Search

Purpose: Retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) has been a major drawback of endovascular treatment. To our knowledge, no studies have simulated and validated aortic injuries caused by stent grafts (SGs) in animal models. Therefore, the aim of this study was to evaluate and quantify the SG–aorta interaction through computational simulations and to investigate the underlying mechanism through histopathological examinations. Methods: Two custom-made Fabulous® (DiNovA Meditech, Hang Zhou, China) SGs were implanted in 2 canine aortas with a 5-mm difference in the distance in landing locations. The aortic geometries were extracted from RTAD and non-RTAD cases. A computational SG model was assembled based on the implanted SG using the software Pro-ENGINEER Wildfire 5.0 (PTC Corporation, Needham, Mass). TEVAR simulations were performed 7 times for each canine model using Abaqus software (Providence, RI, USA), and the maximum aortic stress (MAS) was calculated and compared among the groups. Three months after SG implantation, the canine aortas were harvested, and were examined using hematoxylin and eosin staining and Elastica Van Gieson (EVG) staining to evaluate histopathological changes. Results: In the computational models for both canines, MAS was observed at the proximal bare stent (PBS) at aortic greater curve. The PBS generated higher stress toward the aortic wall than other SG parts did. Moreover, the MAS was significantly higher in canine No.1 than in canine No.2 (0.415±0.210 versus 0.200±0.160 MPa) (pConclusion: The characteristic MAS distribution remained at the location where the apex of the PBS interacted with the aortic wall at greater curve. RTAD histopathological examinations showed intimal damage and medial necrosis at the proximal landing zone, at the same MAS location in computational simulations. The in vivo results were consistent with the computational simulations, suggesting the MAS at greater curve may cause RTAD, and the potential application of computational simulation in the mechanism study of RTAD.

Background:. Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency. Methods:. Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis. Results:. A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age

Background: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. Materials and Methods: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. Results: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5–71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. Conclusions: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. Graphical Abstract [Formula: see text]

Objective Retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) has been a major drawback of endovascular treatment. To our knowledge, no studies have evaluated aortic injuries caused by stent grafts (SGs). Therefore, the aim of this study was to evaluate and to quantify the SG-aorta interaction and to analyze the risk factors for injury through computational simulation. Methods The aortic geometry was extracted from an RTAD case. Five SG models were assembled based on Valiant and Talent (Medtronic Vascular, Santa Rosa, Calif) SGs, and modifications were made to the original SG design by adding and removing the connecting bar. TEVAR simulations were performed seven times for each SG model with 0% and 15% oversizing ratio (OSR), and the maximum aortic stress (MAS) was calculated and compared within the groups. Results In all TEVAR models, MAS was seen at the proximal bare stent (PBS). The PBS in the Valiant and Talent SGs generated higher stress toward the aortic wall than other SG parts did. MAS was significantly higher for the 15% OSR (0.54 ± 0.07 MPa) than for the 0% OSR (1.32 ± 0.74 MPa) in 172.5-mm Valiant models. MAS was significantly higher in the Talent with connecting bar SG model (0.73 ± 0.24 MPa) than in the Talent without connecting bar SG model (0.51 ± 0.11 MPa). MAS was significantly higher in the Valiant with connecting bar SG model (0.82 ± 0.29 MPa) than in the Valiant without connecting bar SG model (0.54 ± 0.07 MPa). MAS was not significantly different in models with 172.5-mm and 140-mm Valiant SG implantations with 0% OSR (0.54 ± 0.07 MPa vs 0.60 ± 0.12 MPa) and 15% OSR (1.32 ± 0.74 MPa vs 1.12 ± 0.33 MPa). Conclusions The characteristic MAS distribution remained at the location where the apexes of the PBS interacted with the aortic wall at its greater curve. Both higher OSR and the presence of a connecting bar can significantly increase the MAS after SG implantation. Moreover, the chronic MAS at the PBS area may injure the aortic wall, causing RTAD.

Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this.From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed.There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length 165 mm. The SG length 165 mm increased the overall proximal and distal SINE incidence in multivariate analysis.The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length 165 mm increases the risk of RTAD and SINE after TEVAR.

It was very difficult for the smelting of vanadium-bearing titanomagnetite by blast furnace because the content of TiO2 of blast furnace slag could amount to 20%–25%. After long term development and continuous improvement, special intensified smelting technologies for vanadium-bearing titanomagnetite by blast furnace were obtained and improved gradually. With the improvement of beneficiated material level and equipment level, smelting intensity has been increased gradually and the highest comprehensive smelting intensity reached 1.45 t/(m3 · d). Technical-economic indexes of blast furnace have also been increased remarkably. The highest utilization coefficient exceeded 2.7 t/(m3 · d) on the condition that the burden grade was only about 50%.

The smelting of vanadium-bearing titanomagnetite by blast furnace was very difficult because the content of TiO2 of blast furnace slag could amount to 20-25%. After long term development and continuous improvement, special intensified smelting technologies for vanadium-bearing titanomagnetite by blast furnace were obtained and improved gradually. With the improvement of beneficiated material and equipment, smelting intensity has been increasing gradually and the highest comprehensive smelting intensity that is fuel comsumption per unit useful volume per day reached 1.45t/(m3·d). Technical-and-economic indexes of blast furnace have also been increasing remarkably. The highest monthly utilization coefficient exceeded 2.7t/(m3·d) on the condition that the burden total ferrum grade was only about 50%.

Constructed wetlands are widely used throughout the world to treat a wide variety of wastewater. Numerous researches on phosphorus removal have been reported, however, in practice, phosphorus removal efficiency through the constructed wetland is still relatively lower due to various reasons. In this paper, the phosphorus adsorption capacity of aerated concrete (a building material) was investigated by using Freundlich and Langmuir adsorption isotherm equations, and then the possibility, using aerated concrete waste residues for the treatment of effluent with relatively higher concentration phosphorus at the outfall of constructed wetland end through certain engineering measures, was explored. The results showed that aerated concrete not only had a higher phosphorus adsorption capacity (6.064mg/g), but also had a higher adsorption rate, compared with some other substrate materials commonly used for constructed wetlands. Coupled with the lightweight characteristic of aerated concrete, the imagination of the secondary purification pond was likely to be formed. If the imagination turns into a reality, it will not only effectively purify sewage emissions from the constructed wetland forever, but also realize the resource utilization of large quantities of aerated concrete waste residues resulting from the construction process.

(Ba0.7Ca0.3)TiO3 (BCT) powders and ceramics have been prepared by sol-gel technique. Structural evolution of the BCT dry gels are investigated by thermal gravimetric analysis–differential scanning calorimetry. It is found that BCT crystallites can be formed before 800 . Well-sintered samples are synthesized at 1260 for 2h. The crystal structure of the BCT powders is studied by XRD and ferroelectric properties of the ceramics are characterized by TF analyzer 2000. The Curie temperature Tc of the BCT ceramics is at about 125 . The maximum dielectric constant (εr) reaches about 4851 at 125 and hysteresis loops are measured with the temperature range from 25 to 150 .

Hysteresis loop and dielectric properties of lead-free BaTiO3-La2O3 piezoelectric ceramics and BaTiO3 ceramic compared with pure BaTiO3 has been systematically studied. The amount of La2O3 addition ranged from 0.3~0.5mol% by controlling the sintering temperature. Dielectric properties of BaTiO3-La2O3 were promoted after the addition of La2O3, the maximum value of dielectric constant reached 8,624, recently. The role of La2O3 on the solid-state sintering of BaTiO3 is discussed on the basis of the solid-solution defect model.

The(1-x)BaTi0.8Zr0.2O3-xBa0.7Ca0.3TiO3 ceramics have been prepared by sol-gel technique, where x is from 0.2 to 0.6. It reveals that the dense ceramics can be obtained when the sintered temperature is above 1250°C. It is lower than that of solid state reaction ceramics. In particular, when x=0.3, at which is near the MPB composition, the ferroelectric and piezoelectric properties are more excellent than the others. The maximum dielectric constant is above 9000, which can be observed in the butterfly shape curves of dielectric constant as a function of electric field. The maximum piezoelectric coefficient d33 can reach 400 pm/V, and it is obtained from the piezoelectric response loops.

Introduction Hirudin is a direct thrombin inhibitor that has potential mechanistic advantages over indirect inhibitors. Peptides containing the RGD motif competitively inhibit binding of fibrinogen to glycoprotein IIb/IIIa on platelets, thus inhibiting platelet aggregation. A novel hirudin derivative, recombinant RGD-hirudin (r-RGD-hirudin), was engineered by fusing the tripeptide RGD sequence to the native hirudin. We tested the antithrombotic effect of r-RGD-hirudin using a carotid artery reconstruction model in rabbits. Materials and methods A fusion gene encoding r-RGD-hirudin was constructed and expressed at high levels in Pichia pastoris. Following traumatic injury and anastomosis, 42 New Zealand White rabbits were randomized to receive normal saline, abciximab, wild-type hirudin, or r-RGD-hirudin. Fibrinogen concentration, aPTT, TT, PT, and PAGm were measured prior to and following the operation. Carotid angiography and pathological examination of the anastomotic site were performed to compare patency rates among the groups. Results The r-RGD-hirudin significantly prolonged aPTT, TT, PT and inhibited PAGm following carotid anastomosis in rabbits. The median dose of r-RGD-hirudin (0.5 mg/kg) had a therapeutic effect equal to that of wild-type hirudin (1.0 mg/kg) and higher than that of abciximab (0.2 mg/kg) with regard to patency rates. Conclusions Compared to wild-type hirudin or antiplatelet agent, the novel anticoagulant, r-RGD-hirudin was capable of inhibiting both thrombin activity and platelet aggregation, and was demonstrated to be effective in the prevention of thrombosis.

The (Ba0.88Ca0.12)( Zr0.12Ti0.88)O3 powders and piezoelectric ceramics were prepared by sol-gel process. The reaction process was analyzed with the help of thermo gravimetric and differential scanning calorimetry. X-ray diffraction characterized results showed that the structure of the (Ba0.88Ca0.12)( Zr0.12Ti0.88)O3 powders was perovskite structure and the particle size was approximately 37nm. Piezoelectric measurements revealed that Curie temperature and the maximum piezoelectric coefficient d33 is 95°C and 215pm/V, respectively.

Background— Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further. Methods and Results— Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan–Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months. Conclusions— Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting–related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.

Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases, few people have applied it surgically. In fact, MPR is also very useful to clinical operation, especially for patients with type B aortic dissection. It helps the surgeon to locate accurately with more information about aortic dissection, so that the safety and effectiveness of operation can be improved. This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a cross-section, a spin angle of the coronal plane, and a tilt angle of the sagittal plane in treatment of type B aortic dissection.The conventional and the MPR approaches were compared on positioning the aortic arch for surgery. A group of 40 patients (group A) and another group of 42 patients (group B) was sampled. About the comparison of baseline characteristics, a fourfold table χ(2) test was conducted on gender, and two independent samples t-test was applied to age between group A and group B. Spin as well as tilt angles for group A were obtained from the patients using both approaches, and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group. Stent graft placement of group B was based on the conventional approach. Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement. They were also compared with a fourfold table χ(2) test.Gender difference was not found between group A and group B (χ(2)0.80, P0.05), and age difference was not statistically significant (F = 2.55, homogeneity of variance, t = -1.46, P0.05). A significant difference was found between the conventional and the MPR approaches for spin angle (t = 9.17) as well as tilt angle (t = 2.07), P0.05. Percentage of proximal distributed markers (5.0%) of group A was significantly lower than that of group B (42.9%), χ(2) = 15.92, P0.05; and incidence of complications (5.0%) of group A was also significant lower than that of group B (21.4%), χ(2) = 4.76, P0.05.Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA. It is feasible in endovascular treatment of type B aortic dissection, and can effectively and safely guide surgical operations.

To evaluate the short and middle-term efficacies of endovascular repair for isolated iliac artery aneurysms (IIAAs).Retrospective analyses were performed for the clinical and follow-up data of 27 patients undergoing endovascular repair at Department of Vascular Surgery, Affiliated Zhongshan Hospital, Fudan University from January 2008 to December 2012. For asymptomatic aneurysms, repair criterion was a diameter over 3 cm while under 3 cm for symptomatic aneurysms.There were 19 asymptomatic and 8 symptomatic cases. And 25 selective and 2 emergent operations were performed. The interventions included endovascular stent grafts (n = 17), coil embolization (n = 1), both stent grafts and coils (n = 7) and hybrid operations (n = 2). Technical success was achieved in all cases. No delayed healing or infection of inguinal access sites occurred. In-stent thrombosis could be observed in 2 cases. Buttock claudication was observed in one case. Sexual dysfunction occurred in three cases. Endoleaks were confirmed by intraoperative digital subtraction angiography in three cases. There was no occurrence of colorectal ischemia or postoperative aneurysmal rupture. Patients were followed up for a mean period of 33 ± 18 months. One patient died of recurrent renal cell carcinoma.Endovascular repair of isolated iliac artery aneurysms provides good short and middle-term patency. It may become a first-choice for treating isolated iliac artery aneurysms in the future.

Genetic study can provide important insight into the etiology of aortic dissection. To explore the pathogenesis and natural history of aortic dissection, a number of genes have been identified through microarray chip screening and undergone testing of polymorphisms to find mutations strongly associated with the disease. The results suggested aortic dissection to be a multi-gene disorder. Multiple genes probably work together to promote its development. Several diseases with a genetic predisposition are closely connected with aortic dissection, which also implied a role of genetic changes and malfunction in this disease.

Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage (RIFLE) kidney disease criteria. The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.Of the 71 patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU). Risk factors for AKI were ruptured AAA (odds ratio (OR) = 5.846, 95% confidence interval (CI): 1.346 - 25.390), intraoperative hypotension (OR = 6.008, 95%CI: 1.176 to 30.683), and perioperative blood transfusion (OR = 4.611, 95%CI: 1.307 - 16.276). Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in Surgical Intensive Care Unit.Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.

Considering the low fluidity and the difficulties in separating high Ti-bearing blast furnace slag from hot metal, the effect of B2 O3 on apparent viscosity under argon atmosphere was studied from 1340 °C to 1475 °C using Brookfield Rotational Viscometer, Metallographic Microscope, et al. The results showed that the addition of B2 O3 could decrease melting temperature of high Ti-bearing blast furnace slag and increased its fluidity. With increasing the amount of B2 O3 from 0 to 3%, mass fraction of perovskite in high Ti-bearing blast furnace slag gradually decreased, but four times the mass fraction of anosovite. The Ti(C,N) appeared enrichment in the high Ti-bearing blast furnace slag, and the enrichment changed with the addition of B2 O3 increasing.

We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery.

Xu, Wei-Bin, Huang, Yu-Song, Wei, Guo-Fu, Tan, Wei-Ning, Liu, Yan (2012): Paraboea angustifolia (Gesneriaceae): a new species from limestone areas in northern Guangxi, China. Phytotaxa 62 (1): 39-43, DOI: 10.11646/phytotaxa.62.1.8, URL: http://biotaxa.org/Phytotaxa/article/view/phytotaxa.62.1.8

To detect deep-level microvascular structure in rat hind limb by synchrotron radiation and microangiographic technique.Microangiography in vivo and ex vivo was performed by synchrotron radiation based absorption imaging and phase contrast imaging, with omnipaque and barium sulfate solution as contrast media, respectively, and synchrotron radiation-based micro-computed tomography (SRmCT) was also performed to reveal three-dimensional morphology of the blood vessel in rat hind limb.Using microangiographic technique in vivo and in vitro (with barium sulfate), blood vessels in the rat limb muscle could be visualized with high resolution, and the fourth branches of iliac artery in rat hind limb could be detected with the minimum visualized blood vessels about 40 µm and 9 µm in diameter, respectively. In addition, the vascular network could be defined and analyzed at the micrometer scale from the 3D renderings of limb vessel as shown by SRmCT.Synchrotron radiation-based microangiography and SRmCT thus provided a practical and effective means to observe the microvasculature of rat hindlimb, which might be useful in assessment of angiogenesis in lower limbs.

To develop a type II endoleak porcine model with continuous pressure monitor by the strain-gauge pressure transducer and the patch.Nine tamed porcine was randomized as the experiment group of 6 domesticated pigs and the control group of 3 domesticated pigs. When the abdominal aortic aneurysm (AAA) was created, the 2(nd) and 3(rd) pair of infrarenal lumber arteries were preserved in the experiment group, while ligated in the control group. The stent-graft was implanted in the endovascular repair. CT angiography was performed to seek endoleak, and the angiography was performed to excluded the type I and type III endoleak. The pressure in the excluded AAA monitored by the strain-gauge pressure transducer was recorded and compared in both groups to evaluated the effect of type II endoleak in the experiment group.The AAA porcine model with pressure monitor were successfully developed in all 9 porcine. The endoleak and the retrograde flow of the lumber arteries were confirmed by CT angiography in the experiment group. The ratio of the average pressure after the procedure to before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). The ratio of the pulse pressure after the procedure to the average pressure before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020).It is feasible to develop type II endoleak domesticated pig model by preserving the lumber arteries for the retrograde flow, and the AAA model with pressure monitor by the strain-gauge pressure transducer and the patch.

To review the prevention and treatment strategies in the complications after endovascular repair (EVAR) of abdominal aortic aneurysms, retrospectively in a single medical center.From January 2003 to December 2010, clinical data of 344 EVAR cases were analyzed retrospectively, including postoperative period and long-term results. There were 302 male and 42 female patients, with a mean age of (69 ± 8) years. Patients were followed up at 3 months, 6 months, and then every year with abdominal x-ray and spiral CT angiography.The surgical success rate was 99.7% (343/344). The mortality with elective and emergency surgery was 0.30% (1/334) and 1/10 respectively. The average follow-up time was 3 to 84 months with a mean of 32.9 months. The follow-up rate was 81.8% (279/341). The mortality was 1.1% (3/279), the re-intervention rate was 10.4% (29/279) and the overall complication rate was 12.9% (36/279), including endoleak 5.7% (16/279), stent-graft migration 1.1% (3/279), aneurysm expansion or rupture 5.4% (15/279), limb occlusion 2.5% (7/279) and stent-graft infection 1.4% (4/279).EVAR has allowed a minimally invasive approach to aortic pathology. A careful preoperative assessment is the key for EVAR. Endoleak continues to be the major long-term complication of the endoluminal grafting technique, and the major cause for re-intervention. Life-long follow-up is an integral part of EVAR.

The development of regenerative therapies using derivatives of embryonic stem (ES) cells would be facilitated by a non-invasive method to monitor transplanted cells in vivo, for example, magnetic resonance imaging of cells labeled with superparamagnetic iron oxide (SPIO) nanoparticles. Although ES cells have been labeled with SPIO particles, the potential adverse effects of the label have not been fully examined. The objective of this study was to determine whether SPIO labeling affects murine ES cell viability, proliferation, or ability to differentiate into functional endothelial cells (ECs).Cross-linked iron oxide (CLIO, an SPIO) was conjugated with human immunodeficiency virus transactivator of transcription (HIV-Tat) peptides, and murine ES cells were labeled with either CLIO-Tat, CLIO, or HIV-Tat. After labeling, ES cells were cultured for 4 days and Flk-1(+) ES cells identified and sorted by immunocytochemistry and fluorescence activated cell sorting (FACS). Flk-1(+) cells were replated on fibronectin-coated dishes, and ECs were obtained by culturing these for 4 weeks in endothelial cell growth medium supplemented with vascular endothelial growth factor (VEGF). ES cell viability was determined using trypan blue exclusion, and the proportion of SPIO(+) cells was evaluated using Prussian blue staining and transmission electron microscopy. After differentiation, the behavior and phenotype of ECs were analyzed by reverse transcription-polymerase chain reaction, flow cytometry, immunocytochemistry, DiI-labeled acetylated low-density lipoprotein (AcLDL) uptake, and Matrigel tube formation assay.CLIO-Tat was a highly effective label for ES cells, with96% of cells incorporating the particles, and it did not alter the viability of the labeled cells. ECs derived from CLIO-Tat(+) ES cells were very similar to murine aortic ECs in their morphology, expression of endothelial cell markers, ability to form vascular-like channels, and scavenging of AcLDL from the culture medium.CLIO-Tat is a highly effective label for ES cells and does not adversely affect cell viability, differentiation, or behavior. CLIO-Tat could be a useful marker for the non-invasive monitoring of transplanted stem cells.

to assess the the mid-term renal function of abdominal aortic aneurysm (AAA) patients following supra-renal endovascular repair.from March 2005 to December 2009, 290 AAA patients were included and grouped depending upon whether they had received infra-renal (IR) or supra-renal (SR) EVAR. SR was performed in 173 patients, with a mean age of (72 ± 8) years and 85.0% for male. IR was performed in 117 patients, with a mean age of (71 ± 9) years and 90.6% for male. Preoperative and 1 week, 1-, 3-, 6-, 12-month postoperative serum creatinine (Cr) and cystatin C (Cys-C) were detected. Estimated glomerular filtration rate (eGFR) were calculated by Cystatin-based formula and Cr-based Cockcroft formula. T test were used to determine statistical difference between or within groups.all Patients received Talent or Zenith endograft. The ratio of device-used were 67/106 in SR group and 25/92 in IR group (P0.05). The other characteristics and operative files in two groups were well matched. Preoperative Cr and Cys-C were (82 ± 8) µmol/L and (0.89 ± 0.11) mg/L for SR group, (81 ± 11) µmol/L and (0.87 ± 0.15) mg/L for IR group, no difference between groups. Compared to preoperative renal markers within each group, Cr, Cys-C and eGFR worsening were found at 1 week and 12 months postoperative (P0.05). At 1 week postoperative, Cr in SR group and IR group were (98 ± 11) µmol/L and (95 ± 13) µmol/L, Cys-C were (1.01 ± 0.10) mg/L or (0.99 ± 0.10) mg/L. At 12 months postoperative, Cr in SR group and IR group were (91 ± 15) µmol/L or (90 ± 12) µmol/L, Cys-C were (1.03 ± 0.20) or (1.02 ± 0.21) mg/L. Also, Cys-C [SR: (0.93 ± 0.17) mg/L, IR: (0.92 ± 0.31) mg/L] and eGFR by Cys-C worsening were found at 6 months postoperative. There was no difference between groups in patients Cr, Cys-C and eGFR at each follow-up time interval.the use of SR fixation was not significantly associated with mid-term postoperative renal injury.

To report the contrast medium induced pancreatitis after angiography or endovascular therapy, analyze the possible cause of this complication, the treatment specialty and the prognosis.The patients suffered from contrast medium induced pancreatitis after angiography or endovascular therapy during last 10 years were retrospectively analyzed. The patients' comorbidity, the onset time of the pancreatitis, the specialty of the pancreatitis, the treatment method and the prognosis were documented. The relative literature was retrieved and reviewed. The clinical data was compared with the relative literature and analyzed.Three cases of contrast medium induced pancreatitis were documented. One case was a young man, received angiography because of renal artery stenosis. He was suffered from moderate abdominal pain 2 hours after the procedure. Pancreatitis of edema type was confirmed by CT scan. He recovered thoroughly after the medical treatment. One case was an old man, underwent angiography for renal artery stenosis and abdominal aortic aneurysm. He was suffered from acute abdominal pain during the procedure. The CT scan revealed as edema pancreatitis. He died from cardiac infarction during the treatment. The last case was an old female, suffered from sustained abdominal distension after endovascular treatment of endoleak post AAA EVAR. Edema pancreatitis was confirmed by CT scan. The symptom was not alleviated well after the treatment. Finally she was died from MOSF.The incidence of contrast medium induced pancreatitis is relatively low. It's not easy to detect in early stage. Early diagnosis and treatment is the key to improve the therapeutic effect. The prognosis of patient with multiple comorbidity is poor.

To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection.From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups.The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P0.01). Four out of 24 cases of intramural hematoma had recurrent dissection.Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.

To make preliminary cross-sectional study on epidemiology of deep vein thrombosis of lower extremity of inpatients with high risk in Zhongshan hospital, and analyze risk factors in these patients.From Sep 2008 and Feb 2009, we performed compressed ultrasound to detect deep vein thrombosis of lower extremity of in-patients with high-risk in Zhongshan hospital, including bedrid stroke patients, post-surgery bedrid patients from department of orthopaedics, gynecology, general surgery and vascular surgery and patients of surgical intensive care unit. Prevalence rate of DVT of the whole study group as well as each department were calculated and analyzed. We collected detailed clinical information of each recruited patient. We made statistical single-factor and then Logistic regression multiple-factor analysis of these data with SPSS 16.0, to determine high risks of deep vein thrombosis of in-patients.(1) Totally 372 patients were enrolled in our study with 38 patients detected with DVT of lower extremity, so the prevalence rate of whole series was 10.2% (38/372). (2) High risks of lower extremity deep vein thrombosis for the whole series were bedrid time (30 day boundary) (P = 0.000), thrombin time (P = 0.007) and history of vascular surgery (P = 0.009). (3) The prevalence rate of DVT of lower extremity of department of neurology, orthopaedics and gynecology were 12.7% (13/102), of 10.0% (10/100) and 6.3% (7/111) respectively. (4) High risk for DVT in post-surgery gynecological patients was resection of uterus and both attachments (P = 0.032).In our study, the prevalence rate of DVT of lower extremity for high-risk in-patients was high, most of whom were asymptomatic and left-sided. High risk factors were bedrid time (30 day boundary), thrombin time and history of vascular surgery. It is necessary to strengthen prophylactic anticoagulation in these patients.