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Objective The decease of varicose vein and telangiectasis of lower extremity has always been difficult to treat.Regular treatments and medicines are invalid.This research aimed to study the effect of foam sclerotherapy and the long-pulsed 1064 nm Nd∶YAG laser in treatment of reticular veins and telangiectasis of lower extremity.Methods From January 2012 to June 2012,excluding deep and superficial veins valve insufficiency of the lower extremity through duplex uhrasonography,72 patients with simple reticular veins and telangiectasis of the lower extremity were treated with foam sclerosing agent injection combined with Nd∶YAG 1064 nm laser therapy.Results Of the 72 patients,cure was achieved in 38 cases,significantly effective in 32 cases,effective in 2 cases,and total effective rate was 100％.Follow-up showed that after 3 months 1 case was dissatisfied,3 cases were discontent,6 relatively satisfied,32 satisfied,and 30 very satisfied;after 12 months no cases were very dissatisfied,1 cases were discontent,9 relatively satisfied,28 satisfied,and 34 cases very satisfied.There were no severe complications in all cases.Conclusions Foam sclerotherapy and Nd:YAG 1064 nm laser can be used for different stages of the treatment process and different caliber of blood vessels.Treatment with foam sclerotherapy and Nd∶YAG 1064 nm laser for reticular veins and telangiectasia of lower extremity is a safe,simple and effective way.
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Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.
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MicroRNAs as a novel class of endogenous gene regulators at post-transcription level have been found to play important roles in many biological processes including cellular differentiation, proliferation, apoptosis and regulation of development. The biological mechanisms of microRNAs involved in the pathogenesis of various diseases have been revealed gradually. This paper reviews the Current situation and progress on the microRNAs and their roles in vascular diseases.
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CD36 is involved not only in the metabolism of lipids,but also in the inflammatory reaction,in the formation of foam cells and in the pathogenesis of atherosclerosis.Monocyte/macrophage CD36 has been shown to play a critical role in the development of atherosclerotic lesions by its capacity to bind and en-docytose oxidized low density lipoproteins(oxLDL),and it is implicated in the formation of foam cells.CD36 expression and regulation mechanism already provides a new understanding and the relevant drug research has attracted more attention of scholars.This article is to carefully review the importance of CD36 as an essential component in the pathogenesis of atherosclerosis.
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Objective To investigate the risk factors and clinical characteristics of deep venous thromboembolism (DVT) of the lower extremities in Chinese people. Methods The clinical manifestations and risk factors in 2742 DVT patients diagnosed by phlebography were retrospectively studied. Results DVT made up 22.39% of all the venous diseases of the lower extremity. The most common clinical presentations of DVT were swelling and pain (92. 34% ), varicose vein ( 32. 57% ), pigmentation (24. 95% ) and ulceration( 18.45% ). The left lower extremity was more frequently involved. The whole limb type was 60. 09%, 80. 23% DVT patients had identified risk factors including age over 40 years old (76. 29% ), history of major surgery ( 12. 18% ) and severe trauma ( 8.42% ), pregnancy and the puerperium ( 4. 87% ). The history of general surgery ( 26. 05% ), vascular surgery ( 23. 35% ), gynaecoiogy and obstetrics (20. 96% ), orthopaedics ( 16. 47% ) and urinary surgery (7.49%) was among the most common surgery. Primary hypercoagulable syndrome was identified in 0. 22% DVT patients. Conclusion DVT makes up 22. 39% of the disease of veins of the lower extremity. The most common clinical presentations of DVT were swelling and pain. The most common risk factors were age over 40 years, major surgery, severe trauma. Primary hypercoagulable syndrome is a heritage risk factor for DVT pathogenesis.
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Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.
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Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty (PTA)for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007,35 patients with critical limb ischemia (CLI)were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA Was 83%.Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57%and 82%,respectively.Mean length of tibioperoneal arterial PTA was 9.5 cm(4.5～14 cm),concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting.There were three complications including arterial spasm and thrombosis in one, which Was relieved by thrombolysis and antispasmodics, and artery perforation in 2 cases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salrage rate,tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.
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Aortic aneurysms involving major visceral arteries or those with short necks are always contraindications to traditional endovascular aortic repair(EVAR).The advent of the fenestrated endovascular aortic repair(F-EVAR)which could exclude aortic aneurysms while presenving blood flow to major organsthrough visceral branches using fenestrated stent-grafts raises the possibility for the treatment of these aorticaneurysms.To update our knowledge,we reviewed the publications on F-EVAR in recent years.
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Restenosis is the major causee which leads to arterial occlusion and graft failure after vascular reconstruction.Thus to clarif the mechanism of restenosis is of great importance to prevent and treat postprocedural restenosis and improve long-term graft patency.Current studies on restenosis focus on elastic recoil,thrombosis,inflammatory reaction,neointimal hyperplasia and vascular remodeling,herein,we reviewed literatures.
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Objective To evaluate the effects of Husni's operation in treatment of femoropopliteal vein occlusion.Method Eight consecutive patients were operated on for femoropopliteal vein occlusion from 1988 to 2000.Results Six patients were followed up, the mean follow-up period was 74 months. Four cases failed as the graft had thrombosed. Conclusions Careful selection of candidates for Husni's procedure is the key-point for satisfactory results. The operation should be performed early before the muscle pump disfunction occurs. Elastic compression of the lower limb may be important.
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Objective The purpose of this study was to investigate the associated risks and optimal management of groin lymphatic complications (GLC) after vascular operations.Methods Retrospectively review of 520 vascular operations requiring a groin incision was carried out.Results Sixteen GLC were recognized, the incidence GLC was 3 08%. Increased incidence of GLC in this series was found in previously dissected groin, excessive tissue anatomy and inguinal enlarged lymph nodes . 12 GLC were treated by conservative approach ,4 GLC were treated by early reoperation. Early reoperation reduced hospitalization time and less wound infection complications.Conclusions GLC is a troublesome problem in clinic,key is prevention.Treatment of GLC should be individualized,early reoperation should be performed if persistent lymphocutaneous fislula and large drainage existed.
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<i>Purpose</i>: To apply staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. To avoid amputation of the limb or to limit it to necrosed segments.<br><i>Methods</i>: Exactly 138 patients (a total of 153 severely ischemic limbs) were applied staged arteriovenous reversal (AVR) from January 1984 to December 1995. Generic-specific involvement totaled 106 men and 32 women. Their ages ranged from 24 to 71, averaging 48.7 years. The duration of symptoms ranged from 15 days to 17 years. A total of 112 patients were diagnosed as having Buerger's disease, and 25 had arteriosclerosis. In one patient, the popliteal artery was completely obstructed by acute emboli of atheromatous plaques. Three patients with Buerger's disease had not benefited from lumbar sympathectomy or partial adrenalectomy done several years ago. According to different levels of extensive and diffuse arterial occlusion, arteriovenous reversal was formed at three different sites: (1) high-deep reversal, produced between the external iliac, common femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal between the distal popliteal artery and tibioperoneal venous trunk; (3) superficial reversal, established between the distal popliteal artery and distal portion of the long saphenous vein.<br><i>Results</i>: Until June 1996, a total of 132 patients were followed up for 0.5-12 years, averaging 6.5 years. The postoperative results of all limbs except 12 in this series are excellent or good. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb.<br><i>Conclusion</i>: We consider that if the deep venous trunks are patent, the limbs with extensive arterial occlusion are indicated for staged AVR if severe ischemia is present and all other therapeutic methods have failed. Even with necrotic limbs, this operation may lower the level of amputation. The authors suggest that staged arteriovenous reversal is a new and effective approach in the treatment of extensive arterial occlusive disease of the limb.