterol (VLDL-C), apoprotein A1 (apoA1) and fibrinogen (Fb) were compared between the 2 groups., Results: (1) The blood biochemistry parameters, including the levels of FPG, PPG, TC, TG, VLDL-C, LDL-C, apoB and Fb were higher in diabetic patients than in normal subjects, while HDL-C was lower (all P < 0.05). (2) The thickness of intima-media (IMT) in the lower limb arterial disease group was significantly increased and the presence of arterial stenosis and wall plaques more in diabetic patients [IMT in 205 cases (78.85%), atherosclerotic plaque in 241 cases (92.69%), multivessel disease (more than 2 vessels) in 60 cases (23.08%) and arterial stenosis in 89 cases (34.23%)] than in normal subjects [IMT in 37 cases (17.96%), atherosclerotic plaque in 51 cases (24.76%), multivessel disease in 27 cases (13.11%) and arterial stenosis in 3 cases (0.01%)], all P < 0.01. (3) Regression analysis showed that lower limb arterial disease was correlated with high level of LDL-C and low level of HDL-C., Conclusions: Arteriosclerotic plaque is one of the early manifestations in elderly diabetic patients and hyperlipidemia may provide the basis of its formation. Doppler ultrasonographic examination of lower limbarterial discloses the early arteriosclerotic changes of lower limb arterial disease in elderly patients and offers the basic data of indication for clinical treatment.

Objective: To investigate the relationship between syndrome differentiation of traditional Chinese medicine (TCM) and characteristic changes of vascular endothelial function in patients with diabetic arterial occlusion (DAO) of lower extremities., Methods: Forty patients with DAO were selected as trial group. Twenty patients among them were attributed to blood stasis syndrome (group A1), and the others were attributed to syndrome of pathogenic dampness-heat attacking the lower limb (group A2) according to syndrome differentiation type of TCM. Patients with diabetes (group B), arteriosclerosis obliterans (group C) and healthy people (group D) were observed as the control groups, respectively. There were 20 cases in each group. Endothelium-dependent dilation (EDD) and endothelium-independent dilation (EID) were measured by high resolution ultrasound in the 100 subjects and the changes of vascular tension factors were also studied., Results: The results showed that EDD in group A was reduced significantly as compared with that in the groups B, C and D. The levels of vascular contractile factors such as endothelin-1 (ET-1) and thromboxane B2 (TXB2) in group A were higher than those in the groups B, C and D, while the levels of vascular dilatory factors such as nitric oxide (NO) and 6-keto-prostaglandin F1alpha(6-Keto-PGF1alpha) were declined significantly as compared with those in the groups B and D. Linear correlation analysis showed that EDD was correlated positively with the levels of NO and 6-Keto-PGF1alpha, while the levels of ET-1 and TXB2 had negative correlation with EDD. EDD and EID in group A2 were declined significantly as compared with those in group A1., Conclusion: Our findings indicate that endothelial dysfunction may play an important role in the pathogenesis of DAO and may be associated with syndrome differentiation of TCM.

Objective: To explore the action mechanism of Tongxinluo Capsule (TXL) in protecting brain from ischemic damage., Methods: SD rats were divided into five groups randomly, the sham operation group, the model group, the MK-801 group, the large and low dosage TXL groups (TXLL and TXLS). After the middle cerebral arterial obstructive (MCAO) model was established, peritoneal injection of MK-801 0.5 mg/kg per day was given to the MK-801 group, and 1.0 g/(kg x d) and 0.5 g/(kg x d) of TXL powder was administered in twice via gastrogavage to the two TXL groups respectively. The nerve cell apoptosis rate, protein and mRNA expressions of Caspase-3, p53 and heat shock protein (HSP70) were observed using flow cytometry, Western blot and RT-PCR technique., Results: Both TXL and MK-801 could obviously lower the apoptosis rate in model rat (P < 0.05, P < 0.01), TXLL showed the optimal effect. Caspase-3, p53 protein and mRNA expression in the model group were obviously higher than those in the sham operated group. As compared with the model group, the expressions of Caspase-3 and p53 were lower and those of HSP70 and mRNA were higher in the two TXL and MK-801 groups (P < 0.05 or P < 0.01)., Conclusion: TXL displays it brain protective effect through reducing nerve cell apoptosis rate in MCAO model rats, the mechanism may be related to its actions in inhibiting apoptosis related factors Caspase-3 and p53, and promoting stress protecting factor HSP70.

Objective: To elucidate the incidence and risk factors of acute radial artery occlusion (RAO) following transradial percutaneous coronary intervention (TRI)., Methods: A total of 7215 patients who underwent TRI were divided into normal group and RAO group, according to whether the patient without and with RAO. Risk factors of RAO were analyzed by logistic regression model., Results: Acute RAO occurred in 68 patients (0.94%). As compared to the patients in normal group, there were more female and diabetes mellitus patients in RAO group. The dosage of heparin used in the operational procedure in RAO group were significantly less than normal group (3723 IU +/- 556 IU vs 7603 IU +/- 1533 IU, P < 0.01). The post-procedure duration of high-pressure compression hemostasis were longer in RAO patients than normal patients (103.8 min +/- 23.3 min vs 87.7 min +/- 31.2 min, P = 0.02). Logistic regression analyses showed that the dosage of heparin used in the procedure, the category and size of sheath and the post-procedure compression time were independent risk factors for RAO., Conclusion: The incidence of RAO can be minimized by appropriate anticoagulation, proper sheath selection, and avoiding prolonged duration of high-pressure compression hemostasis following the procedure.

Objective: To assess the value of magnetic resonance imaging (MRI) in mid- and long-term complication monitoring after liver transplantation., Methods: Twenty-one recipients receiving orthotropic liver transplantation between Feb 2003 and May 2005 were enrolled in this study. FLASH T(1)-weighted, T(2)-weighted fast spin echo, T(2)-weighted fat suppression, dynamic gadolinium-enhanced, MR cholangiopancreatography (MRCP) and three-dimensional dynamic gadolinium-enhanced FISP MRA images were obtained., Results: Of the 21 patients, bile duct complications were detected in all cases and liver arterial and venous complications in 8 cases. Liver cancer relapse occurred in 5 cases and allograft failure in 4., Conclusion: MR imaging allows effective monitoring of mid- and long-term complications of liver transplantation, which provides valuable clues for their clinical treatment.

Objective: To explore the clinical feature and treatment efficiency of patients with early hepatic arterial insufficiency (HAI) and biliary complications (BC) following liver transplantation (LT)., Methods: The clinical data of 240 patients receiving LT from February 1999 to February 2004 were analyzed retrospectively. End-to-end choledococholocostomy was applied to 236 patients as the major biliary reconstructive method. Hemodynamic monitoring of the hepatic artery was performed to discover HAT, including hepatic arterial thrombosis (HAT) or hepatic arterial stenosis (HAS) in the first 3 months after transplantation., Results: In HAI Group, 7 cases of stricture of biliary tract and 4 cases of biliary leakage occurred; and 6 cases underwent endoscopic and/or intervention treatment, 4 cases underwent repair of anastomotic stoma and biliary drainage, 1 case underwent medication. Eight patients died and 3 were cured. A total of 32 patients (13.3%) developed biliary complications (BCs), Eleven of the 32 patients with BCs, biliary stricture in 8 cases and biliary leakage in 3 cases, had early HAI (HAI Group) with an incidence of 4.6% for BC with background of HAI (11/236). Another 21 patients with BCs (21/236, 8.7%) did not showed background of HAI (non-HAI Group). Preoperative serum total bilirubin levels were 373.3 +/- 93.9 micromol/L in HAI Group and 110.8 +/- 45.0 micromol/L in non-HAI Group (P = 0.008). Three cases with HAT underwent emergency thrombectomy then the hepatic arterial flow turned to normal. Two cases with HAS received short-term anticoagulant therapy. Recipients with BC underwent radiological and/or endoscopic interventional treatment (n = 6), surgical repair of leak site and biliary drainage (n = 4), and ordinary medication (n = 1). The 1 and 3-year survival rates of HAI Group were 54.6% and 16.4% respectively; both significantly lower than those of non-HAI Group (66.3% and 61.2%, both P = 0.042)., Conclusion: The recipients with BC following early HAI are associated with poor outcome. The monitoring protocol of hepatic hemodynamics by color dopplar ultrasonography should be enhanced, which contributes to urgent revascularization or recovery of hepatic hemodynamics. Interventional therapies should be immediately applied and transferred to surgical treatment or even retransplantation when necessary for patients with BC following early HAI.

Objective: To explore the diagnosis and management of early hepatic artery thrombosis (HAT) after liver transplantation., Methods: Routine examination of Color Doppler Imagine (CDI) was used to detect hepatic artery flow after liver transplantation in 220 cases from April 2001 to November 2004. Suspected patients were further confirmed by immediate hepatic artery angiography, and continuous infusion of urokinase through hepatic artery with catheter was performed to the patients with HAT., Results: HAT was identified in 6 patients (2.7%), occurring 5.5 days (2 - 19 days) after liver transplantation. Hepatic artery recanalization was obtained in 6 cases. One patient died from lung infection 2 months after liver transplantation. One patient underwent the second liver transplantation because of the recurrence of HAT 6 months after the first transplantation, but died from multiple system organ failure 2 months after the operation. The other 4 cases have been surviving well disease-freely., Conclusions: CDI is useful for the diagnosis of early HAT after liver transplantation. Contributes to recovery of the hepatic artery flow, continuous infusion of urokinase through hepatic artery with catheter may be the first choice of the therapy for early HAT.

Objective: To explore the pathological changes of lower extremity arteries of patients with metabolic syndrome., Methods: Fifty patients with metabolic syndrome (MS) and 30 normal volunteers were included in this study. The inner diameters, peak systolic velocities and intima-media thicknesses of the lower extremity arteries, and the sizes and numbers of the plaques in the lower extremity arteries were obtained with color Doppler ultrasound (CDU)., Results: In the fifty MS patients, the intima-media thicknesses of forty-one were thicker than 1.1 mm and thirty-three had plaques which had brought stenosis in different degrees. The intima-media thicknesses of the common femoral, popliteal and posterior tibial arteries in the MS patients were significantly thicker than those in the normal volunteers (P<0.01 or P<0.05), and a greater number of plaques in the lower extremity arteries were observed in the patients, as compared with the normal volunteers (P<0.01)., Conclusion: Various pathological changes had taken place in the lower extremity arteries of the MS patients. The sites and degrees of the lower extremity arterial diseases in MS patients can be definitely detected with CDU.

12 cases of subclavian arterial stenosis or obstruction were treated with percutaneous transluminal angioplasty (PTA). Atherosclerosis was considered as the cause of the arterial lesion in 7 cases. In 6 of them the lesion was located near the orifice of the subclavian artery. The lesion was 10.8 +/- 5.4 mm in length and 1.67 +/- 0.8 mm in diameter. After PTA the lumen was 6.58 +/- 1.11 mm in diameter. The clinical result was satisfactory. Arteries was found in 5 cases. Most of them had long segment obstructed lesion (46 +/- 36.6 mm in length, and 0.5 +/- 0.5 mm in diameter). The result of PTA was not satisfactory. The technique of PTA has been discussed.