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Uterine arteriovenous fistula is a rare but life-threatening gynecologic entity. Meanwhile, long-term radiation exposure will do serious harm to doctors' health. So we improve the operation method to reduce the radiation exposure time. The patient, a 24-years-old woman with a history of dilation and curettage, had long-term menorrhagia and anemia. Uterine arteriovenous fistula was confirmed by ultrasonography and computed tomography angiograph. Percutaneous anhydrous ethanol sclerotherapy was performed under the guidance of the X-ray imaging. The patient was followed up for 2 years without recurrence and had normal menstruation. Recently, she is successfully pregnant again. Percutaneous anhydrous ethanol sclerotherapy is a new option treating uterine arteriovenous fistula, which can greatly shorten the irradiation time and reduce the recurrence rate and has no obvious adverse effect on fertility.

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

Objective Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease characterized by localized progressive dilatation. Currently, paeonol has been shown to possess anti-inflammatory and protective cardiovascular properties. Our study aimed to investigate the potential influences of paeonol on AAA progression. Methods Experimental AAAs were created in C57BL/6J mice by intra-aortic infusion of porcine pancreatic elastase, and then intragastrically administered paeonol (20 mg/kg/day) for 14 days. The effects of paeonol on experimental AAA were measured by ultrasound imaging, histopathology, and western blot analyses. Results Paeonol treatment limited the enlargement of the aneurysmal diameter and alleviated the depletion of elastic fibers and vascular smooth muscle cells (VSMCs). Furthermore, the infiltration of CD68+ macrophages and CD8+ lymphocytes was obviously attenuated after paeonol administration, along with mural neoangiogenesis. Western blot results showed that paeonol inhibited the expression of matrix metalloproteinase (MMP) and the NF-κB pathway activation. Conclusions Paeonol might prevent experimental AAA progression by inhibiting the NF-κB pathway, which suggests that it is a potential drug for AAA.

Chronic inflammation plays an essential role in the pathogenesis of abdominal aortic aneurysm (AAA), a progressive segmental abdominal aortic dilation. Chemerin, a multifunctional adipocytokine, is mainly generated in the liver and adipose tissue. The combination of chemerin and chemokine-like receptor 1 (CMKLR1) has been demonstrated to promote the progression of atherosclerosis, arthritis diseases, and Crohn’s disease. However, chemerin-9 acts as an analog of chemerin to exert an anti-inflammatory effect by binding to CMKLR1. Here, we first demonstrated that AAA exhibited higher levels of chemerin and CMKLR1 expression compared with the normal aortic tissues. Hence, we hypothesized that the chemerin/CMKLR1 axis might be involved in AAA progression. Moreover, we found that chemerin-9 treatment markedly suppressed inflammatory cell infiltration, neovascularization, and matrix metalloproteinase (MMP) expression, while increasing the elastic fibers and smooth muscle cells (SMCs) in Ang II-induced AAA in ApoE−/− mice. This demonstrated that chemerin-9 could inhibit AAA formation. Collectively, our findings indicate a potential mechanism underlying AAA progression and suggest that chemerin-9 can be used therapeutically.

Hepatitis B virus (HBV) X protein (HBx) is a key regulator of HBV-associated hepatocarcinogenesis. C-terminal-truncated HBx is frequently detected in hepatocellular carcinoma (HCC). The role of HBx, especially C-terminal-truncated HBx, in HCC pathogenesis has been controversial. To elucidate the biological role of C-terminal-truncated HBx underlying HBV-associated hepato-oncogenesis, we constructed a vector expressing HBx-C30 (deletion of 30 aa from the C terminus of HBx) and functionally analyzed its regulation on farnesoid X receptor (FXR) signaling, which is known to inhibit hepatocarcinogenesis. In the present study, we found full-length HBx and HBx C-terminal truncation coexist in HCC, and both full length HBx and HBx-C30 can activate FXR signaling. Moreover, HBx-C30 weakly coactivates FXR-KNG1 signaling compared to full-length HBx.

Epigallocatechin-3-gallate (EGCG) is a kind of polyphenol compound, called catechin, and is extracted from green tea. EGCG has a wide range of biological activities. The present study aimed to evaluate the effect of EGCG on neointimal hyperplasia in a rat model of carotid artery balloon injury and to explore the molecular mechanisms involved. Various experiments were performed to assess the effects of EGCG on thickening of neointima, expression levels of high mobility group box 1 protein (HMGB1) and receptor of advanced glycation end products (RAGE), the inflammatory response, oxidative stress and activation of nuclear factor (NF)-κB. Results demonstrated that EGCG decreased the intimal area and the ratio of intimal area/medial area compared with the balloon injury group. The expression levels of HMGB1 and RAGE induced by balloon injury were markedly inhibited by EGCG treatment. Furthermore, the inflammatory response and oxidative stress damage, which have close correlations with HMGB1, were restrained by EGCG. Finally, EGCG treatment markedly inhibited NF-κB activation. The present data provided evidence that EGCG attenuates neointimal hyperplasia in a model of carotid artery balloon injury, which indicated that EGCG may serve as a potential drug for restenosis in clinics.

Tumors arising from or secondarily involving the vena cava (VC) are broad-spectrum diseases, ranging from benign to malignant. The benign tumors include myxoma, leiomyomatosis and leiomyoma. The primary malignant tumors of the VC are rare, and of these rare entities, leiomyosarcoma is the most frequently encountered. The direct extension of a tumor arising from an adjacent organ such as hepatocellular carcinoma or renal cell carcinoma is more common than primary malignant tumor in the inferior VC. In this article, the authors review the spectrum of VC pathologic processes and the relevant findings from magnetic resonance imaging, ultrasonography, and computed tomography.

To evaluate the efficacy and clinical outcomes of endovascular treatment for superior mesenteric artery dissection (SMAD) and its effect on superior mesenteric artery (SMA) remodeling compared with medical management alone after successful initial medical management.In this retrospective analysis, all patients with spontaneous SMAD at a single institution were identified from March 2007 to August 2019. The primary outcomes were freedom from major adverse events (MAEs, a composite of dissection-related death, the recurrence of mesenteric ischemia symptoms, and a requirement for intervention). The secondary outcomes were morphologic remodeling of the dissections and stenosis or occlusion of the SMA.A total of 94 patients with SMAD who underwent successful initial medical management (91 males; mean age, 50.4 ± 6.3 years) were enrolled in the study. Fifty-seven (60.6%) received medical management alone, and 37 (39.4%) underwent endovascular repair after initial medical management. In the endovascular group, the technical success rate was 86.5% (32 of 37). During a mean follow-up period of 33.6 ± 26.2 months (range, 1-120 months), nine (9.6%) patients experienced a recurrence of abdominal pain, and six had additional interventions for SMAD. The patients in the endovascular group showed more complete or partial remodeling (22 [81.1%] vs 24 [44.4%]; P .0001) or unchanged dissections (5 [13.5%] vs 23 [42.6%]; P = .0001) than those in the conservative group. Survival analysis showed that the estimated MAE-free survival rates were 95.6%, 88.9%, and 85.4% at 1, 3, and 5 years, respectively. There was a higher freedom from SMA stenosis or occlusion in the endovascular group (log rank P = .046).Endovascular treatment and medical management alone result in similar MAE-free survival for patients with SMAD after successful initial medical management. Moreover, endovascular therapy is associated with a higher complete remodeling rate and greater freedom from SMA stenosis or occlusion.

Background Deep vein thrombosis (DVT) is a rare cause of arteriovenous fistula (AVF). The pathogenesis of acquired AVF after DVT remains unclear, and publications focusing on therapy and follow-up are also inadequate. In this study, the diagnosis and treatment of 24 patients with acquired AVF in the lower extremity after DVT was reported. Methods This is a retrospective study. We studied 24 patients with acquired AVF after DVT who were screened by ultrasound and confirmed by arteriography or computed tomographic arteriography (CTA) in our hospital. Treatments included simple compression therapy (SCT), venous hypertension-relieving therapy (VHRT) and transarterial embolization; VHRT included iliac vein stenting and Palma-Dale surgery (fem-fem bypass). Results All 24 patients exhibited symptoms in the left lower extremity including swelling (24 cases, 100%), pain (14 cases, 58.33%), pigmentation (13 cases, 54.17%) and ulcers (8 cases, 33.33%). No cardiac enlargement or cardiac insufficiency was reported in any case. The initial ultrasound screening suggested PTS in all 24 cases, with arterialized waveform in veins in 24 cases and high-velocity turbulent flow within the fistulas in 16 cases. The AVF recurrence rate of embolization was 66.7% (4/6). In 7 patients who underwent SCT, the circumference difference of bilateral lower limbs at the 1-year follow-up was not significantly different from that before treatment (thigh, P=0.413; calf, P=0.478). In 14 patients who underwent VHRT, the circumference difference of bilateral lower limbs at the 1-year follow-up was significantly smaller than that before treatment (thigh, P=0.000; calf, P=0.001), and the follow-up difference value of the Venous Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL) scores was significantly higher than that in the SCT group (1 month, P=0.012; 6 months, P=0.000; 1 year, P=0.000; 2 years, P=0.003). Conclusions Ultrasound plays an important role in screening and diagnosing AVF. Iliac vein obstruction rather than AVF was most likely the primary cause of the symptoms. Due to the high recurrence rate of DVT, transarterial embolization of AVF is not effective; thus, VHRT should be recommended as the preferred treatment.

Aims: Aortic mural inflammatory damage takes a vital part in abdominal aortic aneurysm (AAA). Recently, ulinastatin (UTI) has attracted attention for its anti-inflammatory function. Our study aimed to evaluate potential influences of UTI on experimental AAA. Methods: A mouse model of AAA was induced by infusion of porcine pancreatic elastase (PPE) into the abdominal aorta. Mice were treated with UTI (50,000 U/kg/day i.p.) beginning either immediately or on the 4th day after PPE infusion, with treatment being continued until the 14th day. UTI effects were assessed by aortic diameter measurements and aortic histopathological analysis. Results: Significant and time-dependent aortic diameter enlargement persisted in the control mice from day 0. In the UTI group, aortic diameter increased, and depletion of aortic mural smooth muscle cells and elastin was significantly ­attenuated. Simultaneously, mural CD68+ macrophages, CD8+ T-cell and B220+ B-cell density, as well as neoangiogenesis were suppressed by UTI. In addition, delayed UTI treatment could still effectively limit aneurysm expansion. Conclusions: UTI treatment limits the formation and growth of experimental AAA, and UTI may be a potential treatment for early AAA disease.

Introduction: Cases of May–Thurner syndrome associated with pelvic arteriovenous fistula (AVF) are uncommon. All the treatments reported are embolizations. The efficacy of recanalization of the left common iliac vein (CIV) in treatment of such cases is reported. Report: The case of a 78 year old man with co-existing May–Thurner syndrome and pelvic AVF confirmed by computed tomography angiography and arteriography is reported. Treatment by recanalization of the left CIV followed by a bare stent was selected instead of embolizing the AVF; a good result was obtained. Discussion: Recanalization of the left CIV by an endovascular technique can be an effective treatment for May–Thurner syndrome associated with AVF. Keywords: May–Thurner syndrome, Cockett syndrome, Arteriovenous fistula, Venous thrombosis

The aim of this study was to evaluate the clinical results of lateral subfascial endoscopic perforating vein surgery (SEPS).Our study was conducted from February 2002 to January 2007. Sixty-three patients with lateral incompetent perforating veins (IPVs) and venous ulceration were allocated to two groups. Group 1 comprised 31 patients (33 limbs) who underwent only routine surgery (saphenofemoral or saphenopopliteal ligation, stripping, phlebectomies, endovascular laser treatment [EVLT], medial SEPS, and skin grafting). Group 2 comprised 32 patients (35 limbs) who underwent our routine surgery with the addition of lateral SEPS. Bidirectional ultrasonography was performed before the operation, and 6 weeks, 6 months, and 1 year after surgery. Clinical score and disability score were collected at the same time.Twenty-nine (87.9%) of 33 limbs with active ulcers in group 1 healed, with recurrence in four (12.1%) limbs at follow-up at 25.9 +/- 10.0 months. All 35 limbs in group 2 healed, with recurrence in 0 (0.0%) limbs at follow-up at 25.4 +/- 10.1 months. Lateral SEPS could reduce the rate of recurrence of ulcers (Kaplan-Meier analysis). Patients in group 2 also showed improvement in clinical and disability scores, although they were not statistically significant differences (t test, p0.05). A significantly higher proportion of patients in group 1 had IPVs on the lateral aspect of the lower leg on ultrosonography imaging.Lateral SEPS could contribute to ulcer healing and reduce ulcer recurrence. The addition of lateral SEPS to routine surgery did reduce the number of IPVs. Lateral SEPS may be safe and effective for lateral perforating vein incompetence and venous ulceration.

Objective: To determine the short- and long-term effect of bone marrow stromal cells (BMSCs) transplantation as a treatment for breast cancer-related lymphedema. To contrast it with complex decongestive physiotherapy (CDT). Methods: Fifteen women with lymphedema, who had undergone breast cancer surgery and/ no radiotherapy 5 years before, served as the experimental group and received BMSC transplantation; 35 patients were measured as the control group treated with CDT. They were kept on follow-up for 1 year. Results: Two patients in the CDT Group failed to keep follow-up. Before treatment, patients had average volume of edema in the affected arm of 1166.2 ml in BMSC Group and 1091.0 ml in the CDT Group. With therapy, there was an average decrease in lymphedema volume of 730.7, 887.9 and 958.6 ml in the BMSC Group and 714.8, 657.9 and 571.3 ml in the CDT Group after 1, 3 and 12 months, respectively. Before treatment, the percentage of lymphedema was 28.6% in the BMSC Group and 26.8% in the CDT Group. After treatment, there was a decrease of 64.6, 78.5 and 81.0% in the BMSC Group and 67.2, 60.4 and 54.5% in the CDT Group after 1, 3 and 12 months, respectively. When asked to quantify subjectively their pain on a numeric scale from 0 to 5, the average score of these patients was 3.4 in the BMSC group and 4.0 in the CDT Group. The average score was reduced to 1.6, 0.8 and 0.6 in the BMSC Group and to 1.2, 1.7 and 1.6 in CDT Group after 1, 3 and 12 months, respectively. Conclusions: Autologous BMSCs transplantation for the treatment of breast cancer related lymphedema is effective and feasible.

Leiomyomas are benign smooth muscle tumors. A leiomyoma originating from the vein is rare. We describe a primary femoral vein tumor that was diagnosed as an unusual leiomyoma in a 50-year-old woman. It was the first reported leiomyoma in the femoral vein in English studies. We have reviewed the studies on leiomyoma from the blood vessel and summarized their characteristics, therapies, and prognosis.

Severe acute pancreatitis (SAP) is an extremely dangerous acute abdominal disorder which causes multiple complications and has a high mortality rate. Previous research has suggested that high-mobility group box 1 (HMGB1) plays an important role in the pathogenesis of SAP; however, the mechanisms underlying this strong correlation remain unclear. In this study, to further investigate whether HMGB1 acts as a stimulating factor, and whether Toll-like receptor 4 (TLR4) acts as its major mediator in the development of pancreatic injury during SAP, recombinant human HMGB1 (rhHMGB1) and TLR4-deficient mice were used. We found that HMGB1 and TLR4 were highly expressed, and nuclear factor-κB (NF-κB) was activated in our mouse model of SAP. We noted that the rhHMGB1 pancreas-targeted injection activated the TLR4-mediated NF-κB signaling pathway and induced pancreatic injury in wild-type mice. In TLR4-deficient mice, the rhHMGB1-induced activation of NF-κB and pathological changes in the pancreas were less evident than in wild-type mice. Therefore, this study provides evidence that HMGB1 promotes the pathogenesis of pancreatitis, and its downstream TLR4-mediated NF-κB signaling pathway is a potential important mediator in the development of this form of pancreatic injury.

The aim of this study was to evaluate the initial results of 41 patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis, with regard to the clinical safety and feasibility of the therapeutic approaches selected according to the classification of the condition. Forty-one patients with BCS and IVC thrombosis were admitted for retrospective analysis. All 41 patients were classified as having one of three types of BCS. Interventional therapy was used successfully in 28 patients (68.3%), 7 patients (17.1%) were given conservative treatment and 6 patients (14.6%) were treated with surgical shunts. The interventional approach was used in 29 patients in total and was successful in 28 patients (all those of types I and II, and 3 of the 4 patients of type III with acute thrombosis; 96.6%). None of these 28 patients had pulmonary embolism, pericardial tamponade or intra-abdominal bleeding. After 1–5 years, 4 patients (9.8%) had a second dilation of the IVC. In the 7 cases treated in a conservative manner, 2 cases succumbed to upper gastrointestinal bleeding and 1 case succumbed to liver and kidney failure. This study indicates that the classification of BCS patients with IVC thrombosis is helpful in selecting a therapeutic approach. Interventional therapy is the first therapeutic choice for BCS patients with IVC thrombosis of type I, type II or type III with acute thrombosis. For the patients of type III with an obsolete thrombus, surgical shunts or conservative treatment are the main therapeutic methods.

The objective of this study was to evaluate the clinical effect of endovascular treatment on postoperative blood pressure (BP) control and kidney function of hypertensive patients with renal artery stenosis (RAS). Between January 2004 and December 2011, RAS was diagnosed in 120 renal arteries from 115 hypertensive patients. Preoperative and postoperative BPs and glomerular filtration rate (GFR) were monitored. Postoperative oral antiplatelet and antihypertensive agents were administered. Clinical follow-up was available for all patients for at least 6 months. Balloon angioplasty was performed successfully in 110 patients, and stents were deployed in 94 renal arteries from 89 patients. Hypertension was cured and lessened in 19 and 61 patients, respectively. Blood pressure was stable and worsened in 26 and 9 patients, respectively. The renal function was improved and stable in 23 patients and 57 patients, respectively. Deterioration of renal function was observed in 11 patients. Doppler ultrasound after discharge revealed 87 patent renal arteries and fixed stents in 82 patients 6 months after procedure. Balloon angioplasty and stent deployment are effective and feasible procedures for patients with RAS that help in controlling BP and improving renal function moderately.

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment. Clin. Anat. 25:986–988, 2012. © 2012 Wiley Periodicals, Inc.

Objective: We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. Materials and Methods: The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and posttreatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. Results: A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in fi ve iliac veins. Clinically signifi cant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During followup (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular refl ux occurred in 24 (21%) limbs. Conclusion: Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous fl ow in patients with non-acute lower extremity deep venous thrombosis. Index terms: Non-acute lower extremity deep venous thrombosis; Catheter-directed thrombolysis; Stent placement; Bleeding complication; Post-thrombotic syndrome

Transplantation of adult marrow stromal cells (MSCs) has been developed as a new method of treating severe ischemia diseases by therapeutic angiogenesis. Erythropoietin (EPO) is capable of inducing angiogenesis and inhibiting MSCs apoptosis. The effect of EPO on the therapeutic potency of MSCs transplantation in a rat model of limb ischemia was investigated in the current study. The results indicate that the combined treatment with MSC transplantation and EPO infusion is superior to MSC transplantation alone in the treatment of limb ischemia. MSCs transplantation and EPO infusion could enhance the angiogenic effect of each other to achieve a better therapeutic effect. This combination therapy may become a more effective approach for ischemia diseases of the limbs.

Heart rate (HR) variability immediately prior to the onset of a spontaneous ventricular tachycardia or ventricular fibrillation (VT/VF) may be higher. Power spectral estimation using periodogram technique was performed on HR obtained from 135 sets of 1000 RR intervals that preceded spontaneous onset of VT/VF and 125 control sets. Ten frequency bands, each of 0.1 Hz bandwidth were analyzed. Time course analysis of spectral power was also performed at 7 non-overlapping segments of 100 samples (50 seconds) each prior to time of onset of VT/VF (ONSET) and on control data sets. The RR interval rhythms associated with ONSET had higher power in all spectral bands compared to the control group (p