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OBJECTIVE To construct the integrated pharmaceutical care model of in-hospital pharmaceutical care+out-hospital pharmacy outpatient service for patients with lower extremity artery disease （LEAD）， so as to improve patients’ disease self- management ability， and the efficacy and safety of therapy. METHODS The in-hospital pharmaceutical care and out-hospital pharmacy outpatient service model was constructed for LEAD patients， including pharmaceutical evaluation， self-management ability education， and pharmacy follow-up， to perform long-term management of patients. Totally 65 LEAD patients admitted to the vascular surgery department of our hospital， receiving pharmacist management， from September， 2021 to December， 2022 were selected as the study objects， and pharmacists conducted in-hospital pharmaceutical care+continuous out-patient management. The efficacy indicators， safety indicators， and patients’s disease self-management ability indicators were compared before and after 3 months of pharmacist management. RESULTS After 3 months of pharmacists’ participation in the management of 65 patients， Fontaine stage decreased in 55 patients， there was the significant difference in Fontaine stage before and after management （P＜ 0.001）. The proportion of patients who completely followed the guidelines for medication increased from 63.1% to 96.9%； the incidence of small bleeding was reduced by 7.7% after pharmacists’ management. The scores of Morisky medication compliance and patients’ disease self-management ability were higher than 3 months ago （P＜0.001）. Patient proportion with “good” medical satisfaction increased by 18.4%. CONCLUSIONS The in-hospital pharmaceutical care and out-hospital pharmacy outpatient service model of LEAD patients can effectively improve patients’ disease self-management ability， and improve the efficacy and safety of therapy.
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Objective:To investigate impacts of a deep learning image reconstruction (DLIR) algorithm on image quality of lower extremity CTA with low kVp and reverse flow direction scanning.Methods:From January 2021 to March 2021, fifty patients with suspected lower extremities diseases and received lower extremity CTA with low kVp and reverse flow direction scanning in Union Hospital affiliated to Fujian Medical University were retrospectively collected in this study. Six groups of CT images were reconstructed at the thickness of 0.625 mm using two algorithms including ASIR-V of three blending ratios (ASIR-V 20%, ASIR-V 50% and ASIR-V 80%) and DLIR of three strengths (DLIR-H, DLIR-M and DLIR-L). Regions of interest (ROIs) were placed on proximal abdominal aorta (AA), distal AA, left and right common iliac arteries, left and right femoral arteries (upper segment), left and right superficial femoral arteries (middle segment), left and right popliteal arteries. The CT value and SD value were measured for each group; the signal-noise ratio (SNR) and contrast-noise ratio (CNR) were calculated. The lower extremity CTA was divided into four segments, and the subjective evaluation was independently performed on noise and sharpness using 4 points scales by two radiologists. One-way analysis of variance was utilized to evaluate the differences in subjective scoring and objective parameters among the six groups.Results:For all arteries segments, with the increase of blending ratios for ASIR-V and reconstruction strength of DLIR, the SD values were reduced while SNR and CNR were increased (all P<0.05). Among the six groups, DLIR-H and ASIR-V80% images had lowest SD as well as highest SNR and CNR (all P<0.05). In comparison to ASIR-V20% and ASIR-V50% images, DLIR-H images showed lower SD, higher SNR and CNR values (all P<0.05). There were no statistical differences between ASIR-V80% and DLIR-H images in SD, SNR and CNR values (all P>0.05). Subjective scoring results showed that the DLIR-H images displayed the best noise performance for the entire lower extremity arteries from AA to the foot artery, and the sharpness scores of DLIR-H images were also significantly higher than ASIR-V80% (all P<0.05). Conclusion:DLIR can significantly reduce the image noise and improve the image quality in CTA for abdominal aorta to lower extremity arteries. DLIR-H showed the greatest noise reduction ability and the best effect balancing noise and sharpness, providing highest image quality.
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Objective:To evaluate the clinical efficacy of Rotarex percutaneous mechanical thrombectomy(PMT) for treatment of lower extremity arterial graft occlusion.Methods:The clinical data of 19 patients with lower extremity arterial bypass occlusion admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients were treated with Rotarex-based endovascular therapy. After 12 months follow-up, the clinical features, surgical outcomes and follow-up data were analyzed to identify effectiveness and safety of the therapy. Independent sample t test was used to analyze the measurement data of continuous normal distribution which were expressed as mean±standard deviation( ± s), enumeration data were expressed as number and percentage, and the comparison between groups were analyzed by chi-square test. Results:A technical success rate of 100% was demonstrated. Rotarex combined with catheter directed thrombolysis was performed in 2 cases, Rotarex combined with percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Rotarex combined with stent implantation was performed in 8 patients. The Ankle brachial index significantly increased (0.82±0.14 vs 0.47±0.11, P<0.05). Critical limb ischemia (Rutherford class 4 or higher) improved significantly (0 case vs 9 cases, P<0.05). Distal embolism occurred in 1 patient and acute myocardial infarction occurred in 1 patient. There was no vascular rupture, haemorrhage, infection, pseudoaneurysm, death and amputation. Kaplan-Meier survival analysis revealed 12-month primary patency rate and freedom from clinically driven target lesion revascularization was 78.9% and 89.5% respectively. Conclusion:Rotarex-based endovascular therapy is a safe and effective treatment for graft occlusion after lower extremity arterial prosthesis bypass with high patency rate and few complications.
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Objective To explore the feasibility of advanced virtual monoenergetic (mono-plus)image reconstruction combined with low concentration of contrast agent in lower extremity computed tomography angiography (CTA).Methods 30 patients underwent lower extremity arterial CTA were collected in our study.Dual-energy mode (80/140 snkVp)was applied after the administration of 1 mg/kg body weight contrast media(350 mg I/mL).40 and 50 keV mono-plus images and conventional mono images at optimal keV were reconstructed.The objective image quality of CT value,SNR and CNR as well as subjective image quality between three groups were compared.Results CT value, SNR and CNR of both group A and B were higher than group C (P<0.0 0 1);The CT values in three groups were 691.75 (571.02-780.57)HU,470.80(399.67-532.10)HU,(279.62±5.15)HU respectively;SNR were 27.65±0.45,25.45±4.08,20.95±0.33 respectively;CNR were 24.76±4.02,21.94±0.36,16.65±0.28 respectively.There were significant differences among the three groups for subjective scores.In the aortoiliac area and femoro-popliteal district,the highest score was obtained in group B,no significant difference between group A and group C.In the crural segment and plantar arteries,the highest score was obtained in group A,but there was no significant difference between group A and group C.Conclusion Mono-plus images at 40 keV and 50 keV levels significantly improve the contrast of lower extremity runoff compared with mono image,and enable a reduction of required contrast media.
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Objective To observe the clinical effect of percutaneous endovascular angioplasty ( PTA) for the treatment of diabetic lower extremity arterial disease( LEAD) , so as to provide a reference for the selection of the best treatment for diabetic lower extremity arterial dis-ease(LEAD). Methods In this parallel study, totally 60 patients were equally divided into the control group and the intervention group. The control group were treated by the conventional method, and the intervention group were treated by percutaneous endovascular angioplasty (PTA). The changes of ankle brachial index (ABI),average blood flow velocity of dorsalis pedis,pulsation index(PI) and the maximum walking distance were observated in 12 weeks and 24 weeks after the treatment. Results Compared with the control group, the ankle brachi-al index ( ABI) , average blood flow velocity of dorsalis pedis, pulsation index ( PI) and the maximum walking distance in the intervention group were significantly improved 12 weeks and 24 weeks after treatment, and the difference between the two groups was statistically signifi-cant (P0. 05). Conclusion Percutaneous endovascular angioplasty ( PTA) is better than traditional drug therapy in the treatment of diabetic lower extremity arterial disease( LEAD) . It is a feasible clinical treatment of lower extremity arterial disease( LEAD) .
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Objective To investigate the relationships between patients′self- management behaviors and self- efficacy with lower extremity arterial disease, and supply evidence for effective management and intervention of lower extremity arterial disease for clinical medical workers. Methods In August 2014 to January 2015,a total of 110 cases of hospitalized patients with lower extremity arterial disease of two hospitals′vascular surgery from Guangzhou completed questionnaires, including the General Information Questionnaire, Chronic Disease Self- management Behavior - Chinese version, Chronic Disease Self- efficacy -Chinese version. Results The total score of self- management behavior of patients with lower extremity arterial disease ranged from 0 to 69, with an average score of 18.93 ± 6.79, the overall level was not high. Self- efficacy score ranged from 6 to 60, with an average score of 32.25 ± 9.65, the overall level was moderate. Self -management behavior was positively correlated with self- efficacy and its dimensions, and negatively correlated with the dimensions of communication with doctors and Common disease management. Conclusions The clinical staff should strengthen education and guidance of self- management behaviors in patients with lower extremity arterial disease, promote the level of self- management behaviors and self- efficacy, improve the confidence of disease treatment and prevention, in order to achieve the purpose of health promotion.
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OBJECTIVE:To explore the effects and safety of atorvastatin combined with probucol on the vascular elasticity in patienits with hypertension. METHODS:246 hypertensive patients were randomly divided into control group and observation group,123 cases in each group. All patients received conventional antigypertensive treatment,based on it,control group was given 10 mg Atorvastatin tablet,qd;observation group was additionally given 0.25 g Probucol tablet,qd,on the basis of control group. They were treated for 1 year. Clinical efficacy,lipid levels(total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol),cystatin C (Cys-C),C-reactive protein (CRP),elastic parameters of common carotid artery and lower limb artery(stiffness,pressure-strain elastic modulus,compliance,augmentation index,pulse wave velocity)before and af-ter treatment in 2 groups were observed,and the incidence of adverse reactions was compared. RESULTS:Before treatment,there were no significant differences in lipid levels,Cys-C,CRP and elastic parameters of common carotid artery and lower between 2 groups (P>0.05);after treatment,the above-mentioned indexes were significantly improved,and the improvement degree in ob-servation group was superior to control group,the differences were statistically significant(P<0.05). And there were no severe ad-verse reactions during treatment in both 2 groups. CONCLUSIONS:Atorvastatin combined with probucol can improve lipid level and elasticity of common carotid artery and lower limb artery,with good safety.
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Objective To discuss the application of spiral CT angiography in postoperative re-examination of lower limb artery stent implantation. Methods During the period from March 2012 to March 2014 at the Affiliated Nanjing Hospital of Nanjing Medical University, CT angiography was carried out in 67 patients who had received stent implantation for arteriosclerotic occlusion of lower limb. The diseases involved 78 lower limbs, and a total of 85 stents were employed. The volume rendering (VR), maximum intensity projection (MIP), multi-planar reformation (MPR) and curved surface reconstruction (CSR) were performed to stereoscopically display the lesion’s anatomy as well as the implanted stents, and the imaging manifestations were compared with the clinical symptoms and DSA findings. Results Successful examination was accomplished in 65 patients (81 stents in total), and clear images were obtained. Of the 81 stents, no stenosis was seen in 43, Ⅱ - Ⅳ grade stenosis in 32 and complete occlusion in 6. The results were closely correlated with the clinical symptoms. The CT angiography manifestations in 31 patients (34 stents in total) were compared with their DSA performed in two weeks, and the results showed that the stenotic degrees of three stents judged by CT angiography were not consistent with those judged by DSA. The consistent rate of CT angiography was 91.2% when taking DSA as the standard. Conclusion Lower limb arterial CT angiography examination is a safe and non-invasive technique, it can clearly display the stent inner canal. Therefore, this technique is of great value in postoperative re- examination of lower limb artery stent implantation.
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Objective To discuss the methods, advantages and indications of multipoint puncturing in performing endovascular therapy for complex lower extremity arterial occlusive diseases. Methods During the period from Oct. 2011 to Oct. 2013, a total of 46 patients with complex lower extremity arterial occlusive diseases were treated with endovascular therapy by using multipoint puncturing technique. The puncturing type, the advantages of multipoint puncturing technique and the success rate of this technique were analyzed. Results The multipoint puncturing was divided into three types: type Ⅰ : puncturing from the opposite direction to deal with the same target vessel; type Ⅱ: direct puncturing of the target vessel; and type Ⅲ:using the same puncturing direction to deal with different target vessels. The success rate of endovascular treatment was 80.4%. Conclusion Multipoint puncturing technique helps improve endovascular treatment success rate for lower extremity arterial occlusive diseases. Full understanding of the advantages of multipoint puncturing technique, perfect preoperative planning, precise puncturing technique and proper interventional equipments are helpful to ensure a successful treatment.
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Objective To evaluate the application value of 256 slice spiral CT angiography (CTA)in the bridge vessels lesions af-ter grafts operation in lower extremity arteriosclerosis obliterans patients.Methods Taken DSA as the gold standard,using 256 slices spiral CTA to analysis the post-processing image of 76 article Bridge vascular which can be assessed in 65 cases patients with lower extremity arteriosclerosis obliterans,and to evaluated the diagnosis accuracy,sensitivity,specificity,positive predictive rate and negative predictive rate of postoperative bridge intravascular lesions.Results Using 256 slices spiral CTA,the bridge vascular of grafts operation patients can be clearly displayed,stenosis or unobstructed,and the anastomosis of the bridge vascular.5 graft occlu-sion,22bridge intravascular plaque were diagnosed correctly,3 vascular lesions were undiscovered.The accuracy,sensitivity,speci-ficity,positive predictive rate and negative predictive rate were 98.15%,96.15%,97.90%,92.59% and 97.96% respectively. Conclusion Using 256 slices spiral CTA can clearly show the endovascular lesions of lower extremity arteriosclerosis obliterans after grafts operation,and has high accuracy and specificity.It can be safely used as one of noninvasive follow-up means after grafts oper-ation.
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Objective To explore the differences among CT angiography(CTA) at different doses in both lower extremity arteries,and the relationship among volume rendering(VR) image quality,CT number and standard deviation(SD) value.Method CTA in lower extremity artery was performed in 90 patients.The participants were randomly divided into three groups,including a routine group (120 kV,150 mAs),120 kV and 80 mAs group,and 100 kV and 130 mAs group with 30 cases in each group.The images were processed with VR and classified into three degrees,the first class,the second class and the third class,and VR image quality levels of three groups were compared.The receiver operating characteristic curve(ROC) was used to analyze the correlation among VR image quality level,CT number and SD value.Results The percentage of VR image level at the first class was 93.3％ in the routine group,86.6％ in the 120 kV and 80 mAs group and 96.6％ in the 100 kV and 130 mAs group.According to the correlation analysis between the SD value and VR image quality of CTA in lower extremity artery,the area under curve in ROC analysis was 0.9078.According to the correlation analysis between the CT number and VR image quality of CTA in lower extremity artery,the area under curve in ROC analysis was 0.9116.Conclusions The low-dose CAT in lower extremity artery is feasible.Application of 100 kV and 130 mAs could ensure better image quality.
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Objective To study the feasibility of reducing radiation dose in aorto-iliac and lower extremity arteries CT angiography (CTA) with low tube voltage (100 kV) and automatic tube current modulation(ATCM).Methods Totally 61 patients requiting aorto-iliac and lower extremity arteries CTA for clinical reasons were prospectively enrolled in study.The patients were randomly assigned to 3 groups:Group A(120 kV),Group B (100 kV) and Group C (100 kV with automatic tube current modulation).Both quantitative and qualitative analysis were included in this research.Group C was divided into obese group(BMI≥ 24.9 kg/m2) and normal group(BMI ＜ 24.9 kg/m2).The radiation doses were analyzed respectively among two groups.Results The subjective evaluations of image quality for axial,MIP and VR were good.There were no significant differences among group A,B and C in SNR and CNR (P ＞0.05).The effective dose of group A,B and C was 8.20 mSv,5.36 mSv,and was 7.48 mSv,respectively Group B was 34.6％ less than group A.Group C was 39.5％ more than group B,and there was no significant differences between group A and C (P ＞ 0.05).The effective dose of group C1 was 7.11mSv,group C2 was 9.69 mSv,the E with group C1 were significantly less than group C2 (t =-3.163,P ＜0.05),the effective dose of group C1 was 13.3％ less than group A (Z =-2.822,P ＜ 0.05),but the group C2 was more than group A (P ＞ 0.05) and group B (Z =-3.426,P ＜ 0.05).Conclusions Lowkilovoltage (100 kV) CT scanning protocol is feasible in multi-detector CT angiography for aortoiliac and lower extremity arteries.Automatic low tube voltage (100 kV) with automatic tube current modulation (ATCM) scanning protocol can be used for someone with BMI less than 24.9 kg/m2.
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PURPOSE: Prompt operative management of patients with peripheral artery embolism remains the treatment of choice for this malady. The clinical status of the limb, rather than the elapsed time from the onset of occlusion, was recently determined to be the best predictor of limb salvage. We investigated the clinical features, therapeutic modalities and treatment results of popliteal artery embolism compared with that of ilio-femoral artery embolism. METHODS: A retrospective review was carried out for 21 cases that were treated for lower extremity arterial embolism, from March 2000 to June 2006. The patients were classified into two groups; Group A (ilio-femoral artery embolism, n=11) and Group B (popliteal artery embolism, n=10). We analyzed the interval time from the onset of symptoms to starting treatment (the interval time), the degree of limb ischemia, the therapeutic modalities and the treatment results. RESULTS: The average interval time was 16.2+/-16.9 hours in the total 21 cases; the average interval time for Group A was 7.7+/-2.9 hours and that for Group B was 25.5+/-20.9 hours (P<0.05), and the incidence of severe limb ischemia (class IIb according to the SVS/ISCVS reporting standard) was 72.7% vs 20.0%, respectively (P<0.05). For the therapeutic modalities, surgical thromboembolectomy was performed in all cases of Group A and for 3 cases of Group B. Seven cases of Group B received radiologic intervention (3 cases percutaneous aspiration embolectomy only, and 4 cases of additional thrombolytic therapy). CONCLUSION: This study shows that the interval time for popliteal artery embolism is longer than that for ilio-femoral artery embolism. In other words, it is suggested that the symptomatic progression of popliteal artery embolism is slower than that of ilio-femoral artery embolism. Therefore, we can have more chances for variable therapeutic options such as surgical thromboembolectomy, percutaneous aspiration embolectomy and/or thrombolytic therapy in patients suffering with popliteal artery embolism.
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Humanos , Arterias , Embolectomía , Embolia , Extremidades , Incidencia , Isquemia , Recuperación del Miembro , Extremidad Inferior , Arteria Poplítea , Estudios Retrospectivos , Estrés Psicológico , Terapia TrombolíticaRESUMEN
0.05). Conclusion Comparedwith DSA and operation,there is excellent correlation among 3D contrast-enhanced moving-bed MRA,DSA and operation.MRA canaccurately and entirely assess occlusive disease of the arteries of the lower extremity.It is a ono-invasive,reliable and potential newtechnique.