Application of Rotarex mechanical thrombectomy system in treating in-stent restenosis of lower extremity arteriosclerosis obliterans / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the role of Rotarex mechanical thrombectomy system in treating instent restenosis of peripheral artery disease (PAD).@*METHODS@#The clinical data of 7 in-stent restenosis (ISR) cases of lower extremity PAD from June 2017 to Dec 2018 were retrospectively analyzed. There were 5 males and 2 females and the mean age was (70.0±7.6) years from 59.0 to 76.0 years. All the cases were treated by Rotarex mechanical thrombectomy system. In the 7 cases, time interval from the previous stent implantation to ischemia recurrence was 1.0 to 72.0 months, and the median time was 6.0 months. The period from ischemia recurrence to endovascular therapy was 3 days to 2 years, and the median time was 62 days. Rotarex mechanical debulking catheter and percutaneous transluminal angioplasty (PTA) were used in all the cases, and the stent was used only when it was necessary. Anticoagulation was used for 24 hours after procedures and then antiplatelet agents were used as usual. Doppler ultrasonography was taken during the followed-up.@*RESULTS@#All the 7 cases were successful in technology, 3 of which were implanted with new stents for the fracture of the old ones. while for the other four cases, no new stent was implanted. The ankle-brachial index (ABI) increased from 0.31±0.08 to 0.86±0.08 after treatment (t=-12.84, P < 0.001). Thrombectomy was applied urgently in one case because of acute thrombosis in the stent, and the result was good. There was no other complications in hospital. All the patients were followed up for 5.0-22.0 months, and the median time was 14.0 months. No death and amputation occurred during the follow-up. One patient stopped antiplatelet agents because of gastrointestinal bleeding, which resulted in acute thrombosis. in-stent restenosis reappeared in 3 cases.@*CONCLUSION@#Debulking using Rotarex catheter is safe and effective in treating in-stent restenosis of PAD, especially in reducing stents implantation, but is not good at dealing with old thrombus and proliferating intima, and can do nothing about fractured stents and hyperplasia of intima, so it needs to be combined with stents and drug coated balloons.

Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy / 中华医学杂志(英文版)

BACKGROUND@#Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.@*METHODS@#In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.@*RESULTS@#The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t = 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t = 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t = 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.@*CONCLUSION@#Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.

Femoral-popliteal Arteriosclerosis Obliterans:Review of Evidence-based Studies on Drug-eluting Endovascular Treatment / 中国医学科学院学报

Atherosclerosis-related diseases have increasingly become health concerns with the increased living conditions and aging.Globally,about 200 million people have suffered from arteriosclerosis obliterans(ASO),which can even be life-threatening in some cases.The past seven decades have witnessed the rapid advances in the treatment of ASO,which has developed from surgery to endovascular interventions including plain balloon angioplasty,bare metal stent placement,drug-coated balloon,and drug-eluting stent.However,the roles of these new techniques for femoral-popliteal lesions,especially their real-world clinical outcomes and indications,remain unclear.This article reviews the latest evidences on the use of drug-eluting devices in treating femoral-popliteal arteriosclerosis obliterans.

Ultrasound-Guided Regional Nerve Block in Below-Knee Amputation / 대한정형외과학회잡지

PURPOSE: This study compared the clinical results of an ultrasound (US)-guided regional nerve block with those of general anesthesia in below-knee amputation (BKA) surgery. In addition, the 1-year mortality rate of BKA patients was evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level. MATERIALS AND METHODS: Among 47 patients who underwent BKA between January 2011 and August 2016, 18 patients in the US-guided regional nerve block group (group 1) and 29 patients in the general anesthesia group (group 2) were analyzed retrospectively and compared. For the clinical assessment, the 30-day mortality, 1-year mortality, postoperative hemoglobin level, and postoperative complications of both groups were investigated. The visual analogue scale (VAS) pain scores at postoperative 1, 6, and 12 hours for both groups were evaluated. The 1-year mortality of BKA patients was also evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level (hemoglobin < 7 g/dl). RESULTS: Significant differences in the 30-day mortality were observed between the two groups (p=0.023). Group 1 showed a higher 30-day mortality but the 1-year mortality was similar in both groups (p=0.051). The postoperative hemoglobin level was similar in the two groups (p=0.085). The VAS pain scores for the postoperative 1-hour and 6-hour differed significantly between the two groups (p < 0.001). The VAS pain scores for postoperative 12-hour showed no significant difference (p=0.10). The 1-year mortality rate of both groups was not affected by hypertension, diabetes mellitus, arteriosclerosis obliterans, and postoperative hemoglobin less than 7 g/dl, but was affected by chronic kidney disease (CKD) (Pearson's chi-square=14.39, p < 0.05). CONCLUSION: Although US-guided regional nerve block showed comparable 1-year mortality and postoperative hemoglobin levels compared to general anesthesia in BKA, it showed better results in postoperative 1, 6 hour pain control than general anesthesia. The 1-year mortality of BKA was affected by CKD. Therefore, careful consideration is needed for patients with CKD before undergoing BKA regardless of the anesthetic methods.

Effects of puerarin on blood lipids and inflammatory factors in rats with lower limb arteriosclerosis obliterans

This study investigated the effects of puerarin (PUE) on blood lipid and inflammatory factor levels in rats with lower limb arteriosclerosis obliterans (ASO). Sixty rats were randomly divided into control, model, simvastatin, low-PUE, middle-PUE and high-dose PUE group. The animals in later 5 groups were with lower limb ASO, and the later 4 groups were given 1 mg/kg simvastatin and 5, 10 and 20 mg/kg PUE, respectively. The blood lipid and inflammatory factor levels were determined. Results showed that, the serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) level in model group were significantly increased (P <0.01), while the high-density lipoprotein cholesterol (HDL-C) was significantly decreased (P <0.01). Compared with model group, TC, TG, LDL-C, IL-6, TNF-α and hs-CRP in high-dose PUE and simvastatin group were significantly decreased (P <0.01 or P <0.05), and HDL level was significantly increased (P <0.01 or P <0.05). There was no significant difference of each index between simvastatin and high-dose PUE group (P >0.05). PUE can obviously decrease the blood lipid and inflammatory factor levels in rats with lower limb ASO.

Correlation between autophagy and polarization of macrophages in atherosclerosis plaque in arteriosclerosis obliterans amputees / 药学学报

This study was designed to investigate the correlation between autophagy and polarization of macrophages in atherosclerosis (AS) plaque in arteriosclerosis obliterans amputees. Femoral artery specimens from arteriosclerosis obliterans amputees were performed hematoxylin and eosin (HE) staining, oil red O and immunofluorescence staining to observe the morphology of atherosclerotic plaque, phenotype of macrophages and autophagy in plaque; using real-time quantitative RT-PCR technology to detect the mRNA level of M1 and M2 type markers in arterial tissue; to analyze polarized signal pathway and autophagy protein levels in macrophages by Western blotting. Arterial specimens staining showed obvious lipid deposition and obvious infiltration of amount of foam cells and inflammatory cells. Macrophages were mainly expression M1 type in percentage in fibrous plaque. Although both M1 and M2 macrophages were upregulated in atheromatous plaque, the increase was dominant in M2 type in percentage. The level of autophagy was significantly higher in the atheromatous plaque than that of fibrous plaque. The expression of tumor necrosis factor- α (TNF-α), monocyte chemotactic protein-1 (MCP-1), inducible nitric oxide synthase (iNOS), interleukin-6 (IL-6) and interleukin-12 (IL-12) mRNA was significantly higher in fibrous plaque than that of atheromatous plaque (P < 0.01 or 0.05), and arginase-1 (Arg-1), transforming growth factor-β (TGF-β), CD163 and interleukin-10 (IL-10) mRNA was significantly lower than that in atheromatous plaque (P < 0.01). The levels of p-STAT1 and NF-κB were significantly increased in fibrous plaque (P < 0.01), while p-STAT6 expression was significantly increased in atheromatous plaque (P < 0.01). The level of LC3-II was significantly higher in atheromatous plaque than that in fibrous plaque (P < 0.01). Macrophages in early atherosclerotic plaque were induced to M1 type through p-STAT1/NF-κB pathway and expressed moderate levels of autophagy; while macrophages in advanced plaques were induced to polarization of M2 type through p-STAT6 pathway. M2 macrophages expressed a higher level of autophagy than M1 macrophages.

Logistic Regression Analysis of Depression in Arteriosclerosis Obliterans Patients and Its Risk Factors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the depression in arteriosclerosis obliterans (ASO) patients and its risk factors.</p><p><b>METHODS</b>The self-rating depression scale (SDS) was applied in 228 ASO patients hospitalized in the vascular surgery department of Peking Union Medical College Hospital from March 2010 to October 2011. The risk factors of depression were analyzed by using univariate and multivariate Logistic regression analysis.</p><p><b>RESULTS</b>Of these 228 ASO patients, 133 (58.3%) were found to be depressive. Univariate and multivariate analysis showed that female (OR=0.15,95% CI:0.05-0.45), hypertension (OR=4.63,95% CI:1.90-11.29), coronary heart disease (OR=3.62,95%CI:1.43-9.18), as well as Fontaine 2a (OR=20.76,95% CI:3.21-134.28), 2b (OR=26.34,95% CI:4.20-164.97), 3(OR=192.28,95% CI:25.97-1423.51), and 4(OR=291.41,95% CI:28.67-2962.21) were the risk factors of depression in ASO patients.</p><p><b>CONCLUSIONS</b>ASO patients can easily develop depression. Female, hypertension, coronary heart disease, and Fontaine 2a, 2b,3,and 4 are the risk factors of depression in ASO patients.</p>

Effect of ASO Blood Stasis Syndrome Serum on Vascular Endothelial Cell Injury and Regulation of Taohong Siwu Decoction on it / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of arteriosclerosis obliterans (ASO) blood stasis syndrome (BSS) serum on vascular endothelial cell injury and to study the regulation of Taohong Siwu Decoction (TSD) on it.</p><p><b>METHODS</b>Umbilical vein endothelial cell culture system was established. The serum endothelial cell injury model with ASO BSS was prepared. Low, medium, and high concentrations TSD containing serums were respectively added. The endothelial cell proliferation activity was observed by MTT method. Ultrastructures of endothelial cells were observed under transmission electron microscope. Changes of intracellular calcium ion concentration and the cytoskeleton were observed under laser confocal microscope. Contents of ET, NO, and transforming growth factor beta1 (TGF-beta1) in endothelial cell culture supernatant were detected by ELISA.</p><p><b>RESULTS</b>In ASO BSS serum group endothelial cell proliferation activities decreased, the cell structure was obviously destroyed, calcium ion concentration increased, contents of ET, NO and TGF-beta1 increased significantly (P < 0.01), and ET/NO ratio was imbalanced. After incubating with TSD drug containing serum, endothelial cell proliferation activities and injured cell structures were obviously improved; ET, NO and TGF-beta1 levels decreased (P < 0.05, P < 0.01), ET/NO ratios approximated to the normal level.</p><p><b>CONCLUSION</b>The main mechanism of TSD for treating ASO ASS lied in improving injured vascular endothelial cells and endocrine disorder.</p>

Plasma heparin cofactor II activity correlates with the incidence of in-stent restenosis after the intervention of arteriosclerosis obliterans in lower extremity / 中南大学学报(医学版)

OBJECTIVE@#To explore the relationship between activity of plasma heparin cofactor II (HC II) and the incidence of in-stent restenosis aft er the intervention of arteriosclerosis obliterans in lower extremity.@*METHODS@#A total of 62 patients with arteriosclerosis obliterans in lower extremity underwent femoropopliteal stent implantation. They were divided into 2 groups: A high HC II activity group (≥100%, n=40) and a low HC II activity group (<100%, n=22). All patients filled in follow up tables and conducted body examination. Possible risk factors resulting in restenosis were collected. Patients were followed up for 6 months after femoropopliteal stent implantation.@*RESULTS@#Baseline clinical characteristics were not significantly different between the 2 groups. The degree and incidence of angiographic restenosis at the end of the 6th month after the implantation in the high HC II activity group were all significantly lower than those in the low HC II activity group (P<0.05). Multivariate analysis demonstrated that high plasma HC II activity was an independent factor in reducing the incidence of angiographic restenosis (OR=0.982, P=0.048, 95%CI, 0.966, 0.998).@*CONCLUSION@#High plasma HC II activity is an independent factor in reducing the degree of in-stent restenosis. The lower the plasma HC II activity, the severer the degree of in-stent restenosis.

Taohong Siwu Decoction regulated functions of endothelial cells and treated arteriosclerosis obliterans: an experimental study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To discuss the effect of Taohong Siwu Decoction (TSD) in regulating functions of endothelial cells and treating arteriosclerosis obliterans (ASO).</p><p><b>METHODS</b>The ASO model was prepared by using high-fat diet plus intimal injury. They were randomly divided into the model group (n = 10), the normal control group (n = 9), the low dose TSD group (group A, n = 12), the middle dose TSD group (group B, n = 10), and the high dose TSD group (group C, n = 9). Eight weeks after modeling, the limb blood perfusion was observed using laser Doppler flowmetry. The arterial morphology was observed using light microscope and transmission electron microscope. The number of circulating endothelial cells (CECs) was determined using Percoll density gradient centrifugation method. Serum levels of TNF-alpha, IL-1, ET-1, and NO were detected using double antibody sandwich assay of enzyme linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The ASO rat model was successfully established. Blood lipids levels significantly increased, the blood perfusion of left hind limbs significantly decreased, the number of CECs in the peripheral blood significantly increased, the arterial lumen was irregularly narrowed, the ultra-structure of vessel walls was damaged, serum levels of TNF-alpha, IL-1, and ET-1 significantly increased, and the serum level of NO significantly decreased in the model group, showing statistical difference when compared with the normal control group (P < 0.01). Compared with the model group, significant improvement in the aforesaid indices was shown in group B and C (P < 0.05, P < 0.01).</p><p><b>CONCLUSIONS</b>The injury and abnormal functions of endothelial cells is an important pathological process of ASO. As an effective recipe for treating ASO, TSD could protect vascular endothelial cells and improve the secretion function of vascular endothelial cells.</p>

Clinical efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities.</p><p><b>METHODS</b>In this single-center retrospective study, the clinical data of consecutive 114 cases with TASC II type C/D lower extremity obstructive disease and clinical stage of Fontaine ≥ IIb and ankle brachial index <0.9 underwent endovascular therapy from December 2011 to January 2013 were collected. Telephone or clinic interviews were conducted to investigate the clinical outcomes.</p><p><b>RESULTS</b>There were 39 TASC II type C patients and 75 TASC II type D patients, 78 patients were in Fontaine IIb, 30 patients in Fontaine III and 6 patients in Fontaine IV stages. Immediate procedural success rate was 94.9% (131/138). Ankle brachial index was increased from 0.54 ± 0.26 at baseline to 0.83 ± 0.30 at discharge (P < 0.01). No adverse event was observed during the perioperative period. During (15.7 ± 8.7) months follow-up, cumulative patency rate of 6, 12 and 18 months was 75.8% (94/124) , 68.7% (68/99) and 39.2% (20/51) respectively and limb salvage rate was 100%.</p><p><b>CONCLUSION</b>Endovascular therapy for complex arteriosclerosis obliterans of the lower extremities is effective and safe.</p>

The Characteristics and Factors Affecting Patients Diagnosed with Lower Limb Arteriosclerosis Obliterans in an Emergency Department

PURPOSE: This study investigated the relationship between the laboratory results of patients diagnosed with lower limb arteriosclerosis obliterans (LASO) in an emergency department (ED), general characteristics, clinical manifestation, hematological conditions, and clinical views of severity. Another purpose of the study was to determine the factors that could contribute to clinical severity to facilitate the prediction and diagnosis of LASO in the ED. METHODS: From January 2005 to December 2012 we conducted a retrospective study on patients diagnosed with LASO in the ED. Included in the study were 52 patients diagnosed with LASO through CT. The patients were divided into two groups according to the Fontaine classification-for comparative analysis: "less severe" (for stage II and below) and "more severe" (for stage III and above). Vital signs, clinical findings, laboratory data, and CT findings were analyzed in each patient. The SPSS package with the Mann-Whitney U test, Fisher's exact test, and logistic regression were used for data analysis. A p-value <0.05 was considered statistically significant. RESULTS: The average age of patients diagnosed with LASO was 73.1+/-10.1 and male saccounted for 76.9% of the population (n=40). Based upon the levels of severity by the Fontaine classification, patients were divided into 28 "more severe" and 24 "less severe" cases. The "more severe" LASO patients showed a high pulse rate (p=0.017) and a higher current smoking rate (p=0.04). The laboratory data from "more severe" LASO patients showed significant differences in total white blood cell count (p=0.040), erythrocyte sedimentation rate (p=0.000), and the levels of lactate dehydrogenase (p=0.002), creatine kinase (p=0.000), creatine kinase-MB (p=0.002), myoglobin (p=0.000), and C-reactive protein (p=0.000). The significant factors that could affect clinical severity were erythrocyte sedimentation rate (OR 1.066, 95% CI 1.010-1.125, p=0.021), and the levels of lactate dehydrogenase (OR 1.015, 95% CI 1.002-1.029, p=0.027), creatine kinase-MB (OR 1.229, 95% CI 1.028-1.468, p=0.023), and C-reactive protein (OR 1.533, 95% CI 1.074-2.188, p=0.019). CONCLUSION: The patients diagnosed with more severe LASO showed a high pulse rate, a higher current smoking rate, high levels of inflammation (erythrocyte sedimentation rate and C-reactive protein), and high levels of muscle enzymes (lactate dehydrogenase, creatine kinase, myogolobin, creatine kinase-MB). The factors that could influence clinical severity were erythrocyte sedimentation rate, and the levels of lactate dehydrogenase, creatine kinase-MB, and C-reactive protein.

The Characteristics and Factors Affecting Patients Diagnosed with Lower Limb Arteriosclerosis Obliterans in an Emergency Department

PURPOSE: This study investigated the relationship between the laboratory results of patients diagnosed with lower limb arteriosclerosis obliterans (LASO) in an emergency department (ED), general characteristics, clinical manifestation, hematological conditions, and clinical views of severity. Another purpose of the study was to determine the factors that could contribute to clinical severity to facilitate the prediction and diagnosis of LASO in the ED. METHODS: From January 2005 to December 2012 we conducted a retrospective study on patients diagnosed with LASO in the ED. Included in the study were 52 patients diagnosed with LASO through CT. The patients were divided into two groups according to the Fontaine classification-for comparative analysis: "less severe" (for stage II and below) and "more severe" (for stage III and above). Vital signs, clinical findings, laboratory data, and CT findings were analyzed in each patient. The SPSS package with the Mann-Whitney U test, Fisher's exact test, and logistic regression were used for data analysis. A p-value <0.05 was considered statistically significant. RESULTS: The average age of patients diagnosed with LASO was 73.1+/-10.1 and male saccounted for 76.9% of the population (n=40). Based upon the levels of severity by the Fontaine classification, patients were divided into 28 "more severe" and 24 "less severe" cases. The "more severe" LASO patients showed a high pulse rate (p=0.017) and a higher current smoking rate (p=0.04). The laboratory data from "more severe" LASO patients showed significant differences in total white blood cell count (p=0.040), erythrocyte sedimentation rate (p=0.000), and the levels of lactate dehydrogenase (p=0.002), creatine kinase (p=0.000), creatine kinase-MB (p=0.002), myoglobin (p=0.000), and C-reactive protein (p=0.000). The significant factors that could affect clinical severity were erythrocyte sedimentation rate (OR 1.066, 95% CI 1.010-1.125, p=0.021), and the levels of lactate dehydrogenase (OR 1.015, 95% CI 1.002-1.029, p=0.027), creatine kinase-MB (OR 1.229, 95% CI 1.028-1.468, p=0.023), and C-reactive protein (OR 1.533, 95% CI 1.074-2.188, p=0.019). CONCLUSION: The patients diagnosed with more severe LASO showed a high pulse rate, a higher current smoking rate, high levels of inflammation (erythrocyte sedimentation rate and C-reactive protein), and high levels of muscle enzymes (lactate dehydrogenase, creatine kinase, myogolobin, creatine kinase-MB). The factors that could influence clinical severity were erythrocyte sedimentation rate, and the levels of lactate dehydrogenase, creatine kinase-MB, and C-reactive protein.

Proteomics analysis of distinct proteins in human atherosclerosis obliterans: identification and verification / 中华外科杂志

<p><b>OBJECTIVE</b>To identify distinct proteins involved in human atherosclerosis obliterans (ASO) by a differential proteomic approach.</p><p><b>METHODS</b>Eight atherosclerotic femoral arteries with a mean age of 68.6 years (6 male and 2 female) and 5 normal femoral arteries with a mean age of 44.2 years (3 male and 2 female) were obtained from high amputation patients. Then the first 2-dimensional maps of the proteome of human femoral arteries was plotted to compare ASO and control specimens. Proteomic profiling was to differentiate and identify histological proteins that were associated with ASO. The differentially expressed proteins were sequenced by matrix assisted laser desorption/ionization mass spectrometry (MALDI-TOF-MS). The result was verified by immunohistochemistry (IHC) and Western blot.</p><p><b>RESULTS</b>ASO was associated with distinct patterns of protein expression in the femoral arteries. A total of 25 distinct spots corresponding to 13 different proteins were identified by MALDI-TOF-MS using the NCBI and IPI databases. These proteins were mainly involved in the pathogenetic mechanisms such as inflammation, oxidative stress, proliferation and transformation of SMCs. The low level of heat shock protein 27 (HSP27) in ASO was verified by IHC and western-blot in accord with the result of MS.</p><p><b>CONCLUSION</b>Proteomic analysis can be used to investigate differentially expressed proteins, which may provide new insights into ASO pathogenesis, such as HSP27.</p>

Treatment of long-segment iliofemoral occlusive disease: two extra-anatomic bypass surgeries / 中华外科杂志

<p><b>OBJECTIVE</b>To report and evaluate the clinical results of surgical treatment for long-segment iliofemoral arteriosclerosis obliterans, including external iliac-popliteal (EIP) and femoral-deep femoral (FDF) crossover bypass surgeries.</p><p><b>METHODS</b>From July 1995 to December 2009, 85 patients (61 male, 24 female, aged from 64 to 91 years, mean age 75 years) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were involved in this research. According to Fontaine classification, the 85 patients could be graded as 62 class IIb-III patients (72.9%), and 23 class IV patients (27.1%). In CT angiography or DSA examinations, the 85 patients were grouped into EIP (n = 49) and FDF (n = 36) surgical groups on the basis of visualizations in the affected deep femoral, supra-knee/infra-knee popliteal arteries. The healing time of ulcers and toe amputation wound, ankle-brachial index, and blood flow velocity in the affected limb together with accumulative patency rates in 1, 3 and 5 years and limb salvage rates in 3 and 5 years were analyzed.</p><p><b>RESULTS</b>None of the 85 patients died or had extremity amputated in perioperatively. Seventy-four patients (87.1%) had been followed up from 2 to 13 years (mean 5.7 years). Postoperative ankle-brachial index of FDF and EIP groups was 0.55 ± 0.11, and 0.94 ± 0.13 (t = -21.88, P = 0.000). Postoperative velocity of popliteal artery blood flow in FDF and EIP groups was (32 ± 9) cm/s, and (48 ± 4) cm/s (t = 16.76, P = 0.000); velocity of anterior or posterior tibial artery was (22 ± 7) cm/s, and (42 ± 4) cm/s (t = 10.50, P = 0.000). The primary and secondary patency rates of FDF and EIP groups were 87.8% and 88.3%, 80.7% and 81.2%, 68.4% and 57.4% at 1, 3 and 5 years, respectively. Limb salvage rates of FDF and EIP groups were 87.6% and 88.6%, 76.7% and 71.3%, at 3 and 5 years, respectively. There were no statistically significant differences in 1, 3, and 5 years' cumulative secondary patency rate and limb salvage rate between FDF and EIP groups.</p><p><b>CONCLUSIONS</b>As extra-anatomic bypass surgeries, FDF and EIP are both determined to be alternative procedures for unilateral common iliac-superficial femoral artery occlusive disease, especially suitable for high-risk patients. EIP group patients have better clinical outcomes than those in FDF group.</p>

Anaphylaxis induced by hydroxyethyl starch during general anesthesia: A case report / 대한마취과학회지

Hydroxyethyl starch (HES) solutions are synthetic non-protein colloid solutions used to treat hypovolemia. However, their use is not free from the risk of allergic reactions. A 42-year-old male was scheduled to undergo aortic-iliac-femoral bypass surgery for the treatment of arteriosclerosis obliterans. He had no history of allergy. Two hours after the start of surgery, and within minutes after HES administration, facial erythema, hypotension and bronchospasm developed. HES infusion was discontinued under the estimation of anaphylaxis. The patient received phenylephrine, ephedrine, diphenhydramine and hydrocortisone with hydration. After restoration of vital signs, surgery was performed without complications.

A Case of Intimal Sarcoma Arising in the Left Common Iliac Artery

Primary tumors of the great vessels are rare. Most encountered cases are sarcomas which most commonly develop in the aorta, pulmonary artery, and inferior vena cava. We experienced an intimal sarcoma arising in the left common iliac artery in a 68-year-old male, who suffered from claudication in his left lower extremity for a year and was diagnosed as arteriosclerosis obliterans, clinically. Bypass surgery was performed on the obstructive lesion. Grossly, the vascular lumen was filled with dark hemorrhagic materials. Microscopically, the lesion showed proliferation of anaplastic spindle cells with a marked nuclear atypia, arranged haphazardly. There were numerous mitotic figures. Foci of cholesterol clefts were also found in the intima. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin, and cytokeratin in certain areas. Stains for CD34, desmin, myosin heavy chain, caldesmon, and S-100 protein were negative. A pathologic diagnosis was made as intimal sarcoma with myofibroblastic differentiation.

The evaluation of surgical reconstruction for intermittent claudication by the Walking Impairment Questionnaire / Avaliação da reconstrução cirúrgica para claudicação intermitente pelo Walking Impairment Questionnaire

BACKGROUND: No standards reflecting the quality of life (QOL) and activity of daily living (ADL) in postoperative clinical course have been validated in the area of vascular disease. The Walking Impairment Questionnaire (WIQ) is a disease-specific questionnaire that evaluates patients with intermittent claudication due to arteriosclerosis obliterans (ASO). The WIQ uses four subscales: pain severity, walking distance, walking speed, and stair climbing while walking. OBJECTIVE: To evaluate the correlation between postoperative arterial blood flow and the Japanese edition of the WIQ. METHODS: Thirty-one patients (47 limbs) with intermittent claudication who had been subjected to lower limb surgical arterial reconstruction were assessed by WIQ, and compared with Ankle-Brachial Pressure Index (ABPI) and angiography. RESULTS: A significant increase in the WIQ score was identified in walking pain (26 versus 89.5, p<0.001), walking distance (13.1 versus 83.3, p<0.001), walking speed (10 versus 46, p<0.001), and stair climbing (6.2 versus 79, p<0.001). The correlation coefficient between the increase in postoperative ABPI and the WIQ score was R²=0.1889, which shows weak correlation. The correlation between blood flow obstruction due to the postoperative bypass that was scored by angiography and WIQ score was R²=0.3894, which shows moderate correlation. CONCLUSION: An improvement in the Japanese edition of the WIQ score was correlated not only with the patients' QOL after bypass revascularization but also with the rate of increase of postoperative ABPI and image findings, such as the postoperative angiography.

INTRODUÇÃO: Nenhum padrão de qualidade de vida e atividades diárias no período pós-operatório já foi validado na área de doenças vasculares. O Walking Impairment Questionnaire (WIQ) é um questionário específico para pacientes com claudicação intermitente devido à aterosclerose obliterante. O WIQ se baseia em quatro subescalas: intensidade da dor, distância caminhada, velocidade de caminhada e subir degraus durante caminhada. OBJETIVO: Avaliar a correlação entre fluxo sanguíneo periférico pós-operatório e a edição japonesa do WIQ. MÉTODOS: Trinta e um pacientes (totalizando 47 membros inferiores) com claudicação intermitente que se submeteram à reconstrução arterial cirúrgica foram avaliados pelo WIQ e comparados por meio do índice de pressão tornozelo-braço (ITB) e angiografia. RESULTADOS: Um aumento significativo no escore do WIQ foi observado em relação à dor durante caminhada (26 versus 89,5, p<0,001), distância caminhada (13,1 versus 83,3, p<0,001), velocidade da caminhada (10 versus 46, p<0,001) e ato de subir escadas (6,2 versus 79, p<0,001). O coeficiente de correlação entre o aumento no ITB pós-operatório e o escore WIQ foi R²=0,1889, demonstrando correlação baixa. A correlação entre obstrução do fluxo sanguíneo devido ao bypass pós-operatório avaliado por angiografia e WIQ foi R²=0,3894, o que revela uma correlação moderada. CONCLUSÃO: Uma melhora na edição japonesa do escore WIQ esteve correlacionada não apenas com a qualidade de vida dos pacientes após revascularização com bypass, mas também com a taxa de aumento no ITB pós-operatório e achados imaginológicos, como a angiografia pós-operatória.

Percepção da doença arterial obstrutiva periférica por pacientes classe I ou II de Fontaine de um programa de saúde da família / Perception of the peripheral arterial occlusive disease in Fontaine class I or II patients included in a family health program

CONTEXTO: A doença arterial obstrutiva periférica (DAOP) se destaca por deteriorar a qualidade de vida dos pacientes, quando associada a elevado risco de eventos cardiovasculares e cerebrovasculares. O diagnóstico clínico é sensível e específico, por meio do índice tornozelo-braquial (ITB), que, se precocemente detectado, otimiza o controle dos fatores de risco. OBJETIVO: Avaliar a percepção da DAOP em pacientes classe I ou II de Fontaine assistidos pela Estratégia de Saúde da Família em Pará de Minas (MG), analisando características socioeconômicas e determinantes da qualidade de vida. MÉTODOS: Após cálculo amostral estratificado por gênero e idade, um questionário elaborado para o estudo foi respondido por 123 indivíduos com diagnóstico de DAOP classe I ou II de Fontaine. Para as associações, utilizaram-se testes do c² e exato de Fisher (p<0,05). RESULTADOS: Dos indivíduos que responderam o questionário, 96 (78 por cento) eram do gênero feminino e tinham baixa escolaridade. Observou-se associação entre claudicação intermitente, o sintoma mais frequente da doença, e aperto nas pernas, câimbras, adormecimento dos pés, cansaço, inchaço e agulhadas. Não houve associação com tabagismo, hipertensão arterial sistêmica, diabetes e alteração do colesterol. Dos participantes, 76 (61,8 por cento) nunca ouviram falar da doença, apesar de serem portadores. Dor durante execução de tarefas dentro e fora de casa foi relatada por 48 (39 por cento) indivíduos. A prática de atividade física foi mais recomendada por médico clínico geral - mencionada por 18 (14,6 por cento) indivíduos - sendo que a caminhada, única atividade praticada em níveis recomendados, foi relatada por 102 (27,7 por cento). CONCLUSÃO: É necessário esclarecimento para essa população quanto ao tratamento clínico não-farmacológico para controle das manifestações crônicas irreversíveis. Ressalta-se a relevância da veiculação de informações sobre a evolução silenciosa e sintomatologia da doença.

BACKGROUND: The peripheral arterial occlusive disease (PAOD) is characterized by the deterioration in the quality of life of patients when associated with high risk of cardiovascular or cerebrovascular events. The clinical diagnosis is sensitive and specific, by means of the Ankle Brachial Pressure Index (ABPI), and, when there is early detection, the control of risk factors is optimized. OBJECTIVE: To assess the perception of PAOD in Fontaine class I or II patients by means of the Family Health Strategy in Pará de Minas (MG), Brazil, through an analysis of the socioeconomic characteristics and life quality determinants. METHODS: After the sample calculation, stratified by genre and age, a questionnaire elaborated for the purposes of this study was applied to 123 individuals who were diagnosed with Fontaine class I or II PAOD. Aiming at the associations, the c² and Fisher's exact tests were used (p<0.05). RESULTS: Among the participants who answered to the questionnaire, 96 (78 percent) were women and had low schooling. An association between intermittent claudication, the most common symptom, and the sensation of pressure on the legs, cramps, foot paresthesia, fatigue, swelling, and tingling was observed. There was no association with smoking, systemic arterial hypertension, diabetes and cholesterol alterations. Among the participants, 76 (61.8 percent) had never heard about the disease despite the fact that they had it. Pain during activities at home or elsewhere was reported by 48 individuals (39 percent). The practice of physical activities was more recommended by clinicians - mentioned by 18 (14.6 percent) individuals - and walking, the only activity that was practiced according to the recommended levels, was reported by 102 participants (27.7 percent)...

Endovascular revascularization for lower extremity atherosclerosis obliterans in elderly patients:a report of 86 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the outcome and risk factors of endovascular revascularization of lower limb artery for elder patients.</p><p><b>METHODS</b>From January 2006 to November 2008, 86 elder patients (98 ischemia limbs) underwent endovascular revascularization due to lower limb ischemia. Age of this group were 60 to 82 years old with a mean of (70 +/- 6) years old. Fifty-four limbs (55.0%) had severe intermittent claudication, 28 limbs (28.6%) had rest pain, 11 limbs (11.2%) had ulcer, and 5 limbs (5.1%) had gangrene. Sixty-six limbs were mono segment disease, including 25 aorta-iliac lesions, 33 femoral-popliteal lesions and 8 infra-popliteal lesions. Thirty-two limbs were multiple segment disease involving 2 or 3 segment lesions. Mortality, morbidity, primary patency, secondary patency and limb salvage were retrospectively analyzed. Risk factors on outcome were also evaluated.</p><p><b>RESULTS</b>Ten limbs underwent angioplasty, while the rest 88 limbs underwent angioplasty plus primary stent implantation. The total operation success rate was 95.9%. Perioperative mortality within the first 30 d was 0. Perioperative morbidity within the first 30 d was 5 cases (5.1%), including 2 myocardial infarction, 2 major amputations and 1 irreversible contrast-induced nephropathy. Follow-up duration were 1 to 35 months with a mean of (18 +/- 10) months. Eighty-three (96.5%) patients had effectively follow-up. Mortality was 2.3% (2 cases died due to myocardial infarction). Primary patency rate was 83.7%, secondary patency rate was 94.9% and limb salvage rate was 95.9%. Risk factor analysis showed that diabetes mellitus, critical ischemia and multiple segment lesions were associated with worse patency.</p><p><b>CONCLUSIONS</b>Endovascular treatment is effective, safe and repeatable revascularization for elder patients of Critical lower limb ischemia. Patients with diabetes mellitus, critical ischemia and multiple segment lesions should be paid more attention because their rather worse outcome.</p>