Kang, Ning. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references. / Abstract also in Chinese. / Abstracts --- p.i / Abbreviations --- p.v / List of Figures and Tables --- p.vii / Contents --- p.viii / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1. --- Saphenous vein graft patency after coronary artery bypass grafting --- p.1 / Chapter 2. --- Mechanism of vein graft failure and therapeutic strategies --- p.8 / Chapter 2.1 --- Mechanism --- p.15 / Chapter 2.2 --- Therapeutic strategies --- p.18 / Chapter 3. --- Summary --- p.22 / Chapter 4. --- References --- p.23 / Chapter Chapter 2: --- Animal model and laboratory investigations --- p.34 / Chapter 1. --- Surgical procedure --- p.35 / Chapter 2. --- Postoperative management --- p.37 / Chapter 3. --- Adenoviral-mediated gene transfer ex vivo for gene therapy study --- p.38 / Chapter 4. --- Laboratory investigations --- p.39 / Chapter 5. --- Statistical analysis --- p.40 / Chapter 6. --- Summary --- p.41 / Chapter 7. --- References --- p.41 / Chapter Chapter 3: --- "Impact of osteopontin expression in vein grafts on VSMC migration, proliferation, and neointimal formation" --- p.42 / Chapter 1. --- Introduction --- p.42 / Chapter 2. --- Methods and materials --- p.43 / Chapter 3. --- Results --- p.43 / Chapter 4. --- Discussion --- p.49 / Chapter 5. --- Summary --- p.52 / Chapter 6. --- References --- p.53 / Chapter Chapter 4: --- Potential Role of gene therapy in prevention of vein graft failure --- p.56 / Chapter 1. --- Vectors --- p.56 / Chapter 2. --- "Reporter gene, timing and titer" --- p.57 / Chapter 3. --- Candidate genes --- p.58 / Chapter 4. --- Summary --- p.64 / Chapter 5. --- References --- p.66 / Chapter Chapter 5: --- Conclusions --- p.70 / Acknowledgements --- p.72

A revascularização da oclusão arterial ilíaca crônica com implante de endoprótese vascular é uma nova modalidade terapêutica para os pacientes com aterosclerose obliterante das extremidades. Os objetivos deste trabalho são verificar: os resultados clínico e radiológico do tratamento percutâneo com implante de endoprótese vascular nas oclusões arteriais crônicas do território ilíaco; a influência da aterosclerose e seus principais fatores de risco; os principais sintomas clínicos segundo os estágios de Fontaine e o comportamento das endopróteses vasculares, avaliando as permeabilidades primária e secundária. Foram estudados 67 pacientes, com 69 oclusões arteriais ilíacas crônicas, submetidos a intervenção de janeiro de 1992 a dezembro de 1998, por meio de avaliação clínica, Doppler com medida do índice tornozelo/braço e arteriografia dos membros inferiores. As revascularizações arteriais ilíacas foram realizadas sob anestesia local, utilizando-se as endopróteses tipos Wallstent® e Cragg®. O índice de sucesso técnico foi de 97,10%. A mediana do período de internação foi de dois dias e as complicações mais importantes foram tromboses arteriais (2,99%), roturas arteriais (2,99%) e embolia poplítea (1,49%). O índice tornozelo/braço pré e pós-procedimento demonstrou um incremento, estatisticamente significante, após a intervenção (P = 0,0001), e os eventos durante o seguimento foram as estenoses (5,97%) e tromboses (8,96%) das endopróteses. Houve algum grau de melhora clínica em 92,5% dos pacientes. Os casos que não apresentaram melhora tiveram associação, estatisticamente significante, com cardiopatia associada (P = 0,003) e estágios III e IV de Fontaine (P = 0,022). Não houve associação, estatisticamente significante, entre os fatores analisados e permeabilidade das endopróteses vasculares. A revascularização percutânea com implante de endopróteses vasculares nas oclusões arteriais ilíacas crônicas, demonstrou apresentar bons índices de permeabilidades primária (75%) e secundária (95%) durante o período médio de 30 meses de acompanhamento. / Arterial recanalization with percutaneous transluminal angioplasty and implantation of a vascular endoprosthesis in an occluded iliac artery is a ew therapeutic modality for those patients with obliterative atherosclerosis of the extremities. The objectives of this work are to demonstrate the clinical and radiological results of treatment of chronic occlusions of the iliac arteries; to demonstrate the effects of atherosclerosis as well as primary risk factors; to evaluate the primary clinical symptoms using the Fontaine classification and to study the effectiveness of the vascular endoprostheses with primary and secondary patency rates. Sixty-seven patients with 69 chronically occluded iliac arteries underwent percutaneous intervention from January 1992 throught December 1998. Evaluations included clinical assessment, Doppler examinations with ankle/brachial indexes and bilateral lower extremity arteriograms. The iliac artery recanalizations were performed under local anesthesia and using Wallstent® and Cragg® vascular endoprostheses. Technical success rate was 97.10%. The mean hospitalization time was two days and major complications included arterial thrombosis (2.99%), arterial rupture (2.99%) and popliteal embolization (1.49%). The prior and post procedure ankle/brachial indexes demonstrated a statistically significant increase following intervention (P = 0.0001). During follow-up there was 5.97% of stenosis and 8.96% thrombosis of the endoprostheses. There was clinical improvement in 92.42% of patients. Patients that did not show clinical improvement had association with coronary disease (P = 0.003), Fontaine stages III and IV (P = 0.022) and arterial hypertension (P = 0.087). There was no statistically significant factor associated with lower patency of the endoprostheses. Percutaneous revascularization of chronically occluded iliac arteries with utilization of vascular endoprostheses has shown good primary (75%) and secondary (95%) patency rates during 30 months of mean follow-up period.

A revascularização da oclusão arterial ilíaca crônica com implante de endoprótese vascular é uma nova modalidade terapêutica para os pacientes com aterosclerose obliterante das extremidades. Os objetivos deste trabalho são verificar: os resultados clínico e radiológico do tratamento percutâneo com implante de endoprótese vascular nas oclusões arteriais crônicas do território ilíaco; a influência da aterosclerose e seus principais fatores de risco; os principais sintomas clínicos segundo os estágios de Fontaine e o comportamento das endopróteses vasculares, avaliando as permeabilidades primária e secundária. Foram estudados 67 pacientes, com 69 oclusões arteriais ilíacas crônicas, submetidos a intervenção de janeiro de 1992 a dezembro de 1998, por meio de avaliação clínica, Doppler com medida do índice tornozelo/braço e arteriografia dos membros inferiores. As revascularizações arteriais ilíacas foram realizadas sob anestesia local, utilizando-se as endopróteses tipos Wallstent® e Cragg®. O índice de sucesso técnico foi de 97,10%. A mediana do período de internação foi de dois dias e as complicações mais importantes foram tromboses arteriais (2,99%), roturas arteriais (2,99%) e embolia poplítea (1,49%). O índice tornozelo/braço pré e pós-procedimento demonstrou um incremento, estatisticamente significante, após a intervenção (P = 0,0001), e os eventos durante o seguimento foram as estenoses (5,97%) e tromboses (8,96%) das endopróteses. Houve algum grau de melhora clínica em 92,5% dos pacientes. Os casos que não apresentaram melhora tiveram associação, estatisticamente significante, com cardiopatia associada (P = 0,003) e estágios III e IV de Fontaine (P = 0,022). Não houve associação, estatisticamente significante, entre os fatores analisados e permeabilidade das endopróteses vasculares. A revascularização percutânea com implante de endopróteses vasculares nas oclusões arteriais ilíacas crônicas, demonstrou apresentar bons índices de permeabilidades primária (75%) e secundária (95%) durante o período médio de 30 meses de acompanhamento. / Arterial recanalization with percutaneous transluminal angioplasty and implantation of a vascular endoprosthesis in an occluded iliac artery is a ew therapeutic modality for those patients with obliterative atherosclerosis of the extremities. The objectives of this work are to demonstrate the clinical and radiological results of treatment of chronic occlusions of the iliac arteries; to demonstrate the effects of atherosclerosis as well as primary risk factors; to evaluate the primary clinical symptoms using the Fontaine classification and to study the effectiveness of the vascular endoprostheses with primary and secondary patency rates. Sixty-seven patients with 69 chronically occluded iliac arteries underwent percutaneous intervention from January 1992 throught December 1998. Evaluations included clinical assessment, Doppler examinations with ankle/brachial indexes and bilateral lower extremity arteriograms. The iliac artery recanalizations were performed under local anesthesia and using Wallstent® and Cragg® vascular endoprostheses. Technical success rate was 97.10%. The mean hospitalization time was two days and major complications included arterial thrombosis (2.99%), arterial rupture (2.99%) and popliteal embolization (1.49%). The prior and post procedure ankle/brachial indexes demonstrated a statistically significant increase following intervention (P = 0.0001). During follow-up there was 5.97% of stenosis and 8.96% thrombosis of the endoprostheses. There was clinical improvement in 92.42% of patients. Patients that did not show clinical improvement had association with coronary disease (P = 0.003), Fontaine stages III and IV (P = 0.022) and arterial hypertension (P = 0.087). There was no statistically significant factor associated with lower patency of the endoprostheses. Percutaneous revascularization of chronically occluded iliac arteries with utilization of vascular endoprostheses has shown good primary (75%) and secondary (95%) patency rates during 30 months of mean follow-up period.