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Introducción: la medición del índice tobillo-brazo (ITB) es una prueba de primera línea y con alta precisión diagnóstica para detectar la enfermedad vascular periférica (EVP). El método Doppler, considerado el estándar de oro, requiere del dispositivo y de un operador capacitado, lo que limita su uso en la atención primaria. Como alternativa, un método oscilométrico que emplea un dispositivo de presión arterial automático es una prueba simple y accesible que podría minimizar los sesgos del observador y eliminar la necesidad de capacitación especial. Objetivos: validar la capacidad diagnóstica de un dispositivo oscilométrico automatizado frente al método Doppler para la medición del ITB. Materiales y métodos: se incluyeron pacientes con diabetes mellitus tipo 1 y 2 (DM1 y DM2), mayores de 50 años, con uno o más factores de riesgo cardiovascular. Luego de que los pacientes permanecieran 5 minutos acostados, se registró la presión arterial sistólica (PAS) con tensiómetro Welch Allyn DS 45-11 y Doppler Vascular Contec Sonoline B 8 Mhz en ambas arterias tibiales posteriores y en arteria braquial derecha. Posteriormente se realizaron los mismos registros con monitor de presión arterial automático modelo Omrom HEM-7130. Se calculó el ITB de cada miembro inferior y las capacidades diagnósticas (sensibilidad [S-, especificidad [E], concordancia por coeficiente kappa, valor predictivo positivo [VPP] y valor predictivo negativo [VPN]) del método oscilométrico para detectar un ITB patológico por Doppler (≤0,90). Resultados: se evaluaron 66 pacientes, 52 varones y 14 mujeres, 7 con DM1 y 59 con DM2, 69 años de edad (DS 9,8), con una antigüedad de la DM de 18,05 años (DS 12,01). La prevalencia de EVP detectada por Doppler (ITB ≤0,90) fue del 16,7% (IC 95% 9,9-23,4). El método oscilométrico para detectar un ITB ≤0,90 por Doppler mostró una S del 72,7% (IC 95% 51,8-93,6), una E del 96,3% (IC 95% 92,4-100), una concordancia del 92,4% (IC 95% 87,5-97,3), un VPP del 80,0% (IC 95% 59,9-100) y un VPN del 94,6% (IC 95% 90,0-99,3). Conclusiones: el alto VPN hallado (condición esencial para un método de screening) significa que si el método oscilométrico da un ITB >0,90, hay un 94,6% de posibilidad de que el ITB por Doppler no sea ≤0,90. El VPP de 80% encontrado significa que si el ITB oscilométrico es ≤0,90, hay un 80% de posibilidad de que el ITB Doppler sea verdaderamente ≤0,90. Por lo tanto, consideramos que la simple medición del ITB con el método oscilométrico podría recomendarse en la atención primaria, donde se requieren métodos rápidos, fáciles y confiables.
Introduction: the measurement of the ankle-brachial index (ABI) is a first-line test with high diagnostic accuracy for the detection of peripheral vascular disease. The Doppler method, considered the gold standard, requires the device and a trained operator, which limits its use in primary care. Alternatively, an oscillometric method using an automated blood pressure device is a simple and affordable test that could minimize observer bias and eliminate the need for special training. Objectives: to validate the diagnostic capacity of an automated oscillometric device against the Doppler method for ABI measurement. Materials and methods: diabetes mellitus type 1 and 2 (DM1 and DM2) patients older than 50 years with 1 or more cardiovascular risk factors were included. After 5 minutes lying down, SBP was recorded with a Welch Allyn DS 45-11 sphygmomanometer and Contec Sonoline B 8 Mhz Vascular Doppler in both posterior tibial arteries and in the right brachial artery. Subsequently, the same recordings were made with an Automatic Blood Pressure Monitor Model Omrom HEM-7130. The ABI of each lower limb and the diagnostic capabilities (sensitivity [S], specificity [E], concordance by kappa coefficient, positive predictive value [PPV] and negative predictive value [NPV] of the oscillometric method to detect a pathological ABI were calculated by Doppler (≤0.90). Results: 66 patients were evaluated, 52 men and 14 women, 7 DM1 and 59 DM2, 69 years old (SD 9.8) with a history of diabetes of 18.05 years (SD 12.01). The prevalence of PVD detected by Doppler (ABI ≤0.90) was 16.7% (95% CI 9.9-23.4). The oscillometric method to detect an ABI ≤0.90 by Doppler showed an S of 72.7% (95% CI 51.8-93.6), an E of 96.3% (95% CI 92.4-100), a concordance of 92.4% (95% CI 87.597.3), a PPV of 80.0% (95% CI 59.9-100) and a NPV of 94.6% (95% CI 90 .0-99.3). Conclusions: the high NPV found (essential condition for a screening method) means that if the oscillometric method gives an ABI >0.90, there is a 94.6% chance that the Doppler ABI is not ≤0.90. The PPV of 80% found means that if the oscillometric ABI is ≤0.90, there is an 80% chance that the Doppler ABI is truly ≤0.90. Therefore, we consider that the simple measurement of ABI with the oscillometric method could be recommended in primary care, where fast, easy and reliable methods are adequate.
Subject(s)
Peripheral Vascular Diseases , Diabetes Mellitus , Ankle Brachial IndexABSTRACT
A 71-year-old male was admitted to our institution because of right leg pain and paleness, accompanied by sudden chest-back pain. The right femoral artery was not palpable. The reticulated cyanosis appeared on the right leg. Contrast enhanced computed tomography (CT) revealed an acute type B aortic dissection (TBAD) extending from the descending thoracic aorta to the left common iliac artery and right external iliac artery. The intimal tear was located at thoraco-abdominal aorta. There was a severe stenosis of the true lumen at bilateral common iliac arteries because of the dynamic compression caused by the extended false lumen. Blood to the right leg was not supplied from the dissected iliac artery, the peripheral circulation was maintained by collateral flow. The patient was diagnosed acute TBAD complicated with lower limb ischemia. An emergent right axillary artery-bifemoral arteries bypass was carried out for malperfusion of lower extremities. The symptoms in the lower limbs disappeared immediately. The bilateral femoral arteries were well palpated. However, 4 days later, uncontrollable severe hypertension and anuria appeared suddenly. Contrast enhanced CT revealed the stenosis of true lumen at bilateral renal arteries and an exacerbation of stenosis of true lumen at abdominal aorta. Emergent thoracic endovascular aortic repair (TEVAR) for entry closure was performed to improve the renal function and prevent mesenteric ischemia. Postoperative contrast enhanced CT revealed the complete closure of the entry tear and dilatation of the true lumen at the descending and abdominal aorta. At the bilateral renal arteries, the blood flow improved. The renal function recovered and mesenteric ischemia did not occurred. In this report, we presented a case of acute TBAD complicated with lower limbs ischemia and late onset acute ischemic renal failure. We first performed the right axillary artery-bifemoral arteries bypass grafting, after that we had to perform TEVAR to close the entry tear. One-stage emergent TEVAR should be considered for acute TBAD with the dynamic compression at the level of abdominal aorta in future.
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BACKGROUND: The research on lower extremity vascular disease is becoming popular. In the experiment of large animals as research platform, It Is necessary to detect the shape and density of lower extremity vascular In order to study and verify the effectiveness of Intervention measures, and this detection method needs high feasibility and repeatability. OBJECTIVE: To investigate the feasibility, influencing factors and application value of digital subtraction angiography in lower limb arteriography of a canine animal model. METHODS: Six Beagle dogs were fixed on the working bed after anesthesia and punctured percutaneously through the femoral artery with an indwelling needle. Contrast agent was injected artificially. Digital subtraction angiography bolus chase technology was used to collect contrast images. The image effect and influencing factors were analyzed. RESULTS AND CONCLUSION: (1) The final arteriography images of all six Beagle dogs’ hind limbs were clear, and the branches of small vessels could be distinguished without artifacts. (2) The first beagle shook when encountering contrast agent stimulation during the initial angiography, resulting in poor image effect. After fixing the limbs and diluting the contrast agent, the clear images were obtained by re-angiography. (3) These results indicate that arteriography using digital subtraction angiography can clearly reveal the shape and density of blood vessels in canine animal models. It is simple and reproducible, and is of great significance for research on animal models of limb ischemia.
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Objective To summarize the clinical experience and efficacy of surgical treatment for Stanford type A aortic dissection leading to acute lower limb ischemia.Methods From January 2014 to January 2018,12 patients with severe lower limb ischemia caused by acute type A aortic dissection were treated with Suns surgery.Among them,11 patients were treated with restoration of lower limb blood supply preferentially,including 10 cases of femoral artery bypass and 1 case of abdominal aorta-iliac artery stent graft implantation.Another case was treated with ascending aorta-femoral artery bypass after Sung surgery.Results 3 cases died of ischemia and necrosis of the lower extremities.Two of them died of multiple organ failure due to amputation and one died of low cardiac output due to refractory acidosis.Acute renal failure performed bedside CRRT in 5 patients and ECMO in 1 patient.The remaining 9 patients were discharged from the hospital and the symptoms of lower limb ischemia disappeared.After an average follow-up of 23 months,the re-examination of the aorta CTA showed that the bypass artery was unobstructed and the distal femoral artery was well developed.One patient infecting vascular prosthesis was cured by taking out the unit.Conclusion For acute lower limb ischemia caused by type A aortic dissection,blood flow of lower extremities should be restored as soon as possible to reduce mortality and complications.Femoral artery bypass and abdominal aorta-iliac arterial repair are simple and effective in reconstructing lower limb blood supply.
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We describe a rare complication and treatment progression that occurred in a 64-year-old man with an aortic abdominal aneurysm (AAA) that had been treated by endovascular aneurysm repair (EVAR). He had undergone EVAR to treat an infra-renal type AAA 21 months previously and returned to the emergency department with back pain. Contrast-enhanced computed tomography (CT) revealed acute type B aortic dissection, so he was admitted and conservative medical management was started. Acute stomachache and limb pain appeared on hospital day 7, which prevented him from moving his lower limbs. The main body of the stent graft had collapsed, blocking blood flow, and contrast was not found in arteries from the collapsed stent graft portion to the knee level on emergency contrast CT images of the leg. His legs were revascularized by an extra-anatomical right axial-bilateral external iliac bypass. His symptoms disappeared and reperfusion injury was avoided. The collapsed stent graft had retained its original shape at 11 and 18 days after surgery. Furthermore, follow-up CT 4.5 years later showed that the stent graft retained its original form.
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Objective To compare the efficacy and safety of surgical thrombectomy with those of catheter-directed thrombolysis (CDT) in treating acute lower limb ischemia (ALLI) . Methods The clinical data of 107 patients with ALLI, who underwent CDT or surgical thrombectomy at authors' hospital during the period from January 2012 to December 2017, were retrospectively analyzed. The incidence of complications, mortality, re-intervention rate and amputation rate within 30 days after operation were calculated. Cooley standard of efficacy score was used to assess the clinical curative effect of patients with grade Ⅱ of American Society of Vascular Surgeons (SVS) and International Society of Cardiovascular Surgery (ISCVS) classification of acute limb ischemia. Results A total of 107 patients with ALLI were enrolled in this study. Among them, 59 patients received CDT therapy and 48 patients received surgical thrombectomy. The technical success rate of both groups was 100％. Within 30 days after operation, the incidence of complications in CDT group and surgical thrombectomy group was 11.9％ and 14.6％ respectively, the mortality was 5.1％ and 6.3％respectively, and the re-intervention rate was 17.0％ and 22.9％ respectively, all the differences were not statistically significant (P>0.05) . The amputation rate of patients with grade Ⅱ of SVS/ISCVS ischemia classification in CDT group was 8.9％, which was higher than 2.3％ in surgical thrombectomy group, but the difference between the two groups was not statistically significant (P>0.05) . In patients with grade Ⅱ of ischemia assessed by the ca uses and Cooley curative effect standard at the time of discharge, the cure percentage of embolism-caused ALLI patients in surgical thrombectomy group was 82.5％, which was remarkably higher than 62.8％ in CDT group (P <0.05) . The cure percentage of thrombosis-caused ALLI patients in CDT group was 92.3％, which was strikingly higher than 25.0％ in surgical thrombectomy group (P <0.05) . The difference in the improvement of ischemia, which was assessed by the duration of ischemia and Cooley therapeutic criteria at the time of discharge, between the two groups was not statistically significant (P>0.05) . Conclusion In treating ALLI, no significant differences in curative effect, incidence of postoperative complications and mortality exist between surgical thrombectomy and CDT. The formulation of therapeutic regimen should be based on ischemia grade of SVS/ISCVS, etiology and coexisting underlying diseases.
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Critical lower limb ischemia(CLI) is a severe manifestation of arteriosclerosis obliterans of lower extremity,infrapopliteal artery occlusion is an important cause of CLI.Both limb salvage and life quality improvement are therapeutic targets for CLI.With the development of technology and equipment,endovascular treatment has become the main means for infrapopliteal arterial occlusive diseases.Because of the unique anatomic features of infrapopliteal artery,great therapeutic difficulty and high incidence of restenosis,a series of controversial issues have been emerged.The main controversial issues are as follows:(1) Which should be taken as first choice of treatment,endovascular therapy or traditional bypass surgery? (2) How to select target vessels in treating infrapopliteal artery occlusion? (3) How to select optimal access in performing endovascular treatment of infrapopliteal artery? (4) How to optimize the endovascular surgical method for infrapopliteal arterial occlusive disease? Based on the latest advance in evidence-based medicine and on the clinical treatment experience,this paper aims to make a detailed description concerning the above mentioned hot issues in clinical practice as well as in academic consideration about endovascular treatment of infrapopliteal arterial occlusive diseases.
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Lower limb ischemia is common and refractory diseases,in severe cases,it can impact on life quality even threat life.The traditional treatment contain medical and surgical,but cannot obtain satisfactory results.And therapeutic angiogenesis has achieve satisfactory results in animal experimnents and clinical study as its put forward.In recent years,Cell Therapy as one of the research hotspot,the micle aims to introduce the research of progress about therapeutic angiogenesis in detail.
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Objective Stem cell transplantation is a new approach to the treatment of lower limb ischemia ( LLI) .This study was to investigate the therapeutic effect of the transplantation of autologous bone marrow mesenchymal stem cells ( BM-MSCs) in the treatment of LLI. Methods We established the left LLI model in 12 New Zealand rabbits and divided them into a control and a trial group of equal number.The control animals were injected with DMEM, while the rabbits in the trial group with autologous BM-MSCs, into the ischemic skeletal muscle.Four weeks after injection, we performed CT angiography and perfusion imaging of both lower limbs of the rabbits and conducted HE staining of the paraffin sections of the skeletal muscle of the ischemic limbs. Results Dynamic ob-servation revealed different degrees of ecderon necrosis in 2 of the LLI models in the control group, even with toenail coloboma, but no necrosis in the trial group except for some slight muscular atrophy. Both collateral arteries and blood perfusion were obviously increased in the ischemic lower limbs in the trial than in the control group.HE stai-ning showed a significantly higher density and percentage of capillaries in the skeletal muscle fibers in the former than in the latter ([6.500 ± 1.049]/HP vs [3.670 ±0.816]/HP, [9.68 ±0.56]%vs [5.87 ± 0.86]%, P<0.01), with no necrosis in either group, nor hematoma, bony tissue, or fibroid tumor in the trial group. Conclusion Autologous transplantation of BM-MSCs can improve neovascularization in ischemic lower limbs in rabbits and can be used as a safe and effective treatment of limb ischemia.
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Se hizo una evaluación de la calidad de vida en 45 pacientes mayores de 60 años con isquemia arterial crónica de miembros inferiores; de ellos, 34 con isquemia severa y 11 con pie diabético isquémico, también con lesiones severas. A todos se les habían implantado en el miembro inferior afectado, células mononucleares derivadas de la médula ósea movilizadas a la sangre periférica con factor estimulador de colonias de granulocitos. Para la evaluación de la calidad de vida se seleccionó el cuestionario SF-36, que centra su contenido en 2 áreas: el estado funcional y el bienestar emocional. En todos los casos se manifestó una mala calidad de vida preimplante. La mejoría fue evidente a partir del sexto mes después de la terapia celular. Los casos con un año de evolución habían logrado una buena calidad de vida. La mayor parte de los pacientes que evolucionaron satisfactoriamente pudieron incorporarse a las actividades sociales y laborales, lo que con anterioridad no les era posible
An assessment of the quality of life in 45 patients older than 60 years with chronic arterial ischemia of the lower limbs was conducted. Out of them, 34 had severe ischemia, and 11 had ischemic diabetic foot, as well as severe injuries. All had been implanted mononuclear cells in the affected lower limb, which derived from the bone marrow, and mobilized to the peripheral blood with granulocyte colony stimulating factor. For assessing quality of life, SF-36 questionnaire was selected, which focuses its content on two areas: functional status and emotional well being. All cases showed poor quality of life before implantation. Improvement was evident on the sixth month after cell therapy. Cases with a year of evolution had achieved good quality of life. Most of the patients, who had successful outcomes, could join social activities and employment, which was previously not possible
Subject(s)
Humans , Male , Female , Quality of Life/psychology , Lower Extremity/injuries , Ischemia/complications , Ischemia/rehabilitation , Stem Cell Transplantation/methodsABSTRACT
Objective To assesse prognostic factors regarding long-term primary patency for patients who underwent intra-arterial thrombolysis and/or adjuvant endovascular techniques due to acute lower limb ischemia. Methods Consecutive patients with ALI of the lower extremities treated via interventional methods between January 2005 and June 2010 were identified and reviewed ( exclude patient suffered from aortic dissection involved artery of lower extremity or trauma). Analyze the potential variables with univariable analysis and only factors associated with long-term primary patency with a P value less than 0.1 in univariable analysis were introduced into the Cox regression mode.Total long-term primary patency and grouped primary patency were assessed using Kaplan-Meier estimation.Results The analyzed dataset included 107 limbs treated in 101 patients presenting with ALI (class Ⅰ 15,class Ⅱ A 36,class Ⅱ B to Ⅲ 56,according to Rutherford classification ).Eight nine limbs were enrolled in follow-up.The mean followup was 34 months ( range:1 to 53 months).Primary patency at 12,24 and 36 months was 87％,68％ and 55％,respectively.Multivariable analyses identified patients presenting with diabetes mellitus ( P =0.00),PAOD ( P ＜ 0.02 ) and thrombolysis time ( P ＜ 0.02 ) were associated with primary patency.Compare the patency rate of patients with different thrombolysis time,the results showed that the patency rate of the patients thrombolysis time less than 4 d was higher than those more than 4 c. Conclusions lnterventional therapy remains an effective treatment option for patients presenting with lower extremity ALI.Diabetes mellitus and PAOD negatively affect the rates of limb primary patency. Thrombolysis should be limited to ＜4 days.
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ObjectiveTo investigate the efficiency of autologous transplantation of peripheral blood stem cells for treatment of patients with diabetic lower limb ischemia.MethodsEighteen patients of type 2 diabetes with diabetic lower limb ischemia (30 legs) were treated by autologous transplantation of peripheral blood stem cells.ResultsThe limb pain, cool feeling and numbness feeling improved significantly after PBSC transplantation,the improvement rate were 96.7％, 100.0％ and 95.8％ respectively.Intermittent claudication was also relieved significantly, total remission rate was 76.9％.The ABI and TcPO2 of patients increased significantly at 3 months after transplantation.After the transplantation ABI raised from 0.60 ± 0.11 to 0.71 ±0.12(t =-6.882, P ＜ 0.01) .93.3％ of patients' TcPO2 raised in different degrees.The foot infections were well controlled.Ulcer or toes gangrene got better or healed.No obvious complications or adverse reaction were observed after the transplantation.ConclusionAutologous transplantation of peripheral blood stem cells shows to be a simple, safe and effective method in treating patients with diabetic lower limb ischemia.
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An ischemic foot can be developed by acute arterial occlusion. Given proper treatment within critical time, the patient can avoid foot amputation and death. Early proper diagnosis and treatment by family physician at the initial clinical interviewing is important in saving the affected leg and the life. Thrombosis and embolism are the common causes of acute arterial occlusion. Thrombosis mostly arises from underlying cardiac disease such as arrhythmia, coronary artery disease and valvular heart disease while arterial occlusion by embolism can be shown on a narrowed artery related with systemic atherosclerosis. Because the treatment options depend on the underlying cause of the acute ischemic foot, it is important to identify the cause of acute ischemic foot. At this paper, we reported a case that the cause of acute ischemic foot of the patient proved paroxysmal atrial fibrillation after some diagnostic tests.
Subject(s)
Humans , Amputation, Surgical , Arrhythmias, Cardiac , Arteries , Atherosclerosis , Atrial Fibrillation , Coronary Artery Disease , Diagnostic Tests, Routine , Embolism , Embolism and Thrombosis , Foot , Heart Diseases , Heart Valve Diseases , Ischemia , Leg , Lower Extremity , Physicians, Family , ThrombosisABSTRACT
Objetivo: caracterizar la diabetes mellitus como factor de riesgo independiente para el grado de severidad de isquemia crítica de miembros inferiores y para la viabilidad de extremidades afectadas. Contexto y tipo de estudio: censo de base hospitalaria sobre el registro de pacientes sometidos a revascularización o amputación primaria mayor de miembros inferiores por isquemia crítica aterosclerótica, a partir del primero de enero de 2005 hasta el 30 de junio de 2009. Las unidades de análisis fueron los registros clínicos de todos los pacientes intervenidos que cumplieran con los criterios de ingreso al estudio. Material y métodos: descripciones univariada y bivariada dependiendo del tipo y distribución de las variables. Detección de variables confundidoras y con efectos de modificación de las medidas de asociación entre diabetes y severidad de isquemia crítica, y diabetes y tipo de intervención, mediante estratificación en el análisis. Resultados: ajustada la relación para el efecto confundidor positivo de la hipertensión arterial, la posibilidad de diabetes mellitus en los pacientes Fontaine IV fue 8.23 veces la de los pacientes Fontaine III (X²MH 1gl 13.18; valor p = 0.0003). Controlado el efecto confundidor positivo de la insuficiencia renal crónica, la posibilidad de diabetes mellitus en los pacientes Fontaine IV fue 7.99 veces la de los pacientes Fontaine III (X²MH 1gl 12.00; valor p = 0.0005). Al controlar por la severidad de la isquemia crítica de miembros inferiores, los pacientes con diabetes mellitus conllevan una posibilidad de amputación primaria mayor de 6.32 en relación con los pacientes no diabéticos (X²MH 1gl 8.455; valor p = 0.0036). Conclusión: la diabetes mellitus se señala como un factor de riesgo independiente para el desarrollo del estado más severo de isquemia crítica de miembros inferiores, Fontaine IV, tras ajustar para hipertensión arterial e insuficiencia renal crónica. Igualmente, la diabetes se constituyó en factor de riesgo independiente para la viabilidad de la extremidad con isquemia crítica (Acta Med Colomb 2010; 35: 40-47).
Objective: to characterize diabetes mellitus as an independent risk factor for the severity of critical lower limb ischemia and for viability of affected limbs. Context and type of study: Hospital based census on registers of all surgical patients for revascularization or major amputation by atherosclerotic critical ischemia or lower limbs from 1st January, 2005 until 30th June, 2009. Units of analysis were clinical records of patients who met the study's admission criteria. Material and methods: univariate and bivariate descriptions depending on type and distribution of variables. Detection of confounders and modifiers of effects of the association between diabetes and severity of critical ischemia, and diabetes and intervention, by stratification in the analysis. Results: adjusted for the positive confounding effect of hypertension, odds of diabetes mellitus in patients with ischemic disease Fontaine IV was 8.23 to patients with Fontaine III (X²MH 1df 13.18; p value = 0.0003). Controlled for the positive confounding effect of chronic renal failure, odds of diabetes mellitus in patients with Fontaine IV was 7.99 to patients with Fontaine III (X²MH 1df 12.00; p value = 0.0005). Controlled for the severity of critical lower limb ischemia, patients with diabetes mellitus had a possibility of primary major amputation 6.32 in relation to non-diabetic patients primary amputation (X²MH 1df 8.455; p value = 0.0036). Conclusion: Diabetes mellitus is an independent risk factor for the development of the most severe state of critical ischemia of the lower limbs, Fontaine IV, after adjusting for hypertension and chronic renal failure. Also, diabetes became an independent risk factor for the viability of the limb with critical ischemia. (Acta Med Colomb 2010; 35: 40-47).
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Objective To investigate the efficiency of autologous transplantation of peripheral blood stem cell for treatment of patients with chronic lower limb ischemia. Methods Forty-six patients with chronic lower limb ischemia were treated by autologous peripheral blood stem cell transplantation. Results Fortytwo patients had pain relief on legs, and cold and cool feelings in lower limbs disappeared. Thirty-five patients had pain relief on feet, and 29 of them had disappearance of cold and cool feelings. Due to necrosis in middle and lower part of leg, 4 patients took extremity amputation after 4 weeks of the transplantation. In the 42 patients who kept their legs 3 months after transplantation, the distance of anginacruris extended from (87. 45 ±41.22) m to (348.52 ± 147.24) m, skin temperature increased from(28.52 ±0.51 ) ℃ to(33.56±0.62) ℃ ,and ankle-brachial index (ABI) increased from(0.48 ±0.06)to(0.75 ±0.07). There were statistical differences, and the scores of the distance of anginacruris, skin temperature, and ABI after transplantation were better than before. six months after transplantation autobiography of lower extremity was used, and neonatal lateral vessels of different degrees were found in 37 patients. Conclusion Autologous transplantation of peripheral blood stem cell is a simple, safe, and effective method, especially in treating patients with lower limb ischemia in which no arterial reconstruction is feasible.
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Acute aortic dissection is a catastrophic event. Nowadays, the management of aortic dissection can be challenging with performing procedures such as aortic fenestration, stenting and endovascular treatment. While most cases of acute Stanford type A dissection are managed surgically, many cases of acute Stanford type B dissection are treated medically, although open surgery or stent-graft placement is sometimes performed. Patients with Stanford type B dissection may develop vascular complications such as mesenteric or peripheral ischemia, which cannot be managed medically. Fenestration is a procedure for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap and this allows outflow from the false lumen, it relieves branch vessel obstruction, it restores the flow to the ischemic organ and it reduces the risk of extension or rupture of the dissection. Urgent revascularization is required to correct mesenteric and renal ischemia and to restore distal perfusion if there is rest pain and ischemia signs at the lower extremity. We report here on a case of successful surgical fenestration of an acute aortic dissection for relief of lower limb ischemia, and we utilized a transfemoral artery to puncture the obstructed intimal flap.
Subject(s)
Humans , Arteries , Femoral Artery , Glycosaminoglycans , Ischemia , Lower Extremity , Perfusion , Punctures , Rupture , StentsABSTRACT
Objective To investigate the efficiency of autologous transplantation of bone-marrow mononuclear cells for treatment of patients with diabetic lower limb ischemia. Methods Twenty patients of type 2 diabetes (22 legs) with diabetic lower limb ischemia were treated by autologous transplantation of bone-marrow mononuclear cells. Results All ischemic legs were preserved except three feet, which were amputated due to the previously existed foot gangrene in one and unsolved pain in two. The pain-alleviated rate was 85.0%. The amputation rate was 13.6%. The skin turned warm in all legs(100.0%). TcPO2 of the ischemic legs was elevated in 17 patients with 19 legs. Angiography showed a noticeable increase of visible collateral vessels in 7 patients with 8 limbs who had angiographic follow-up. Conclusion Autologous transplantation of bone-marrow mononuclear cells could be a simple, safe, and effective method to treat patients with diabetic lower limb ischemia.
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Persistent sciatic artery (PSA) is a continuation of the internal iliac artery into the popliteal-tibial vessels and this structure provides the major blood supply to the lower limb bud during early embyrologic development, Its remnants participate in the formation of the inferior gluteal, deep femoral, popliteal, peroneal and pedal vessels. When the femoral artery develops, the PSA then involutes. In rare circumstances it persists and so provides the only major blood supply to the lower limb. The PSA was first reported by Green in 1832 and until now, only about 100 cases have been reported in the world literatures. This rare vascular anomaly is associated with aneurysmal formation in 15% to 46% of cases and it has a bilateral location in 22% of PSA cases. In more than 40% of cases, PSA is asymptomatic. When present, such non-specific symptoms as gluteal pain and painful buttock mass are presented. However, the most frequent clinical finding is lower limb ischemia because in 25% of such cases, the presented symptoms are limb threatening. We describe here the case of a 54 year-old female affected with PSA occlusion, and she was treated with a combination of thrombolysis and thromboembolectomy.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Arteries , Buttocks , Extremities , Femoral Artery , Iliac Artery , Ischemia , Lower ExtremityABSTRACT
PURPOSE & METHOD: To evaluate clinical pattern and operative outcome of the ischemic lower extremity, 142 patients who were admitted to Yeungnam University Hospital between January 1996 to December 1998 were analyzed. RESULTS: The patients were 125 males and 17 females ranging from 21 to 88 years of age. The mean age was 59, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. The causes of arterial occlusive disease were artherosclerotic obliterans (ASO) in 87 cases (61.2%), thromboangitis obliterans (TAO) in 44 cases (30.9%), thromboembolism in 10 cases and superficial femoral aneurysm in 1 case. Associated diseases in ASO were hypertension in 37 cases (42.5%), diabetes mellitus in 17 cases (30.9%), cardiac disease in 24 cases (27.5%) and cerebrovascular disease in 7 cases (8.0%). History of smoking was noted in 77.4% of the cases. The major arterial occlusive site of ASO were femoral artery in 36 cases (41.3%), aortoiliac artery in 26 cases (29.8%), iliofemoral artery in 9 cases (10.3%), popliteal artery in 5 cases (5.7%), tibial artery in 6 cases (6.8%) and multi-level occlusion in 5 cases (5.7%). The major arterial occlusive site of TAO were tibial artery in 35 cases (79.5%), pedal artery in 8 cases (18.1%) and popliteal artery in 1 case. According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade 0 0 case, Grade I 48 cases (33.8%), Grade II 46 cases (32.3%) and Grade III 48 cases (33.8%). The operative procedures of arterial occlusive disease were bypass graft operation in 72 cases, thromboembolectomy in 12 cases, endarterectomy in 2 cases and percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Arterial bypass operation with autogenous or artificial prosthesis were done in 72 cases, which included aortobifemoral or aortobipopliteal bypass in 12 cases, iliofemoral bypass in 5 cases, femoropopliteal bypass in 26 cases, femorotibial bypass in 5 cases, popliteotibial bypass in 8 cases. axillobifemoral bypass in 4 cases and femorofemoral bypass in 12 cases. In over 90% of the operative cases, the early outcome was good with 3+ to 2+ rating according to Rutherford criteria. Mortality for 114 cases was 2.6% (3 cases), including 2 resulting from associated cardiac condition and 1 resulting from ARDS. CONCLUSION: Strategies for successful revascularization and long term patency may be made by consideration of the extent of diseases, associated diseases, clinical symptoms and status of distal perfusion.