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Objective The goal of the present study was to test the safety and efficacy of chemical stabilization of the arterial extracellular matrix as a novel nonoperative treatment of abdominal aortic aneurysms (AAAs) in a clinically relevant large animal model. Methods To achieve matrix stabilization, we used 1,2,3,4,6-pentagalloylglucose (PGG), a noncytotoxic polyphenolic agent capable of binding to and stabilizing elastin and collagen against the action of degrading enzymes. We first optimized the therapeutic PGG formulation and time of exposure by in vitro testing on porcine aortas using phenol histologic staining with iron chloride, elastic recoil assays, and PGG quantification as a function of tissue thickness. We then induced AAAs in 16 swine using sequential balloon angioplasty and elastase/collagenase and calcium chloride treatment of the infrarenal segment. We monitored AAA induction and development using digital subtraction angiography. At 2 weeks after induction, after the AAAs had reached ∼66% arterial expansion, the swine were randomly assigned to 2 groups. In the treatment group, we delivered PGG to the aneurysmal aorta endoluminally using a weeping balloon and evaluated the AAA diameters using digital subtraction angiography for another 10 weeks. The control swine did not receive any treatment. For the safety evaluation, we collected blood and performed comprehensive metabolic panels and complete blood counts every 2 to 3 weeks for all the animals. The swine were routinely monitored for neurologic and physical attributes such as behavior, inactivity, alertness, appetite, discomfort, and weight gain. After euthanasia and full necropsy, we analyzed the AAA tissue samples for PGG content, elastic recoil, and histologic features. Results In vitro, a single 2.5-minute intraluminal delivery of 0.3% PGG to the swine aorta was sufficient for PGG to diffuse through the entire thickness of the porcine arterial tissues and to bind with high affinity to the elastic lamellae, as seen by positive iron chloride staining, a reduction of elastic recoil, and an increase in PGG content. In vivo, the control swine AAA tissues were thickened and showed the typical aspects of AAA, including chronic inflammation, adventitial reactivity, smooth muscle cell proliferation, elastic lamellae degradation, and medial and adventitial calcification. Similar aspects were noted in the PGG-treated arteries, except for the lack of calcification and an apparent diminished hyperplasia. PGG treatment was effective in reducing AAA expansion and reversing the process of AAA dilation by reducing the aortic diameters to ≤30% by week 12 (P < .05). PGG was specifically localized to the aneurysmal segments as seen by histologic examination, the reduction of elastic recoil, and an increase in PGG content. PGG treatment did not affect the swine's neurologic or physical attributes, weight, blood chemistry, blood cells, or functionality of remote organs. The control, untreated swine exhibited progressive increases in AAA diameters up to a mean value of 104%. Conclusions Localized delivery of PGG to the aneurysmal aorta attenuated AAA growth and reversed the course of the disease in the swine AAA model. Such specificity for diseased tissue is unprecedented in nonoperative AAA treatment. This novel paradigm-shifting approach has the potential to revolutionize AAA management and save thousands of lives., Clinical Relevance Abdominal aorta aneurysm (AAA) is an asymptomatic chronic degenerative disease characterized by localized dilatation of the arterial wall caused by elastin and collagen degradation by proteases. We found that local delivery of 1,2,3,4,6-pentagalloylglucose (PGG) to a developing AAA in a swine animal model safely and effectively stabilized the vascular matrix, reduced AAA expansion, and promoted healing and AAA diameter reduction by limiting tissue degeneration. PGG is a noncytotoxic agent capable of rapid diffusion through arterial tissue and irreversible binding to elastin and collagen. PGG-mediated chemical stabilization of the aortic matrix could be used for safe nonoperative AAA management.

Objectives The aim of the present study was to review our institutional experience of endovascular treatment for isolated subclavian artery aneurysms and evaluate the long-term outcomes. Methods A retrospective review of all patients with isolated subclavian artery aneurysms who underwent endovascular treatment between March 2008 and March 2020 was performed. The demographics, aneurysmal characteristics, treatment strategies, and in-hospital and follow-up outcomes were recorded and then analyzed. Results From March 2008 to March 2020, 35 isolated subclavian artery aneurysms were endovascularly treated at our institution. Atherosclerosis was the most common cause of aneurysms in this series. Most aneurysms were intrathoracic (91.4%) and located at the right side (77.1%). There were 26 true aneurysms, seven pseudoaneurysms, and two ruptured isolated subclavian artery aneurysms. Five types of endovascular strategies were performed. Covered stent placement across the aneurysm was the most (54.3%) commonly used method. Technical success was achieved in all patients. The median postoperative in-hospital stay was 4.0 days (range, 1–15 days). One patient died after discharge but within 30 days of surgery due to myocardial infarction. The median follow-up time was 62.0 months (range, 3–132 months). No death, stroke, stent fractures, or severe upper limb ischemia developed during the follow-up period. The cumulative survival rate at five years was 97.1%. The overall complication rate was 25.7% and one-third of complications (8.6%) required reinterventions. Conclusions Endovascular treatment for isolated subclavian artery aneurysms is safe, effective and technically achievable in most patients. Short- and long-term outcomes are promising. Reasonable and flexible use of covered stents can also get satisfactory outcomes in some complicated lesions such as isolated subclavian artery aneurysms located at the origin of the right subclavian artery, avoiding the huge surgical trauma caused by conventional open repair.

IntroductionInferior vena cava (IVC) filters are commonly used in patients with venous thromboembolism to prevent fatal pulmonary embolism, but the thrombosis risk increases after filter placement. Warfarin is a widely anticoagulant, but long-term monitoring and dose adjustments are required. Anticoagulation with rivaroxaban is more straightforward as it dose not require laboratory monitoring. This study compares the efficacy and safety of rivaroxaban and warfarin as an in anticoagulation therapy for patients with IVC filter placement.Methods and analysisThis is a multicentre, randomised controlled trial. In total, 200 patients with deep vein thrombosis (DVT) with IVC filter implantation from 10 hospitals will be recruited. The patients will be randomised to the experimental group (rivaroxaban) or the control group (nadroparin overlapped with warfarin). The primary outcomes include death of any cause, pulmonary embolism (PE)-related death, bleeding and recurrent PE/DVT. The secondary outcomes include the percentage of other vascular events, IVC filter retrieval failure and net clinical benefits. This study aims to provide reliable, verification for the efficacy and safety of rivaroxaban antithrombotic therapy after IVC filter placement.Ethics and disseminationThe study was approved by the Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (approval number: (2019) 295). The results will be disseminated through presentations at scientific conferences and publications in peer-reviewed journalsTrial registration numberNCT04066764.

Objective The objective of this study was to evaluate the safety, efficacy, and outcomes of the conformable thoracic endograft (Conformable TAG Thoracic Endoprosthesis [CTAG]; W. L. Gore & Associates, Flagstaff, Ariz) for acute complicated and uncomplicated type B aortic dissection (TBAD). Methods Between February and October 2016, 52 consecutive patients with acute complicated or uncomplicated TBAD were treated with a CTAG device. We assessed safety, complications, and device conformability using intraoperative angiography and computed tomography angiography. The mean follow-up period was 8.2 ± 3.5 months (range, 4-12 months). Results All patients survived through the follow-up period. No endoleaks, retrograde aortic dissection, distal new entry tear, stroke, or paraplegia was observed postoperatively. Two patients (3.8%) experienced minor wound hematomas without further treatment. Eleven patients (21.2%) underwent a chimney technique to rebuild supra-arch vessels. A bird-beak configuration was observed in seven (13.5%) patients, five of whom underwent a chimney technique. Analysis of aortic remodeling showed that the minimal true lumen area significantly increased in both complicated and uncomplicated acute TBAD ( P P = .047, respectively). Likewise, the maximal false lumen area significantly decreased in uncomplicated dissection ( P = .006), but no change in maximal false lumen area was detected in complicated dissection ( P = .32). Conclusions Early outcomes indicate that the CTAG device provides reliable clinical effectiveness and excellent conformability in treating acute complicated and uncomplicated TBAD without risk of major complications. Studies with larger sample sizes and longer follow-up periods are required to evaluate longer term outcomes.

Introduction The nerve fibers innervating the annulus fibrosus are the major origin of degeneration-associated discogenic pain. Coblation is a tissue-dissociating technique in which the nerve fibers in the degenerative disc tissue are ablated. We hypothesized that coblation annuloplasty would be an effective maneuver for cervical discogenic pain without radiculopathy. Aim To observe the therapeutic efficacy of coblation annuloplasty in patients with cervical discogenic pain without radiculopathy. Material and methods Forty patients diagnosed with cervical discogenic pain without radiculopathy were screened for coblation annuloplasty therapy. The patient-rated visual analog scale (VAS) score for pain, significant pain relief rate, and Modified MacNab pain-relieving effect were adopted to evaluate the therapeutic effect within a 1-year follow-up period. Results Thirty-three patients eventually completed the study. The average pain duration was 4.6 ±1.6 years (range: 0.5-8 years). The mean VAS pain score decreased from preoperative 6.8 ±0.9 to postoperative 2.5 ±1.3 (p < 0.01). For all participants, the immediate pain relief rate was 78.7% (26/33), which continued to postoperative 6 months. One year later, 22 (66.6%) subjects reported that their pain was significantly alleviated. According to the Modified MacNab criteria, 63.6-82.1% considered the effect of surgery for their pain therapy as "excellent" during the 1-year follow-up period. No significant complications such as hemorrhage, paresthesia, or infection were observed. Conclusions This study is the first to demonstrate that coblation annuloplasty is an effective intervention providing significant alleviation of neck pain from cervical discogenic injury without radiculopathy.

Background The perfused elastase AAA model and subcutaneous Angiotensin II infusion AAA model are widely used murine AAA models. We modified these two current models and developed a new murine model to study aneurysm formation and rupture. Methods The murine abdominal aorta was treated with elastase. Angiotensin II was infused at a dose of 1,000 ng/kg/min via an osmotic pump placed subcutaneously. A saline osmotic pump was used as the control. The aortas were harvested from the mice 4 weeks later, or earlier if mice died. The abdominal aorta was inspected using ultrasound and microscopy for aneurysm formation and/or signs of rupture. The aneurysm outcome was measured using aortic expansion and proinflammatory cytokine expression. It was also compared with the established conventional elastase perfusion and angiotensin II infusion abdominal aortic aneurysm models. Results By day 28 after surgery, all abdominal aortas of mice treated in the modified group had dilated and progressed to abdominal aortic aneurysms with 60% ruptured aneurysms, whereas none of the control aortas treated with saline became aneurysmal. In mice treated with elastase solution alone, 100% developed aneurysms and only one had a ruptured aneurysm. In mice given angiotensin II infusion alone, 37.5% developed aneurysms and none had a ruptured aneurysm. Histological examination of the modified murine abdominal aortic aneurysm rupture model was identical to that observed in the conventional elastase model. Quantitative polymerase chain reaction analysis revealed similarly increased levels of proinflammatory cytokines. Conclusions We modified two current murine abdominal aortic aneurysm models to develop a murine abdominal aortic aneurysm model with consistent aneurysm formation and high rupture incidence, which can be used for studying abdominal aortic aneurysm rupture and treatment.

Background Podocyte injury was reported to be involved in the major pathogenesis of ischemia/reperfusion (I/R)-induced ischemic acute renal failure. Our purpose was to study the mechanism of miR-187 improving I/R-induced podocytes injury. Materials and methods The miR-187 mimics and inhibitor were transfected into the immortalized mouse podocyte (MPC-5) cells, and then transfected cells were subjected to hypoxia/reoxygenation (H/R, 3/3 h) to establish an H/R cell model. To investigate the effects of miR-187 on H/R-induced cell injury, cell viability and apoptosis were measured by Cell Counting Kit-8 (CCK-8) assay and flow cytometry. Dual-luciferase report system was used to verify whether miR-187 could directly target acetylcholinesterase (ACHE). The animal ischemia/reperfusion model was established and injected with miR-187 agomir. Kidney tissue sections were subjected to histological examination by hematoxylin and eosin staining to assess the renal injury. Real-time quantitative PCR and western blot were performed to determine gene expressions. Results The transfection of miR-187 mimics contributed to MPC-cells resistance to H/R-induced cell injury, which was reflected by enhanced cell viability and reduced apoptosis (from 20.05% to 9.43%) in H/R + negative control group. ACHE was confirmed as a target of miR-187, and ACHE siRNA had a similar efficiency to miR-187 mimic. The injection of miR-187 agomir not only effectively protected the kidney from I/R-induced injury, but also reduced the concentrations of serum creatinine. Moreover, nephrin was noticeably increased and desmin was decreased under the effects of agomir. Conclusions Our findings indicated that miR-187 improved I/R-induced ischemic acute renal failure through protecting glomerular filtration barrier by blocking the expression of ACHE.

Background: To report the experience of a single centre regarding the application of the triple-chimney technique using C-TAG with Viabahn or Excluder iliac extension devices for the endovascular management of aortic arch dilation diseases. Methods: From July 2016 to August 2017, 7 patients (5 men; mean age 56.1±10.8 years) with aortic arch dilation diseases were treated with the triple-chimney technique. All patients were followed up at 1, 3, and 6 months and every 6 months thereafter. Results: Six innominate arteries were deployed with Excluder iliac extensions and one with a Viabahn cover-stent. All the left common carotid arteries and left subclavian arteries were placed with Viabahn. Reverse chimney technique was applied in four patients. Three (42.0%) type I endoleaks were found on the final angiogram. Two were apparently reduced, and one disappeared after balloon dilation. The mean follow-up time was 15.7 months (9–20 months). All the type I endoleak was found disappeared within 3 months. One patient died of myocardial infarction at 6 months after discharge. No other complications such as stent-graft migration, occlusion, type II endoleak or neurological stroke occurred. Conclusions: The use of C-TAG coupled with Viabahn or Excluder iliac extension is feasible and effective for the treatment of aortic arch dilatation diseases. However, more patients and longer follow-up time are required to verify its long-term safety and efficacy.

We demonstrate the simultaneous generation of multicolor femtosecond laser pulses in a 0.5 mm Type I BBO crystal from 1028 nm fundamental and weak near-IR supercontinuum of a Yb:KGW ultrafast Yb based laser. The multicolor broadband laser pulses observed are attributed to cascaded four-wave mixing (CFWM) processes. A set of spatially separated CFWM sideband signals with second harmonic-generation and sum-frequency-generation pulses are arose from the interaction between the two pulses intersect at a certain angle. The CFWM sideband signals can be changed by rotating the BBO crystal to achieve the phase matching condition and adjusting the time delay between the two incident pulses to change the time overlapping.

Background Crossover stenting across the origin of the profunda femoral artery (PFA) and occasionally into the common femoral artery (CFA) is commonly used after suboptimal balloon angioplasty of ostial occlusive lesions of the superficial femoral artery (SFA) involving the bifurcation. Late stent occlusion at the bifurcation is not rare and results in severe lower extremity ischemia. Therefore, we tried to assess its possible causes, prevention and reintervention. Methods Using a prospectively maintained single-center database, 12-month femoral bifurcation patency was retrospectively compared and lesion and procedural predictors of stent occlusion were determined among 63 patients (64 lesions) who between July 2011 and February 2013 underwent crossover (36 non-jailed and 15 jailed SFA, and 12 distal and 1 complete CFA) stenting of de novo ostial SFA lesions. Results Twelve-month overall patency rate at the femoral bifurcation was 88%, with no significant difference between jailed-ostial SFA (80%) and distal CFA (67%) stenting (P = 0.731), and significant differences between either and non-jailed ostial stenting (100%, P = 0.035 and 0.002). When PFA ostium was jailed by the stent, patients with preexisting CFA or PFA lesions had a 12-month bifurcation patency rate of 20%, significantly lower than those with simple ostial SFA lesions (83%, P = 0.015). Stent induced intimal hyperplasia caused bifurcation occlusion in 6 surgical reintervention cases. Conclusions In crossover stenting of ostial lesions in SFA, bifurcation patency loss was significantly higher in distal CFA and jailed ostial SFA stenting than non-jailed ostial SFA stenting. Preexisting CFA or PFA lesion is a significant risk factor for bifurcation patency loss when PFA ostium is jailed by crossover stenting.

Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were 30-day mortality and survival at 2 years. The secondary endpoints were major complication and re-intervention. The aortic remodelling was investigated by comparison of the maximum diameter of the aneurysm and the diameter of true and false lumen at the same level between baseline and 2 years after TEVAR. Besides, we also analysed the possible relevant factors of aortic remodelling including the course of dissection, the involvement of dissection, and the length and shape of the stent graft. Results: The 30 day mortality was 2.9 % (1/34). The paraplegia rate post-TEVAR was 2.9 % (1/34). Overall, 32 out of the 34 cases were followed-up for 24 - 79 months. At 2 years, the overall and aortic specific survival were 87.5 % and 90.3 % respectively. The two year freedom from re-intervention rate was 87.5 %. Compared to the preoperative data, maximum diameter of descending aorta at 2 years demonstrated a slight increase (65.4±14.1mm Vs 63.9±9.1mm), but without significance (P>0.05). Meanwhile, we noticed a significant increase of true lumen (P < 0.01) and decrease of false lumen (P < 0.01) at the same level. Relevant analysis showed that positive aortic remodelling of the maximum diameter was associated with chronic phase (≥ 90 days of dissection onset) (P < 0.05) and the application of 150 - 170mm stent grafts (P < 0.05). Conclusions: Proximal TEVAR of post type B dissection thoracic aneurysm had generally favourable short- and mid-term outcomes with low paraplegia rate. Besides, it can achieve a certain extent of aortic remodelling.

Background: Early treatments are profoundly beneicial and improve outcomes in peripheral arterial disease (PAD). However, asymptomatic patients do not receive the optimal treatments as early as patients with CAD. So far, the changes in the vasomotor function with the chronic occlusion of the supericial femoral artery (SFA) are still unknown. We evaluated endothelium function for both conduit and collateral resistance arteries (CA) following long-term SFA ligation in Yucatan miniswine.

Background: TAVI is by now a valid therapeutic option in elderly patients (pts) with severe symptomatic aortic stenosis considered at high risk or with contraindication to aortic valve replacement (AVR). The impact of postprocedural leaks on mortality is still debated. Methods: Since May 2008 to July 2011, 100 consecutive pts underwent TAVI (60 Edwards Sapien Valve, 40 CoreValve). Transthoracic echocardiogram (TTE) was performed before discharge and after 3 months. Prosthesis insufficiency (PI) was considered significant if at least mild according to ASE and EAE recommendations. The aim of the study is to evaluate the effect of postprocedural periprosthetic and intraprosthetic leaks on mortality. Results: Retrograde approach was performed in 67 pts, while 33 pts benefited from the transapical access. Predischarge TTE was performed in all pts, and 24 had at least mild PI: 17 (70.8%) periprosthetic, 3 (12.5%) intraprosthetic, and 4 (16.7%) mixed. VARC mortality was 15%. At 3-month follow-up (range 36–126 days), all 85 alive pts underwent a TTE at our institution. Significant leaks were found in 24 (28.2%) pts: 18 (75%) periprosthetic, 1 (4.2%) intraprosthetic, and 5 (20.4%) mixed. The univariate analysis with Yatescorrected χ showed that postprocedural PI affects 1-year mortality (RR 2.68, IC 1.39–5.18, P=.009). Subgroups analysis showed an increased incidence of leaks in CoreValve group compared to the Edwards Sapien group (28/36 vs. 24/49, P=.02). Conclusion: Periprosthesis leaks, affected also by prosthesis choice, increase 1-year mortality in patients undergoing TAVI. These data confirm the actual limits of this procedure compared to AVR. In the near future, new technologies and devices could help to improve results.

Effects of circumferential stretch vs. deep injury on the in-stent neointimal formation in the atherosclerotic iliac rabbit arteries Jianing Yue , Takamitsu Nakamura, Yuqi Wang , Weiguo Fu, Dongming Guo , Nicolas Chronos c Vascular Surgery Department of Zhongshan Hospital Fudan University, Shanghai, China Department of Internal Medicine II, University of Yamanashi, Chuo, Japan Saint Joseph's Translational Research Institute, Atlanta, GA, USA

Background: Drug-eluting bioabsorbable stents (DEBSs) represent a new device-based therapy for coronary artery disease. It has been reported that the stented segment becomes re-endothelialized after 1 month and the segments proximal and distal to the stented site are functional at 2 years. In order to examine whether after complete degradation the DEBS site function was similar to the unstented segments, we performed ex vivo vasomotor function studies using pig coronary arteries. Methods: Eighteen months after implantation in the pig coronary arteries, 10 DEBS sites [four left anterior descending (LAD), four right coronary, and two left circumflex arteries] were assessed for vasomotor function using an organ chamber apparatus. They were stimulated with potassium chloride (KCl), prostaglandin2α (PGF), and three concentrations of endothelin-1 (ET). Endothelium-dependant relaxation (EDR) to substance P (SbP; 0.01–100 pM) and endothelium-independent relaxation (EIDR) to sodium nitroprusside (SNP; 0.001–10 μM) were assessed following constriction with PGF. Remaining stent segments were fixed for histologic examination. Results: DEBS sites showed rapid response to low and high concentrations of KCl, PGF, and ET. EIDR showed concentration-dependent relaxation to SNP (13.3±4.3%, 21.3±5.6%, 52.7±7.1%, 85.5±5.4%, and 100±0%). However, there was no EDR to SbP concentration-dependent stimulation. Hematoxylin/eosin and Verhoeff–Masson staining showed evidence of smooth muscle cell (SMC) migration across polymer struts, and formation of a new abluminal layer was observed. There was complete polymer strut degradation, infiltration of inflammatory cells, and minor fibrosis around some DEBS sites. Myocardial degeneration (∼1×1.5 cm) was found in the septum adjacent to the stented LAD sites (n=4). Vessel wall within the stented segment was thicker and the lumen was narrower than in the proximal and distal segments. Conclusion: During DEBS degradation period, medial SMCs migrate to the neointima developing new layers. We have demonstrated for the first time the ex vivo contraction and relaxation responses at DEBS sites to vasoactive agents after complete degradation of the stent. SMCs recovered contractile and relaxing capabilities in this segment but endothelial function was still impaired.

Background: Transcatheter delivery of thrombolytic therapy is an effective tool in the treatment of acute deep venous thrombosis (DVT). We sought to determine an effective and safe thrombolytic regimen with tPA in the treatment of severe DVT when used in conjunction with percutaneous endovenous intervention (PEVI). Methods: Eighty consecutive patients with acute symptomatic DVT were randomized to receive four different doses of tPA. They had all undergone PEVI from 0.5 to 18 h following presentation to the hospital. PEVI consisted of any or a combination of the following: Trellis, Angiojet, or manual suction thrombectomy, balloon venoplasty, or stenting. Following initial PEVI, if N50% thrombus remained, tPA was given via an infusion catheter for 16–20 h. Patients were randomized to receive tPA at 0.5, 1, 2, or 4 mg/h and were assigned to Groups I–IV, respectively, with 20 in each group. Warfarin was continued, and during tPA administration heparin dose was reduced to 12 U/kg per hour. The end points evaluated were venous patency post-tPA (b5% residual thrombus), bleeding, and length of hospital stay. Results: The results are demonstrated in the Table 1. Venous patency rate was similar in Groups II–IV. Bleeding was seen more in Group IV, lengthening hospital stay. Venous patency was low in Group I. Conclusions: We conclude that transcatheter endovenous administration of tPA following suboptimal PEVI at 1 mg/h for 16–20 h is highly safe and effective in the treatment of DVT allowing for high patency rate, no complications, and early discharge.