Different endovascular thrombus reduction techniques in the treatment of acute lower extremity arterial thrombosis / 中华普通外科杂志

Objective:To compare the clinical results of different endovascular thrombus reduction techniques in the treatment of acute lower extremity arterial thrombosis.Methods:The clinical data of 96 consecutive patients with acute femoral popliteal arterial thrombosis who were treated with catheter directed thrombolysis (CDT) and mechanical thrombus aspiration system (PMT) between Jan 2016 and Dec 2018 at Cangzhou People's Hospital and Peking University People's Hospital were retrospectively analyzed.Results:Ninty-six patients underwent thrombolytic surgery,including 36 with CDT thrombolysis, 28 with AngioJet aspiration alone and 32 with Rotarex aspiration alone. Angiojet thrombus aspiration reduced thrombus rate by 89.3% (25/28) and clinical success rate by 92.8% (26/28).The thrombus reduction rate of Rotarex group was 87.5% (28/32), and the clinical success rate was 96.8% (31/32). In the CDT thrombolytic group, the thrombolytic reduction rate was 61.1% (22/36), including 8 patients who underwent thrombectomy and 6 patients with PMT, with a clinical success rate of 86.1% (31/36). The rate of distal arterial embolization, puncture point and local subcutaneous hematoma and vascular rupture was 21.4%, 10.7% and 2.1%, respectively. There were no amputation cases reported during a mean 13 months follow-up.The survival rate was 97.9%. The first-stage patency rate of 67.8%, while the second-stage artery patency rate of 85.7% during the follow-up.Conclusion:Compared with CDT, PMT has higher efficiency and lower complication rate in the treatment of acute lower extremity arterial thrombosis.

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system / Mortalidade hospitalar na saúde pública brasileira em pacientes com isquemia aguda dos membros em um período de 12 anos

Abstract Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

Resumo Contexto Doenças arteriais representam um grave problema de saúde pública no século XXI. Apesar de homens apresentarem maior prevalência geral, estudos sugerem que mulheres podem cursar com quadros assintomáticos, clínica atípica e particularidades hormonais, que resultam em desfechos desfavoráveis e urgências graves, como oclusões arteriais aguda (OAA). Objetivos Analisar o perfil de morbimortalidade das urgências em OAA no Brasil entre 2008 e 2019. Métodos Realizou-se estudo ecológico com dados secundários do Sistema de Informações Hospitalares/Sistema Único de Saúde, utilizando-se o código I.74 do Código Internacional de Doenças-10. Dos números absolutos, obteve-se proporções de internamentos de urgência e taxa de mortalidade intra-hospitalar (TMH) por gênero, etnia e idade. Considerou-se p < 0,05 significativo. Resultados Entre 2008 e 2019, houve 195.567 internamentos de urgência por OAA no Brasil, dos quais 111.145 (56,8%) eram homens. Mulheres tiveram maior TMH (112:1.000 hospitalizações) em comparação a homens (85:1.000 hospitalizações) (p < 0,05), assim como maior chance de morte (odds ratio [OR] = 1,36; p < 0,05). Ademais, a média de sobrevida anual foi maior entre homens do que entre mulheres (8.483/ano vs. 6.254/ano, respectivamente; p < 0,05). Estratificando por etnia, mulheres apresentaram maior chance de óbitos entre brancas (OR = 1,44; p < 0,05), pretas (OR = 1,33; p < 0,05) e pardas (razão de risco [RR] = 1,25; p < 0,05), comparadas a homens das mesmas etnias. Nas análises etárias, mulheres com mais de 50 anos apresentaram maior chance de óbito, com aumento progressivo do risco com o envelhecimento. Conclusões Nossas análises comparativas evidenciaram tendência de pior prognóstico nas urgências em OAA associadas a mulheres, sobretudo em grupos de idade avançada. A literatura evidencia que as razões para essas diferenças ainda são pouco estudadas, estimulando investigações mais robustas sobre essa importante casuística da cirurgia vascular.

The midterm result of drug coated balloon with paclitaxel for the treatment of TASC C/D superficial femora-popliteal artery disease / 中华普通外科杂志

Objective@#To evaluate the safety and efficacy of the drug coated balloon(DCB) for complex TASC C/D superficial femora-popliteal artery diseases.@*Methods@#Patency, target lesion revascularization (TLR) rate, clinical improvement and safety endpoints of femora-popliteal lesions in 68 patients from PLA General Hospital treated with DCB were retrospectively analyzed from June 2016 to June 2018. The mean age of the patients were (72.7±13.2) years old. Rutherford categories were from 2 to 5, and ABI baseline were 0.56±0.22.@*Results@#There were 76 limbs treated by DCB in total in this study. Mean lesion length was (26.7±15.3) cm. 73.6% of lesions were totally occluded, 26.4% were of stenosis and 61.8% were highly calcified. Stent implantation was performed in 36.8% cases. Kaplan Meier estimates of primary patency were 74.2%±7.6% and 67.7%±6.4% at 1 and 2 years, respectively, whereas freedom from TLR was 81.4%±5.1% and 73.6%±5.4%. ABI were 0.83±0.16 at 1 year, and 0.79±0.24 at 2 years. Major amputation rate was 2.9% and mortality rate was 2.9% and 4.4% at 1 year and 2 years respectively. Diabetes, highly calcification, renal insufficiency and re-stenotic lesions were identified as predictors of restenosis.@*Conclusions@#DCB are safe and effective in delaying restenosis in complex TASC C/D superficial femora-popliteal artery disease as found by midterm follow-up.

The midterm result of drug coated balloon with paclitaxel for the treatment of TASC C/D superficial femora-popliteal artery disease / 中华普通外科杂志

Objective To evaluate the safety and efficacy of the drug coated balloon (DCB) for complex TASC C/D superficial femora-popliteal artery diseases.Methods Patency,target lesion revascularization (TLR) rate,clinical improvement and safety endpoints of femora-popliteal lesions in 68 patients from PLA General Hospital treated with DCB were retrospectively analyzed from June 2016 to June 2018.The mean age of the patients were (72.7 ± 13.2) years old.Rutherford categories were from 2 to 5,and ABI baseline were 0.56 ± 0.22.Results There were 76 limbs treated by DCB in total in this study.Mean lesion length was (26.7 ± 15.3) cm.73.6％ of lesions were totally occluded,26.4％ were of stenosis and 61.8％ were highly calcified.Stent implantation was performed in 36.8％ cases.Kaplan Meier estimates of primary patency were 74.2％ ± 7.6％ and 67.7％ ± 6.4％ at 1 and 2 years,respectively,whereas freedom from TLR was 81.4％ ±5.1％ and 73.6％ ±5.4％.ABI were 0.83 ±0.16 at 1 year,and 0.79 ±0.24 at 2 years.Major amputation rate was 2.9％ and mortality rate was 2.9％ and 4.4％ at 1 year and 2 years respectively.Diabetes,highly calcification,renal insufficiency and re-stenotic lesions were identified as predictors of restenosis.Conclusions DCB are safe and effective in delaying restenosis in complex TASC C/D superficial femora-popliteal artery disease as found by midterm follow-up.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease / Uso de próteses em amputados de membros inferiores por doença arterial periférica

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients. .

Objetivo Avaliar a protetização, durante a reabilitação, e a manutenção do uso da prótese, e o índice de abandono da mesma após a alta, bem como a mortalidade dos pacientes amputados de membros inferiores por doença arterial periférica. Métodos Estudo retrospectivo e transversal com pacientes amputados de membros inferiores nos níveis transtibial e transfemoral de etiologia vascular. A amostra foi composta por 310 pacientes (205 homens e 105 mulheres, média de idade de 61,8 anos), nos níveis transfemoral (142) e transtibial (150), unilateralmente ou bilateralmente (18). Foram protetizados 217 pacientes e 93 não. Foram utilizados testes estatísticos não paramétricos de igualdade de duas proporções, intervalo de confiança para média de 95% (IC95%) e valor de p<0,05 Resultados . Dos 195 pacientes contatados, 151 haviam sido protetizados e 44 não. Dos protetizados, 54 mantinham-se usando suas próteses, 80 haviam abandonado o uso e 17 faleceram. No grupo dos não protetizados, 27 continuavam usando cadeira de rodas e 17 tinham evoluído para óbito. A mortalidade é estatisticamente maior nos pacientes não protetizados e os 34 óbitos ocorreram, em média, após 3,91 anos da amputação. O tempo de sobrevida dos pacientes não protetizados foi menor que o dos protetizados. Conclusão A protetização de pacientes amputados de membros inferiores de etiologia vascular durante a reabilitação é alta, mas a manutenção do uso da prótese é baixa após o término do tratamento. A mortalidade desses pacientes é elevada e ...

Relationship of Average Volume of Alcohol Consumption and Binge Drinking to Arterial Stiffness in Community-Dwelling Healthy Adults / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to investigate the association of the average volume of alcohol consumption and binge drinking with arterial stiffness. METHODS: The study population consisted of 5944 community-dwelling healthy adults aged 50 years and older. Average volume of alcohol consumption was calculated and frequency of binge drinking defined as the consumption of 7 or more drinks for men and 5 or more for women on a single occasion, was assessed using a structured interview. High brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, was defined as the highest gender-specific quartile of maximal baPWV distribution in the study population. RESULTS: Compared to never drinkers, the multivariate-adjusted odds ratio (OR) of men who consumed 0.1-10.0, 10.1-20.0, 20.1-40.0, and >40.0 g/day was 0.93, 1.18, 1.38, and 2.36, respectively. The OR was 0.90, 0.97, 1.45, and 1.82 in women consuming 0.1-5.0, 5.1-10.0, 10.1-20.0, and >20.0 g/day, respectively. Binge drinking of or =1 day/week (OR=1.61, 95% CI=1.04-2.50) were associated with increased risk for high baPWV in men, and binge drinking of > or =1 day/week (OR=3.12, 95% CI=1.16-8.34) was associated with increased risk for high baPWV in women. CONCLUSIONS: A J-shaped relationship between the average volume of alcohol consumption and high baPWV was observed, suggesting the detrimental effects of heavy alcohol drinking on arterial stiffness. Binge drinking was also significant risk factors for increased arterial stiffness, independently of the average volume of alcohol consumption.

Comparison of contrast angiograpy to Colour-flow Duplex Sonography (CFDS) in lower extremity peripheral arterial diseases.

To study peripheral arterial diseases of the lower extremity by colour-flow duplex sonography (CFDS) and to compare the results between CFDS and angiography. Materials and methods : Ten normal subjects were studied in the control group, together with the second group of nine patients who had occlusive peripheral arterial disease of the legs, by colour-flow duplex sonography (CFDS). AII none patients who had vascular diseases were examined by angiography within one week after CFDS for comparison. The results of both studies were then analysed to determine the sensitivity, specificity, and cost-effectiveness of CFDS 1. In normal subjects (control group), CFDS showed a triphasic flow in the normal vessels. The peak systolic velocity (PSV) showed maximum velocity in the abdominal aorta (100-150)cm/sec and there was decreased velocity in PSV in the peripheral vessels. 2. The study found that in the stenotic segment of artery, there was  (a). Monophasic flow (instead of triphasic flow) ;  (b). Turbulance flow, with spectral broadening ;  (c). Increased PSV above 150 per cent. 3. As angiography is a gold-standard examination for the peripheral vascular disease, the sensitivity and specificity of CFDS are 68.42 and 100 per cent respectively. 4. The limitations of CFDS include :  (a). obese patient or patient with large amount of gas in the bowel loops ;  (b). Calcified wall of vessels, which can obscure sonotransmission.  (c). Experience of sonologist ;  (e). Long examination time. The conclusion is that CFDS is an useful, non-invasive examination for peripheral arterial disease of legs. In the hands of an experience sonologist, arterial diseases can be detected or diagnosed with good accuracy and good result. However, there are still some limitations with CFDS.

Ultrasonic characteristics of peripheral arterial diseases and related risk factors in patients with end stage renal disease / 解放军医学杂志

Objective Peripheral arterial diseases(PAD)are most common conditions in patients with end stage renal disease(ESRD). However, PAD hasn′t been extensively studied like other cardiovascular or cerebrovascular diseases such as coronary heart disease and cerebral infarction among ESRD patients. The present study aims to investigate the ultrasonic characteristics of PAD and risk factors related to peripheral arterial intima thickening and plaques formation. Methods Seventy-three ESRD patients and 21 healthy individuals (as control) were involved in the investigation, and their carotid and lower-extremity arteries including tunica intima, lumen diameter, plaques and Doppler spectrums were examined with color Doppler ultrasonic technique. Then, the risk factors related to intima thickening and plaques formation among ESRD patients were studied combining with their clinical data and biochemical makers. Results The lesions of varying degrees in peripheral arteries occured in 52.1%(38/73) ESRD patients, including intima thickening, coarse and chaotic tunica intima, strong echo masses or atheromatous plaques with different shapes and sizes, widened and deformed Doppler spectrums, accelerated peak systolic velocity and lowered or disappeared diastolic reverse peak at narrow sites, low resistant blood flow at apo-stenosis sites (prolonged systolic accelerative time and decreased acceleration). The incidence of PAD was significantly higher in ESRD patients than that in control group (14.3%, P