ABSTRACT
Currently, recanalization of chronic total occlusions (CTOs) in peripheral arteries remains a challenging obstacle encountered by clinical practitioners. Percutaneous CTO interventions are associated with low rates of procedural success using standard guidewires and catheters. When guidewires cannot cross the occluded segment or fail to reenter the true lumen after subintimal crossing of the occlusion, successful recanalization may be unachievable. In the last few years, the emergence of novel devices and new techniques has dramatically improved the success rates of the revascularization for CTOs. This paper reviews the published data of current devices and specialized techniques of percutaneous intervention to relieve CTOs.
Subject(s)
Arterial Occlusive Diseases/therapy , Myocardial Revascularization/methods , Peripheral Arterial Disease/therapy , Vibration/therapeutic use , Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/methods , Animals , Arterial Occlusive Diseases/diagnosis , Catheterization, Peripheral/methods , Equipment Design/instrumentation , Equipment Design/methods , Humans , Myocardial Revascularization/instrumentation , Peripheral Arterial Disease/diagnosis , Treatment Outcome , Vascular Surgical Procedures/instrumentation , Vascular Surgical Procedures/methodsABSTRACT
OBJECTIVE: Using two antithrombotic treatment (clopidogrel vs. clopidogrel combined warfarin) strategies after femoral-popliteal artery angioplasty prospectively, to evaluate which strategy is more effective for the restenosis prevention. METHODS: Totally 50 patients referred for endovascular treatment (including the percutaneous transluminal angioplasty (PTA) and stent implantation) of the superficial femoral artery and popliteal artery from January 2008 to May 2009 were randomly divided into clopidogrel group (group A, 25 cases, 30 limbs) and clopidogrel plus warfarin group (group B, 25 cases, 33 limbs) before operation. Clinical outcomes and restenosis rate of the target lesions were evaluated at 3, 6 and 12 months after operation. RESULTS: Totally 88 patients were screened for participation in the study, 56 patients were included after the follow-up of 12 months. At 3 months, the rates of restenosis were 16.7% in group A and 18.2% in group B (χ² = 0.025, P = 0.874). At 6 months, the accumulated restenosis rates were 36.7% in group A and 36.4% in group B (χ² = 0.001, P = 0.98). At 12 months, the accumulated restenosis rates were 53.3% in group A and 42.4% in group B (χ² = 0.75, P = 0.387). Analysis for the critical limb ischemia sub-group showed that follow-up of 12 months, the accumulated restenosis rate was 8/10 in group A and 6/12 in group B (χ² = 1.023, P = 0.312). CONCLUSION: The clopidogrel alone treatment for PTA or PTA plus stent implantation of femoral popliteal artery has no statistically significant difference in comparison with the clopidogrel combined warfarin treatment in terms of the cumulative vascular restenosis rate at 3, 6, 12 months postoperatively.
Subject(s)
Arterial Occlusive Diseases/prevention & control , Femoral Artery , Popliteal Artery , Ticlopidine/analogs & derivatives , Warfarin/therapeutic use , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon , Arterial Occlusive Diseases/etiology , Clopidogrel , Female , Femoral Artery/surgery , Humans , Male , Middle Aged , Popliteal Artery/surgery , Postoperative Complications/prevention & control , Prospective Studies , Ticlopidine/therapeutic useABSTRACT
Early diagnosis of acute mesenteric ischemia (AMI) remains very difficult, partly due to the fact that useful markers of early small bowel ischemia have not yet been identified. Thus, in this study, we aimed to evaluate the levels of serum intracellular enzymes in the tissues and organs in a controlled animal model of mesenteric intestinal ischemia. Forty-eight New Zealand rabbits were divided into 4 groups including the control, artery ligation, vein ligation, and both artery and vein ligation groups. Plasma samples were obtained at 0-, 1-, 3-, 6- and 9-h time-points and enzyme levels were determined. The bowel color and vitality were observed at the same time. The bowel showed an appearance of infarction after a period of ischemia in the animals. Six and 9 h after superior mesenteric artery ischemia, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels increased significantly. However, after 3 h of superior mesenteric venous (SMV) ligation, γ-glutamyl transpeptidase levels in the blood were considerably higher compared to the control group. Six hours after SMV ischemia, ALT, AST, alkaline phosphatase and lactate dehydrogenase levels were significantly elevated compared to those pre-ligation. Serum enzyme levels during intestinal ischemia are not able to provide sufficient information as regards the extent and reversibility of intestinal ischemia, although, they may be able to reflect the presence of injury.
