Science Letters:Cellular growth under hydrostatic pressure using bovine aortic EC-SMC co-cultured ePTFE vascular graft

High blood pressure (hypertension) is implicated in the development of atherosclerosis. Blood vessels are constantly subjected to stretch due to blood pressure and changes in stretch usually instigate adaptive vascular remodeling, including abnormal growth and proliferation of vascular smooth muscle cells (VSMCs) as well as extracellular matrix (ECM). In this experiment, we used bovine aortic endothelial cells and smooth muscle cells (EC-SMC) co-cultured ePTFE vascular grafts subjected to normal atmospheric pressure (as a control), and 100 mmHg hydrostatic pressure for 7 d. The increase of cell layer thickness was observed. When measured, the cell layer thickness increased by 116.2%. The increase of collagen (Type Ⅳ)synthesis was also observed in the immunohistochemistry assay. When stained with toluidine blue, the cells showed metachromatic phenomenon.

Revascularization for Iliac-femoral Artery Pseudoaneurysm with Greater Saphenous Vein

Objective To investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers. Methods Twenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them,15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up,and the complications were recorded. Results The surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin. Conclusions The use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats

AIM： To explore the influence of portal vein hemodynamic changes after portal venous arterialization （PVA） on peribiliary vascular plexus （PVP） morphological structure and hepatic pathology, and to establish a theoretical basis for the clinical application of PVA. METHODS： Sprague-Dawley rats were randomly divided into control and PVA groups. After PVA, hemodynamic changes of the portal vein and morphological structure of hepatohilar PVP were observed using Doppler ultrasound, liver function tests, ink perfusion transparency management and three-dimensional reconstruction of computer microvisualization, and pathological examination was performed on tissue from the bile duct wall and the liver. RESULTS： After PVA, the cross-sectional area and blood flow of the portal vein were increased, and the increase became more significant over time, in a certain range. If the measure to limit the flow in PVA was not adopted, the high blood flow would lead to dilatation of intrahepatic portal vein and its branches, increase in collagen and fiber degeneration in tunica intima. Except glutamic pyruvic transaminase （GPT）, other liver function tests were normal. CONCLUSION： Blood with a certain flow and oxygen content is important for filling the PVP and meeting the oxygen requirement of the bile duct wall. After PVA, It is the anatomic basis to maintain normal morphology of hepatohilar bile duct wall that the blood with high oxygen content and high flow in arterialized portal vein may fill PVP by collateral vessel reflux. A adequate measure to limit blood flow is necessary in PVA.

MEDIASTINAL CAVERNOUS HEMANGIOMA:REPORT OF ONE CASE

MEDIASTINAL cavernous hemangioma is a kind of primary mediastinal mesenchymal tumor that occurs rarely in any age. It was first reported by Shennon in 1914. In this study we reported a case of mediastinal cavernous hemangioma with abnormal vessel originating from left brachiocephalic vein.

Advances and progress of endarterectomy in the treatment of carotid stenosis

Carotid stenosis, one of the risk factors that tend to result in cerebral ischernia, infarction as well as ischemic manifestations. CEA （carotid endarterectomy）, was initially designed delicately to excise of the thickened, atheromatous tunica intima from the focal stenosis segment, which therefore has been acknowledged as an efficacious way in the management of the prophylaxis of cerebral ischemia. Deruing 1990＇s, carotid endarterectomy （CEA） has matured to a widely performed, standard intervention with well defined successive steps. In the recent years, appearance of angloplasty, stenting, and distal protection procedures provides competitive alternatives to classical endarterectomy. However, long-term benefits of carotid angioplasty should be confirmed by larger, randomized, comparative clinical trials.

Surgical treatment of post-traumatic pseudoaneurysms and arteriovenous fistulas

Objective: To report the experience in the diagnosis and treatment of post traumatic pseudoaneurysms and arteriovenous fistulas. Methods: A series of 30 patients (11 women and 19 men) with posttraumatic pseudoaneurysms were reviewed retrospectively. Among them 7 patients (5 women and 2 men) were associated with arteriovenous fistula. Results: The causes included sharp penetrating trauma (18 cases), blunt trauma (6 cases) and iatrogenic arterial injury (6 cases). The main clinical manifestations consisted of local pulsatile mass (26 cases), vascular bruits (19 cases), thrill (13 cases), ischemia of distal limb (9 cases), neuropathy (5 cases) and pseudoaneurysm rupture (2 cases). All patients underwent surgery. The operations included: ligation of the vessels (12 cases), surgical resection and primary suture repair of the vascular defect or anastomosis (11 cases), vascular reconstruction with autogenous saphenous vein (3 cases) and synthetic vascular graft (4 cases). Conclusions: Because of the imminent clinical course, early operation is usually indicated. The operative treatment is effective and safe for most of the patients with post traumatic pseudoaneurysms and arteriovenous fistulas.

Vascular reconstruction of segmental intestinal grafts using autologous internal iliac vessels

Background The aim of this study was to assess whether the autologous internal iliac artery and vein could be used as an interpositional graft for vascular reconstruction in segmental intestinal allografts and autografts.Methods Thirty-four intestinal transplants(19 living-related allografts and 15 autografts)were conducted in our programs between January 2011 and January 2019.Patient characteristics,type of vascular reconstruction,and post-operative complications were reviewed.Results There were 20 males and 14 females with a median age of 35 years.Of 34 grafts,22(64.7%)(11 allografts and 11 autografts)were revascularized using the autologous internal iliac artery and vein for reconstruction.Vascular reconstruction on the back table took 2166min to complete.Both total operative time and cold ischemia time tended to be longer in the vascular-reconstruction group than in the direct-anastomosis group(5306226 vs 4406116 and 159649 vs 125666 min,respectively),but these differences were not significant.The incidence of vascular thrombosis tended to be higher in the direct-anastomosis group than in the vascular-reconstruction group(16.7%vs 0%,P=0.118).At a median follow-up of 36.9 months,no stenosis or pseudoaneurysms developed.In 19 allografts,acute rejection occurred in 4(21.1%)and chronic rejection occurred in 1(5.2%).Conclusions Our results indicate that the use of an autologous internal iliac interposition graft greatly facilitates intestinal graft implantation and minimizes the risk of vascular complications.