[The effect of heparan sulfate on percutaneous transluminal angioplasty in the vessels supplying the lower extremities]. / Vliv heparansulfátu na efekt perkutánní transluminální angioplastiky v oblasti tepen zásobujících dolní koncetiny.

BACKGROUND: The condition of patients after percutaneous transluminal angioplasty is influenced among others by the subsequent development of restenoses and reocclusions. The objective of the submitted work was to assess whether oral administration of heparan sulphate can influence the development of restenoses after percutaneous transluminal angioplasty in the pelvic and femoropopliteal region. METHODS AND RESULTS: 102 patients (78 men and 24 women, age 42-86 years) were divided into four groups. Percutaneous transluminal angioplasty was performed either on account stenosis in the aortoiliac or femoropopliteal area. (The original number was 115 patients, 13 patients were eliminated: the reasons were technical failure of the intervention procedure, reocclusion, the patient was lost from records.) As antiaggregant the patients were given acetylsalicylic acid, 250 mg/day: patients included in the heparan group were given heparan sulphate (Hemovasal, Manetti and Roberts) 100 mg/day for a period of 3 - 4 months. As compared with controls, the patients treated with heparan sulphate had within the 3 - 4 month period a significantly longer claudication distance (p < 0.05), a higher Doppler index (p < 0.05) and maximal blood flow in the feet. CONCLUSIONS: Heparan sulphate administration to patients after percutaneous transluminal angioplasty on account of stenosis of the aortoiliac or femoropopliteal area improves some angiological parameters which can suggest a slighter tendency of early restenosis.

Objectification of compression therapy haemodynamic effect by means of light reflex rheography.

Light reflex rheography (LRR) is one of the non-invasive diagnostic methods which makes it possible to examine venous haemodynamics. Through the use of this method we wanted to prove the positive influence of compression therapy on varices of the lower extremities in the 2nd degree chronic insufficiency. In all, 32 patients were examined (39 extremities), and evaluations were done on them of the initial venous refilling time-Ti, i.e. a segment of the LRR curve during the first three seconds after the cessation of muscle work (12 dorsal flexions sitting). Measurements were made without stockings and with the use of the 2nd compression class stockings made by Loana and with the use of Cambren the 1st compression class stockings. With the 1st compression class stockings, measurements were made with one and two stockings simultaneously. The arithmetic mean of the values measured in the individual groups was evaluated by Student's t-test. Our results confirmed the anticipated prolongation of the initial time (Ti) segment in the monitored patients, even when the 1st class Cambren C stockings were used. Especially when two of these stockings were used simultaneously, the Ti period was fully comparable to the Ti values when the 2nd class compression stockings were used. It has been demonstrated that when two lower compression class stockings are used simultaneously, there is a significantly increased compression effect and an improvement of the function parameters, even in patients with varices and the 2nd degree chronic venous insufficiency.

Midodrine, a new therapeutic agent: recent experience.

Midodrine, marketed as Gutron by Hafslund Nycomed, was given at a dose of 2.5 mg three times daily always half an hour after the main meal for a period of 84 days to 8 women in the age of 25.42 years--average 34.5 yrs--and BMI of 19.8. These women with a blood pressure value below 100/60 mmHg most of the time displayed signs of neuroticism but had no organic and neurologic lesion. Clinical internal examination, Jarmatz-de Marée test, ECG-supine, standing, Holter dynamic ECG, ergometry, arterial and venous plethysmography, Doppler distal pressures-supine, standing, clinical neurological examination, EEG, perfusion brain tomography-supine, standing, urine examination--chemically and microscopically--, blood count, Na, K, Cl, glucose, urea, creatinine, uric acid, bilirubin, gamma-GT, alk. phosphatase, LDH, ALT, AST, thrombocyte index and the count of desquamated endothelia in blood before and after the end of 84-days Gutron therapy were carried out. It was ascertained that: (1) Gutron had no side effects; the marked subjective improvement reported by all patients persisted for months after the end of therapy. (2) No changes in biochemical parameters, ECG, Holter ECG monitoring, pulse rate, Doppler index and EEG were found. (3) Gutron did not raise the tendency to platelet aggregation and had no toxic effect on the vascular endothelium as demonstrated by unchanged thrombocyte index and endothelaemia. (4) Gutron administration was associated with a significant rise in upright diastolic pressure, especially when standing for prolonged periods--Jarmatz-de Marée test.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous transluminal angioplasty of the deep femoral artery.

Percutaneous transluminal angioplasty (PTA) of the deep femoral artery (DFA) was performed in 21 patients with chronically occluded superficial femoral artery (SFA) and a significant DFA lesion as documented by arteriography. The authors failed to pass the guidewire through the occlusion in two patients. The results do not include another patient who, while the PTA was technically successful, had to have a limb amputated because of skin lesion infection. The remaining 18 patients showed a significant increase in the ankle-arm pressure index, prolongation of the claudication interval and reported subjective improvement immediately after PTA; plethysmography performed in 14 patients revealed a significant increase in maximum foot blood flow. While the claudication intervals were found to have further significantly prolonged 6-12 months following PTA, the ankle-arm pressure index remained unchanged. There were no serious complications during and after the PTA procedure. In patients with both superficial and deep femoral artery involvement, where SFA PTA is not suitable or feasible, PTA of the DFA seems to be the method of choice. Considering its probable clinical benefits, it is appropriate to attempt it even in cases where the chances of technical success are low.

Some interrelations between blood pressure parameters and claudication distances.

Sixty males and 2 females with the mean age of 58.1 years ranging from 39 to 80 years with atherosclerotic lesions of the arteries of lower extremities were studied. The claudication distance was subdivided into two segments: the first included the distance up to the onset of pain and the second one when the patients had to stop walking because of the severity of pain. The systemic systolic pressure and the poststenotic ankle pressure over both arteries on both calves by a Doppler ultrasound apparatus were measured and the individual pressure gradients were calculated. It was demonstrated that both claudication intervals were related to the poststenotic pressure as well as to the pressure gradient. The stepwise regression analysis showed a significant relationship between both distances and the lowest value of all ankle pressure measurements over four tibial arteries. The closest correlation (R = 0.98) was recorded between the initial and final claudication distance and it persisted even after the elimination of all pressure parameters.

[What is the relation between pressure parameters and claudication distance?]. / Jaký je vzájemný vztah mezi tlakovými parametry a klaudikacními vzdálenostmi?

The authors examined the relationship between the ankle pressure, or pressure gradient on the one hand, and the walking distance and different actions, i.e. equalting and standing on tip toes, on the other hand. In 56 male patients with obliterating atherosclerosis, the first stage showed both pressure parameters as closely correlated to the final claudication distance, but not to the actions indicated above. At the second stage, 62 persons showed both the initial and final claudication distances as dependent on the poststenotic pressure as well as on the pressure gradient. Stepwise regression analysis showed a significant dependence of both distances on the lowest pressure measured on four crural arteries. The closest correlation [R = 0.98] was found between the initial and final claudication distances which persisted even after elimination of all pressure parameters.