Abstract:The peripheral arterial disease is increasing in prevalence as population aging in China. The diagnosis and treatment of arteriosclerosis obliterans of the lower extremities is a complex project. Based on latest literatures and our own experience, we presented a brief review of the progress in diagnosis and treatment for the disease. Aspirin and statins are important basic medical therapy recommended by latest guidelines. Vascular surgeons should be skillful enough in surgical, endovascular and hybrid techniques. We must constantly be concerned about the latest development of new endovascular techniques, such as debulking techniques, drug coated balloons and new types of stents, etc. We also need to attach importance to quality control of open surgeries as always. Hybrid techniques might have advantages in treating complex multifocal lesions and were increasingly used nowadays. Timely diagnosis, comprehensive treatment and appropriate vascular reconstruction were very important for successful management of arteriosclerosis obliterans of the lower extremities.

Abstract:Objective To investigate the feasibility and efficacy of therapeutic strategy using modified endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA) patients with chronic renal insufficiency (CRI). Methods Modified EVAR was performed on AAA 19 patients with CRI, and routine EVAR on 40 cases with normal renal function (control group). The two groups were compared in surgical procedures, outcomes, and complications. GraphPad statistics 8.0 was used for statistical analysis. t test, χ² test or Fisher exact test was performed for data comparison between 2 groups. Results Modified EVAR was successful for all the 19 patients without perioperative death. There was no significant increase of SCr in CRI patients after EVAR (P=0.6109). One patient (5.26%) underwent bilateral renal arterial stenting due to partial coverage of the renal arteries. Slight endoleak (type Ⅱ) were detected in 2 patients (10.53%) without intervention, hematoma/infection puncture site was observed in 1 patient (5.26%), and postoperative fever occurred in 2 patients (10.53%). All patients had no acute renal failure, acute spinal or limb ischemia and other serious perioperative complications. No difference was found in total complications between the two groups. Imageological examinations at 3 months of follow-up showed the stents in all CRI patients in good shape and position with no endoleak, complete thrombosis in the aortic aneurysm cavity, and patency in all branch arteries. During the follow-up period (2 to 28 months, median 15 months), none of the patients except 1 who died of acute myocardial infarction had serious complications such as stent displacement, acute/chronic renal failure or limb ischemia. Conclusion The modified EVAR could protect renal function, reduce the incidence of complication and effectively extend the indications for EVAR in AAA patients with CRI.

Abstract:Objective To explore the effect of pain nursing intervention on postoperative pain in the patients with lower extremity arteriosclerosis obliterans (ASO). Methods From May 2016 to January 2018,2 patients with ASO were enrolled in this study, who underwent surgical treatment in the Department of Vascular Surgery of the Shanghai Ninth People′s Hospital. They were divided into observation group and control group (46 patients each). Both groups received unilateral balloon dilatation and stenting in the lower extremity. The control group received routine nursing after operation, while the observation group received pain nursing intervention featuring pain assessment management, multi-facet assessment, individualized pain management, multimodal health education, and intraoperative intervention. The two groups were compared in postoperative pain scores (digital rating scale or WONG-BAKER facial expression scale), sleep time, anorexia, ambulation after operation, days of hospitalization, and satisfaction with nursing. SPSS statistics 19.0 was used for data analysis. Depending on the data type, t test or χ² test is employed for comparison between two groups. Results On admission, there was no significant difference in pain score between control group and observation group [(3.50±1.14) vs (3.50±1.10), P=1.000]. At discharge, the pain score of the observation group was significantly lower than that of control group [(1.28±0.41) vs (2.39±0.77), P<0.001], and the scores for both groups were significantly lower as compared with those at admission with a statistically significant difference (P<0.05). Compared with control group, the observation group had earlier ambulation after operation, shorter hospitalization, longer sleep time, and better nursing satisfaction, the difference being statistically significant. However, no significant difference was observed in appetite between two groups (P=0.086). Conclusion Pain nursing intervention can relieve pain to a greater degree, improve sleep quality in ASO patients after operation, and enhance patients′ satisfaction with nursing.

Abstract:Objective To observe efficacy of drug-coated balloon (DCB) in the treatment of long-term occlusion or stenosis of lower limb arteriosclerosis obliterans (ASO) in the elderly patients. Methods A total of 21 elderly patients (32 limbs of lower limb ASO ≥10 cm) were selected from Department of Vascular Surgery of Inner Mongolia People′s Hospital, who received interventional therapy form August 2018 to August 2019. After an appropriate surgical approach was decided, each limb was pre-expanded with a common balloon, and depending on the target lesion, DCB (n=12) or bare metal stent (BMS; n=20) was implanted. At 6 and 12 months after intervention, the patients were assessed for the alleviation in the main symptoms (skin temperature, skin color, and oral report of pain in the affected limb and the patients′ self-feeling), riding distance, and Rutherford classification. The rate of blood reconstruction of the affected limb was observed at 12 months after intervention. SPSS statistics 22.0 was used for data analysis. Depending on the data type, t-test or χ² test was used for the comparison between groups. Results The intervention in all affected limbs was successful with a follow-up rate of 100%. During the follow-up period, no reoperation was performed, and no bleeding, death, amputation and other adverse clinical events occurred. There was no significant difference in the alleviation of main symptoms, riding distance and Rutherford grade between the two groups (P>0.05 for all). The revascularization rate of BMS group was significantly lower than that of DCB group [35.0%(7/20) vs 58.3%(7/12); P＜0.05)]. Conclusion DCB is as effective as BMS in the treatment of ASO in the elderly in the near and medium term, the former having a lower revascularization rate.

Abstract:Objective To evaluate mid- and long-term effect of selective shunting in carotid endarterectomy (CEA) under general anesthesia. Methods A retrospective analysis was made of 129 patients who received CEA in Department of Vascular Surgery of the First Affiliated Hospital of Sun Yatsen University from March 2013 to June 2019. They were divided into shunting group (n=48) and non-shunting group (n=81). Color Doppler ultrasound was performed for the head and neck at 3 months after operation. The patients received a follow-up visit once every 6 months to 1 year. The two groups were compared in the overall survival rate and restenosis-free survival rate. SPSS statistics 20.0 was used to analyze the data. Depending on data type, t test or χ² test was used to compare the two groups. Kaplan-Meier was used to analyze overall survival and restenosis-free survival rate. Results The shunting group had a higher occlusive rate of contralateral carotid artery than the non-shunting group [29.2%(14/48) vs 3.7%(3/81)], the difference being statistically significant (P<0.001). Compared with the non-shunting group, the shunting group had longer clamping time [(22.6±5.9) vs (13.7±4.6)min] and operation time [(168.4±63.3) vs (143.0±50.2)min], more intraoperative bleeding [(108.0±65.2) vs (69.8±53.9)ml], shorter length of hospital stay [(5.5±1.4) vs (6.1±1.7)d], higher usage of patch [60.4%(21/48) vs 25.9%(29/81)], all the differences having statistical significance (P<0.05 for all). No death occurred in both groups at 6 weeks after operation. There was no significant difference in stroke [2.1%(1/48) vs 1.2%(1/81)] and carotid restenosis [(4.2%(2/48) vs 1.2%(1/81)] between the two groups (χ²=0.142, P=0.706; χ²=1.141, P=0.285). Kaplan-Meier analysis showed no significant difference in the overall survival rate (χ²= 0.287, P=0.592) and restenosis-free survival rate (χ²=0.285,P=0.593) between the two groups (P>0.05). Conclusion The selective use of carotid artery shunt in CEA has no effect on the long-term survival rate and restenosis-free survival rate .

Abstract:Objective To evaluate the clinical efficacy and safety of TurboHawk plaque system in lower extremity atherosclerotic occlusive disease. Methods A retrospective analysis was made of the clinical data of 23 patients with lower extremity atherosclerotic occlusive disease admitted to the Vascular Surgery Department of Yibin First People′s Hospital from March 2017 to June 2018. The TurboHawk plaque system was selected for intervention. An ankle brachial index (ABI) was performed for all the selected patients before and at 3 days after procedure. The patients were followed up for 6 months. The clinical data and follow-up findings before and after surgery were compared. SPSS statistics 19.0 was used for data analysis. The t test was used for comparison between groups. Results ABI at 3 days postoperatively was significantly higher than preoperative reading [(0.81±0.13) vs (0.26±0.19), t=31.52, P=0.012]. The treatment were markedly effective in 9 patients and effective in 14. Postoperative retroperitoneal hematoma occurred in 1 patient, plaque radial artery embolization in 1, anterior tibial artery rupture in 1, and superficial femoral artery dissection was performed in 1 patient, complication rate being 17.4%(4/23) and all being improved after treatment. After 6 months of follow-up, all patients showed no obvious resting pain, and only 1 patient developed claudication. All of the 6 patients with lower extremity ulcers were healed within 4 months after surgery without recurrent ulcers during follow-up. There was no significant difference in ABI at 6 months after surgery compared to 3 days after surgery [(0.81±0.17) vs (0.81±0.13), P>0.05]. Conclusion TurboHawk plaque system is an effective option worthy of popularization for patients with lower extremity atherosclerotic occlusive disease, with minimal invasiveness and satisfactory efficacy and safety.

Abstract:Objective To investigate the establishment and preliminary practice of home management mode for patients with lower extremity arteriosclerosis obliterans (ASO). Methods A total of 81 patients with lower extremity ASO were enrolled, who were admitted to Department of Vascular Surgery of Yibin First People′s Hospital from May 2016 to April 2018. According to management modes employed after discharge, they were divided into control group (n=40) and study group (n=41). The patients in the control group were followed up by telephone at 1 and 12 months after discharge. For the study group, the home-based management mode was adopted,i.e. supervision and guidance were provided concerning the patients′ compliance behaviors (medication, smoking cessation, diet, rehabilitation exercise, limb protection, family support, and regular reexamination) via telephone + Wechat at 1,2, 3,6, 9 and 12 months after discharge. The two groups were compared in the respects of recorded rate of compliance, recurrence and amputation, and improvement of ASO Fontaine stage. SPSS statistics 19.0 was used for analysis, and Chi square test for the comparison between two groups. Results On discharge, 10 patients in the study group were of Fontaine stage Ⅰ, 19 of stage Ⅱ, 10 of stage Ⅲ, and 2 of stage Ⅳ; and the numbers were 23,3, 5 and 0 in the same order of stages at 12 months after discharge. In control group, 9 were of Fontaine stage Ⅰ, 17 of stage Ⅱ, 12 of stage Ⅲ, and 2 of stage Ⅳ, and the numbers were 7,6, 13, and 4 in the same order of stages at 12 months after discharge. There was no significant difference in the proportion of Fontaine stages between the two groups at the time of discharge (P>0.05). At 12 months after discharge, there was significant difference between the two groups in the proportion of Fontaine staging (P<0.05). Compared with those on discharge, the ASO symptoms in the study group were significantly improved at 12 months after discharge (P<0.05), while those in control group were significantly worse. Compared with control group, the proportion of patients with good compliance behaviors in the study group increased significantly, and the proportion with recurrence and amputation decreased significantly at 12 months after discharge (P<0.05). Conclusion The implementation of home management for the patients with lower extremity ASO can enhance patient′s compliance, alleviate lower limb ischemia, and reduce recurrence rate and amputation rate.

Abstract:Objective To investigate the clinical efficacy of endovascular treatment of the complex Trans-Atlantic Inter-Society Consensus (TASC)ⅡD aortoiliac occlusive disease (AIOD). Methods A retrospective analysis was made of the clinical data of 69 patients treated by vascular surgery for TASCⅡD aortic and iliac artery disease in the First Hospital of Shanxi Medical University. Before the operation, a therapeutic protocol was instituted according to Fontaine staging and corresponding imaging examination. All the patients were treated endoscopically and were followed up regularly for 3 to 36 months on phone or at the outpatient clinic. Analyses were made of their clinical symptoms, ankle brachial index (ABI), complications, and patency rate. SPSS statistics 17.0 was used for data analysis, and t test was used for comparison between groups. Results The overall success rate of endovascular therapy was 94.2% (65/69), and postoperative complications occurred in 4(5.8%). Sixty-five patients were followed up for more than 6 months, 4 were lost after 12 months, and 20 were lost after 24 months. ABI at 3 months after operation was significantly higher than that before admission [(0.38±0.12) vs (0.81±0.15), P<0.05]. Patency rate was 96.7%(59/61) after one year and 88.9%(40/45) after two years. Conclusion Endovascular therapy is safe and effective for TASCⅡD AIOD with satisfactory clinical outcomes and short- to mid-term patency rates.

Abstract:Objective To evaluated the efficacy of Straub Rotarex System combined with drug-coated balloon (DCB) in the treatment of lower extremity arteriosclerosis obliterans complicated with thromboembolism. Methods The clinical data of 16 elderly patients with lower limb ischemia treated with volume reduction using Straub Rotarex System combined with DCB dilatation from June 2015 to June 2018 were retrospectively analyzed. After definite diagnosis, percutaneous thrombectomy was performed for volume reduction with Straub Rotarex System, angiography was then performed, and residual stenosis was dilated with a DCB. The symptom improvement was observed, and ankle-brachial index (ABI) before and after treatment was compared, and the complications were observed. Patency and clinical efficacy were evaluated with color Doppler ultrasound at the outpatient clinic on follow-up visits during postoperative 6-12 months. SPSS statistics 22.0 was employed for data processing and t test for comparison between groups. Results Success rate of the operation was 100%. In 11 patients with resting pain, the pain was significantly relieved with significantly decreased visal analogue scale score [(2.0±0.3) vs (8.6±1.1), P<0.01]. Out of 5 patients with intermittent claudication, claudication disappeared in 3, and distances between two episodes of claudication were significantly lengthened. Postoperative ABI of the affected limb was significantly increased [(0.87±0.06) vs (0.29±0.10), t=19.89, P＜0.01]. Distal arterial embolization occurred intraoperatively in 1 patient, which was relieved after mechanical volume reduction. All patients were followed up for 6 to 12 months with a patency rate of 100%. Conclusion Rotarex thrombus system combined with DCB is safe and effective for patients with arteriosclerosis obliterans of the lower limb with thromboembolism, serving as a preferred therapeutic option for such patients.

Abstract:Objective To investigate the clinical effect of intracavitary interventional therapy in iliac artery occlusion in the elderly.Methods A retrospective analysis was made of 21 elderly patients with iliac artery occlusion in the Department of Vascular Surgery of Weifang People′s Hospital from October 2010 to October 2016. All the patients were diagnosed by computed tomography angiography via the arteries in the lower extremity before operation and were graded according to the Trans-Atlantic Inter-Society Consensus. Changes of ankle-brachial index (ABI) were recorded preoperatively and postoperatively at 3,6, 12 and 24 months, and changes of patency rate of iliac artery were calculated. SPSS statistics 19.0 was used for data analysis. The measurement data were analyzed with t-test, and Kaplan-Meier survival curve analysis was performed for patency rate. Results Different treatment choice should be made for iliac artery occlusion of different lesions. Thrombolytic catheter can be retained for thrombolytic occlusion. In the case of iliac artery occlusion caused by arteriosclerosis, balloon dilatation of and stent implantation in the iliac artery were performed in the first stage. No perioperative death occurred. ABI was 0.92±0.20 at 3 months, 0.90±0.18 at 6 months, 0.84±0.14 at 12 months and 0.79±0.21 at 24 months after operation, being significantly improved as compared with that before operation (P<0.01). The patency rate was 95.7% at 6 months, 80.2% at 12 months, and 72.9% at 24 months. Conclusion Total intracavitary treatment of iliac artery occlusion is minimally invasive, and has good mid-term efficacy, which is particularly suitable for the elderly.

Abstract:Splenic aneurysms are the most common visceral aneurysms, which are usually isolated sacs. Most of them are associated with old age, pregnancy, and increased portal vein blood flow with a high risk of rupture. At present, the choice of the treatment of splenic aneurysms remains controversial. Traditional open surgery is mostly used for emergency ruptures, while endovascular treatment is favored for elective surgery because of the slight trauma and rapid postoperative recovery. Both procedures have their own advantages and disadvantages. Lack of evidence-based medicine results in controversy concerning the treatment of splenic aneurysms. Therefore, further study is needed for the choice of endovascular treatment, long-term therapeutic effect and the application of perioperative anti-coagulant and antiplatelet drugs.

Abstract:With rapid development and support of medical, computer and internet technologies, remote electrocardiography (ECG) monitoring is becoming more and more mature. Currently, remote ECG monitoring, as an important method for cardiology-related remote medical monitoring, plays a decisive role in pre-hospital first aid, remote diagnosis and follow-up management. Remote ECG monitoring can more easily capture the ECG in case of sudden or transient symptoms, provide timely diagnosis and treatment for high-risk groups of cardiovascular diseases, decrease the rates of missed diagnosis and misdiagnosis of cardiovascular events, and reduce the social economic and medical burden. Therefore, it has a good application and development prospect.

Abstract:Frailty is a clinical syndrome with decreased ability of maintaining homeostasis and increased vulnerability to stress as a result of declined physiological reservation and function of multiple systems in the elderly. It can lead to higher risks for such adverse outcomes as disabilities and ultimate death. Frailty is reversible, and early identification and intervention is critical. Rehabilitation nutrition refers to the improvement of nutritional status, sarcopenia, and frailty by using combined nutrition and rehabilitational exercise. This article reviews the progress in research on exercise, nutrition and rehabilitation nutrition intervention for the patients with frailty.

Abstract:Diabetic foot is one of the serious complications of diabetes and develops in up to 25% of diabetic patients during their lifetime. Studies have shown that diabetic neuropathy is one of the important factors for the onset of diabetic foot, that about 85% diabetic feet are associated with neuropathy, and that diabetic neuropathy usually involves sensory nerve fibers. Therefore, it has become crucial to investigate how to better diagnose and treat diabetic foot sensory neuropathy. This review summarizes the current evaluative and therapeutic methods for diabetic foot sensory neuropathy with a view of providing reference for clinicians.

Abstract:Cancer-related fatigue (CRF), associated with occurrence of cancer or anti-cancer therapy, is a major symptom of cancer patients. With a high incidence, CRF seriously affects the quality of life and treatment compliance of cancer patients, which has become the focus of cancer research in recent years. CRF may be multifactorial and highly varied in clinical manifestations. At present, several hypotheses have been put forward about the mechanism of CRF. The current article is to review the status quo of the research on the pathophysiological mechanism of CRF.

Abstract:Vasculitis features in many diseases, making it a complex condition. Aggravation or recurrence is seen in a considerable number of patients receiving conventional treatment of vasculitis. In recent years, biologic agents alone or in combination with other drugs have shown some advantages in treating refractory vasculitis and controlling the recurrence of vasculitis. In 2012, the European League against Rheumatism classified vasculitis into 7 categories. This article mainly reviews the progress in biological agents for the treatment of these 7 categories of vasculitis in recent years with a view to providing reference for clinicians.