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NL003 is a plasmid engineered to simultaneously express two isoforms of hepatocyte growth factor. This phase II study was performed to assess the clinical safety and efficacy of intramuscular injection of NL003 in critical limb ischemia (CLI) patients for 6 months. Two hundred patients (Rutherford scale 4-5) were randomly assigned: placebo (n = 50), low-dose NL003 (n = 50), middle-dose NL003 (n = 50), or high-dose NL003 (n = 50). The drug was administered in the affected limb of 197 patients on days 0, 14, and 28. No significant differences in the incidence of adverse events (AEs) or serious AEs were found among the groups. At 6 months, pain severity was significantly reduced in all NL003 groups, but not in the placebo group (p 0.05). The proportion of patients with complete ulcer healing in the high-dose group was significantly higher than that of the placebo group (p = 0.0095). There were no statistically significant differences in transcutaneous oxygen pressure (TcPO

International audience; Exertional lower limb pain is a frequent diagnostic issue in elderly patients. Arterial claudication results from the mismatch between the oxygen requirement of, and oxygen delivery to the exercising muscles. Non-invasive vascular investigations (ultrasound imaging, plethysmography or segmental pressure) are used in routine at rest or following exercise, but none can be used during walking or to directly monitor cutaneous oxygen delivery to the limb. Here, we review the methods, tips and traps of the transcutaneous oxygen pressure measurement technique and potential applications.Transcutaneous oxygen pressure measurement is largely used in vascular medicine for patients with critical limb ischemia. It can also detect regional blood flow impairment at the proximal and distal limb simultaneously and bilaterally during exercise. Exercise-oximetry can also analyze systemic oxygen pressure changes on a reference area on the chest, to screen for occult pulmonary disease. As a surface technique, it does not directly measure muscle oxygen content but provides a reliable estimation of regional blood flow impairment.With the use of a recently reported index that is independent of the unknown transcutaneous gradient for oxygen, exercise-oximetry provides some accurate information compared to classical non-invasive vascular investigations to argue for a vascular or non-vascular origin of exertional lower limb pain during exercise. Although a time consuming technique, it is a simple test and it is progressively spreading among referral vascular centers as a useful non-invasive diagnostic tool for patients suspected of arterial claudication.

Background Despite increased interest in treating common femoral artery (CFA) with endovascular technology, there are little data regarding the long-term outcomes of different endovascular treatment modalities. We report the results after endovascular therapy of symptomatic obstructions of the CFA in a single center. Methods We retrospectively reviewed the records of consecutive patients with eligible CFA lesions who were treated with endovascular methods between 2011 and 2013. The preoperative demographic operative details and postoperative outcomes were compared and statistically analyzed. Results Ninety patients with CFA lesions were treated, and 76 (84.4%) completed a follow-up. Claudication was present in 62 of 76 (81.6%) patients, and stenosis was present in 60 of 76 (78.9%) patients. Angioplasty was performed in 45 patients, and atherectomy was performed in 31 patients. There was no significant difference in the preoperative demographic data, procedure time, contrast administration, or length of hospital stay between the 2 groups. In-hospital treatment costs were significantly higher in the atherectomy group (69,822 RenMinBi Yuan vs. 49,078 RenMinBi Yuan; P = 0.043). During the 4-year primary patency, for whole group or bifurcated/claudicant subgroup, all patients within the atherectomy group were significantly better than those in the angioplasty group. Conclusions Atherectomy may be a better alternative to angioplasty for CFA atherosclerotic obstructions lesions. Compared with angioplasty, atherectomy seems to have better results in bifurcated lesions or claudicant patients. In diabetic patients, no superiority was found on either patency or improvement in walking distance.

Background Patients presenting a carotid stenosis and contralateral carotid occlusion (CCO) have been historically considered at high risk of carotid surgical treatment, and there are few data regarding short-term recovery after stenting therapy in patients with CCO. The aim of this study is to evaluate the short-term recovery and safety of stenting for patients with CCO and different subgroup population. Methods We retrospectively reviewed the records of consecutive patients with CCO who were treated with stenting endovascular methods between 2008 and 2014. The postoperative outcomes were analyzed according to age, ischemic symptom, cerebral infarction history, and collateral situation subgroups, respectively. Results Fifty-eight consecutive patients with CCO were treated and 49 (84.5%) completed a 3-year follow-up. There were significant higher stroke, myocardial infarction, or death events in the aged (≥75 years old) group and poor collateral group (P = .007 and .0024, respectively). There was no difference in the 3-year primary endpoint incidence between the cerebral ischemia symptom subgroups and cerebral infarction history subgroups. Event-free survival, aged group, and poor collateral group were lower (P = .007 and P = .0024, respectively). Conclusions Carotid artery stenting (CAS) for patients with common carotid artery is a safe and effective therapy. Factors such as age 75 years or older and poor collateral are associated with a higher 3-year rate of postprocedural stroke, myocardial infarction and death, and lower event-free survival in patients with CCO treated by CAS. Meanwhile, our data do not show a significant impact of cerebral ischemic symptom and cerebral infarction history on clinical outcome of patients with CCO undergoing CAS.

Background: Drug-coated balloons (DCBs) have shown promising results in treating femoropopliteal artery lesions while data on infrapopliteal lesions are controversial. We undertook this clinical trial to compare the safety and efficacy of DCBs versus uncoated balloon percutaneous transluminal angioplasty (control) of de novo or recurrent steno-occlusive lesions of the infrapopliteal arteries in patients with critical limb ischemia. Methods: In this prospective multicenter single-blind randomized study, 120 patients were randomized to the DCB group (Litos/Tulip, Acotec Scientific; n=61) or control group treated with uncoated balloons (n=59) in 11 centers in China from May 22, 2014, to June 13, 2018. Follow-up was scheduled at one and six months and included angiographic assessment at six months. Adverse events were assessed by an independent clinical events committee, angiographic parameters by an independent core laboratory. The study is registered at ClinicalTrials.gov, number NCT02137577. Findings: Regarding the primary safety endpoint (composite of all-cause mortality, target extremity major amputation, and target lesion revascularization at 30 days), there was one event (1·6%) in the DCB group and none in the control group (p=0·33). The primary efficacy endpoint-primary patency (defined as absence of target vessel occlusion, major amputation, or target lesion revascularization) at six months was accomplished in 77·1% [95% Cl 65·2%-89%] of the DCB group and 28·3% [95% Cl 15·3%-41·3%] of control group (p

Background Patients undergoing carotid artery stenosis who are prescribed aspirin, clopidogrel, or sarpogrelate as treatment options to inhibit platelet aggregation continues to increase. The purpose of this study was to compare the efficacy and safety of clopidogrel combined with aspirin (CA) versus sarpogrelate combined with aspirin (SA) treatment in carotid endarterectomy (CEA) patients. Methods This retrospective study included 197 CEA patients (mean age 61.4 years, mean follow-up time 42.5 months), who were divided into a CA group (Group A: 65 male and 44 female patients) and an SA group (Group B: 58 male and 30 female patients). Preoperative demographic and clinical characteristics and postoperative results were compared between the 2 groups and statistically analyzed. Results Preoperative demographic and clinical characteristics, transfusions, hospital stay, occurrence of transient ischemic attack, stroke, myocardial infarction, restenosis, general or life-threatening bleeding, and 30-day mortality showed no significant differences between the 2 CEA patient groups. However, the mean operative blood loss ( P = 0.023) and the operative time ( P = 0.040) were significantly higher in Group A compared with Group B. A highly significant incidence of neck hematoma ( P = 0.024) was observed in patients of Group A. Conclusions In this study on CEA patients, antiplatelet treatment with CA resulted in a significant risk of developing neck hematoma, increased operative blood loss, and operative time compared with SA treatment. Long-term prospective studies with larger study populations are needed to further confirm the utility of SA treatment for CEA patients.

Background Extracranial carotid artery aneurysm is an extremely rare peripheral arterial aneurysm. The treatments of extracranial CAAs include open surgical, endovascular, and conservative options. Main surgical indications are transient ischemia attacks, strokes, or progressive growth. But both open surgery and endovascular repair have disadvantages and complications. Methods We report a case of true internal carotid artery aneurysm (ICAA) with hostile anatomic conditions for both open surgery and endovascular approach in a 53-year-old man who presented with new cerebral infarctions. According to the features of this case, the patient was treated with a new hybrid procedure with extra-luminal aneurysm repair. A sheath was inserted through the common carotid artery, maneuvered out of the lumen through the proximal landing zone of the ICAA, and then returned into the distal normal vessel of the internal carotid artery. A stent graft was delivered through the sheath and was deployed while retrieving the sheath. Results The aneurysm was repaired successfully with an uneventful postoperative course and no postprocedural complications. The patient has been followed up for 2 years with no symptom, and the stent was patent without restenosis. Conclusions The procedure is feasible and provides a new solution for difficult cases like this.

Deep venous thrombosis rarely occurs in conjunction with other vascular anomalies, and is therefore an understudied area. Although arteriovenous fistulae (AVFs) most commonly arise from congenital defects or as a result of trauma, some reports suggest that they may form in association with thrombosis of cerebral veins. In this report, we present a case of acquired pelvic and lower extremity AVFs following left common iliac vein thrombosis. The special feature of this case is that the patient received a series of treatments of which recanalization resulted in best clinical outcome. As a result of long-term follow-up (5 years), this case allows for a better understanding of the natural progression of this rare disease.

Budd-Chiari syndrome (BCS) is a rare but life-threatening disease. If not treated promptly, it is almost always lethal with progressive liver failure, severe nutritional depletion, and renal failure at the late stage. We report the successful treatment of a 5-year-old boy with BCS due to a stenosis of the inferior vena cava (IVC) with a 26-year follow-up. We performed a percutaneous transluminal angioplasty, which resulted in a great improvement of BCS and the disappearance of ascites. Restenosis occurred at 25 years after the initial angioplasty, for which balloon angioplasty was repeatedly performed. The IVC was patent at 1-year follow-up after the second angioplasty.

Le traitement du syndrome de Budd-Chiari est bien etabli. Pour les lesions localisees habituelles, l’angioplastie transluminale percutanee ou le stenting est le traitement de premiere intention. Des methodes de traitement des malades severement atteints chez qui une intervention a echoue ou ceux en mauvais etat general doivent etre evaluees. De fevrier 2002 a juillet 2008, 31 malades nous ont ete confies. Dix-huit malades avaient un echec therapeutique, 4 avaient ete operes, et 10 avaient eu un traitement conservateur. Tous avaient une l’ascite refractaire ou/et des hematemeses. Les procedures utilisees dans cette serie ont inclus un shunt mesenterico-cavo-atrial chez 10 malades, un traitement radical chez 9 malades, un shunt mesenterico-cavo-jugulaire chez 7 (y compris 2 shunts mesenterico-jugulaires), un shunt mesenterico-cave chez 2 malades, un shunt cavo-atrial chez 2 malades (y compris la revision d’un shunt cavo-atrial), et un shunt cavo-jugulaire. La mortalite chirurgicale et les complications postoperatoires etaient de 3,2%. Vingt-huit malades ont eu un suivi moyen de 40 mois. Les resultats du suivi etaient mesures comme excellents, bons, moyens, mauvais, et le deces (respectivement 28,6%, 53,6%, 10,7%, 3,6%, et 3,6%). La mortalite totale du groupe est de 6,5%. Apres evaluation et preparation preoperatoires appropriees, un traitement actif et prudent adapte a la maladie fondamentale peut aider les malades ayant un syndrome de Budd-Chiari severe.

Therapy for patients with Budd-Chiari syndrome is well established. For those with commonly seen localized lesions, percutaneous transluminal angioplasty or stenting is the first-line treatment. Treatment methods for severely ill patients in whom intervention has failed, or those in a poor general condition, are worth exploring. From February 2002 to July 2008, 31 patients were referred to us. Eighteen patients had a failed intervention, 4 had undergone surgery, and 10 had conservative therapy. All had intractable ascites or/and hematemesis. The procedures carried out in this series included mesocavoatrial shunt in 10 patients, radical correction in 9, mesocavojugular shunt in 7 (including 2 mesojugular shunts), mesocaval shunt in 2, cavoatrial shunt in 2 (including a revision of cavoatrial shunt), and cavojugular shunt in 1. Surgical mortality and postoperative complications were both 3.2%. Twenty-eight patients had a mean follow-up of 40 months. Outcome of follow-up was measured as excellent, good, fair, poor, and death (28.6%, 53.6%, 10.7%, 3.6%, and 3.6%, respectively). The total mortality of the group is 6.5%. After appropriate preoperative evaluation and preparation, active and cautious treatment individualized to the underlying disease may help severely ill patients with Budd-Chiari syndrome.

Endothelial cells (ECs) detachment under high shear stress at the early period of transplantation resulted in thrombosis and occlusion. To solve this problem, we developed a novel bioreactor. The bioreactor mimicked the formation of pulsatile flow in physiological conditions. Human umbilical vein ECs were seeded onto the lumen of living tissue conduits grown within dog peritoneal cavity. The shear stress generated by the bioreactor was increased step by step from 1.5 ± 0.8 dyn/cm2 to 5.3 ± 2.4 dyn/cm2, and was applied to ECs after static culture for 2 days. The results showed that completely confluent monolayer ECs were elongated, and were oriented parallel to the flow direction. The bioreactor could provide good environment for formation of endothelium. Stepwise increase shear stress could strengthen cell–cell and cell–extracellular matrix. The flow conditions of the bioreactor play a key role to determine the quality of the ECs lining.

We cultured bone marrow-derived endothelial progenitor cells by a simple ex vivo expansion method and observed the expansion efficacy. Bone marrow mononuclear cells from five mongrel adult dogs were cultured with EGM-2MV medium in culture flasks coated with fibronectin. Morphology was observed with phase contrast microscopy, and a growth curve was constructed to evaluate the efficacy of expansion. Incorporation of Dil-ac-LDL was tested to evaluate the function. At different time points, immunocytochemical staining for flk-1, CD133, and factor VIII-related antigens was done and compared to staining of endothelial cells and mesenchymal stem cells and percentages of CD133, vascular endothelial growth factor receptor 2 (VEGFR-2), and the double-positive cells measured with flow cytometry to identify the quality and efficacy of expansion. Cluster-like attached cells grew to confluence at an average time of 10 days, and the mean number of cells harvested from 1 mL of bone marrow was (1.3 +/- 0.3) x 10(6). The cells presented a cobblestone-like appearance and took up Dil-ac-LDL. Immunocytochemistry showed that flk-1, CD133, and factor VIII-related antigens were positive. Flow cytometry showed that VEGFR-2 and CD133 double-positive cells augmented 242-fold at the tenth day. Ex vivo expansion can effectively proliferate endothelial progenitor cells from bone marrow; the expansion efficacy could meet the requirements for tissue engineering of blood vessels.

As initial step for developing tissue-engineered vascular autografts, a novel series of biodegradable aliphatic–aromatic copolyesters were synthesized and tubular scaffolds were fabricated. Cytotoxicity, adhesion and growth of different kinds of cells on the polyester films and in vivo biocompatibility have been evaluated. The results indicate that these copolyesters possess good biocompatibility. Canine bone marrow cells were seeded on the scaffolds and cultured in a bioreactor for 3 days. A confluent, adherent monolayer bone marrow cells was observed in the scaffold lumen. All the testing results suggest that these copolyesters might ultimately find applications for vascular tissue engineering.

Mesenchymal chondrosarcoma (MCS) is an infrequent malignancy of bone and soft tissue that is characterized by a peculiar bimorphic histologic pattern with areas of undifferentiated malignant small cells surrounding well-differentiated cartilaginous islands. Involvement of the large vessels is a rare occurrence. Here, we report a case of MCS arising from the femoral vein that was treated by wide-margin resection combined with autogenous vein revascularization and then followed up for 8 years. The long-term postoperative results showed distant metastasis to the pancreas and both lobes of the lung, without recurrence at the primary site. This case indicates that for MCS arising from the femoral vein, although wide-margin resection combined with autogenous vein revascularization may avoid recurrence at the primary site, this treatment strategy has no obvious benefit for controlling long-term distant metastases.

Treatment of subclavian artery aneurysm is typically performed as an open procedure. In recent years, the use of an endovascular approach has been reported. We experienced a case of subclavian artery aneurysm treated by simultaneous kissing stent technique. With fewer complications, this is a promising technique.

Background The treatment of portal hypertension caused by an occlusive lesion in the retrohepatic inferior vena cava and terminal portal venules is complicated because both portal and system venous flow are compromised. Methods A 47-year-old woman presented with this issue, and we reasoned that the only way to achieve successful management was to create a meso-cavo-jugular shunt. This patient was referred to us after undergoing a splenectomy for hypersplenism, which made her ascites intractable. She had a retrohepatic vena caval stenosis and noncirrhotic portal hypertension. Percutaneous transluminal angioplasty of the inferior vena cava stenosis failed. She underwent substernal placement of a 14-mm ringed GoreTex graft (WL Gore and Associates, Flagstaff, AZ) with end-to-side connections to the superior mesenteric vein, internal jugular vein, and vena cava. Result Her ascites resolved, and at follow-up 8 years later her graft was patent. Conclusion The meso-cavo-jugular shunt can simultaneously decompress both portal and systemic venous systems and is worth considering in the rare circumstance of suprahepatic vena caval obstruction coupled with occlusion of the portal venules.

L'ischemie cerebrale resultant de l'occlusion des quatre arteres cervicales a destinee cerebrale est une pathologie rare. Le pontage entre l'aorte ascendante et une ou deux des arteres carotides internes constitue une modalite therapeutique. Cependant, le syndrome de reperfusion postoperatoire reste une complication redoutable de ce type de procedure, potentiellement fatale. Le cas presente ici est original. Une patiente presentait un infarctus cerebral massif hemispherique gauche, des lesions des quatre arteres cervicales, ainsi qu'un syndrome de vol sous-clavier bilateral. Un pontage entre l'aorte ascendante et les deux arteres axillaires permettait la restauration d'un flux vertebral, avec pour consequence une amelioration clinique majeure. Au contraire des pontages entre l'aorte ascendante et le systeme carotidien qui augmentent directement la perfusion cerebrale, notre procedure permettait une amelioration du flux cerebral via les arteres axillaires. C'est pourquoi, nous recommandons l'usage du pontage entre l'aorte ascendante et les deux arteres axillaires chez les patients presentant une ischemie cerebrale consecutive a des lesions des quatre arteres cervicales associees a un vol sous-clavier bilateral inversant le flux des deux arteres vertebrales.

Cerebral ischemia resulting from four cervical arterial occlusions due to Takayasu's arteritis is a rare condition. Ascending aortounilateral/-bilateral internal carotid arterial bypass is a means for relieving it. However, postoperative reperfusion syndrome remains an unsolved severe, even fatal complication. The following case report reveals new findings. The patient presented massive cerebral infarction in the left cerebral hemisphere, four cervical arterial lesions, and bilateral subclavian steal syndrome. An ascending aorta to bilateral axillary bypass resumed the vertebral blood flow, and as a result the patient had a marvelous improvement. Unlike ascending aorta-carotid bypass, which directly increases brain perfusion, our procedure does so indirectly via axillary arteries. Therefore, there is strong reason to recommend ascending aorta to biaxillary bypass for patients with cerebral ischemia due to four cervical arterial lesions accompanying a bilateral subclavian steal phenomenon that has reversed vertebral flow.