Abstract:Objective To compare the effects of general anesthesia (GA) versus regional block anesthesia (RA) on the postoperative outcome in the elderly patients with lower limb ischemia. Methods The clinical data of 56 elderly patients with lower extremity ischemia surgically treated in our hospital from January 2013 to March 2021 were collected and analyzed retrospectively. The patients were divided into GA group (n=28) and RA group (n=28) according to the anesthesia method they underwent. The gender, age, modified cardiac risk index (RCRI), anesthesia method, intraoperative hemodynamic indexes postoperative length of hospital stay (LOS), and incidence of postoperative complications were recorded and compared between the 2 groups. SPSS statistics 19.0 was used for data analysis. Multivariate logistic regression or linear regression analysis was used to analyze the effects of different anesthesia methods on myocardial injury (MINS), intraoperative blood pressure fluctuation and postoperative LOS in the patients. Results Among the 56 patients, 18 (32.1%) developed MINS, including 12 (42.9%) in the RA group and 6 (21.4%) in the GA group. But there were no significant differences in the incidence of MINS and postoperative LOS between the 2 groups (both P>0.05). The fluctuation of intraoperative blood pressure was significantly lower in the RA group than the GA group (P<0.05). Female was an independent risk factor for postoperative MINS in the patients (OR=0.191,95%CI0.051－0.720; P=0.015). Anesthesia mode was not a risk factor affecting MINS and LOS. The RA group had more stable intraoperative hemodynamics than the GA group. Conclusion Female is an independent risk factor for postoperative MINS in the elderly patients with lower limb ischemia. Anesthesia mode has no significant effect on the occurrence of MINS and post-operative LOS, but the hemodynamics in RA group is more stable.

Abstract:Objective To compare the efficacy of arteriovenous fistula reconstruction and percutaneous transluminal angioplasty (PTA) balloon dilatation in the treatment of stenosis in autologous arteriovenous fistula (AVF) in elderly hemodialysis patients with hypertension. Methods A retrospective analysis was performed on the 23 elderly patients with hypertensive nephropathy who underwent AVF surgery due to hemodialysis treatment and then developed stenosis in the fistula in the Vascular Surgery Department of the People′s Hospital of Inner Mongolia Autonomous Region from February 2019 to February 2020. They were divided into 2 groups, receiving arteriovenous fistula reconstruction (control group, n=10) and PTA (study group, n=13), respectively. The general data, surgical success rate and AVF reconstruction rate in 6 months after operation were compared between the 2 groups. SPSS statistics 22.0 was used for data analysis. Data comparison between two groups was performed using student′s t test, Mann-Whitney test or Chi-square test depending on date type. Results The success rate was 80% (8/10) in the control group and 84.61% (11/13) in the study group, with no statistical difference between the two groups (P>0.05). Significant differences were observed in the reconstruction rate of AVF [61.54% (8/13) vs 40% (4/10)], size of wound [(3.10±1.76) vs (35.00±11.60) mm], operation time [(0.90±0.60) vs (1.50±0.40) h], intraoperative blood loss [10 (9,11) vs 30 (20,50) ml) and amount of contrast agent used [(50.00±25.17) and (8.13±3.34) ml] between the study group and control group (all P<0.05). Conclusion The efficacy of PTA is not inferior to arteriovenous fistula reconstruction in the treatment of AVF stenosis in elderly patients with hypertensive nephropathy, and PTA has higher revascularization rate.

Abstract:Objective To analyze the clinical characteristics of varicose veins of lower extremity in the elderly patients in order to provide reference for the diagnosis, treatment and management in elderly population. Methods Clinical data of 3 860 patients with varicose veins of lower extremity who underwent surgery in the First Affiliated Hospital of Xi′an Jiaotong University from January 2015 to December 2020 were collected and retrospectively analyzed in this study. According to the age, the subjects were divided into elderly group (≥60 years old, n=1 540) and non-elderly group (<60 years old, n=2 320). SPSS statistics 18.0 was used to perform the statistical analysis. Student′s t test, Chi-square test, or Mann-Whitney U test was used for intergroup comparison based on the data type. Results According to the results of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, there was statistically significant difference between the two groups in the CEAP grades (P<0.05). The patients in the elderly group were mainly in grade C4, and those in the non-elderly group were mainly in grade C3. The elderly group had an obviously longer duration of illness, larger proportion of more systemic or localized complications and longer length of hospitalization, but later for out-of-bed activities when compared with the non-elderly group (all P<0.05). Conclusion For varicose veins of lower extremities, the elderly patients have a longer duration of illness, severer condition, and more systemic or localized complications. Therefore, comprehensive assessment and individualized treatment are required for them.

Abstract:Objective To evaluate the patency rate of iliac vein stenting after thrombectomy in patients of deep venous thrombosis (DVT) with iliac vein compression syndrome (IVCS, also known as May-Thurner syndrome or Cockett′s syndrome). Methods Clinical data of 83 patients with acute lower limb DVT with IVCS and undergoing thrombectomy treated in Weifang People′s Hospital from January 2016 to December 2019 were collected and analyzed retrospectively. According to their treatment, they were divided into drug group (n=32) and stent group (n=51). The detumescence rate of limbs at discharge, venous patency rate and Villalta score at 6 and 12 months after operation were employed as evaluation indexes, and compared between the two groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test, Chi-square test, or Fisher exact probability test was employed for intergroup comparison depending on different data types. Results The detumescence rates of thigh and calf were (29.75±11.74)% and (30.40±10.79)% in the drug group, and (64.35±12.67)% and (61.0±18.89)% in the stent group, with significant differences between the two groups (all P<0.05). The venous patency rates at 6 and 12 months after operation were 87.50% and 75.00% in the drug group and 96.07% and 92.15% in the stent group, respectively. The Villalta scores at 6 and 12 months after operation were (8.16±1.80) and (7.44±1.50) in the drug group and (6.76±2.40) and (6.17±2.11) in the stent group, with statistical differences between the two groups (P<0.05). Conclusion One-stage iliac vein stent therapy can significantly improve the patency rate of vein and improve the symptoms of lower extremities after thrombectomy in patients with DVT and IVCS of lower extremities.

Abstract:Objective To investigate the clinical efficacy of secondary balloon dilatation or stenting based on D-dimer (D-D) in iliac vein stenosis with thrombosis. Method A prospective study was conducted in 33 patients with iliac vein stenosis or occlusion with thrombosis in Yibin First People′s Hospital from August 2016 to August 2020. They were randomized into study group (n=18) and control group (n=15), the former received lower extremity venography with balloon dilation iliac vein (8 cm) on the 4th day after the first-stage thrombolysis if the DD did not increase much (rang<10mg/L) within three days. The latter underwent venography of the lower extremities on day 7 after the first-stage thrombolysis, and ballooning dilation of the iliac vein or stenting would be considered according to the results of the angiography. The two groups were compared in the respects of D-D, calf circumference under the knee, venous reflux time, number of stents and usage rate, days of discharge and hospitalization expenses before surgery and on the 6th day after surgery. SPSS statistics 19.0 was used for statistical analysis. Depending on date type, data comparison between two groups was performed using t test or χ² test. Result The study and control groups had no significant difference in DD before operation [(15.62±6.21) vs(14.39±7.21) mg/L, P>0.05] but significant difference on day 6 after operation showed [(28.37±7.01)vs(20.54±5.78)mg/L, P<0.05]; no significant difference in the circumference at 15 cm below the knee at discharge [(1.2±0.6) vs(1.3±0.8)cm, P＞0.05] and venous reflux time at discharge[ (2.3±1.4) vs (2.4±1.6)s, P＞0.05]; significant differences in length of hospitalization [(8.35±1.51) vs (9.41±2.36) d, P＜0.05], hospitalization expenses [(56 750.6±12 387.8) vs (65 217.2±13 585.7) yuan, P<0.05], and number of stenting [3(16.7%) vs 5(33.3%), P＜0.05]. During the treatment, there were no serious life-threatening complications such as gastrointestinal bleeding between two groups. Conclusion Monitoring iliac vein stenosis and thrombosis through the D-D level can improve the efficiency of thrombolysis, reduce the use rate of stents and the cost of surgery, and reduce the length of hospital stay when the same effect is achieved in the early stage.

Abstract:Objective To explore the clinical application and clinical efficacy of Fogarty catheter thrombectomy combined with high-pressure balloon intraluminal angioplasty in elderly hemodialysis patients with stenosis and thrombosis in autologous arteriovenous fistula. Methods A total of 42 elderly hemodialysis patients who underwent thrombus removal with Fogarty catheter and high-pressure balloon angioplasty at the same time in the hybrid operating room of Yibin First People′s Hospital from March 2018 to March 2019 were recruited in this study. Their clinical outcome, complications, patency rate and its influencing factors were analyzed. SPSS statistics 22.0 was used for data analysis. Breslow test was used to analyze the factors influencing the postoperative fistula time after hybrid surgery, and Cox risk regression analysis was employed to analyze the factors influencing the patency rate of postoperative fistula. Results The success rate of operation was 95.24% (40/42), and the postoperative complication rate was 9.52% (4/42). The patency rate of the patients with successful operation was 97.5% (39/40) at 1 month, 87.5% (35/40) at 3 months, 72.5% (29/40) at 6 months, 52.5% (21/40) at 12 months, and 22.5% (9/40) at 24 months. The results of univariate analysis showed that postoperative smoking, poor control on blood glucose and blood pressure, residual stenosis, anastomotic stenosis and puncture point stenosis were independent risk factors affecting the patency time of internal fistula in elderly patients (all P<0.05). The results of multivariate Cox analysis showed that postoperative smoking, poor control on blood glucose and blood pressure, residual stenosis, anastomotic stenosis and puncture site stenosis were independent risk factors affecting the patency rate of postoperative internal fistula in elderly patients (all P<0.05).Conclusion Fogarty catheter thrombectomy combined with high-pressure balloon endovascular angioplasty has a high success rate, high short- and mid-term postoperative patency rate and fewer postoperative complications in the treatment of stenosis and thrombosis in autologous arteriovenous fistula in the elderly hemodialysis patients. Postoperative smoking, poor control on blood glucose or pressure, residual stenosis, anastomotic stenosis, and puncture point stenosis are important factors that affect the patency of internal fistula after surgery in these patients.

Abstract:Objective To explore the clinical effect of Mailuo Shutong Pills combined with rivaroxaban in the treatment of post-deep vein thrombosis syndrome of lower extremity. Methods A retrospective study was conducted of the clinical data of 60 patients with sequelae of lower extremity deep venous thrombosis treated in the Department of Vascular Surgery of Weifang People′s Hospital from June 2019 to September 2020. According to the treatment regimen, they were divided into control group (n=30) and study group (n=30). The control group received basic treatment such as rivaroxaban tablets and elastic stockings, and the study group were treated with additional Mailuo Shutong Pills. The Villalta score, fibrinogen (FIB), activated partial thromboplastin time (APTT), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were recorded. SPSS statistics 22.0 was used for data analysis. According to the data type, t-test, χ² test, or Fisher′s exact test was used for comparison between groups. Results After treatment, the study group had significantly better Villalta score (including swelling, pain and pigmentation of the affected extremity), lower inflammatory indexes (IL-6 and hs-CRP) and FIB than the control group [(6.17±2.20)vs (7.43±1.50) points, (32.35±4.68)vs(48.75±5.21)pg/ml, (13.51±3.89) vs (18.87±4.28) mg/L, (2.43±0.41)vs (2.79±0.47)g/L, P<0.05]. There were no significant differences in APTT and adverse reactions between the two groups (P>0.05). Conclusion Mailuo Shutong Pills combined with rivasaban can significantly enhance the therapeutic efficacy in PTS, improving blood coagulation and inflammatory reaction with good safety.

Abstract:Objective To investigate the correlation of arteriosclerosis obliterans (ASO) of the lower extremity with coronary artery disease (CAD) and stroke. Methods The clinical data of 587 elderly patients with lower extremity ASO hospitalized in our hospital from October 2013 to March 2021 were collected and analyzed retrospectively. Their incidences of CAD and stroke were investigated. The correlations of Fontaine ischemic stage and ankle brachial index (ABI) with CAD and stroke were analyzed with Spearman correlation analysis. SPSS statistics 26.0 was employed for statistical analyses. Results The incidence rates of CAD, stroke, and CAD complicated with stroke were 32.20% (189/587), 13.12% (77/587) and 17.21% (101/587), respectively in the 587 patients. The Fontaine ischemic stage in the lower extremity was positively correlated with the occurrence of CAD (r=7.57, P<0.01) and stroke (r=3.57, P<0.01), and number of cardiovascular and cerebrovascular diseases (r=0.13, P=0.02). There was significant difference in ABI between the patients with CAD and those without [0.30 (0.00,0.55) vs 0.68 (0.50,0.80)], and those with stroke and without [0.40 (0.15,0.62) vs 0.60 (0.20,0.75)] (both P<0.01). ABI value had a negative correlation with the number of cardiovascular and cerebrovascular diseases (r=-0.48, P<0.01). Conclusion The incidence of cardio-cerebrovascular diseases is quite high in the elderly patients with lower extremity ASO. The more severe the lower extremity ischemia is, the higher risk for cardiovascular and cerebrovascular diseases.

Abstract:Objective To investigate the efficacy of local injection of foam sclerosing agent, polidocanol, combined with high ligation and stripping of the great saphenous vein and observe the incidence of complications in patients with great saphenous vein varicosity complicated with elevated D-dimer level. Methods A retrospective analysis was performed on the clinical data of 838 patients with varicose saphenous veins admitted to the Department of Vascular Surgery of Weifang People′s Hospital from March 2020 to February 2021. Then from them, 66 patients with elevated preoperative D-dimer level were selected and assigned into the study group, and another 66 patients with normal D-dimer level preoperatively were subjected into the control group. All of them received high ligation and stripping of the great saphenous vein+varicose vein injection of polidocanol. The therapeutic effect and the occurrence of common phlebitis, superficial thrombophlebitis, deep vein thrombosis and other complications were observed in the two groups after operation. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup compa-rison depending on different data types. Results The CEAP scores [CEAP classification stands for Clinical (C), Etiology (E), Anatomy (A), and Pathology (P)] were compared between before treatment and 1 month after surgery [study group:(2.86±1.02) vs (0.97±1.48)points; control group:(2.80±1.13) vs (0.92±1.49) points], the differences were statistically significant (all P＜0.05). But there were no statistical differences in the CEAP scores between the two groups 1 month after surgery (P>0.05), and no significant differences in the incidence of complications between the study group and control group (59.1% vs 53.0%) (P>0.05). Conclusion Local injection of polidocanol combined with high ligation and stripping of the great saphenous vein is a safe and feasible treatment for varicose veins complicated with elevated D-dimer.

Abstract:Perivascular adipose tissue (PVAT) is an important regulator of endovascular homeostasis. It is a special adipose tissue around blood vessels. In addition to supporting tissue, it is also an endocrine organ, which can lead to vascular dysfunction in the process of aging. PVAT can release a variety of adipose cytokines, chemokines and growth factors. PVAT-derived factors regulate vascular signaling and inflammation to regulate the function of adjacent layers of the vascular system in an endocrine and paracrine manner. Under physiological conditions, PVAT can store and burn lipids, generate heat, and absorb fatty acids from the blood. PVAT can also release a variety of vasoactive molecules, such as NO, H₂S and adiponectin, to prevent the development of atherosclerosis. At the same time, PVAT plays a key role in the development of atherosclerosis. When obesity, type 2 diabetes mellitus, vascular injury and aging can lead to PVAT dysfunction, vascular endothelial cell and smooth muscle cell dysfunction. The main manifestation is the release of pro-inflammatory adipokines by PVAT, which further causes endothelial dysfunction, inflammatory cell infiltration and vascular smooth muscle cell migration, thus promoting the development of atherosclerosis. PVAT is considered to be a predictor of age-related vascular diseases and a potential target for therapeutic intervention. In this review, we summarize the relationship fo PVAT with age-related vascular diseases, and the role of PVAT in different diseases related to vascular system was reviewed.

Abstract:Aortic aneurysm(AA) is an important disease threatening human health. The general performance of AA is the pathological dilation of the aorta, and abdominal aortic aneurysm(AAA) is the most common type. miRNA is known as the single-stranded non-coding small RNA, which is widely involved in the regulation of post-transcriptional gene expression. With the deepening of research, miRNA has been regarded as a crucial regulatory molecule in the development of AAA. Understanding the regulatory role that miRNA plays in the development of AAA contributes to the early diagnosis and targeted therapy of AAA and facilitates the prognosis estimation.

Abstract:The advent of interventional technology has generated new approaches to clinical diagnosis and treatment, and its develop-ment has also been accompanied by continuous improvements in procedure safety. Regardless of whether in peripheral vascular intervention or in cardiovascular and cerebrovascular intervention, intravascular administration of contrast agents is mostly required, and the use of contrast agents has the risk of causing acute kidney injury, leading to major complications, prolonged hospital stay, and poor prognosis. This article reviews the clinical problem of acute contrast-induced kidney injury in the respects of its pathophysiology, diagnosis, predictive factors, and clinical management, with a view to providing references in clinical decisions.

Abstract:The elderly constitute the main patient population of end stage renal disease (ESRD), and most of them had diabetes, hypertension and other complications. The main treatment for ESRD has been renal transplantation and hemodialysis. Because of scare kidney source, hemodialysis dominates the treatment at present. The guidelines for vascular pathways both at home and abroad set arteriovenous fistula (AVF) as the primary choice for patients undergoing maintenance hemodialysis. AVF enjoys advantages of long service life and fewer complications, but its establishment is difficult in the elderly patients due to vascular calcification, intimal hyperplasia and peripheral vascular diseases. The established AVF often has dysfunction, which requires intervention and remedy. Because the blood supply system in the forearm is valuable, most experts recommend that the principle of establishing AVF be in the sequence of the distal end of the arm and the posterior proximal end to the heart. This paper proposes that the establishing vascular pathway in the proximal forearm should be prioritized in the elderly patients with poor quality of blood vessels with advantages over the AVF at the distal end to the heart in terms of earlier maturation, higher success rate of first puncture and higher 2-year potency rate of of internal fistula. This provides a new idea for vascular surgeons to establish vascular pathway in the elderly patients with end-stage nephropathy.

Abstract:Post-thrombolic syndrome (PTS) in lower extremity deep vein is a group of diseases secondary to lower extremity deep vein thrombosis (DVT). Although the pathogenesis of PTS remains unclear, its high incidence and harm seriously affect the patients′ life quality. This article reviews its risk factors such as gender, age, obesity, genetic factors, treatment protocol for acute DVT, choice of anticoagulants, DVT recurrence, varicose veins, wearing stretch hoses, and functional exercises of the lower extremity, exploring possible solutions and interventions to reduce the incidence of PTS.

Abstract:Superficial varicose veins of lower extremities is a common venous condition clinically. The incidence of varicosity increases with age. The development of minimally invasive technology leads to wide application of foam sclerotherapy in the treatment of varicose veins. Foam stability, the key in foam sclerotherapy, is closely related to the therapeutic effect and safety. At present, polydocanol sclerosant is commonly used for sclerotherapy. Studies have shown that stability of polydocanol foam is affected by multiple factors such as temperature, gas composition, liquid-gas ratio, concentration of sclerosant, surfactant and preparation. This article mainly reviews recent research on the stability of polidocanol sclerosant foam with a view to providing evidence for safe and effective clinical application of polydocanol sclerosant foam.

Abstract:Objective To investigate the clinical outcomes of de-escalation from ticagrelor to clopidogrel in patients with acute coronary syndrome (ACS) or those after undergoing percutaneous coronary intervention (PCI) in the real world. Methods A total of 746 consecutive inpatients with ACS or after PCI who received combined ticagrelor and aspirin therapy in the Department of Cardiology of Chinese PLA General Hospital from October 2013 to August 2016 and then de-escalated from ticagrelor to clopidogrel during hospitalization or within 1 year after discharge were recruited in this study. According to the de-escalation time, the patients were divided into acute phase group (≤1 month, n=212) and non-acute phase group (1-3 months, n=262; 3-6 months, n=156; 6－12 months, n=116). All patients were followed up for 1 year to analyze the causes of de-escalation. The incidences of primary endpoints [net clinical adverse events within 1 year:a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, target vessel reconstruction and bleeding type 2,3 or 5 according to the Bleeding Academic Research Consortium (BARC) criteria] and secondary endpoints (cardiovascular ischemic events and BARC type 2,3 or 5 bleeding events) were compared between the groups. SPSS statistics 26.0 was used for data analysis. Multivariate logistic regression analysis was employed to evaluate the risk of primary endpoints and secondary endpoints after the de-escalation at different time periods. Results The main reason for de-escalation was no serious stenosis on coronary angiogram in the acute phase group (23.1%), and was ticagrelor unavailable in the non-acute phase group (41.9%). The incidence rate of 1-year net clinical adverse events was slightly higher in the acute phase group than the non-acute 1-3 months group (14.6% vs 12.2%, HR=0.72,95%CI 0.41-1.26; P=0.252), but there was no statistical difference. The incidence rate in the non-acute 1-3 months group was significantly lower than that of the 3-6 months group (12.2% vs 19.2%; HR=1.90,95%CI 1.07-3.37; P=0.029) and that of the 6-12 months group (12.2% vs 21.6%; HR=1.48,95%CI 1.10－2.00; P=0.010). There was no significant difference in the incidence of 1-year cardiovascular ischemic events among the groups (P≥0.05). The rate of 1-year bleeding events was significantly lower in the non-acute 1-3 months group than the 6-12 months group (9.2% vs 15.5%; HR=1.42,95%CI 1.01-2.00; P=0.044). Conclusion In the real world, the patients with ACS or after PCI can obtain best net clinical benefit from de-escalation of ticagrelor to clopidogrel in an early non-acute phase (1-3 months).

Abstract:Objective To establish an individualized bleeding risk assessment system for the elderly coronary heart disease (CHD) patients complicated with intestinal malignant tumor based on single-center clinical big data. Methods Clinical data of the elderly CHD patients with intestinal cancer and being treated in the Chinese PLA General Hospital during January 2008 and December 2018 were collected retrospectively from the Clinical Database in the Big Data Center of the hospital, and they were subjected as the validation cohort. Taking the occurrence of major as the research endpoints, baseline analysis, decision tree model, support vector machine, logistic regression model and random forest model were performed on the clinical data. And then the CHD patients with intestinal tumor admitted into the hospital from January 2019 to December 2020 were prospectively recruited and served as derivation cohort. Finally, the performance of above models were evaluated and verified based on the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A predictive system for bleeding risk was established on the obtained optimal model. SPSS statistics 15.0 and R 3.6.1 were used for statistical analysis. Data comparison between two groups was performed using student′s t test, Chi-square test or Wilcoxon test depending on different data types. Results There were 511 patients in the derivation cohort and 35 patients with clinically significant bleeding events; 205 patients in the validation cohort and 11 patients with clinically significant bleeding events.Recursive feature elimination was used to screen the variables, and the logistic regression model containing 5 variables (brain natriuretic peptide precursor, total bilirubin, aspartate aminotransferase, carcinoembryonic antigen and urea) was selected as the optimal model. In the training set, the AUC value, accuracy, sensitivity, and specificity of the model were 0.791,0.757,0.714, and 0.800, respectively. In the verification set, the AUC value, accuracy, sensitivity, and specificity were 0.748,0.747,0.500 and 0.760, respectively. Based on this model, we constructed the bleeding prediction score for clinical application. Conclusion Our establised risk model and score system can predict bleeding events in the elderly CHD patients with intestinal malignant tumor.