Background: This study aimed to assess the short-term effect of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis (PCDT) on the incidence of post-thrombotic syndrome (PTS) and iliofemoral vein patency rate in patients who underwent PCDT. Methods: There were 94 continuous patients with severe deep vein thrombosis (DVT) of the lower extremities admitted to our hospital between March 2016 and June 2018; 73 cases receiving PCDT and verified with iliac vein compression syndrome (IVCS) were assigned into two groups. Thirty-nine patients without thrombus of the popliteal and infrapopliteal veins were assigned to the proximal DVT group. The remaining 34 cases were placed in the extensive DVT group. The thrombus scores, including venous registry index (VRI) score, Marder score, and Society for Vascular Surgery (SVS) score before and after PCDT, the primary two years' cumulative rate of iliofemoral patency, and the rate of PTS, and complications were analyzed retrospectively.Results: Ultimately, 27 patients in the proximal DVT group and 26 cases in the extensive DVT group completed the study. The two groups had no significant differences in terms of basic characteristics, complication and the rate of PTS (P>0.05). However, there were significant differences in terms of postoperative mean thrombus score and the mean degree of thrombosis removal score by Marder and SVS scores, residual thrombus by lower thrombosis classification (LET) and the two years' cumulative iliofemoral vein patency rate (P<0.05). And the logistic regression analysis demonstrated the residual thrombus of LET class II [odds ratio (OR), 4.619, 95% confidence interval (CI), 1.090-19.567, P=0.038] was an independent risk factor for iliofemoral vein occlusion. Conclusions:The residual thrombus of LET class II is an independent risk factor for iliofemoral vein occlusion. It is very important to keep the patency of the popliteal vein when deciding to use a stent to maintain iliofemoral vein patency. Furthermore, the anterior tibial vein approach and crisscross technique may be two important alternative methods that can be used to address the thrombus of popliteal vein for patients with extensive DVT.

ObjectiveTo generate reference values of the normal areas of the abdominal aorta at various levels among Chinese people and to explore the factors that may promote the expansion of the abdominal aorta.MethodsThe areas of normal abdominal aortas were gauged at various levels based on inner-to-inner measurements in 1,066 Chinese adult patients (&gt;18 years) without the abdominal aortic disease. The areas of subphrenic abdominal, suprarenal abdominal, infrarenal abdominal, and distal abdominal aortas were measured. The demographic and clinical characteristics were collected into a specifically designed electronic database. Multivariable linear regression was used to analyze the potential risk factors promoting the expansion of the abdominal aorta.ResultsIn males, the median areas of the subphrenic abdominal aorta, suprarenal abdominal aorta, infrarenal abdominal aorta, and distal abdominal aorta were 412.1, 308.0, 242.2, and 202.2 mm2, respectively. In females, the median areas of the subphrenic abdominal aorta, suprarenal abdominal aorta, infrarenal abdominal aorta, and distal abdominal aorta were 327.7, 243.4, 185.4, and 159.6 mm2, respectively. The areas of the abdominal aorta at different levels were larger in males than in females and increased with age. Multiple linear stepwise regression analysis showed that the subphrenic abdominal aortic area was significantly related to age (β = 0.544, p &lt; 0.001), sex (β = 0.359, p &lt; 0.001), and hypertension (β = 0.107, p &lt; 0.001). Suprarenal abdominal aortic area was related to age (β = 0.398, p &lt; 0.001), sex (β = 0.383, p &lt; 0.001), history of smoking (β = 0.074, p = 0.005), and hypertension (β = 0.111, p &lt; 0.001). The infrarenal abdominal aortic area was correlated with age (β = 0.420, p &lt; 0.001), sex (β = 0.407, p &lt; 0.001), and history of smoking (β = 0.055, p = 0.036). The distal abdominal aortic area was correlated with age (β = 0.463, p &lt; 0.001), sex (β = 0.253, p &lt; 0.001), and hypertension (β = 0.073, p = 0.013).ConclusionThe abdominal aortic areas at different levels were larger in males than in females. Aging, hypertension, and smoking prompt the expansion of abdominal aorta.

BackgroundLiver cancer (LC) is one of the most prevalent malignancies with a high morbidity and mortality. Cancer stem cells (CSCs) are capable of tumorigenicity, self-renewal and long-term survival. However, the relationship between LC and CSCs remains unclear.MethodsThe clinical data of LC patients and multi-omics data including mRNA-seq, lncRNA-seq, miRNA-seq, mRNA expression-based stemness index (mRNAsi), alternative splicing, DNA methylation and copy number variation (CNV) were obtained from The Cancer Genome Atlas (TCGA). Besides, the clinical data and RNA-seq of validation group were obtained from International Cancer Genome Consortium (ICGC). Integrative analysis of genes associated with CSCs characteristics were performed by stemness indices combined with multi-omics data in LC.ResultsThe stemness degree of cells in liver tumor group was higher than that of the normal group. The patients with high stemness degree of tumor tissue had significantly poorer overall survival. Besides, 6 methylation-driven genes and 4 CNV-driven genes related to CSCs characteristics were obtained. Alternative splicing factor regulatory network and ceRNA regulatory network were constructed respectively. Furthermore, the mRNAsi score of LC was negatively correlated with the tumor immune score. The proportion of CD8 T cell, activated memory CD4 T cell, follicular helper T cell and M1 macrophages was up-regulated in tumors with a higher degree of stemness. Finally, a prediction model was established, which has been proved to be a good predictor of prognosis by ICGC data.ConclusionsCancer cells with high degree of stemness aggravated the malignant progression of LC, which may be related to low immune infiltration. The proposed prediction model was a powerful predictor for patients and helpful to clinical work.

Background: Floating right heart thrombi (FRHTS), known as thrombi in transit, are usually located in the atrium or ventricle. Generally, it occurs in patients with pulmonary embolism (PE) and dyspnea, chest pain, syncope and palpitations are the most common symptoms on presentation. The mortality of patients with FRHTS is higher than that of those without FRHTS. Current treatment includes anticoagulation, systemic thrombolysis, catheter directed interventions, and surgical embolectomy. However, there is no consensus on the optimal management options.Case Description: Herein, we report the case of a patient who presented with hypotension and tachycardia accompanied by an asymptomatic right leg deep vein thrombosis, right atrial thrombus, and pulmonary embolus. He had a history of radical resection of colon cancer 1 month prior. And he had developed chest tightness accompanied by stabbing pain in the chest area 1 day ago. He experienced an episode of syncope 8.5 hours ago. So he was referred to the local hospital. After the pulmonary computed tomography angiography (CTA) scan, he was diagnosed with pulmonary embolus and administrated with 5,000 u low molecular weight heparin. Then he was transferred to our hospital. On arrival in the emergency department, the bedside transthoracic echocardiography (TTE) revealed there was an enlarged right atrium and right ventricle, with a floating right atrial mass prolapsing through the tricuspid valve during diastole. The patient accepted anticoagulation treatment, but refused to undergo thrombolysis or surgical embolectomy. Eventually, the right heart thrombi (RiHT) floated to the left main branch of pulmonary artery. It was successfully treated by using AngioJet device and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Our case provides clinical evidence supporting the feasibility and efficacy of AngioJet device and VA-ECMO in the treatment of the RiHT and PE.Conclusions: Patients with PE combined with RiHT have higher mortality than those without RiHT, VA-ECMO could be used to maintain the circulation, and the AngioJet device could be used as an alternative treatment for patients who are reluctant to receive thrombolysis or surgical embolectomy.

In this study we report on a patient with a left common iliac vein aneurysm; a condition rarely seen in vascular surgery. A 49-year-old man with no history of trauma or surgery underwent computed tomography (CT) for the evaluation of lumbago. A subsequent 64-slice CT angiogram revealed a left common iliac vein aneurysm. Surgery was performed due to the possibility of rupture. The aneurysm was successfully treated with clipping and sutures and a pre-discharge CT showed the aneurysm had shrunk. We combine our experience treating this patient with a review of the characteristics of other reported cases and methods used to treat iliac vein aneurysms. A definitive diagnosis is recommended in patients in whom an iliac vein aneurysm is suspected, with a CT angiogram being a dependable diagnostic method. There is still no unified standard for the treatment of aneurysms. Conservative treatment can be chosen for some small aneurysms in early stage, but close follow-up is needed. Surgical treatment is still recommended for some large aneurysms. Because we know that if an aneurysm ruptures, it can be life-threatening. If appropriate artificial blood vessels or coated stents are available, aneurysms resection combined with artificial blood vessel reconstruction or directly coated stents are good choices for aneurysms isolation. For some very large aneurysms, I personally think that lateral wall resection and suture of our aneurysms is also a method. Early follow-up results also proved that the method was effective. Surgery should be performed as early as possible.Our method of surgery may be used as a selective surgical method if the aneurysm is large or saccular in morphology.

A 55-year-old male carpenter had a history of hypertension and repeat hospitalizations with complaints of dizziness over a 1-year period. Computed tomography angiogram (CTA) showed that the left common carotid artery was penetrated by a metal nail, which had stopped at the 7th cervical anterior edge (Panel A, arrow). Catheter-directed angiography showed a filling defect of the left common carotid artery (Panel B, arrow). The preoperative physical examination was unremarkable. Upon review of cervical CT scans for