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Objective:To study the changing characteristics of the levels of plasma thrombin-antithrombin complex (TAT) in atherosclerosis obliterans (ASO) patients with different conditions and the clinical value of predicting luminal restenosis after revascularization.Methods:A total of 386 ASO patients were collected, including 209 males and 177 females, aged 70 (44-97) years old, including 196 patients with intermittent claudication and 190 patients with critical limb ischemia. There were 172 patients with intermittent claudication and 185 patients with critical limb ischemia who received revascularization therapy. During the 30-day follow-up period, 23 patients with intermittent claudication and 49 patients with critical limb ischemia developed restenosis after surgery. Venous blood samples were collected before surgery, on the 3rd day after surgery, and on the 7th day after surgery. Plasma TAT levels were determined by Shine i2900-automatic chemiluminescence immunoassay analyzer; Kruskal-Wallis H test was used for comparison among multiple groups; Mann-Whitney U test was used for data comparison between the two groups; continuous comparison of patient data in the same group was done by using Friedman rank test; multivariate correlation analysis by Logistic regression was conducted to obtain odds ratio( OR). The diagnostic performance of TAT was evaluated by ROC analysis. Kaplan-Meier curve was used to analyze the survival curve, and the hazard ratio (HR) was obtained by Cox proportional hazard regression model. Results:Compared with the healthy control group, the level of plasma TAT in patients with intermittent claudication was significantly higher ( P<0.001); the level of plasma TAT in patients with critical limb ischemia was significantly higher than that in patients with intermittent claudication ( P<0.001). The plasma TAT of patients with Rutherford grade 3 >grade2, grade4 >grade3, and grade6 >grade5 ( P values were 0.038, <0.001, and 0.013, respectively).In the intermittent claudication group, the plasma TAT levels of the patients with restenosis on the 3rd and the 7th day after revascularization were both higher than that of the patients with unobstructed blood flow ( P values were 0.004 and <0.001, respectively); The plasma TAT level of patients with unobstructed blood flow on the 7th day after surgery was lower than that on the 3rd day after surgery and before surgery (both P values <0.001); the plasma TAT level of patients with restenosis on the 7th day after surgery was lower than that on the 3rd day after surgery and higher than before surgery (both P values < 0.001). In the critical limb ischemia group, before surgery, on the 3rd and the 7th day after surgery,the plasma TAT levels of the patients with restenosis were higher than that of the patients with unobstructed blood flow ( P values were 0.001, 0.013, and <0.001, respectively); The plasma TAT level of patients with unobstructed blood flow on the 7th day after surgery was lower than that on the 3rd day after surgery and before surgery (both P values <0.001); the plasma TAT level of patients with restenosis on the 7th day after surgery was lower than that on the 3rd day after surgery ( P<0.001), but was not significantly difference from that before surgery. The ROC analysis showed that the areas under the curve (AUC) of plasma TAT on the 7th day after surgery to predict postoperative restenosis in all the patients, patients with intermittent claudication and those with critical limb ischemia were 0.839, 0.783 and 0.853, respectively. Survival analysis indicated that in the critical limb ischemia group, patients with plasma TAT levels higher than the critical value (≥7.66 ng/ml) on the 7th day after surgery showed significantly higher cumulative risk of restenosis events within 30 days after surgery (Log-rank χ 2=93.674, P<0.001). Cox regression analysis showed that the plasma TAT level on the 7th day after the surgery could be used as an independent indicator to predict the occurrence of restenosis within 30 days after surgery in the critical limb ischemia group ( HR=2.259, P<0.001). Conclusion:Plasma TAT can reflect the hypercoagulable state of ASO patients in different conditions, which is helpful for stratification of disease severity. In addition, TAT is highly sensitive for luminal restenosis after revascularization and can be used as an independent marker for evaluating postoperative restenosis events in patients with critical limb ischemia.
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Objective:To explore the risk factors of antiplatelet drug compliance after stent implantation in patients with lower extremity arteriosclerosis obliterans, and to construct an online prediction model tool.Methods:Retrospective analysis of the clinical data of patients with lower extremity arteriosclerosis obliterans who received lower extremity arterial stent implantation in Department of Vascular Surgery, Provincial Hospital Affiliated to Shangdong First Medical University from January 2019 to January 2021 was carried out. 90 patients with poor compliance and 90 patients with good compliance were selected into the observation group and the control group, respectively. Univariate analysis was used to screen the influencing factors of antiplatelet drug compliance, and the variables with statistical significance were substituted into the binary Logistic regression to carry out independent risk factor test to screen the risk factors of cross-over antiplatelet drug compliance and establish the prediction model.Results:Married ( OR = 0.316, 95% CI 0.135-0.738), number of follow-up visits during the follow-up period ( OR = 0.866, 95% CI 0.760-0.987), the amount of medication ( OR = 0.755, 95% CI 0.654-0.919) were the protective factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. Advanced age ( OR = 1.136, 95% CI 1.066-1.211), male ( OR = 3.727, 95% CI 1.533-9.060), junior high school and below education level ( OR = 4.949, 95% CI 1.501-16.313), the average monthly income less than 3 000 yuan ( OR = 15.774, 95% CI 4.487-55.495) and the monthly expenditure on medicine more than 500 yuan ( OR = 15.323, 95% CI 3.527-66.569) were the risk factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. The consistency index of this prediction model was 0.895, the area under the ROC curve was 0.875. Conclusion:The antiplatelet medication adherence prediction model established has high accuracy and good clinical application values.
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Objective:To investigate the clinical efficacy and safety of antiplatelet combined with anticoagulation therapy for restenosis prophylaxis after stent placement in diabetic patients with leg atherosclerosis obliterans(LASO). Methods:83 diabetic LASO patients with stent placement were collected and randomly divided into the treatment group(42 cases)and the control group (41 cases)with 49 sick limbs in each. The control group was treated with clopidogrel(75mg,for 1 year)plus bayaspirin(100 mg),while the treatment group was treated with low molecular heparin(withdrawal when INR = 2. 0- 3. 0)plus warfarin(for 6 months)additionally. All cases were followed up for 12 months and the efficacy and safety were compared and evaluated. Results:After therapy,there were no differences in FPG,GHbA1C,TC and LDL-C at each time point between the two groups(P >0. 05). Compared with that in the control group,MLD in the treatment group was improved obviously(P 0. 05). Conclusion:Compared with antiplatelet therapy,antiplatelet combined with anticoagulation therapy for restenosis prophylaxis after stent placement in diabetic LASO patients is more effective and safer,which is worthy of clinical promotion.
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Subintimal angioplasty had been widely used in the intervention of lower extremity arterial obliterans disease in recent years.True lumen re-entry is the key to subintimal angioplasty.This comprehensive exposition of the true lumen re-entry can improve the chances of ultrasound and subintimal arterial flossing with antegraderetrograde intervention and catheter systems and other emerging technologies in the application of subintimal angioplasty,and various types of technology advantages and disadvantages.
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Atherosclerosis obliterans of lower extremity artery mainly involve the aorto-lliac artery,femoral-popliteal artery and below-knee arteries.At present the major treatment of the disease is endovascular treatment.Due to anatomical differences between the three arteries,the principles and effect of endovascular treatment are different.The endovascular treatment of iliac- femoral lesions,because of its patency rate not lower than surgery,has become the preferred way.On account of the high incidence of femoral- popliteal lesions and the dissatisfaction for patency rate,the endovascular treatment of femoral-popliteal lesions has become a hot research.Endovascular therapy in the below-knee arteries is still in the exploration,currently a small balloon-based.
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OBJECTIVES: This study was performed to study the outcomes of operations in the patients with atherosclerosis obliterans of lower extremities. METHODS: Forty patients underwent vascular bypass operations from January 2006 to December 2010 and were analyzed retrospectively with clinical records. RESULTS: Forty six bypassing procedures were performed in 40 limbs. The type of operations were femoro-popliteal bypass in 29 limbs, femoro-femoral bypass in 15 patiens and popliteo-posterior tibial bypass in 2 limbs. Forty three procedure were done with polytetrafluoroethylene(PTFE) graft and 3 were done with great saphenous vein. The cumulative patency rates of 5years was 58.9% respectively. In two patients, amputations of the lower extremities were done. Reoperations were performed in 9 patients. CONCLUSIONS: A thoughtful management can prevent the progress of atherosclerosis obliterans(ASO) and may preserve the function of lower limb. In this study, bypass surgery using PTFE and great saphenous vein as conduit revealed acceptable patency rate.
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Humans , Amputation, Surgical , Atherosclerosis , Extremities , Lower Extremity , Polytetrafluoroethylene , Retrospective Studies , Saphenous Vein , TransplantsABSTRACT
Objective To investigate the association between chlamydia pneumoniae(Cpn)and atherosclerosis obliterans(ASO). Methods Sixty ASO patients and 40 healthy persons were selected,and their Cpn DNA expressions in venous blood determined by polymerase chain reaction(PCR). Results The ASO patients had significantly higher positive expression rate of Cpn DNA than that of healthy persons(78. 33% vs. 47.50% ,P ＜0.05). In all 60 cases the Cpn DNA expressions were positively correlated with the severity of ASO. Conclusions Cpn DNA expression closely relates with ASO severity,and it plays an important role in the ASO pathogenesis.
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Popliteal artery entrapment syndrome is a rare disorder and lead to claudication and disturbance of blood flow from the results of an abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in a young male population. The specific diagnosis is difficult. In most cases, surgical treatment provides a definitive diagnosis of the lesion and is necessary for the patient's recovery. A 34-years-old male was admitted complaining of claudication and pain on left leg. Ankle-brachial index, vascular sonography, CT-angiogram and MRI revealed an occlusion of proximal popliteal artery of left leg. The patient was confirmed as a popliteal artery entrapment syndrome (type IV) that the popliteal artery was entrapped by a fibrous band around the popliteus muscle in the operative field. Completely occluded fibrotic popliteal artery was removed, and interposition with ipsilateral greater saphenous vein graft was done. After surgery, symptoms of the patient have improved.
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Humans , Male , Ankle Brachial Index , Arteries , Diagnosis , Leg , Magnetic Resonance Imaging , Muscle, Skeletal , Peripheral Vascular Diseases , Popliteal Artery , Saphenous Vein , TransplantsABSTRACT
PURPOSE: Chlamydia pneumoniae (CP) infection seems to be related to atherosclerotic diseases. A prospective sero- epidemiologic study was performed to analyze the relationship between CP infection and peripheral vascular disease in Korean patients. The aims of this study were to find the prevalences of CP antibody in the serum and CP antigens in the vascular tissues, and to analyze the differences between several disease groups. METHODS: Our subjects included a total of 61 patients (76 vascular tissues) who had undergone operative procedures for peripheral vascular diseases. They were classified into 3 groups: Group 1; 14 abdominal aortic aneurysm, Group 2; 15 atherosclerosis obliterans, and Group 3; 32 varicose vein cases. The CP antibody titers were determined using the microimmunofluorescence test (MIF) and the CP antigen in the vascular tissues with a semi-nested polymerase chain reaction (PCR) and an in situ hybridization technique (ISH). RESULTS: The prevalences of chronic or past CP infection from the MIF (IgG antibody titer > or = 1: 32) in Groups 1, 2 and 3 were 78.6, 73.3, and 68.8% respectively, but with statistically significant differences. The prevalences of PCR- positive tissues in Groups 1, 2 and 3 were 21.4, 6.7, and 0% respectively. There was no CP DNA detected in the venous tissue. CP DNA was detected more frequently in aneurysmal disease than atherosclerosis obliterans, but this was not statistically significant(p=0.265). In comparison with the varicose veins, aortic aneurysms showed a significantly higher PCR positivity ratio (p=0.002), and a similar result was seen with ISH. There was no relationship between CP antigen positivity and the known risk factors for atherosclerosis. CONCLUSION: A high prevalence of CP antibodies was observed in the serum of Korean patients with vascular disease, which matched that in western populations. CP DNA was also detected in atherosclerotic tissues, which was especially high in aneurysmal disease, implying a possible causative role of CP infection in the pathogenesis of the atherosclerotic disease. This is the first report on the prevalence of CP in vascular tissues in Korean population.
Subject(s)
Humans , Aneurysm , Antibodies , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Arterial Occlusive Diseases , Atherosclerosis , Chlamydia , Chlamydophila pneumoniae , DNA , Epidemiologic Studies , In Situ Hybridization , Peripheral Vascular Diseases , Polymerase Chain Reaction , Prevalence , Prospective Studies , Risk Factors , Surgical Procedures, Operative , Varicose Veins , Vascular DiseasesABSTRACT
A retrospective analysis was performed on the 72 cases of peripheral artery occlusive disease treated at Yonsei Medical School Yongdong Severance Hospital, from March 1, 1990, through July 31, 1992, focusing on the operative procedures, surgical results and perioperative complications. The etiologic causes of vascular obstruction were atherosclerosis in 28 cases, Buerger's disease in 31, traumatic orgin in 7, operative complications in 4, and malignancy and arteritis in one case each. Treatment modalities, actually performed include bypass graft. (27), infusion of PGE1 (23), Embolectomy (16), Sympathectomy (4) and end-to-end anastomosis (2). There were 21 satisfactory cases and 9 unsatisfactory cases of atherosclerotive occlusive disease, defining the operative outcome as "satisfactory" if the obstructive symptoms disappeared completely and "unsatisfactory" if they did not. The patients of TAO induced Buerger's disease with preoperative Foutain class III or IV were surgically converted to class 0 in 14 cases, class I in 12 and class II in 3.
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Humans , Alprostadil , Arteries , Arteritis , Atherosclerosis , Embolectomy , Retrospective Studies , Schools, Medical , Surgical Procedures, Operative , Sympathectomy , Thromboangiitis Obliterans , Transplants , TroleandomycinABSTRACT
AIM:To explore the dynamic changes of ET,NO,SOD and MDA in atherosclerosis obliterans(ASO) rabbits,as well as the effects of Tongxinluo Capsule(Radix et Rhizoma Ginseng,Hirudo,Scorpio,Eupolyphaga seu Steleophaga,etc.)(TXL) and the candidate mechanisms. METHODS: Rabbits were randomly divided into 7 groups: sham,model,TXL(0.8,0.4,0.2 g/kg),Tongsaimai tablet(0.8 g/kg) and Laishike((0.002 g/kg)).The animal model of ASO was established with a combined method of mechanical trauma,immunologic injury and high fat fodder feeding.Rabbits were administrated the drugs for 8 weeks after surgery.The levels of ET,NO,SOD and MDA were determined at the time points below: pre-experiment,pre-drug administration,4 weeks after drug administration,8 weeks after drug administration,12 weeks after drug administration.The histopathological changes in iliofemoral artery were examined after opacification. RESULTS: TXL significantly extenuated the decrease in the caliber of the iliofemoral artery of the injured hind limb and decreased MDA content while increased SOD activity and NO content in serum. CONCLUSION: TXL might show effects on improving endothelial cell dysfunction,clearing free radicals and antagonizing lipid peroxidation,which might be the candidate mechanisms for the prevention and treatment of TXL for ASO.