A century ago, the Chinese nation was poor and weak, the people did not have enough to eat and were malnourished, infectious diseases were rampant, and tuberculosis was rampant, so the Chinese nation was given the humiliating nickname “the sick man of East Asia”, which it wore for more than a hundred years. A century later, the Chinese nation is rich and strong, people’s lives have improved greatly, eat well, live well has long been no problem. However, rich but not expensive is not rich, gluttony is not good enough to eat. With the changes in people’s dietary structure and lifestyle, and the aggravation of the aging population, the incidence of diseases of the vascular system represented by atherosclerosis, coronary heart disease, and peripheral vascular disease is on the rise year by year and has developed into one of the main reasons threatening the health of the general public. If tuberculosis is the representative of poor disease in the past, then vascular disease has become the typical of “rich disease” today, which is increasingly presenting the “three high characteristics” of high morbidity rate, high disability rate and high mortality rate. In 2013, the Department of Vascular Surgery of the Second Hospital of Lanzhou University successfully performed more than 30 cases of thoracic and abdominal aortic aneurysms and aortic coarctation, visceral aneurysms and other major vascular surgeries, including traditional open surgery of aneurysm resection with artificial vascular replacement and advanced endovascular stent isolation surgery, which made the patients more satisfied with the results. The stent isolation surgery has made the majority of patients get rid of the torment of the disease and the threat of death for many years and regain a new life, and at the same time, it has also created a new record for the treatment of large-vessel diseases in our province. (I) Life-saving large vessel surgery, humanized service and warm heart Mr. Zhang, who suffered from thoracic and abdominal aortic coarctation aneurysm and bilateral iliac artery aneurysm, not only successfully underwent endoluminal stenting isolation of aortic vessels, but also was warmed up by humanized medical service of the department. Mr. Zhang, who has already reached the age of puzzlement, suddenly suffered from severe chest and abdominal pain after lifting a heavy object, and felt many symptoms such as chest tightness, irritability, anxiety, fear, etc. After treatment in several hospitals, the result was unsatisfactory, and he was urgently transferred to the Department of Vascular Surgery of the Second Hospital of Lanzhou University for further treatment. Immediately after admission, a green channel was opened, and CT imaging of the great vessels was completed in the evening, diagnosing thoracoabdominal aortic coarctation, involving bilateral iliac arteries, and the vessels were severely twisted at an angle, making the surgery difficult and high-risk. We found that Mr. Zhang was suffering from a coarctation aneurysm, which is one of the most common, complex and dangerous aortic diseases. This disease is critical and has a poor prognosis, with a mortality rate of up to 90% within one week, for example, the famous American volleyball player, Hyman, who usually plays very well, suddenly died one day from a coarctation aneurysm. For Mr. Zhang, who was at his wits’ end, the medical staff gave him family-like care and comfort. At the same time, the treatment team, based on his condition, quickly formulated a practical treatment plan, which included stabilizing the blood pressure, sedating and relieving the pain; perfecting the preoperative preparations; and carrying out endovascular stenting and isolation as soon as possible. After the treatment plan was determined, vascular surgery, interventional radiology, anesthesiology, operating room, ICU ward and other departments made all preparations. The operation lasted from 8:00 a.m. to 2:00 p.m. All the medical staff cooperated well and the operation was very successful. Mr. Zhang had no postoperative complications and was transferred to the Vascular Surgery Department for further treatment after passing the dangerous period in the ICU ward. During the recovery period, the medical and nursing staff formulated a set of nursing methods suitable for him, did more detailed ideological work, and tried to meet his reasonable requirements. Mr. Zhang himself found that his condition was gradually improving, and his attitude gradually changed from anxiety and resistance to accepting the treatment on his own initiative, and he recovered very quickly. Mr. Zhou pointed out that the difference between this surgery and traditional surgery lies in its simplicity and minimally invasiveness. Through a small incision at the root of the thigh, a metal alloy stent with artificial blood vessels is placed into the ruptured aorta to repair the rupture, which helps the patient to recover quickly, ensures the efficacy of the treatment, and improves the efficiency of the hospital in treating the patient. Aortic coarctation and aortic aneurysm are regarded as “ticking time bombs” in the human body, and once symptoms of severe chest, back or lumbar abdominal pain occur, they should consult a doctor without delay. Obesity, hypertension, diabetes and other diseases have shown a trend of youth and popularization, long-term high blood pressure will lead to increased pressure on the walls of blood vessels, blood vessels become hard and brittle. Whenever emotional excitement, sudden cold weather or a force, the blood pressure will rise, it is likely to break through the endothelium of the blood vessels to form a sandwich, as in the case of Mr. Zhang. It is recommended that young people should also take regular blood pressure tests, especially those with a family history of high blood pressure or those who are obese. If you have high blood pressure, you should go to a regular hospital immediately, take your medication on time, and do not arbitrarily stop taking your medication or change your doctor’s treatment plan. Adhering to a healthy lifestyle and having a scientific dietary pattern is the most effective way to prevent a laminated aneurysm. (B) Individualized formulation of the program Precise positioning to lift the “ticking time bomb” —— Gansu Province, the first case of Aegis one-piece laminar stent for abdominal aortic coarctation has been successful Recently, the team led by Prof. Zhou Dong of the Department of Vascular Surgery of the Second Hospital of Lanzhou University has successfully completed the first case of Aegis one-piece laminar stent for abdominal aortic coarctation endoluminal repair in Gansu province, which is the first case of Aegis one-piece laminar stent in the Gansu Province. Recently, the team led by Prof. Zhou Dong from the Department of Vascular Surgery of Landa University has successfully completed the first case of Aegis one-piece stent for the treatment of abdominal aortic coarctation in Gansu Province. It brings a good news to patients with large artery aneurysm and arterial coarctation aneurysm in our province. The patient is a female, 55 years old, admitted to the hospital with abdominal pain for one week, and was clearly diagnosed as abdominal aortic coarctation after admission, with the rupture located at the bifurcation of the abdominal aorta, spiral tear-like changes of the right iliac artery, and intermural hematoma formation of the infrarenal abdominal aorta. If aortic coarctation aneurysm is not treated in time, it will lead to the patient’s death due to the rupture of the coarctation. After repeated measurements, the patient’s abdominal aorta was found to be “slender”, and the diameter of the main trunk of the abdominal aorta was only about 37.5px. Currently, domestic and foreign aortic membrane stents used in clinical practice require that the minimum diameter of the aorta of the patient be greater than 45px, or else the stent will form “folds” after the release of the stent from the aorta. Otherwise, after the stent is released from the aorta, it will form “folds” and cause “endoleak”, which cannot isolate the clamped aneurysm and lead to surgical failure. If the Kissing stenting technique is used and 2 iliac artery coated stents are placed in the abdominal aorta, due to the formation of intermural hematoma in the infrarenal segment of the abdominal aorta, the double coated stents will have transverse support to the aortic wall, which may lead to the occurrence of entrapment and aneurysm of the intermural hematoma in the aorta in the long term, and the treatment in the later stage will be very difficult. After repeated discussions, the department decided to customize the minimally invasive 20mm diameter Aegis one-piece coated stent for endoluminal repair. In order to ensure the success of the procedure and minimize complications, the department developed a thorough treatment plan. The department made a comprehensive assessment of the patient’s physical condition, precise measurements and repeated studies of the location of the arterial dissection, and precise measurements of the caliber and length of the overlay stent, as well as customized vascular stents for the patient. After the plan was determined, Director Zhou Dong and Attending Physician Guo Facai performed “Endovascular Aneurysm Repair (EVAR)” for the patient. The procedure started with a small incision of about 75px through the right femoral region, and the left femoral artery was punctured to place a 6F vascular sheath to establish a stent delivery channel. A small incision of about 75px was made in the right femoral region, and a 6F sheath was inserted into the left femoral artery through a puncture, and the stent was delivered through the right femoral artery using a cobra catheter under the guidance of a guidewire. At the same time, the main stent was delivered, the iliac stent connecting guidewire was led out of the left perforator sheath through the “cobra” catheter, and the main stent was entered from the small opening (12.5px) of the femoral artery on the incision side through the ultra-rigid guidewire, and the iliac stent connecting guidewire was held carefully and straightened out, and the outer sheath was withdrawn above the aortic bifurcation, the main stent was retracted and the contralateral iliac stent was connected to it. The outer sheath was withdrawn above the aortic bifurcation, the main stent was pulled back and the guidewire connecting the iliac branch stent on the opposite side was withdrawn to separate the two iliac branches, and the two branches were controlled to enter into their respective iliac arteries, and the bifurcated part of the stent rode on the bifurcation of the abdominal aorta. Postoperative imaging showed complete isolation of the abdominal aorto-iliac artery entrapment. On the second day after the operation, the patient got out of bed without any complication, and five days after the operation, the patient was discharged from the hospital after reviewing the DSA, which showed that the aneurysm of the aortic coarctation had completely disappeared, and the blood flow of both iliac arteries and the femoral artery was smooth, and the patient recovered from the operation. Director Zhou Dong introduced that the one-piece stent has been reported to be used for abdominal aortic aneurysm at home and abroad, especially suitable for abdominal aortic aneurysms with localized stenosis and simple iliac aneurysms. At present, we have not seen any case reports of endoluminal treatment of abdominal aortic coarctation with Aegis one-piece stent in China through searching. If the release and delivery characteristics of the Aegis one-piece overlay stent can be mastered, it is even easier to operate than the traditional split stent. At the same time, the procedure is less invasive than a split stent, as it only requires incision of the femoral artery on one side and puncture on the other side. Since the stent does not require access to a branching stent in the aorta, the occurrence of “endoleak” is also reduced. The bifurcation of the one-piece stent sits at the bifurcation of the abdominal aorta after release, and there is no worry of downward displacement of the stent at a later stage. However, the application of the one-piece stent release procedure is relatively complex and requires the operator to be very familiar with the stent release system. The one-piece stent requires more accurate length of the main stent; if the main stent is too long, it is easy to block the opening of the renal artery; if the main stent is too short, it can not completely isolate the tumor and needs to add a proximal extension stent, therefore, accurate preoperative imaging assessment is required, and customized stenting is needed if necessary; the successful implantation of Aegis one-piece overlay stent in our hospital marks the leading position of the Vascular Surgery Department in the province for the treatment of aortic artery disease. The successful implantation of Aegis one-piece laminating stent in our hospital signifies that our vascular surgery department is at the leading level in the province for the treatment of aortic diseases. (C) Following the international academic frontier, “basket weaving” is used to treat renal artery aneurysm. —— The first case of renal artery aneurysm embolization with Axium detachable spring coil assisted by Solitaire stent in Gansu Province has been successfully treated. A few days ago, the Department of Vascular Surgery of Landa University Second Hospital successfully performed embolization for a renal aneurysm patient by adopting domestic advanced endoluminal treatment technology. This is the first case in our province, marking that the endoluminal treatment of visceral artery aneurysm in Landa University Second Hospital has been among the domestic advanced level. One month ago, Ms. Gu, a 48-year-old patient, started to feel dizzy and had uncontrollable high blood pressure, and consulted a hospital in Gansu, where ultrasound found a right renal artery aneurysm. For further diagnosis and treatment, Ms. Gu came to our hospital for vascular surgery, and was admitted with blood pressure of 210/100mmHg and hemorrhage in the fundus of the eye, and was diagnosed with right renal artery aneurysm with an aneurysm size of 21mm×18.7mm by CTA. renal artery aneurysm is a very rare renal vascular disease, with an incidence rate of 1 in 10,000, and its potential complications include thrombosis, renal infarction, and even ruptured aneurysm bleeding, which can be life-threatening. The patient sought medical treatment from many places, urgently wanted to be treated, and asked for preservation of the right kidney function. The treatment team headed by Zhou Dong, director of the vascular surgery department, carefully organized the analysis of the patient’s condition, discussed the difficulties, and discussed the patient’s treatment with the experts at the recent International Congress of Endoluminal Therapeutics. Finally, it was decided to adopt the technical strategy of renal artery aneurysm embolization with Axium spring coil under the assistance of Solitaire stent. On the day of the operation, the treatment team used the right femoral artery approach, and after the renal artery aneurysm and renal artery branches were clearly identified by imaging, the Solitaire stent was delivered and released to form a “fence” at the neck of the aneurysm, and then the 3D Axium detachable spring coil was delivered along the other catheter to build a “basket” inside the aneurysm with careful maneuvering. The 3D Axium detachable spring coil was then inserted along another catheter to build a “basket” inside the tumor through careful manipulation, then the Axium spring coil was detached and micro-spring coils were inserted to provide dense tamponade inside the tumor and the basket, after which the Solitaire stent was retrieved. After two hours of intense surgery, imaging confirmed that the aneurysm had been completely embolized, and all the branch arteries of the renal artery were patent after the operation. The aneurysm was completely embolized and renal function was preserved. The patient was discharged from the hospital after 3 days. According to Zhou Dong, the Solitaire stent was used to form a “fence” to prevent the spring coil from protruding into the aneurysm-carrying artery, and the Axium can be used to release the spring coil to precisely prepare the “basket”, which can also prevent thrombus from forming inside the aneurysm after the operation. It can also prevent the thrombus formed inside the tumor from “growing out” of the tumor, avoiding the possibility of thrombosis and occlusion of the renal artery. After the operation, it is clear that the tumor-carrying artery and branch arteries are clear. Recovery of the stent through the catheter avoids postoperative complications such as intimal hyperplasia and stenosis of the artery within the stent. It embodies the concept of vascular endoluminal therapeutics of treating the most aggressive diseases with the most minimally invasive technology. At present, the simultaneous use of Solitaire stent-assisted plus Axium detachable spring coil combined with micro-spring coil embolization of renal artery aneurysm treatment has not yet been reported. (D) with the rapid development of science and technology “pipe laying” to cure thirty years of stubborn disease —— Gansu Province, the first case of the use of overlay stent (GORE viabahn) stent endoluminal bypass technology for the treatment of congenital giant multi-start venous malformations has been successful. In July this year, Ms. Zhang, who came to the rural Xigu District of Lanzhou, came to our hospital’s Vascular Surgery Department for consultation. When she put the right upper limb to everyone to see, although we all arteriovenous fistula limb are recognized, or for the shock, Ms. Zhang’s right upper limb coarse deformity, superficial veins significantly dilated and tortuous, full of “pimple-like” mass, the middle finger and ring finger little finger has been accompanied by ulcers and gangrene. Due to the continuous development and spread of the lesions, the whole right upper limb was widely invaded, and the ulcerated finger ends had obvious pain and discomfort at night. Therefore, Ms. Zhang’s whole family has sought medical treatment from many places, but due to the extensive involvement of the lesion, they could not wait for effective treatment. In the face of the patient’s family’s earnest gaze, the department decided to admit the patient after careful consideration. After careful examination, Ms. Zhang’s affected limb lesion was more serious than we believed, the lesion had involved the proximal ulna, and the bone had been attacked to form a cystic lesion, which might lead to pathological fracture after a little external force, and after the fracture, the patient might face the amputation of the whole right upper limb. After discussion in the whole department and at the International Conference on Endoluminal Therapy hosted by Changhai Hospital on October 9, 2013, we were informed that Changhai Hospital had applied GORE viabahn stent for endoluminal therapy and obtained good initial results. Therefore, we decided to use the GORE viabahn stent endoluminal bypass technique to isolate the “fistula” between the arteries and veins for the treatment of congenital arteriovenous fistula. The vascular surgery team, using a double femoral artery puncture approach, successively placed a guide catheter under the guidance of a guidewire in the right axillary artery segment to perform an upper limb arteriogram, and found that the arteries of the upper limb were densely populated with arteriovenous fistulas of varying sizes. The accompanying venous phase was visualized in advance. The inflow into the artery was accompanied by distorted dilated blood. A 375px*25px, 375px*20px Gore coated viabahn stent was inserted into the upper section of the brachial artery and radial artery, respectively, through measurement, and upper extremity arteriography was performed again, and most of the fistulas in the arteries of the upper extremity were closed, and the abnormal arterial and venous communication was reduced significantly. Postoperatively, the patient’s tremor at the arteriovenous fistula of the upper limb disappeared. The distal blood supply of the affected limb improved after 3 days of postoperative observation. Congenital arteriovenous fistula refers to the existence of an abnormal channel between the arteries and veins, which is called the arteriovenous fistula. Congenital arteriovenous fistula is caused by the abnormal passageway of the arteriovenous remnants during the developmental evolution of the embryonic mesoderm. The lesion can occur in any part of the body, generally more common in the limbs, often involving many small arterial branches, fistula with multiple, lesions are often diffuse, fistula small usually no vascular pulsation and murmur, arteriography is also often difficult to observe where the fistula, due to the arterial and venous traffic between the branches of the many small lesions wide range of surgical treatment can often only be the ligation of its main fistula branch, the small fistula branch can be gradually dilated after surgery and recurrence; embolization; embolization, the fistula branch can gradually expand Surgery can only ligate the main fistula branch, after surgery, the small fistula branch can gradually expand and recur; embolization can embolize the small fistula branch, but it is difficult to accurately insert the catheter into the fistula branch, and in many cases can only be used as a palliative treatment method. Although CAVF is a benign lesion, it has the biological characteristics of a malignant tumor, and the lesion continues to develop and spread, often widely invading neighboring tissues and organs, such as muscles, bones, nerves, and so on, until it spreads to the entire body and trunk. Advanced stage can cause systemic blood circulation disorders, such as heart failure. Arteriovenous fistula of vital organs can be life-threatening. The treatment is very difficult and the long-term outcome is unpredictable. Gore laminated viabahn stent for the treatment of congenital arteriovenous fistula is now a new attempt and new method in the world. Early follow-up received a very good short-term results. Long-term remains to be further observed.