[en] Arterial stenotic and occlusive disorders of low limb are commonly the most important factors associated with the prognosis of diabetic foot. The effect of traditional bypass operation is unpredictable for lack of runoff artery. On the other hand, the contributions of special interventional devices and techniques targeted at infrapopliteal artery show unique therapeutic outcomes of interventional management; together with furthermore stem cell thansplantation would present a promising future for the treatment of diabetic foot. (authors)

[en] Objective: To assess the impact of stent implantation on the patency rate of femoropopliteal artery after subintimal angioplasty for occlusive arteriosclerosis. Methods: During the period from January 2007 to May 2009, a total of 43 patients with occlusive femoropopliteal arteriosclerosis (43 diseased legs) were treated in authors' hospital. Of the 43 patients, simple percutaneous subintimal angioplasty was performed in 24 (non-stent group), while percutaneous subintimal angioplasty with subsequent stent implantation was carried out in the remaining 19 (stent group). After the treatment, CTA or Doppler ultrasonic examination was performed to check the results. Interventional therapy was respected in some cases who developed restenosis. Results: The 12-month limb salvage rate was 98%. Perioperative minor complications occurred in 7% of patients (3/43). Two-year mortality rate was 7% (3/43). During the follow-up period, arterial restenosis or occlusion occurred in 22 cases. Three cases in non-stent group developed arterial occlusion within one month after the treatment. Repeated interventional procedure was carried out for 12 diseased legs. The primary patency rates of non-stent group at 6, 12 and 24 months were (83.3±7.6)%, (74.0±9.2)% and (56.1±13.5)%, respectively, while those of stent group were (89.5±7.0)%, (77.5±9.9)% and (32.2±16.6)%, respectively. The primary assisted patency rates at 12 and 24 months in non-stent group were (90.9±6.1)% and (64.2±14.7)%, respectively, while those in stent group were (94.4±5.4)% and (39.0±15.90%, respectively. The difference in both the primary patency rate and primary assisted patency rate between the two groups were of no significance (P>0.05). Cox-regression analysis indicated that the number of patent distal vessels, the type of femoropopliteal occlusive diseases and the history of smoking bore a close relationship to the two-year primary patency rate after subintimal angioplasty (r=-4.417, 2.502, 3.115; S_X=1.627, 0.955, 1.523; P=0.007, 0.009, 0.041). Conclusion: For the treatment of occlusive femoropopliteal arteriosclerosis, it is not necessary to routinely use stent implantation after subintimal angioplasty. Stent implantation will not obviously improve the two-year primary patency rate. The patency of the distal vessels and the history of smoking have a very important effect on the two-year primary patency rate. (authors)

[en] Objective: To discuss the impact of the feeding-artery branch of the false lumen on the remodeling of false cavity in Stanford B aortic dissection after thoracic endovascular aortic repair (TEVAR). Methods: Single-center retrospective cohort study was conducted in 56 patients with acute or chronic Stanford B aortic dissection, who received TEVAR at the Affiliated Zhongda Hospital of Southeast University of China during the period from August 2005 to August 2018. Follow-up CT angiograpy (CTA) materials were used to observe the thrombosis in the false lumen of the aortic abdominal segment as well as the types of blood supply of the visceral branches of the abdominal aorta. Results: In the 56 patients, the visceral branches received blood supply from the true lumen when completely thrombosis or thrombus absorption was observed in the false lumen. The abdominal aortic false lumen was involved in the blood supply of visceral branches, including blood supply from double-lumen and blood supply only from false lumen. Partial thrombosis in the false lumen was mainly seen, at the same time the false lumen was patency. The involvement of false lumen in the blood supply of visceral branches could combined with more intimal tears, which was negatively correlated with false lumen thrombosis. Conclusion: The involvement of false lumen in the blood supply of visceral branches can affect the thrombosis in the false lumen in patients with Stanford B aortic dissection after TEVAR, and it may be a risk factor for the partial thrombosis or obstruction in the false lumen. (J Intervent Radiol, 2020, 29:1039-1042). (authors)

[en] Objective: To evaluate the early effect of hybrid operation in treating popliteal aneurysms with acute lower extremity ischemia. Methods: During the period from Aug. 2004 to June 2007, seven patients with popliteal artery aneurysms complicated by acute lower extremity ischemia were treated with surgical operations together with interventional therapy, which included intraluminal thrombectomy with Fogarty catheter, percutaneous transluminal angioplasty, thrombolysis, etc. The perioperaive complications and early clinical effect were recorded, and the results were analyzed. The relevant medical literature was reviewed. Results: The surgical management included exclusion technique (n = 2) and aneurysmectomy (n = 5). The vascular reconstruction after the resection included vascular replacement with prosthetic graft (n = 6) and end-to-end anastomosis of the vascular incision (n = 1). Transluminal thrombolysis and percutaneous angioplasty were employed in all patients, and thrombectomy was performed in one patient. After hybrid operation, radiological imaging showed that the graft and distal arteries were patent, and the ankle-brachial index increased significantly (P < 0.001). No severe complications occurred in the perioperative period. Conclusion: For the treatment of popliteal aneurysms with acute lower extremity ischemia, hybrid operation is an effective option as this technique can reserve the collateral circulation and reduce the risk of distal artery ischemia. The use of interventional management can ensure the patency of the out-flow tract after the operation, which is extremely helpful in avoiding acute thrombosis in graft and, as a result, effectively reducing the amputation rate. (authors)

[en] Objective: To evaluate the feasibility, safety and short term efficacy of percutaneous transluminal angioplasty with long balloon for the treatment of critical lower limb ischemia (CLI). Methods: Data of 21 patients with critically ischemic limbs, treated with percutaneous transluminal angioplasty (PTA) with long balloon between January and June 2007 were collected and analyzed retrospectively. Balloon with different length was selected according to the extent of the lesions. Procedural success rate, early complications and continued clinical improvement were observed. Primary patency, cumulative patency and limb salvage with survival were statistically calculated. Results: Two cases of pseudoaneurysm formation occurred as the early processing complication at the puncture sites. Procedural success rates were different and associated with the sites and severities of stenosis, but much lower for crural arteries with occlusive lesion. No severe dissection occurred after PTA. Clinical success rate was 90.5%. The average hospital stay was 6 days. Primary patency, secondary patency and limb salvage were 95.2%, 100% and 100% respectively, at 6 months. Conclusions: PTA with long balloon is safe, effective and feasible in patients with critical lower limb ischemic disease, providing good limb salvage and less complications. (authors)

[en] Objective: To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extracranial internal carotid artery (ICA) dissection, and to observe the patency of stent. Methods: The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection, who were treated with endovascular repair during the period from March 2012 to December 2012, were retrospectively analyzed. The U.S. National Institute of Health Stroke Scale (NIHSS) scores were determined before and after endovascular repair, and the postoperative stent patency condition was assessed, the results were analyzed. Results: A total of 6 patients, including 4 males and 2 females with a median age of 50 years old (40.75-54.75 years old), received endovascular repair therapy. The median interval from the onset of disease to accept endovascular treatment was 10 days (one week-3 months). After the implantation of stent, the blood flow in the true lumen returned to normal immediately, although part of the false lumen was still filled with contrast agent. Embolism of retinal artery occurred in one patient during the operation, no death occurred. The median follow-up time was 54.4 months (49.7-57.9 months). The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one (P = 0.102). Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients, and no obvious in-stent stenotic changes were observed. Conclusion: Endovascular therapy of selected symptomatic extracranial carotid artery dissection with bare stents can effectively prevent the recurrence of clinical symptoms and promote ICA remodeling with excellent mid-term patency. (authors)

[en] Objective: To evaluate the efficacy and safety of microcoil embolization in the treatment of traumatic pseudoaneurysm (TPA)of lower extremity. Methods: The clinical data of 4 patients with TPA of lower extremity, who were admitted to Nanjing Zhongda Hospital of China during the period from April 2016 to June 2018 to receive microcoil embolization therapy, were retrospectively analyzed. Preoperative CTA and intraoperative angiography were performed to evaluate the morphological characteristics of TPA, the anatomical characteristics of the parent artery and the collateral circulation. After the diagnosis was confirmed by intraoperative angiography, embolization with microcoils to occlude the parent artery and the pseudoaneurysm cavity was carried out. Postoperative CTA was performed to evaluate the embolization effect for pseudoaneurysm and to detect the recurrence of TPA and the shifting of microcoil. The patients were followed up to observe the improvement of clinical symptoms and signs, and the postoperative complications were recorded. Results: Preoperative CTA and intraopertaive angiography confirmed the diagnosis of TPA in all 4 patients. Successful embolization of pseudoaneurysm cavity was accomplished in all 4 patients. Angiography performed immediately after embolization showed that previous pseudoaneurysm disappeared and no ectopic embolism by coil was seen. After treatment, the symptoms and signs of the patients were significantly improved and no complications occurred. No recurrence of pseudoaneurysm was found on followup CT angiography. Conclusion: For the treatment of TPA of lower extremity, microcoil embolization is safe and effective. This therapy has obvious advantages, and microcoil can be used as preferred embolic material. (authors)

[en] Objective: To study the clinical value of 64-slices spiral CTA with DSA comparatively in diagnosis of lower extremity arterial occlusive diseases. Methods: 31 patients with lower extremity arterial occlusive diseases underwent 64-slice spiral CT angiography of lower extremity arteries and they also underwent digital subtraction angiography (DSA)two weeks later. Reconstruction by maximum intensity projection (MIP), volume render (VR)and multiplanar reformatting (MPR)in working-station was undertaken comparing with the bolus chase DSA and traditional DSA for diagnostic accuracy. Results: The 216 arterial segments of lower extremity were selected, including 157 segments with consistent results in demonstrating degree of stenosis by both examinations. On CT angiography, 5 segmental stenosis were overestimated and 9 were underestimated. When stenosis of detected segments is more than 50%, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CTA were 98.21%, 96.15%, 97.22%, 96.49%, and 98.04%, respectively. Conclusion: 64-slices spiral CT angiography is an effective and reliable method for evaluating the lower extremity arterial occlusive diseases and may provide precious information for planning interventional therapy. (authors)

[en] Objective: To explore the feasibility and efficiency of transfecting human thrombomodulin (hTM) gene into rabbit's endothelial progenitor cells (EPCs) in order to provide experimental evidence for further animal experiments. Methods: The eukaryotic expression plasmid of hTM gene was constructed. Rabbit's peripheral blood mononuclear cells (MNCs) were isolated. EPCs were isolated from the MNCs by adherence method, which were expanded and characterized by CD34, KDR, vWF, Dil-ac-LDL, FITC-UEA-1, and then modified with hTM by using X-tremeGENE HP DNA Transfection Reagent. Direct immunofluorescence was performed to observe hTM expression after 48 hours, and the expression of hTM was detected by Western blot after 72 hours. MTT assay was used to evaluate cell survival and proliferation. Results: The recombinant hTM with recombinant plasmid was confirmed by double endonuclease digesting and sequencing. EPCs were characterized by being positive for the endothelial cellmarks of CD34, KDR, vWF and internalization of Dil-Ac-LDL and binding to FITC-UEA-1. The gene expression was significantly improved in the pcDNA3.1-hTM group compared to control group as demonstrated by direct immunofluorescence and Western Blot analysis. The difference of survival rate was not significant among pcDNA3.1-hTM group, pcDNA3.1 (+)-neo group and untransfected group through MTT analysis. Conclusion: The recombinant plasmid of pcDNA3.1-hTM can be successfully and effectively transfected into rabbit's peripheral blood EPCs by using X-tremeGENE HP DNA Transfection Reagent, and the transfection causes no significant changes in viability and proliferation capacity of EPCs. (authors)

[en] Objective: To evaluate the efficacy and safety of super-selective arterial embolization (SAE) by using the mixed solution of Pingyangmycin and iodine oil combined with the absolute alcohol in treating solitary renal hamartoma. Methods: The clinical data of 6 patients with solitary renal hamartoma, who were admitted to authors' hospital during the period from May 2009 to October 2015, were retrospectively analyzed. Each patient received several times of SAE, and based on the follow-up results different embolization materials were employed for the next embolization procedure. Follow-up enhanced CT or plain MRI was employed to check the elimination rate and the recurrence of the tumor. Results: All SAE procedures were successfully accomplished in all 6 patients, the technical success rate was 100%. Each patient received 3 times of SAE on average. The mean interval time for operation was about one year, and the mean follow-up time was 2.5 years. Follow-up examination at 3, 6 and 12 months after SAE showed that the mixed solution of Pingyangmycin and iodine oil plus polyvinyl alcohol (PVA) particles could only reduce the tumor size, but could not eliminate the lesion, while the mixed solution of Pingyangmycin and iodine oil plus absolute alcohol could eliminate the lesion, and long-term follow-up examination showed that no recurrence of the primary lesion was observed. Conclusion: The mixed solution of Pingyangmycin and iodine oil plus the absolute alcohol can safely and effectively obstruct the renal hamartoma, it may be a good embolism material for solitary renal hamartoma. (authors)