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Objective To investigate the clinical significance of compensatory angiogenesis and the angiosome-based revascularization strategy for endovascular procedures in treating infrapopliteal critical limb ischemia in elderly diabetic patients.Methods A retrospective study of 194 patients with diabetic feet (Fontaine Ⅳ) who had undergone endovascular procedures at our hospital from January 2005 to December 2014 was performed.Based on the angiosome concept,all subjects were classified into the direct revascularization group (DR group),the indirect revascularization through collaterals group (IR-tc group) and the indirect revascularization without collaterals group (IR-wc group).After one-year follow-up,the therapeutic effects were analyzed and compared between the three groups.Results During the one-year follow-up,the rate of unhealed ulcers,the re-intervention rate and the rate of major adverse limb events (MALE) were higher in the IR-wc group than in the DR and IR-tc groups (P=0.000 and 0.000,P=0.025 and 0.013,P=0.014 and 0.023,respectively).The IR-wc group presented a lower limb salvage rate as compared with those in the DR and IR-tc groups (P=0.011 and 0.027).Patients with a single recanalized branch had a higher rate of unhealed ulcers than those with multiple recanalized branches in the IR-wc group (93.9％ vs.71.0％,P=0.015).Conclusions The angiosome-based revascularization strategy has shown important value in guiding endovascular procedures for patients with diabetic foot disease and,in particular,the compensatory angiogenesis approach appears to be critical in generating favorable short-term clinical outcomes in the treatment of diabetic foot disease.
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Objective To investigate the value of creatine kinase and computed tomography(CT)angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism(SMAE).Methods The retrospective cross-sectional study was adopted.The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected.The patients received serologic examination and CT angiography firstly,and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations.Observation indices:(1)clinical features,(2)serum indicators results,(3)CT angiography results:①location(main stem and non-main stem)of SMAE and development of distal branches of superior mesenteric artery(SMA),②indirect signs,such as bowel wall thickening,bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis,(4)therapy and prognosis.Measurement data with normal distribution were presented as-x±s,comparisons among groups were analyzed by one-way ANOVA.Measurement data with skewed distribution were presented as M(range)and analyzed by the Kruskal-Wallis rank sum test,and pairwise comparison was done using the Nemenyi test.Results(1)Clinical features:of 26 patients with SMAE,6 patients had intestinal ischemia,8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis(postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients).Duration of symptoms before diagnosis was(1.7±0.8)days in 6 patients with intestinal ischemia and(2.1±1.1)days in 8 patients with partial intestinal necrosis and(1.5±0.7)days in 12 patients with long segmental intestinal necrosis,with no statistically significant difference(F=1.27,P＞0.05).(2)Serum indicators results:levels of serum creatine kinase in patients with intestinal ischemia,partial intestinal necrosis and long segmental intestinal necrosis were 68 U/L(range,50-86 U/L),98 U/L(range,54-244 U/L)and 300 U/L(range,40-873 U/L),respectively,with a statistically significant difference among patients(H=7.32,P＜0.05)and between patients with intestinal ischemia and with long segmental intestinal necrosis(H=7.21,P＜0.05),and with no statistically significant difference between patients with partial intestinal necrosis and with intestinal ischemia or long segmental intestinal necrosis(H=1.53,2.07,P＞0.05).(3)CT angiography results:①developments of SMAE(main stem and non-main stem)and distal branches of SMA:main stem embolism of SMA in 13 patients demonstrated hypodense shadow,with non-contrast of distal branches of artery,including 1 with intestinal ischemia,1 with partial intestinal necrosis and 11 with long segmental intestinal necrosis.Main stem embolism of SMA in 8 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 3 with intestinal ischemia,4 with partial intestinal necrosis and 1 with long segmental intestinal necrosis.Main stem embolism of SMA in 2 patients demonstrated hypodense shadow,with non-contrast of distal branches of SMA,showing partial intestinal necrosis.Non-main stem embolism of SMA in 3 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 2 with intestinal ischemia and 1 with partial intestinal necrosis.②Indirect signs:5 patients had bowel wall thickening,including 3 with intestinal ischemia and 2 with long segmental intestinal necrosis.Seventeen patients had bowel dilatation combined with effusion and air accumulation,with gas fluid level in local intestinal canal,including 2 with intestinal ischemia,5 with partial intestinal necrosis and 10 with long segmental intestinal necrosis.Two patients had pneumatosis intestinalis,with bubble shadow of bowel wall,showing long segmental intestinal necrosis.(4)Therapy and prognosis:of 6 patients with intestinal ischemia,1 underwent embolectomy of SMA and 5 underwent low-molecular-weight heparin anticoagulation and vasodilator alprostadil therapy.Eight patients with partial intestinal necrosis received resection of necrotic intestine.Of 12 patients with long segmental intestinal necrosis,5 with postoperative short bowel syndrome received resection of necrotic intestine combined with postoperative parenteral hyperalimentation.The above-mentioned patients were improved and discharged from hospital after symptomatic treatment and surgery.Twelve patients with long segmental intestinal necrosis,7 with total small bowel necrosis and partial colonic necrosis underwent only exploratory laparotomy and then were dead in a short time.Conclusion Elevated creatine kinase and main stem embolism of SMA combined with non-contrast of distal branches using CT angiography maybe predict poor short-term prognosis of patients with SMAE.
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Objective To study the treatment effect of multilevel atherosclerotic occlusive disease of lower extremity. Methods From July 2004 to January 2008,intraoperative iliac balloon angioplasty and stenting combined with blood vassel prosthesis or autogenous reversed great saphenous vein bypass were performed on 32 patients suffering from lower extremity multilevel atheresclerotic occlusive disease. Results Surgical procedures were technically successful in all patients. The effect was good,intermittent claudication disappear, and rest pain improved. Preoperative vs postoperative ABI was 0.28±0.14 vs 0.65±0.18 (P<0.05 ).Thirty patients were followed up,the mean following period was 18 months (range of 3-36 months).Conclusions Simultaneous intravaseular interventional therapy combined with vascular bypass are effective in the treatment for patients with severe and multilevel atheroselerotie occlusive disease of lower extremity, the operation is less traumatic and the procedures are easy to do.The result is satisfactory.
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Objective To evaluate short-term therapeutic effects of laser therapy combined with high ligation of the great saphenous vein in the treatment of varicose veins in the lower extremities. Methods Endovenous laser treatment combined with high ligation of the great saphenous vein was performed on 46 patients with varicose veins in the lower limbs (55 limbs). Results The operation time was 30-65 min (mean, 48 min) for each limb. The number of incisions was 1-5 (mean, 2.8) in each limb. Hospital stay after operation was 3-5 d (mean, 3.6 d). Postoperatively, subcutaneous bleeding occurred in 11 limbs (20%), skin burn was seen in 6 limbs (11%). Among the patients, 42 (50 limbs) were followed up for 2-19 months (mean, 13.5 months), during which no recurrence was found. Conclusion Laser treatment combined with high ligation of the great saphenous vein is effective for varicose veins in the lower extremities.