Vascular trauma management from the perspectives of international guidelines and Chinese consensus: an integrated interpretation of the 2025 ESVS guidelines and the Chinese expert consensus
Impact of prophylactic inferior mesenteric artery embolization on outcomes after endovascular abdominal aortic aneurysm repair: a single-center retrospective analysis
Comparison of venous access strategies for endovascular management of central venous stenosis or occlusion in hemodialysis patients
Chinese expert consensus on thyroid reoperation
Feasibility and safety analysis of mixed reality-assisted surgery for substernal goiter: a report of 29 cases
Novel technology for lower esophageal sphincter augmentation: indications and limits in current surgical practice
Prevention and management of bleeding in endoscopic thyroid surgery
Clinical evaluation of the single-tunnel transmural puncture method in small-incision transoral endoscopic thyroidectomy vestibular approach
Exploration and reflection on robotic complex rectal cancer surgery
Reflections on the technical challenges and strategies in laparoscopic intersphincteric resection
Application of α-cyanoacrylate medical glue for mesenteric fissure closure during laparoscopic radical resection of colorectal cancer
Clinicopathologic features and prognostic analysis of colonic rhabdoid carcinoma: a case report and literature review
Feasibility study of a novel three-dimensional small intestinal submucosa patch in porcine hiatal hernia repair
Digital intelligence empowering pancreatic surgery: technological innovation and clinical practice
Advances in the development of novel pancreatic duct stent materials: from inert implantation to intelligent degradation through medical-engineering integration
Prophylactic dual biliary-pancreatic diversion: a conceptual and translational innovation in preventing postoperative complications after pancreaticoduodenectomy
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Chinese expert consensus on quality evaluation index system for extracranial carotid artery stenting
2025,34(12):2513-2519, DOI: 10.7659/j.issn.1005-6947.250465
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In recent years, the scale of extracranial carotid artery stenting (CAS) procedures in China has continued to expand. Establishing a scientific quality evaluation system, optimizing standardized surgical workflows, and effectively improving the survival quality of patients with carotid stenosis and occlusive diseases have become urgent challenges in the field of vascular surgery. After thorough discussions by the Expert Working Group on Carotid Artery Diseases of Expert Committee of the National Center for Medical Quality Control in Peripheral Vascular Interventional Technology, seven safety indicators were proposed: risk-adjusted 30-day postoperative mortality, risk-adjusted non-rehabilitative discharge rate, risk-adjusted in-hospital stroke/transient ischemic attack incidence, risk-adjusted 30-day unplanned carotid reintervention rate, risk-adjusted postoperative acute coronary syndrome incidence, risk-adjusted acute kidney injury incidence, and risk-adjusted access vessel reintervention rate. In addition, five technical indicators were established: pre- and postoperative antiplatelet medication use rate, preoperative carotid stenosis assessment rate, preoperative intracranial vascular evaluation rate, preoperative coronary artery assessment rate, and intraoperative cerebral protection device utilization rate. The promotion of these key quality indicators is expected to enhance the consistency of CAS surgical quality across medical institutions of different levels and regions.
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2025,34(12):2520-2527, DOI: 10.7659/j.issn.1005-6947.250651
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Hiatal hernia (HH) is highly prevalent in individuals with obesity and is closely associated with gastroesophageal reflux disease (GERD), making it a common and clinically important comorbidity in metabolic bariatric surgery (MBS). Currently, standardized diagnostic and therapeutic strategies for obese patients with different types of HH remain lacking. To improve the standardization and consistency of HH management during MBS in China, the Chinese Society for Metabolic and Bariatric Surgery, together with multiple academic societies, organized 93 national experts to develop a consensus based on the latest evidence and clinical experience. The consensus addresses 12 key issues, including preoperative evaluation, intraoperative diagnosis and differentiation, the necessity of dissecting tissues around the gastroesophageal junction, strategies for concomitant repair, procedure selection according to HH subtype, and reinforcement or fixation of the gastric sleeve. This consensus aims to provide evidence-based guidance for diagnosis, classification, procedure selection, and intraoperative management of HH in obese patients undergoing MBS. It also highlights the current limitations in available evidence and emphasizes the need for further high-quality studies to optimize future clinical guidelines.
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YANG Chenzi, LI Ming, SHU Chang
2025,34(12):2528-2535, DOI: 10.7659/j.issn.1005-6947.250609
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The International Society for the Study of Vascular Anomalies (ISSVA) classification system is currently the globally accepted multidisciplinary "golden standard". Since its initial release in 1996, it has undergone multiple revisions, with significant updates in 2014 and 2018 substantially advancing standardized clinical diagnosis and treatment. In 2025, breakthroughs in genomics and molecular imaging technology prompted ISSVA to release a new version of the classification, reflecting a deepened understanding of vascular anomalies from morphology to molecular mechanisms. The main changes are evident in the overall structure and classification approach. The core table content is more concise, consisting of one basic classification interface and three detailed classification pages, suitable for tiered healthcare; a new glossary has also been introduced. Furthermore, shifting from the previous classification based on clinical phenotype to a new classification considering the clinical presentation, histological subtypes, flow velocity, and genetic aspects, the 2025 edition holds milestone significance for standardizing the global diagnosis and treatment of vascular anomalies. This article provides an introduction and interpretation of the 2025 ISSVA classification, aiming to help healthcare professionals gain an in-depth understanding of the new classification system, follow updated guidelines to optimize diagnosis and treatment strategies, and ultimately improve patient outcomes.
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ZHANG Lei, LI Rui, LI Quanming, YE Zijian, XIA Dexiang, FANG Junjie, GUO Pengcheng, LI Xin, SHU Chang
2025,34(12):2536-2551, DOI: 10.7659/j.issn.1005-6947.250639
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Vascular trauma represents a group of life-threatening emergencies with high rates of mortality and disability in the fields of trauma surgery and vascular surgery. Its diagnostic and therapeutic strategies have continuously evolved with advances in endovascular techniques, perioperative management concepts, and multidisciplinary collaboration models. In 2025, the European Society for Vascular Surgery (ESVS) released, for the first time, the Clinical Practice Guidelines on the Management of Vascular Trauma. As an authoritative evidence-based document in the field of international vascular surgery, these guidelines provide a critical foundation for the standardized management of vascular trauma worldwide. Meanwhile, based on China's accumulated experience and research achievements in combat-related trauma care, organizations including the Chinese Military Vascular Surgery Group published Chinese expert consensus on the management of vascular combat injuries. This consensus focuses on special scenarios such as battlefield injuries and disaster settings, and proposes solutions with distinct Chinese characteristics and strong practical value in key areas including tiered trauma care systems, frontline hemorrhage control techniques, and damage control surgery for vascular injuries. It serves as an important supplement and refinement to existing international guidelines. The present article aims to conduct an in-depth comparison, analysis, and integration of these two pivotal documents, systematically summarizing their similarities, differences, and complementarities in terms of epidemiology, diagnostic assessment, management principles, region-specific injury management, and postoperative rehabilitation. By integrating international frontier evidence with China's real-world combat trauma experience, this work seeks to construct a pragmatic clinical decision-making framework to provide feasible and applicable guidance for domestic clinical practice.
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2025,34(12):2552-2560, DOI: 10.7659/j.issn.1005-6947.250574
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Lower extremity deep vein thrombosis (DVT) is a common vascular disorder that may cause severe limb swelling and pulmonary embolism in the acute phase, and can progress to post-thrombotic syndrome (PTS) in the chronic stage, leading to long-term impairment of patients' quality of life. With advances in endovascular techniques, percutaneous mechanical thrombectomy (PMT) has gained increasing attention as an early intervention strategy for DVT and is considered effective in reducing the incidence of moderate-to-severe PTS. Currently available PMT devices can be broadly classified into rheolytic, aspiration-based, stent retriever-based, rotational thrombectomy, and ultrasound-assisted thrombolysis systems, each with distinct mechanisms and clinical applications. Although short-term safety and efficacy of these devices have been preliminarily demonstrated, their comparative effectiveness in acute, subacute, and early chronic DVT, optimal device selection, and long-term impact on venous valve function remain uncertain due to the lack of high-quality evidence. This review summarizes the principles, technical features, and clinical applications of different PMT devices based on current guidelines and recent studies, discusses existing challenges, and outlines future research directions and device development trends, aiming to provide a reference for individualized treatment of DVT.
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2025,34(12):2561-2567, DOI: 10.7659/j.issn.1005-6947.250633
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With the accelerating aging of the population, the coexistence of abdominal aortic aneurysm (AAA) and chronic renal insufficiency (CRI) has become increasingly common, posing substantial challenges to perioperative management and adversely affecting patient outcomes. Although endovascular aortic repair (EVAR) is the standard minimally invasive treatment for AAA, the routine use of contrast-enhanced computed tomography and intraoperative angiography carries a significant risk of nephrotoxicity in CRI patients, potentially leading to contrast-induced nephropathy and acute kidney injury, and consequently increasing the risks of heart failure and mortality. To address these challenges, we propose the "ACIER" renal protection strategy, a structured perioperative management framework encompassing five key components: assessment of renal function, control of renal high-risk factors, enhancement of renal reserve, intraoperative reduction of renal injury, and early postoperative renal salvage. This strategy integrates refined risk stratification, contrast-sparing techniques, alternative imaging modalities, and dynamic postoperative renal monitoring, aiming to minimize contrast-related renal injury and improve outcomes in high-risk patients undergoing EVAR. The ACIER strategy provides a practical and individualized approach for the safe application of EVAR in patients with AAA complicated by CRI.
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LIU Hao, ZOU Lingwei, JIANG Xiaolang, YAN Lutong, CHEN Bin, DONG Zhihui, FU Weiguo
2025,34(12):2568-2576, DOI: 10.7659/j.issn.1005-6947.250354
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Background and Aims Type Ⅱ endoleak remains the most common complication after endovascular aneurysm repair (EVAR) and is closely associated with aneurysmal sac enlargement and secondary interventions. The inferior mesenteric artery (IMA) is a major source of type Ⅱ endoleak; however, the clinical benefit of prophylactic IMA embolization remains controversial. This study aimed to evaluate the impact of prophylactic IMA embolization on postoperative outcomes following EVAR.Methods Patients with infrarenal abdominal aortic aneurysm who underwent EVAR between January 2022 and January 2024 were retrospectively reviewed. Patients were divided into an embolization group and a non-embolization group according to whether prophylactic IMA embolization was performed. Baseline characteristics, perioperative data, and follow-up outcomes were compared. Kaplan-Meier analysis was used to assess endoleak-free survival, type Ⅱ endoleak-free survival, freedom from sac enlargement, and freedom from reintervention.Results A total of 233 patients were included, of whom 62 underwent prophylactic IMA embolization. No significant differences were observed in baseline clinical or anatomical characteristics between the embolization group and a non-embolization group (all P>0.05). During a mean follow-up of (19.6±9.7) months, the embolization group demonstrated significantly higher 2-year endoleak-free survival (93.55% vs. 74.53%, P=0.027), type Ⅱ endoleak-free survival (95.11% vs. 80.02%, P=0.043), IMA-related type Ⅱ endoleak-free survival (100.0% vs. 85.26%, P=0.019), and freedom from aneurysmal sac enlargement (94.27% vs. 81.96%, P=0.026) compared with the non-embolization group. No significant difference was observed in reintervention-free survival between the two groups (P=0.388).Conclusion Prophylactic IMA embolization significantly reduces postoperative endoleaks, particularly IMA-related type Ⅱ endoleaks, and is associated with improved control of aneurysmal sac enlargement after EVAR. However, its effect on reducing reintervention rates remains uncertain and warrants further validation in larger, long-term studies.
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ZHANG Lei, LI Rui, LI Quanming, LI Ming, HE Hao, XIA Dexiang, LI Xin, SHU Chang
2025,34(12):2577-2585, DOI: 10.7659/j.issn.1005-6947.250429
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Background and Aims Thoracic endovascular aortic repair (TEVAR) has become an important minimally invasive treatment for thoracic aortic diseases. However, management of complex aortic arch lesions requiring a proximal landing zone in zone 0 (Z0) remains technically challenging due to the need for supra-aortic branch reconstruction. The Castor single-branched stent-graft enables integrated reconstruction of the left common carotid artery (LCCA), but its application in Z0 TEVAR often necessitates adjunctive techniques for innominate artery (IA) revascularization. This study aimed to preliminarily evaluate the technical feasibility and short-term outcomes of Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent.Methods Patients with aortic pathologies who underwent Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent at the Second Xiangya Hospital of Central South University between February and June 2024 were retrospectively reviewed. Perioperative data and follow-up outcomes were analyzed. Primary endpoints included technical success, perioperative complications, and patency of reconstructed supra-aortic branches. Concomitant left subclavian artery (LSA) revascularization was determined on an individualized basis according to preoperative imaging findings.Results Six patients (mean age 51.5 years; 5 males) were included, with underlying pathologies comprising aortic dissection (n=4), aortic arch aneurysm (n=1), and penetrating aortic ulcer (n=1). All procedures were successfully completed, yielding a technical success rate of 100%. Concomitant LSA revascularization was performed in three patients. No mortality, stroke, spinal cord ischemia, endoleak, retrograde type A aortic dissection, stent migration, or upper extremity ischemia occurred within 30 days postoperatively. During a median follow-up of 13 months (range, 11-15 months), no major adverse cardiovascular or cerebrovascular events or stent-related complications were observed. Imaging follow-up demonstrated 100% patency of the IA, LCCA, and reconstructed LSA.Conclusion In a small, carefully selected cohort, Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent is technically feasible and associated with favorable short-term branch patency. Further studies with larger sample sizes and longer follow-up are required to validate its safety and long-term efficacy.
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ZHANG Xiong, QIU Jian, LI Ming, LI Quanming, SHU Chang, HE Hao
2025,34(12):2586-2595, DOI: 10.7659/j.issn.1005-6947.250587
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Background and Aims Carotid endarterectomy (CEA) is a primary treatment for carotid artery stenosis; however, intraoperative carotid clamping and postoperative reperfusion may lead to neurological complications such as cerebral infarction and cerebral hyperperfusion syndrome (CHS). An effective and standardized strategy for real-time, dynamic assessment of cerebral perfusion and individualized perioperative management is still lacking. This study aimed to evaluate the clinical value of transcranial Doppler (TCD) monitoring in improving perioperative safety and long-term outcomes in patients undergoing CEA.Methods Patients who underwent CEA at the Department of Vascular Surgery, the Second Xiangya Hospital of Central South University between February 2022 and December 2024 were retrospectively analyzed. According to the use of perioperative TCD monitoring, patients were divided into the TCD group and the non-TCD group. Baseline characteristics, perioperative management, complication rates, and long-term follow-up outcomes were compared between the two groups. Cerebral hemodynamic changes monitored by TCD were also analyzed.Results A total of 53 patients were included, with 25 in the TCD group and 28 in the non-TCD group. No significant differences were observed between the two groups in terms of age, sex, or major risk factors (all P>0.05). Operative time, length of hospital stay, and intraoperative shunt use were comparable between the two groups (all P>0.05). Within 30 days postoperatively, no transient ischemic attacks (TIA) or CHS occurred in the TCD group, whereas 2 cases of TIA and 3 cases of CHS were observed in the non-TCD group. During follow-up, no adverse events occurred in the TCD group, while 2 adverse events were recorded in the non-TCD group. Kaplan-Meier analysis demonstrated that the 3.5-year event-free survival rate was significantly higher in the TCD group than in the non-TCD group (P=0.047).Conclusion The use of TCD monitoring during CEA is significantly associated with improved long-term event-free survival. By enabling real-time assessment of cerebral hemodynamics, TCD facilitates identification of patients at high risk for cerebral hypoperfusion and hyperperfusion and guides refined perioperative management, thereby providing substantial clinical value.
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SUN Yuanhao, LUO Guangze, BI Jiaxue, LI Peng, ZHU Jiechang, FAN Hailun, DAI Xiangchen
2025,34(12):2596-2604, DOI: 10.7659/j.issn.1005-6947.250360
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Background and Aims Type Ⅱ endoleak (T2EL) is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR). While many cases remain benign, a subset may progress with aneurysm sac enlargement and require reintervention. Identifying risk factors for progressive T2EL and establishing a reliable risk stratification model may improve perioperative decision-making and postoperative surveillance. This study aimed to investigate the risk factors and threshold values for progressive T2EL after EVAR and to develop a nomogram-based prediction model.Methods Clinical data of patients who developed T2EL after EVAR for abdominal aortic aneurysm between March 2013 and December 2024 were retrospectively reviewed. Patients were classified into a progressive group (n=21) or a stable group (n=62) based on whether intervention criteria (An increase in the maximum aneurysm diameter of ≥10 mm compared with baseline) were met during follow-up. Clinical characteristics, anatomical parameters, and operative variables were compared. Multivariate Logistic regression was performed to identify independent risk factors for progressive T2EL. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values. A nomogram prediction model was constructed and internally validated using discrimination, calibration, and decision curve analyses.Results The progressive group had a significantly larger maximum aneurysm diameter, greater inferior mesenteric artery (IMA) ostial diameter, and a higher number of patent lumbar arteries (LA) compared with the stable group (all P<0.05). Multivariate analysis identified these three variables as independent risk factors for progressive T2EL after EVAR (all P<0.05). ROC analysis demonstrated increased risk of progressive T2EL in patients with a maximum aneurysm diameter ≥54.30 mm, IMA ostial diameter ≥2.82 mm, and ≥6 patent LA. The nomogram achieved a C-index of 0.858, which remained robust after internal validation (corrected C-index: 0.837), showing good discrimination, calibration, and clinical utility.Conclusion Maximum aneurysm diameter, IMA ostial diameter, and the number of patent LA are key predictors of progressive T2EL after EVAR. The proposed nomogram provides effective individualized risk assessment, although external validation is required before widespread clinical application.
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LIANG Zishun, LI Zhigao, CAI Jing, TANG Chen, NI Qian, WANG Qinghe, QI Jialin, QIAO Tong
2025,34(12):2605-2611, DOI: 10.7659/j.issn.1005-6947.250569
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Background and Aims Plaque instability is a major pathological determinant of ischemic stroke in patients with carotid atherosclerosis, in which inflammation plays a pivotal role. The neutrophil-plus-monocyte to lymphocyte ratio (NMLR) is a novel systemic inflammatory marker, but its association with carotid plaque stability remains unclear. This study aimed to investigate the relationship between NMLR and carotid plaque stability and to evaluate its predictive value.Methods A total of 211 patients with carotid artery stenosis who underwent carotid endarterectomy were retrospectively enrolled. According to postoperative pathological assessment, patients were classified into a vulnerable plaque group (n=113) and a stable plaque group (n=98). Clinical characteristics and preoperative laboratory parameters were collected, and NMLR and neutrophil-to-lymphocyte ratio (NLR) were calculated. Multivariate Logistic regression analysis was performed to identify independent predictors of plaque vulnerability. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of NMLR and NLR.Results Patients with vulnerable plaques had significantly higher NMLR and NLR levels than those with stable plaques (both P<0.001). Multivariate Logistic regression analysis identified previous stroke history (OR=4.59, 95% CI=2.22-9.50), NMLR (OR=7.07, 95% CI=3.71-13.48), and NLR (OR=5.89, 95% CI=3.09-11.25) as independent predictors of plaque vulnerability. ROC curve analysis demonstrated that NMLR yielded an AUC of 0.83 with an optimal cutoff value of 2.71, showing a sensitivity of 86.7% and a specificity of 69.7%. The AUC of NLR was 0.79, with comparable predictive performance.Conclusion NMLR, an inflammatory marker integrating the pro-inflammatory effects of neutrophils and monocytes and the protective role of lymphocytes, is closely associated with carotid plaque instability and exhibits good predictive value. It may serve as a convenient and effective tool for risk stratification and stroke prevention in patients with carotid atherosclerosis.
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LI Tianbiao, HUANG Jianhua, LIU Shao, HUANG Qiong, LI Haoyu, DAI Tingting
2025,34(12):2612-2618, DOI: 10.7659/j.issn.1005-6947.250632
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Background and Aims In clinical practice, some patients with arteriosclerosis obliterans (ASO) experience thrombotic events despite regular aspirin therapy, a phenomenon often broadly attributed to "aspirin resistance." However, the true prevalence of biological aspirin resistance and its associated factors remain unclear. Marked heterogeneity in reported resistance rates across studies has resulted mainly from differences in testing methods and diagnostic criteria, leading to uncertainty in clinical decision-making. This study aimed to determine the real-world prevalence of biological aspirin resistance in ASO patients using an arachidonic acid (AA)–induced platelet aggregation assay and to explore its associations with age and sex, thereby providing evidence for the appropriate interpretation of aspirin treatment failure.Methods This retrospective, single-center, cross-sectional study included 597 ASO patients who regularly received enteric-coated aspirin (100 mg/d) at Xiangya Hospital, Central South University, between January 2022 and August 2025. Aspirin resistance was assessed using the AA-induced maximum aggregation rate (MAR), with resistance defined as MAR ≥20%. Differences among age and sex groups were analyzed, and independent predictors were identified using multivariate Logistic regression.Results Among the 597 patients, 16 cases of aspirin resistance were detected, with an overall resistance rate of 2.68%. The resistance rates in different age groups (≤50 years old, >50 to 60 years old, >60 to 70 years old, and >70 years old) were 4.31%, 2.12%, 2.42%, and 2.50%, respectively, and there was no statistically significant difference among the groups (P=0.505). The resistance rates in males and females were 3.17% and 2.24%, respectively, and the difference was also not statistically significant (P=0.686). Multivariate Logistic regression analysis showed that neither age nor gender was an independent predictor of aspirin resistance (all P>0.05).Conclusion The prevalence of true biological aspirin resistance in ASO patients is very low and is not associated with demographic characteristics. Most cases of clinically perceived aspirin treatment failure are likely attributable to pseudo-resistance. Clinical management should prioritize the evaluation of modifiable factors such as medication adherence, formulation and absorption, drug interactions, and dose adequacy rather than routine screening for aspirin resistance.
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LI Weihao, ZHANG Xuemin, ZHANG Tao, LI Jing, ZHANG Xiaoming
2025,34(12):2619-2626, DOI: 10.7659/j.issn.1005-6947.250158
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Background and Aims Acute portal venous system thrombosis may lead to life-threatening complications such as intestinal necrosis and variceal bleeding, while anticoagulation alone often results in a low recanalization rate. This study evaluated the safety and efficacy of direct transabdominal superior mesenteric vein puncture combined with AngioJet mechanical thrombectomy and balloon angioplasty for acute portal venous system thrombosis.Methods A retrospective analysis was conducted on 10 consecutive patients with acute superior mesenteric vein-portal vein thrombosis treated between July 2023 and December 2024. All patients underwent direct puncture of the superior mesenteric vein through a small midline laparotomy under general anesthesia, followed by AngioJet mechanical thrombectomy and adjunctive balloon angioplasty. Immediate thrombus clearance, perioperative outcomes, and follow-up recanalization were evaluated.Results The median operative time was 140 (110-245) minutes, and the median intraoperative blood loss excluding AngioJet-related hemolysis was 80 (50-200) mL. The median thrombus aspiration time using the AngioJet mechanical thrombectomy system was 173 (138-296) s. Immediate postoperative thrombus clearance was grade Ⅲ in 7 patients and grade Ⅱ in 3 patients, yielding a technical success rate of 100%. Perioperative complications included one case of intraperitoneal bleeding and one wound hematoma. All patients experienced significant relief of abdominal pain, with no intestinal necrosis, bowel obstruction, or acute renal failure. During a median follow-up of 5 months, complete portal venous system recanalization was achieved in 5 patients, partial recanalization in 4 cases, and stable thrombosis in 1 case, with no recurrence, anticoagulation-related bleeding, or mortality.Conclusion Direct transabdominal puncture of the superior mesenteric vein combined with AngioJet thrombectomy and balloon angioplasty is a safe and effective treatment for extensive acute portal venous system thrombosis, enabling rapid restoration of portal flow and prevention of intestinal ischemic complications.
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YANG Wenxin, PENG Zhaoxi, PENG Zhiyou, LU Xinwu, YE Kaichuang
2025,34(12):2627-2634, DOI: 10.7659/j.issn.1005-6947.250616
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Background and Aims Improving intraoperative thrombus clearance is critical for reducing the risk of post-thrombotic syndrome (PTS) in patients with acute iliofemoral deep vein thrombosis (IFVT). The fast-track thrombolysis protocol (FTTP), which incorporates balloon-mediated thrombus fragmentation into conventional percutaneous mechanical thrombectomy (PMT), may enhance thrombus removal efficiency. However, comparative evidence between FTTP and standard PMT remains limited. This study aimed to compare the efficacy and safety of FTTP versus conventional PMT in the treatment of acute IFVT.Methods A retrospective cohort analysis was conducted on 100 consecutive patients with acute IFVT who underwent endovascular treatment between May 2022 and December 2024. Among them, 38 patients received FTTP and 62 received conventional PMT. The primary endpoint was the immediate intraoperative thrombus clearance rate, with technical success defined as ≥50% thrombus removal in the iliofemoral vein segment. Secondary endpoints included the use of adjunctive catheter-directed thrombolysis (CDT) or large-bore catheter aspiration, intraoperative thrombus embolization, and 30-day postoperative thrombus recurrence and iliofemoral vein patency.Results Baseline characteristics, including age, affected limb, symptom duration, and history of malignancy, were comparable between the two groups (all P>0.05). The immediate technical success rate was significantly higher in the FTTP group than in the PMT group [100.0% (38/38) vs. 82.3% (51/62), P=0.006]. No patients in the FTTP group required adjunctive CDT, whereas 8 patients in the PMT group did (P=0.023). No intraoperative thrombus embolization occurred in either group. At 30-day follow-up, thrombus recurrence rates and iliofemoral vein patency were similar between the two groups (both P>0.05).Conclusion FTTP significantly improves immediate thrombus clearance in patients with acute IFVT and reduces the need for adjunctive CDT without increasing the risk of intraoperative embolization or early postoperative recurrence, demonstrating favorable efficacy and safety.
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YIN Yuedi, LI Jinyong, LIU Jianlong, JIA Wei, MA Lin, TIAN Xuan, JIANG Peng, CHENG Zhiyuan, ZHANG Yunxin, TIAN Chenyang, ZHOU Mi, LIU Xiao, QU Chengjia, HUA Run
2025,34(12):2635-2644, DOI: 10.7659/j.issn.1005-6947.250681
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Background and Aims Elderly patients with deep vein thrombosis (DVT) are at high risk for bleeding and often have limited therapeutic options with conventional anticoagulation or thrombolytic therapy. Percutaneous mechanical thrombectomy (PMT) enables rapid thrombus removal while reducing thrombolytic drug exposure; however, its clinical efficacy and safety in elderly patients with acute inferior vena cava and/or iliofemoral DVT remain to be clarified. This study aimed to evaluate the effectiveness and safety of PMT in this patient population.Methods Clinical data of 70 elderly patients (≥65 years) with acute inferior vena cava and/or iliofemoral DVT treated with PMT between January 2017 and December 2024 were retrospectively analyzed. All patients underwent inferior vena cava filter implantation prior to PMT. AngioJet or Straub Aspirex systems were used, with adjunctive endovascular procedures including manual aspiration thrombectomy (MAT), catheter-directed thrombolysis (CDT), balloon angioplasty, and stent implantation as indicated. Technical success, thrombus clearance, perioperative complications, filter retrieval outcomes, and 1-year follow-up results-including recurrence, post-thrombotic syndrome (PTS), and target vein patency-were assessed.Results PMT was successfully performed in all patients, yielding a technical success rate of 100%. The overall thrombus clearance success rate (grade Ⅱ+Ⅲ) was 88.57%. No symptomatic pulmonary embolism occurred. Major bleeding was observed in 1.43% of patients, minor bleeding in 5.71%, and hemoglobinuria in 15.71%, all of which resolved with appropriate management. Filter retrieval was attempted in 62 patients, with a 100% success rate and a median dwell time of 58.5 (20-84.25) d. At 1-year follow-up, the recurrence rate was 2.86%, the incidence of PTS was 21.43%, and the target vein patency rate was 82.86%.Conclusion PMT combined with individualized adjunctive endovascular therapy is a safe and effective treatment option for elderly patients with acute inferior vena cava and/or iliofemoral DVT, achieving satisfactory thrombus clearance with acceptable complication rates.
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WANG Rentao, HE Tao, WANG Dile, FENG Haijun, ZHANG Yuanhao
2025,34(12):2645-2653, DOI: 10.7659/j.issn.1005-6947.250672
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Background and Aims Post-thrombotic syndrome (PTS) is a major long-term complication in patients with acute iliofemoral deep vein thrombosis (DVT). Although AngioJet mechanical thrombectomy provides rapid venous recanalization, its long-term impact on PTS remains unclear. This study aimed to compare the long-term efficacy and safety of AngioJet mechanical thrombectomy versus catheter-directed thrombolysis (CDT) in patients with acute iliofemoral DVT, with particular focus on the incidence of PTS.Methods A total of 100 patients with acute iliofemoral DVT (symptom onset ≤14 days) treated between January 2021 and June 2023 were retrospectively analyzed. Fifty-two patients underwent AngioJet mechanical thrombectomy (AngioJet group), and 48 received CDT (control group). The primary endpoint was the incidence of PTS within 24 months, defined as a Villalta score ≥5 or venous ulceration. Secondary endpoints included venous patency rate, calf circumference difference, quality of life assessed by the VEINES-QOL questionnaire, major bleeding events, recurrent thrombosis, and length of hospital stay. Kaplan-Meier analysis and Cox proportional hazards models were used for statistical analysis.Results Baseline characteristics were comparable between groups (all P>0.025). The immediate venous recanalization rate was significantly higher in the AngioJet group than in the CDT group (96.15% vs. 64.58%, P<0.001). At 24 months, the cumulative incidence of PTS was significantly lower in the AngioJet group (11.54% vs. 37.50%, P<0.05). The AngioJet group demonstrated significantly smaller calf circumference differences and higher VEINES-QOL scores at all follow-up time points (all P<0.001). No significant differences were observed in major bleeding or recurrent thrombosis (both P>0.05), while hospital stay was significantly shorter in the AngioJet group (P<0.05). No significant differences were observed in major bleeding or recurrent thrombosis (both P>0.05). Multivariate Cox analysis identified AngioJet treatment (HR=0.31, P=0.003) and BMI <25 kg/m2 (HR=0.38, P=0.012) as independent protective factors against PTS, whereas the number of involved venous segments was an independent risk factor (HR=2.78, P=0.005).Conclusion AngioJet mechanical thrombectomy significantly reduces the long-term incidence of PTS and improves limb function and quality of life in patients with acute iliofemoral DVT, with an acceptable safety profile. Thrombus extent and body mass index are important determinants of long-term prognosis.
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TIAN Chenyang, TIAN Xuan, SONG Yaning, LIU Jianlong, JIA Wei, JIANG Peng, CHENG Zhiyuan, ZHANG Yunxin, LI Jinyong, LIU Xiao, ZHOU Mi, HUA Run
2025,34(12):2654-2663, DOI: 10.7659/j.issn.1005-6947.250621
Abstract:
Background and Aims Chronic iliocaval venous occlusion secondary to long-term inferior vena cava filter (IVCF) implantation is associated with severe post-thrombotic syndrome (PTS). Although balloon angioplasty combined with stent implantation is recommended, long-term patency remains suboptimal and stent-related complications are not negligible. This study aimed to evaluate the efficacy and safety of repeated balloon dilatation combined with final drug-coated balloon (DCB) angioplasty in patients with chronic iliocaval venous occlusion.Methods This single-center retrospective study enrolled 72 patients with chronic iliocaval venous occlusion treated between January 2022 and December 2024. Sixty-two patients who completed a standardized protocol of three balloon dilatation sessions were included in the final analysis. At 6 months postoperatively, patients were classified into a patency group or an occlusion group based on computed tomography venography (CTV). Clinical outcomes, including IVC patency, filter retrieval rate, limb circumference, VCSS and Villalta scores, PTS severity, and CTV-derived morphologic parameters, were compared.Results The technical success rate was 86.1% (62/72). At 6 months, iliocaval patency was achieved in 43 patients (69.4%). The filter retrieval rate was significantly higher in the patency group than in the occlusion group (100% vs. 78.9%, P=0.002). Patients in the patency group showed significant reductions in limb circumference, improvements in VCSS and Villalta scores, and decreased PTS severity (all P<0.05). CTV revealed significant increases in the cross-sectional area of the mid and proximal segments of the IVC (all P<0.05). No severe perioperative complications were observed (all P>0.05).Conclusion Repeated balloon dilatation combined with DCB angioplasty is a safe and effective treatment for chronic iliocaval venous occlusion, providing favorable short-term patency and significant clinical improvement while potentially avoiding stent-related complications.
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FANG Cuifu, TANG Ying, LIU Feng'en, FU Lifeng, CHEN Juzheng, ZHOU Weimin, DUAN Qing
2025,34(12):2664-2671, DOI: 10.7659/j.issn.1005-6947.250617
Abstract:
Background and Aims Central venous stenosis or occlusion (CVSO) compromises the effectiveness of hemodialysis; however, the optimal venous access strategy remains unclear. This study compared the applicability, technical success rates, and clinical success rates of unidirectional venous access (UVA) and bidirectional venous access (BVA) in maintenance hemodialysis patients with CVSO undergoing percutaneous transluminal angioplasty (PTA) or percutaneous transluminal stenting (PTS). Stratified analyses were performed according to lesion location and type, aiming to establish individualized venous access selection criteria for different lesion subtypes.Methods A retrospective analysis was conducted on the clinical data of 63 maintenance hemodialysis patients with CVSO treated between July 2019 and February 2024 at the First Affiliated Hospital of Gannan Medical University and the Second Affiliated Hospital of Nanchang University, including 37 patients in the UVA group and 26 patients in the BVA group. Technical success (residual stenosis <30%), clinical success (symptom relief), and patency outcomes of different venous access strategies in the endovascular treatment of CVSO were compared.Results Baseline characteristics were comparable between the two groups (all P>0.05). No significant differences were observed in overall technical or clinical success rates (both P>0.05). Subgroup analysis demonstrated that the UVA group achieved a higher technical success rate in superior vena cava and brachiocephalic vein stenosis compared to the BVA group, along with a better clinical success rate specifically in brachiocephalic vein stenosis, whereas BVA was associated with significantly higher technical and clinical success rates in subclavian vein occlusion (all P<0.05). No significant differences were found in primary or secondary patency rates at 6 and 12 months (all P>0.05).Conclusion UVA is preferable for stenotic lesions of the superior vena cava and brachiocephalic vein, whereas BVA should be prioritized for subclavian vein occlusion. Tailoring venous access strategies according to lesion location and type may enhance procedural success in endovascular treatment of CVSO.
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LI Xiangtao, SHAN Shuo, LUO Xiaoyun, ZHANG Fuxian, FENG Yaping
2025,34(12):2672-2678, DOI: 10.7659/j.issn.1005-6947.250564
Abstract:
Background and Aims Pelvic venous disease (PeVD) is an important vascular cause of chronic pelvic pain, with ovarian vein reflux being the most common underlying mechanism. Ovarian vein embolization has been proven effective; however, key technical aspects-including embolization extent, coil number, and the need for concomitant treatment of other pelvic venous abnormalities-remain controversial. This study aimed to evaluate the short- and mid-term efficacy and safety of a simplified strategy using left ovarian vein coil embolization combined with sclerotherapy for the treatment of PeVD.Methods A retrospective analysis was performed on 55 female patients with PeVD treated between February 2023 and February 2024. All patients were diagnosed using ultrasound, CT venography, and venography, and underwent left ovarian vein coil embolization combined with sclerotherapy. Follow-up assessments were conducted at 1, 3, 6, and 12 months post-procedure, including visual analog scale (VAS) scores, symptom improvement, and complications. Doppler ultrasound at 3 months was used to evaluate ovarian vein occlusion and pelvic venous changes.Results Technical success was achieved in all patients. At 12 months, the mean VAS score significantly decreased from 7.2±1.2 preoperatively to 2.9±2.8 (P<0.01). Symptom improvement was observed in 81.8% of patients, with complete symptom resolution in 50.9%. Ultrasound at 3 months confirmed complete ovarian vein occlusion in all cases, and the diameter of the left parauterine vein significantly decreased compared with baseline [(7.1±1.4) mm vs. (3.4±0.7) mm, P<0.001]. The overall complication rate was 14.5%, predominantly transient pelvic pain, which resolved with conservative management.Conclusion A simplified embolization strategy using left ovarian vein coil embolization combined with sclerotherapy is safe and effective for patients with PeVD predominantly caused by left ovarian vein reflux and represents a reliable minimally invasive treatment option.
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2025,34(12):2679-2687, DOI: 10.7659/j.issn.1005-6947.250289
Abstract:
Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for Stanford type B aortic dissection (TBAD). However, distal stent graft-induced new entry (dSINE) remains a significant long-term complication, which may result in persistent false lumen perfusion, progressive aneurysmal degeneration, and even aortic rupture, thereby adversely affecting long-term outcomes. With the expanding application of TEVAR, increasing attention has been paid to the mechanisms, risk factors, and management strategies of dSINE. This review systematically summarizes the epidemiology, histopathological and biomechanical mechanisms, as well as patient- and device-related risk factors for dSINE following TEVAR in TBAD. Current preventive and therapeutic strategies, including stent sizing optimization, secondary TEVAR, and emerging endovascular techniques, are also discussed, aiming to provide insights for reducing dSINE incidence and improving long-term prognosis.
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JIANG Jiafu, WEI Lichun, XU Sheng, CHEN Yuyin, ZHANG Jian, DONG Zhen, PENG Huijuan
2025,34(12):2688-2695, DOI: 10.7659/j.issn.1005-6947.250202
Abstract:
Aortic pathologies involving the visceral segment are characterized by complex anatomy and a high risk of perioperative complications. Although open surgical repair remains a definitive treatment, its invasiveness and associated morbidity limit its application, particularly in elderly and high-risk patients. Advances in endovascular techniques, including fenestrated, branched, and parallel stent-graft technologies, have significantly expanded the therapeutic options for complex aortic lesions involving visceral arteries. Current evidence suggests that endovascular repair offers favorable short-term outcomes, reduced perioperative morbidity, and faster recovery compared with conventional open surgery. Nevertheless, challenges remain regarding patient selection, stent-graft design and materials, imaging-guided precision, procedural standardization, and long-term durability. This review summarizes recent progress in endovascular management of aortic diseases involving the visceral segment, focusing on indications, technological innovations, imaging applications, and clinical outcomes. Future directions, including individualized treatment strategies, multidisciplinary collaboration, and long-term outcome assessment, are also discussed to inform clinical practice and future research.
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LIANG Yumeng, TANG Mingjun, ZOU Weipu, ZHU Yuefeng
2025,34(12):2696-2701, DOI: 10.7659/j.issn.1005-6947.250305
Abstract:
Perforating veins connect the deep and superficial venous systems of the lower extremities and play a crucial role in maintaining unidirectional blood flow from the superficial to the deep veins. Incompetence of perforating vein valves may result in reflux from the deep to the superficial venous system, leading to elevated superficial venous pressure and subsequent pathological changes, including varicose veins, skin pigmentation, dermatitis, and venous ulcers. Accumulating evidence suggests that pathological perforating veins (PPVs) are closely associated with the development and delayed healing of lower extremity venous ulcers and represent an important contributor to postoperative recurrence of varicose veins. However, whether routine concomitant treatment of perforating veins provides additional clinical benefits in patients primarily treated for superficial venous reflux remains controversial. With advances in imaging techniques and minimally invasive therapies, diagnostic accuracy and treatment options for PPVs have expanded substantially. This review summarizes the current understanding of the pathophysiology, anatomical characteristics, diagnostic approaches, and therapeutic advances in PPVs, aiming to provide clearer guidance for clinical decision-making and individualized management.
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SU Zhihong, LI Weizheng, LI Pengzhou, ZHU Shaihong, ZHU Liyong, SUN Linli
2025,34(12):2702-2709, DOI: 10.7659/j.issn.1005-6947.250101
Abstract:
Obesity and obesity-related metabolic diseases have become global public health challenges. Bariatric metabolic surgery is currently one of the most effective treatments for morbid obesity and its associated complications, with well-established short- and long-term clinical benefits. However, due to a marked reduction in food intake, alterations in gastrointestinal anatomy and nutrient absorption patterns, as well as inadequate postoperative follow-up and nutritional management, patients frequently develop nutrition-related complications such as anemia and osteoporosis, which may adversely affect quality of life and long-term prognosis. Based on the latest international and domestic clinical guidelines and evidence-based research, this review systematically summarizes the mechanisms and prevention strategies of common nutritional complications after bariatric metabolic surgery, aiming to provide references for optimizing postoperative nutritional management, improving follow-up systems, and reducing the risk of nutrition-related complications.
Volume 34,2025 Number 12
GUIDELINE AND CONSENSUS
INTERPRETATION OF GUIDELINES
COMMENTARY
SPECIALIST FORUM
MONOGRAPHIC STUDY OF ARTERY DISEASES
MONOGRAPHIC STUDIES ON VENOUS DISEASES
REVIEW
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Alliance of Chinese Expert Consensus on Postoperative Adjuvant Therapy for Hepatocellular Carcinoma, Chinese College of Surgeons, Committee of Liver Cancer, Chinese Anti-Cancer Association, Liver Cancer Group, Society of Oncology, Chinese Medical Association, FAN Jia
Abstract:
Recurrence and metastasis after surgery remain major determinants of long-term survival in patients with hepatocellular carcinoma (HCC), and to date, no universally accepted postoperative adjuvant therapy has been established to effectively prevent recurrence. In recent years, postoperative adjuvant strategies involving systemic antitumor therapies—represented by targeted agents and immune checkpoint inhibitors—used alone or in combination with locoregional therapies have been actively explored. The Alliance of Chinese Expert Consensus on Postoperative Adjuvant Therapy for Hepatocellular Carcinoma, together with the Chinese College of Surgeons, the Committee of Liver Cancer of the Chinese Anti-Cancer Association, and the Liver Cancer Group of the Society of Oncology of the Chinese Medical Association, convened experts from relevant disciplines to review and synthesize updated evidence. Through multiple rounds of discussion and revision, the Expert consensus on postoperative adjuvant therapy for hepatocellular carcinoma (2026 edition) was formulated. This consensus aims to systematically summarize the available evidence on postoperative adjuvant therapy for HCC, integrate current clinical practice, and provide practical guidance for clinicians, with the goal of improving postoperative survival outcomes in patients with HCC.
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LI Yongjun, ZHAO Jichun, ZHAO Yu, ZHANG Lan, HUANG Jianhua, GUO Pingfan, WANG Tao, ZHANG Long, WANG Haiyang, CHEN Quan, Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society
Abstract:
Lower extremity arteriosclerosis obliterans, also known as peripheral artery disease (PAD), is a chronic arterial occlusive disease characterized by atherosclerosis affecting the arteries of the lower extremities, leading to luminal stenosis or occlusion, and consequently resulting in ischemia and necrosis of the lower limbs. PAD not only significantly reduces patients"" quality of life but also carries a non-negligible risk of amputation and mortality, imposing a heavy economic and health burden on both patients and society, especially among the elderly. Advanced age has been identified in multiple studies as a key risk factor for amputation and death in PAD patients. The prevalence of PAD in the elderly increases significantly with age, as they often have multiple coexisting conditions such as coronary artery disease, renal insufficiency, and tumors. Consequently, the pathophysiological characteristics, treatment options, and prognostic assessments are more complex compared to those of younger patients. Diagnostically, because comorbidities can often mask the symptoms of PAD in elderly patients, a comprehensive approach involving detailed medical history, physical examination, and auxiliary tests is required. In terms of treatment, the management of elderly patients with PAD is further complicated by issues such as poor adherence to therapy and difficulties in follow-up, which increase the challenges in clinical management. Currently, there is a lack of specific national or international guidelines or consensuses focused on the diagnosis and treatment of PAD in the elderly. To address this gap, the "Chinese expert consensus on the management of lower extremity atherosclerotic disease in the elderly" has been developed. This consensus integrates the latest evidence-based medical data and clinical experience, with a focus on key issues in elderly PAD patients, such as disease characteristics, comorbidity management, personalized treatment, and long-term follow-up. It aims to establish scientific and practical diagnostic and therapeutic standards to provide guidance for clinicians.
