Abstract:Objective To investigate the clinical characteristics, prognosis and risk factors of amputation patients in recent 5 years in Macau Hospital Conde S. Januário. Methods The inpatient amputation patients in our hospital between January 2011 and December 2016 were enrolled in this study. The clinical data, including demography, amputation causes, risk factors, amputation level and concomitant diseases were recorded. SPSS statistics 21.0 was used to perform the statistical analysis. Multivariate logistic regression analysis was employed to determine the effects of risk factors on amputation level. Kaplan-Meier survival analysis was used to analyze the survival time after amputation.Results There were 175 consecutive patients (70.3±14.1 years old) with 208 amputation procedures recruited in this study. They were 71 cases of above knee amputation, 51 cases of below knee amputation, and 86 cases of foot or toe amputation. The causes of amputation were diabetic foot in 130 patients, diabetic foot and peripheral arterial disease in 41 patients, simple peripheral arterial disease in 19 patients, and other causes in 18 patients. Multivariate logistic regression analysis indicated that above knee amputation was associated with hypertension and peripheral artery disease(RR=2.012, P=0.215；RR=1.914, P=0.107), and foot or toe amputation was more prevalent in diabetes mellitus(RR=0.315, P=0.019). Kaplan-Meier survival analysis showed postoperative survival time was effected by amputation level, and survival time was shorter in those with above knee amputation. Conclusion The most common amputation cause in our hospital is diabetic foot, followed by vascular disease of lower extremity and other causes, such as trauma, tumor, and so on. Amputation level is associated with cardiovascular risk factors and concomitant diseases. The amputation patients have comparatively shorter survival time after operation, and amputation level is one of factors influencing the survival time.

Abstract:Objective To analyze the efficacy of carotid endarterectomy (CEA) in the very old patients with carotid stenosis. Methods The patients with arteriosclerotic carotid stenosis treated with CEA in our hospital from January 2010 to December 2015 were recruited in this study. They were divided into ≥70-year-old group and <70-year-old group. All the patients were followed up for at least 1 year. The efficacy, treatment safety, and incidence rates of restenosis and secondary stroke after the procedure were observed and compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. Student’s t test or Chi-square test (Fisher exact probability method) was used to make the comparison between groups for different data types. Results There were 722 patients enrolled in this study, including 279 patients being assigned into ≥70-year-old group and 443 patients into <70-year-old group. There were no significant differences in surgery-related death, 30-day ischemic stroke, or acute myocardial infarction between the 2 groups (P>0.05). ≥70-year-old group had obviously high ratio of hyperperfusion than <70-year-old group (6.8% vs 3.2%, P<0.05). After 1 year’s follow-up, no significant difference was seen in the incidence rates of carotid artery restenosis and secondary stroke between the 2 groups. Conclusion CEA is safe for the very old patients. However, the conditions of the elderly patients should be evaluated before operation in order to reduce the occurrence of post-operative complications.

Abstract:Objective To investigate the endovascular treatment for abdominal aortic aneurysm (AAA) complicated with iliac artery disease. Methods A total of 52 AAA patients who received endovascular treatment in our department from January 2008 to December 2016 were enrolled in this study. Their clinical data, such as sex, age, clinical characteristics (including coronary heart disease, hypertension, diabetes, hyperlipidemia), and patency of deep and superficial femoral artery were collected and analyzed retrospectively. According to the severity of iliac artery disease, they were divided into patent iliac artery group and stenosis or occlusion iliac artery group. All patients received endovascular treatment and futher anticoagulation or antiplatelet after operation to prevent atherosclerosis. According to the data types, Student’s t test or Chi-square test (Fisher exact probability method) was used to compare the differences between groups. Results Fifty-two were divided into patent iliac artery group (41 patients, including 2 patients with severe distortion, 3.8%,2/52)and stenosis or occlusion iliac artery group(11 patients,9 patients with iliac artery stenosis, 17.3%,9/52, and 2 patients with iliac artery occlusion, 3.8%,2/52),there were no significant differences in sex, age, clinical characteristics, and patency of deep and superficial femoral artery between the 2 groups of patients (P>0.05). Two groups underwent endovascular exclusion successfully. Among patent group, distortion were corrected by super-hard guide wire, and in stenosis or occlusion group, balloon dilation and retrograde expansion of the femoral artery was carried out in affected limb or contralateral side. Stent were placed successfully for two groups. All patients were followed up for 12 to 24 months. Two patients had occlusion of lateral iliac artery in stenosis or occlusion group (P<0.05), among which one was treated with 1 leg brace in the right iliac artery and sequentially artificial vessel bypass in bilateral femoral artery, and the blood supply of both lower limbs was good after operation. Conclusion Being complicated with iliac artery disease makes it difficult for endovascular repair of abdominal aortic aneurysm. Endovascular exclusionwill be achieved successfully in cases receiving practical collaboration of surgical skills and instruments, and long-term patency rate was well.

Abstract:Objective To determine the safety and midterm efficacy of hybrid surgery for complex Trans-Atlantic Inter-Society Consensus (TASC) type D iliac and femoral occlusive lesions. Methods Twenty-seven patients with complex type D iliac and femoral lesions admitted in our department from January 2007 to December 2013 were recruited in this study. According to the results of computed tomography angiography (CTA) and TASC recommendation, the patients were assigned into groups of aorto-iliac C type plus femoropopliteal D type segment lesions (n=14), aorto-iliac D type plus femoro-popliteal C type segment lesions (n=7), and aorto-iliac D type plus femoro-popliteal D type segment lesions (n=6), and all of them underwent hybrid surgery for aorto-iliac and femoro-popliteal lesions simultaneously to improve the inflow and outflow. Ankle-brankial index (ABI) before and in 6,2, 24, and 36 months after surgery, and preoperative and postoperative patency rates (12,4, and 36 months) were recorded and analyzed. SPSS statistics 16.0 was used to perform the statistical analysis. Student’s t test was employed in intergroup comparison for measurement data. Kaplan-Meier survival analysis was adopted to analyze the patency rate. Results For aorto-iliac lesions, aorto-femoral artery bypass, iliac artery stenting, crossover femoro-femoral bypass, and endarterectomy or thrombectomy were performed respectively or in combination. For femoro-popliteal lesions, femoro-popliteal bypass, endarterectomy, femoral profundaplasty, thrombectomy, balloon dilatation and stent implantation were chosen respectively or in combination. No peri-operative death or major complications was observed. ABI was significantly increased in 6,2, 24, and 36 months after surgery (0.91±0.16,0.85±0.14,0.82±0.17, 0.77±0.13 vs 0.47±0.24, P<0.01). The patency rate was 95.7%, 80.2% and 72.9% respectively in 12,4, and 36 months postoperatively. Conclusion Hybrid surgery is safe and has good midterm outcomes for the patients with complex type D iliac and femoral lesions, especially for high-risk older patients.

Abstract:Objective To investigate the effect of bare-metal stent with smaller diameter in the elderly patients with illiac artery occlusion. Methods A retrospective study was performed on 104 old patients (131 limbs) with iliac artery occlusion who were admitted in our department from July 2010 to July 2013. According to the treatment, they were divided into those with bare-metal stent with smaller diameter implacement (n=53,6-7 mm in diameter, small diameter group) and those receiving stent with common diameter (n=51,8-10 mm in diameter, control group). All the patients were followed up for 2 years after the implacement, the procedural success rate, occurrence rate of restenosis, primary patency, secondary patency, and ankle-brachial index (ABI) were observed in the both groups. SPSS statistics 21.0 was used for statistical analysis, and Student’s t test and Chi-sqaure test were employed for the comparison between the 2 groups. Results The procedural success rate was 100.0% in the both small diameter group and control group. The occurrence rates of complications and restenosis were significantly lower in the small diameter group than the control group (1.89% vs 9.80%, 9.43% vs 17.60%; P<0.05). The ABI was significantly increased in both groups after the implacement (P<0.05). In the 2 years’ follow-up, there were no differences in primary patency and second patency between the 2 groups (90.5% vs 88.2%, 96.2% vs 96.1%; P>0.05).Conclusion Bare-metal stent with smaller diameter and stent with common diameter both can be an option for the elderly patients with illiac artery occlusion.

Abstract:Objective To explore the safety and effectiveness of percutaneous mechanical thrombectomy (PMT) with Rotarex device in treatment of acute limb ischemia (ALI). Methods Totally 23 patients [(71.0±12.1)years old] admitted in our department from September 2016 to May 2017 were recruited in this study. All of them had sudden onset of coldness, numbness and painfulness in lower extremities, or sudden aggravation of intermittent claudication, and were diagnosed with acute arterial thrombosis via CT angiography (CTA) and digital subtraction angiography (DSA). According to the Rutherford classification, 2 patients (8.70%) were assigned into Grade Ⅰ, 15(65.22%) into Grade Ⅱa, and 6(26.09%) into Grade Ⅱb. They all received PMT using Rotarex device. Results Besides PMT with Rotarex device, 18 patients underwent balloon dilatation (9 with drug-coated balloon), 5 underwent stent implantation, and 5 received catheter-directed thrombolysis. There were 17 cases obtaining complete thrombus removal, 4 cases of most removal and 2 getting no removal, and the success rate of the approach was 91.3%(21/23). There were 19 caes recovering from all symptoms, 2 obtaining symptoms relief and 2 getting no improvement, and the clinical efficiency rate was 91.3%(21/23). Eight patients experienced occlusion of stented arteries, and recovered after operation. During the operation, distal embolization was seen in 3 cases, and angiorrhoxis in 1 case. During the follow-up period, 2 cases developed recurrent thrombosis of ipsilateral lower extremity. Conclusion Under strict indications, PMT with Rotarex device is safe and effective in the treatment of ALI.

Abstract:Objective To summarize the clinical characteristics and treatment options of Stanford type B aortic dissection(AD) in the elderly patients. Methods The clinical data of 55 elderly patients diagnosed with Stanford type B AD in our department from July 2012 to July 2016 were collected. The 19 patients (medication group) with simple Stanford type B aortic dissection were treated with medication, and the other 36 patients (endovascular treatment group) with complicated type were given endovascular surgery plus medication. A statistical analysis was conducted on their age, gender, on-set season, diagnostic duration, clinical manifestations, hypertension grades, and imaging findings. The prognoses of patients with different treatment options were analyzed. SPSS statistics 21.0 was employed for data analysis. And Student’s t test, Chi-square test or rank sum test was employed for comparison for different data between the 2 groups. Results Among the 55 patients, the most common on-set season was spring and winter, accounting for 74.6%(41 patients). There was a significant difference in the age between the medication and endovascular treatment groups [(70.68±6.84) vs (66.75±5.33)years, P=0.022]. But no differences were seen in the gender, diagnostic duration, clinical manifestations, hypertension grades, and imaging findings between the 2 groups (P>0.05). Fifty-three patients (96.4%, 53/55) were followed up for a mean period of 11.2 months, and 2 patients were lost. The rate of symptom relief was significantly lower in the medication group than the endovascular treatment group (68.4% vs 94.4%, P<0.05). No differences were seen in the incidence of complications and mortality rate between the 2 groups (P>0.05). In the medication group, 3 patients were re-hospitalized due to chest pain in 1 to 3 months after discharge, and CT angiography indicated the progressive increase of the dissection, so endovascular surgery was carried out. The re-operation rate was slightly greater in the medication group than the endovascular treatment group, though without obvious difference (P>0.05). Conclusion For the elderly patients, Stanford type B AD is common in spring and winter, and with varied and atypical symptoms. So, great attention should be paid to the disease. Endovascular treatment is still its main treatment.

Abstract:Objective To investigate the efficacy of rosuvastatin in the prevention of carotid restenosis after carotid artery stenting (CAS). Methods Sixty-nine patients who had undergone CAS in our hospital from March 2014 to August 2015 were recruited prospectively, and then randomly assigned to the control group (n=34, bayaspirin 100 mg/d) and treatment group (n=35, bayaspirin 100 mg/d and clopidogrel 75 mg/d). After oral administration for 12 months, the therapeutic effects were compared between the 2 groups. SPPS statisitics 17.0 was used. The data were analyzed by t test, variance analysis, or Chi-square test. Results At 12 months post-CAS, repeated CT angiography showed that the treatment group was superior to the control group in stent smoothness, stent inner diameter, as well as the vascular conditions at the proximal and distal ends of the stent (P<0.01), and in lower stent lumen density and stent restenosis rate (P<0.01). In the treatment group, the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly decreased (P<0.01), while that of adiponectin (APN) was obviously increased after the treatment (P<0.01). However, no changes were found in the levels of TC, LDL-C, or APN in the control group (P>0.05). Conclusion Oral administration of rosuvastatin exerts significant effect on the prevention of post-CAS in-stent restenosis and occlusion, and thus reduces the restenosis rate.

Abstract:Abdominal aortic aneurysms (AAAs) is a medical problem with high mortality rate, and so it is of great significance to understand its pathogenesis. One of main characteristics of the disease is extensive infiltration of macrophages, neutrophils and T-lymphocytes. Much evidence has confirmed that T lymphocytes are closely associated with the pathogenesis, but their role in the progression remains unclear. This article reviewed the possible roles of T lymphocytes in the pathogenesis of AAAs, and provided effective drug treatment strategies for the disease which still lacks of effective drug intervention.

Abstract:Lower extremity arteriosclerosis obliterans (ASO) is one of the most common peripheral vascular diseases. The risk factors for ASO include age, gender, smoking history, hypertension, hyperlipidemia, coronary heart disease, and hyperhomocysteinemia. Although some progresses have been made in current treatments such as surgical procedures, endovascular techniques, and drug therapy, ASO remains a major cause of amputations. Therefore, it is very important to master the related risk factors for ASO and prevent them as early as possible in the elderly patients. Interventional therapy has the advantages of small trauma, easy operation, quick recovery and good reproducibility, and has become the first choice for the treatment of lower extremity ASO.

Abstract:Angiopoietin-like protein 2 (Angptl2) is a member of angiopoietin-like protein family, whose rhythmical expression or secretion helps maintaining body homeostasis, and is associated with coronary heart disease (CHD), abdominal aortic aneurysm (AAA), vascular inflammation and arteriosclerosis obliterians of lower extremity. Thus, it is of great significance for the studies concerning Angptl2. This article reviewed the role of Angptl2 in the pathogenesis of arteriosclerosis obliterians.

Abstract:Venous thrombosis is one of postoperative complications following implantation of cardiovascular implantable electronic devices (CIED), and its mechanisms remain unclear yet. The types, diameters and quantities of the lead may be the risk factors for the disease. Definite diagnosis can be obtained in combination of medical history, clinical manifestations and auxiliary examinations, and the treatment includes anticoagulation, thrombolytic therapy, lead extraction, venous stent implantation and surgery. In this article, we reviewed the recent literatures concerning venous thrombosis after implantation of CIED.

Abstract:Endovascular repair of aortic aneurysm mainly depends on preoperative monitoring, intraoperative management and postoperative follow-up based on radiological imaging technology. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography all play their roles in different stages of treatment. Usually, one imaging modality supports another one by providing additional information. A variety of imaging data must be integrated into a coherent program to manage patients with aortic aneurysms during treatment and follow-up.

Abstract:Isolated iliac artery aneurysm (IIAA), firstly reported in the 1820s, refers to a dilated artery disease limited in the iliac artery, and includes unilateral and/or bilateral common, external and internal iliac artery aneurysms, among which common iliac aneurysms account for 70% to 90%, internal ones for 10% to 30%, while external iliac artery rarely involved. IIAA is very rare clinically, with a prevalence of only 0.1% to 0.9%, and its etiology remains unclear. In clinical practice, it has occult manifestations and poor prognosis, and aneurysm rupture bleeding is the leading cause of death. This article reviewed the progress of IIAA in combination of its clinical characteristics, etiology, diagnosis and treatment.

Abstract:For the evaluation of carotid artery stenosis, the conventional measure is to gauge the narrowing or constriction of the inner surface of the carotid artery in the radiological images, and then the severity of stenosis is as a significant indicator for decision-making for intervention. However, much clinical experiences and clinical evidences have demonstrated that plaque stability and vulne-rability are better indicators in evaluation of symptoms, prognosis and revascularization of carotid artery stenosis. In this article, we integrated the advanced progress of carotid imaging techniques such as ultrasonography, computed tomography, magnetic resonance imaging and PET/CT, and analyzed the advantages and disadvantages of these techniques in the evaluation of plaque morphology and stability for clinical references.

Abstract:With the continuous development of new instruments and technologies and the unremitting efforts of clinicians, the treatment of occlusive diseases of femoral arteries has been progressing steadily, and has been developing toward safe, effective and minimally invasive approaches. For short-segment occlusion of femoral artery, percutaneous transluminal angioplasty (PTA) or PTA plus bare stent implantation is commonly performed, and has reliable effect. But for complex long occluded lesions of superficial femoral artery, the traditional femoral bypass is an accepted treatment modality. The new Viabahn covered stent graft have made “luminal bypass” become possible. Viabahn stent graft implantation is superior to traditional therapy with significant advantages, higher primary patency rate and comparable outcomes with prosthetic femoral-popliteal bypass surgery. This article reviewed the studies in this aspect.

Abstract:Therapeutic strategy-making and instrumental limits still remain 2 major problems that challenge the treatment of arterial chronic total occlusion (CTO) of lower extremity. Guidewire crossing-based strategy requires interventionalists to evaluate the nature of lesion at first,and then choose a right guidewire according to the characteristics of different wires. From hydrophilic coating guidewire to intraluminal tip-weighted guidewire, innovation of guidewire manufacturing may provide more appropriate options for specific lesions. With the advanced understanding of the nature of the lesion, interventionalists also began to adjust treatment strategy for different CTO lesions accordingly.This paper reviewed the previously published reports in the aspect, compared the advantages and disadvantages of various guidewires, and provided strategic suggestion for clinical treatment of arterial CTO lesion of lower extremity.