Gene therapy is expected to open a new strategy for the treatment of refractory vascular diseases, so the development of appropriate gene vectors for vascular lesions is needed. To realize this requirement with a non-viral approach, cyclo(RGDfK) peptide (cRGD) was introduced to block copolymer, poly(ethylene glycol)-block-polycation carrying ethylenediamine units (PEG-PAsp(DET)). cRGD recognizes a v b 3 and a v b 5 integrins, which are abundantly expressed in vascular lesions. cRGDconjugated PEG-PAsp(DET) (cRGD-PEG-PAsp(DET)) formed polyplex micelles through complexation with plasmid DNA (pDNA) and the cRGD-PEG-PAsp(DET) micelles achieved significantly more efficient gene expression and cellular uptake as compared with PEG-PAsp(DET) micelles in endothelial cells and vascular smooth muscle cells. Intracellular tracking of pDNA showed that cRGD-PEG-PAsp(DET) micelles were internalized via caveolae-mediated endocytosis, which is associated with a pathway avoiding lysosomal degradation and that, PEG-PAsp(DET) micelles were transported to acidic endosomes and lysosomes via clathrin-mediated endocytosis. Further, in vivo evaluation in rat carotid artery with a neointimal lesion revealed that cRGD-PEGPAsp(DET) micelles realized sustained gene expression, whereas PEG-PAsp(DET) micelles facilitated rapid, but transient gene expression. These findings suggest that introduction of cRGD to polyplex micelles might create novel and useful functions for gene transfer and contribute to the establishment of efficient gene therapy for vascular diseases.

Side-clamping of the ascending aorta is an indispensable technique for proximal anastomosis in total debranching of supra-aortic trunks and in endovascular aneurysm repair for arch aneurysm. However, this procedure may lead to the dislodging of multiple plaques and to clamp injury of the ascending aorta. We developed a clampless technique to achieve proximal anastomosis between the ascending aorta and an artificial graft used for total debranching of supra-aortic trunks. We applied this method in six patients with arch aneurysm and a plaque-rich ascending aorta and were able to achieve total debranching of the supra-aortic trunks in all of the patients without side-clamping the ascending aorta and no procedurally related complications. This clampless anastomosis technique ("real chimney technique") in the ascending aorta is a valuable option for total debranching of supra-aortic trunks in the hybrid repair of arch aneurysms.

A 55-year-old man developed progressive dysphagia 14 months after palliative colectomy and subsequent systemic chemotherapy for advanced cecal cancer with carcinomatosis peritonei. Radiologic and endoscopic examinations suggested a submucosal tumor in the lower esophagus causing a severe luminal stricture. A self-expanding metal stent was placed for palliation. The prosthesis was effective for several months, but ingrowth of the tumor caused re-stricture of the esophagus. Since his general condition was quite good without any evidence of recurrence of the cecal cancer, we performed bypass surgery for palliation. The pathological appearance of the tumor was compatible with the metastasis of cecal cancer. Our case suggests that a surgical approach can be considered as a therapeutic method for metastatic esophageal tumor, even in patients with advanced cancer, as long as the primary tumor is satisfactorily controlled.

Background Persistent inflammation following vascular injury drives neointimal hyperplasia (NIH). Specialized lipid mediators (SPM) mediate resolution which attenuates inflammation and downstream NIH. We investigated the effects of a synthetic analogue of resolvin D1 (RvD1) on vascular cells and in a model of rat carotid angioplasty. Methods Human venous VSMC and endothelial cells (EC) were employed in migration, cell shape, toxicity, proliferation and p65 nuclear translocation assays. Murine RAW 264.7 cells were utilized to test the effect of pro-resolving compounds on phagocytic activity. A model of rat carotid angioplasty was used to evaluate the effects of 17R/S-benzo-RvD1 (benzo-RvD1) and 17R-RvD1 applied to the adventitia via 25% Pluronic gel. Immunostaining was utilized to examine Ki67 expression and leukocyte recruitment. Morphometric analysis was performed on arteries harvested 14 days after injury. Results Exposure to benzo-RvD1 attenuated PDGF- stimulated VSMC migration across a range of concentrations (0.1–100 nM), similar to that observed with 17R-RvD1. Pre-treatment with either Benzo-RvD1 or 17R-RvD1 (10, 100nM) attenuated PDGF-BB-induced VSMC cytoskeletal changes to nearly baseline dimensions. Benzo-RvD1 demonstrated modest anti-proliferative activity on VSMC and EC at various concentrations, without significant cytotoxicity. Benzo-RvD1 (10nM) inhibited p65 nuclear translocation in cytokine-stimulated EC by 21% (p<0.05), similar to 17R-RvD1. Consistent with pro-resolving activities of other SPM, both 17R-RvD1 and benzo-RvD1 increased the phagocytic activity of RAW 264.7 cells against S. Aureus and Zymosan particles. There were no significant differences in Ki-67 or CD45 staining observed on day 3 after angioplasty. Periadventitial treatment with benzo-RvD1 reduced carotid neointimal area at 14 days compared to control (0.08 mm2 v. 0.18 mm2; p<0.05), with similar efficacy to 17R-RvD1. Conclusions 17R/S-benzo-RvD1 and 17R-RvD1 exhibit similar pro-resolving and anti-migratory activity in cell-based assays, and both compounds attenuated NIH following acute arterial injury in rats. Further studies of the mechanisms of resolution following vascular injury, and the translational potential of SPM analogues, are indicated.

CT scan. Five (10.86%) tight iliac stenoses were found before progression of the delivery system and were treated after CA by PTA and/or stenting. The 1-month mortality rate was 0% and the major morbidity rate was 2.1% (1/46).No conversion to open surgery, graft limb thrombosis or iliac artery injuries were observed.Conclusions: Our experience shows that the Endurant stent-graft is safe and effective in the endovascular repair of AAAs in patients with challenging anatomy. While this graft enables extreme anatomical difficulties to be overcome, only skilled operators after a long learning curve should treat these complex situations. However, further studies are needed to evaluate the long-term results.