Chronic Arterial Occlusive Disease Research Articles

The Differential Diagnosis of Leg Ulcers.

Chronic wounds on the leg (below the knee) are called leg ulcers. They have many causes, and thus patients with leg ulcers are treated by many different kinds of medical specialist. Appproximately 80% of sufferers have chronic venous insufficiency (CVI) and/or peripheral arterial occlusive disease (PAOD). Knowledge of the relevant differential diagnoses is important for appropriate treatment, particularly for patients with atypical findings or an intractable course. This article is based on publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations. The diagnostic evaluation of a leg ulcer can be structured according to the ABCDE rule. This involves individualized, targeted history-taking (anamnesis); bacteriological testing; clinical examination; ancillary testing, particularly for perfusion (defective vascular system); and extras, such as biopsies. Specifically, we present in this article the main aspects of the complex diagnostic evaluation of venous leg ulcers, arterial leg ulcers, vasculitis, vasculopathy, calciphylaxis, pyoderma gangrenosum, necrobiosis lipoidica, ecthyma, and squamous cell carcinoma. There remain many unsolved problems, including interactions between the various areas of clinical treatment and the relative paucity of relevant high-quality research. A timely differential-diagnostic evaluation for the many diseases that can cause leg ulcers, which require treatment from representatives of many different medical specialties and health professions, is a prerequisite for their effective individualized treatment.

Systematic review of clinical guidelines and consensus statements concerning heparin and protamine dosing and monitoring of anticoagulation levels for non-cardiac arterial procedures.

This systematic review was performed to examine all published practice Guidelines and Consensus Statements (together: GCS) on heparin dosing and monitoring during non-cardiac arterial procedures (NCAP). The objective was to scrutinize the recommendations and advice outlined within these GCS documents and to evaluate the supporting evidence for these recommendations. Additionally, the use of the activated clotting time (ACT) and target ACT values were explored. This systematic review was performed in accordance with the PRISMA Guidelines. Medline and Embase databases were searched to identify all GCSs in the English language on NCAP. The final literature search was performed in January 2023. This search was supplemented by searching websites of relevant professional vascular surgical organizations for GCSs. Titles and abstracts were assessed by two independent reviewers. Of 9716 titles identified, 27 GCSs met the predefined inclusion criteria: six GCSs regarding carotid intervention, seven regarding procedures for aneurysmal disease of the abdominal aorta and iliac arteries, 12 regarding interventions for acute and chronic peripheral arterial occlusive disease and two regarding open and endovascular interventions of thoraco-abdominal aortic aneurysms. Administration of heparin is advised for al NCAP. There was high variability concerning heparin dose: both standard dose as weight based dosing (30-150 IU/kg) was advised. Recommendations on repeated doses, ACT monitoring and heparin reversal using protamine also varied widely. In none of the GCSs, the type of the ACT measuring device or used cartridges were specified. Large variability was found between the included GCSs with regard to the recommendations on heparin dose and target ACT values during NCAP. Advice and recommendations in GCSs were based on low-quality studies or without providing any reference at all. The described variability in recommendations emphasizes the need for large prospective (randomized) studies or the incorporation of data on heparin and the use of ACT monitoring into verified vascular surgery registries, to develop evidence-based, practical and uniform applicable recommendations.

Chronic limb-threatening arterial occlusive disease: experience in lifesaving

Chronic limb-threatening arterial occlusive disease: experience in lifesaving

Mesenchymal Stem/Stromal Cells for Therapeutic Angiogenesis.

Mesenchymal stem/stromal cells (MSCs) are known to possess medicinal properties to facilitate vascular regeneration. Recent advances in the understanding of the utilities of MSCs in physiological/pathological tissue repair and technologies in isolation, expansion, and enhancement strategies have led to the use of MSCs for vascular disease-related treatments. Various conditions, including chronic arterial occlusive disease, diabetic ulcers, and chronic wounds, cause significant morbidity in patients. Therapeutic angiogenesis by cell therapy has led to the possibilities of treatment options in promoting angiogenesis, treating chronic wounds, and improving amputation-free survival. Current perspectives on the options for the use of MSCs for therapeutic angiogenesis in vascular research and in medicine, either as a monotherapy or in combination with conventional interventions, for treating patients with peripheral artery diseases are discussed in this review.

Pentoxifylline in dermatology.

Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses in dermatology. The aim of this review is to increase awareness of the several applications of pentoxifylline in the field of dermatology. A comprehensive PubMed search was conducted in May 2022 using the following phrases "dermatology" AND "pentoxifylline." Our search period spanned 34 years from 1988 to 2022. All available literature was reviewed. Reference lists of identified articles were included. Studies were excluded if they were not in English and if the study was out of scope. Eighty-one articles were included in this review. Pentoxifylline has been used to treat various dermatological conditions including peripheral vascular disease, vasculitis and vasculopathies, chilblains, pigmented purpuric dermatosis, granuloma annulare, necrobiosis, keloids, lichen sclerosis et atrophicus, scars, radiation-induced fibrosis, vitiligo, alopecia areata, leishmaniasis, and leprosy. Pentoxifylline's use in dermatology is growing. However, there are limited larger studies and randomized control trials on the use of pentoxifylline in dermatology and more investigation is needed to evaluate its use for many dermatologic conditions. Pentoxifylline's unique mechanism of action as well as its good tolerability, cost-effectiveness, and minimal drug interactions make it a convenient primary or adjunctive option in many dermatological conditions.

Minimally Invasive Procedure Vs Standard Open Approach For Lumbar Sympathectomy

Aim: Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis. Thepresent study was conducted for comparing the efficacy of minimally invasive procedure vs standard open approach for lumbarsympathectomy.Materials & methods: 100 patients were enrolled in the present study (who were scheduled to undergo lumbar sympathectomy) andwere divided broadly and randomly into two study groups: Group 1: Patients undergoing lumbar sympathectomy by minimal invasiveprocedure, and Group 2: Patients undergoing lumbar sympathectomy through standard open approach. Only those patients wereincluded who had Ischemic rest pain that requires continuous analgesia for more than 3 weeks and Ischemic foot ulcers that failed toheal for more than 6 weeks. All the patients underwent surgical procedures according to their respective study groups. All the resultswere recorded in Microsoft excel sheet and were analysed using SPSS software.Results: Mean duration of analgesic consumption for controlling pain postoperatively was 3.9 weeks in group 1 while it was 3.7weeks in group 2. Mean operative time among the patients of group 1 and group 2 was 51 minutes and 83 minutes respectively (pvalue < 0.05). Incidence of complications was significantly higher among the patients of group 2 in comparison to the patients ofgroup 1. Mean recovery time among the patients of group 1 and group 2 was 5.2 days and 7.3 days respectively (p- value < 0.05).Conclusion: Among patients undergoing lumbar sympathectomy, minimally invasive procedure is better in comparison to standardopen procedure.

Risk factors associated with 10-year survival after coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

A meta-analysis of randomized controlled trials on therapeutic efficacy and safety of autologous cell therapy for atherosclerosis obliterans

Objective Atherosclerosis obliterans (ASO) is a chronic occlusive arterial disease and the most common type of peripheral arterial disease. Current treatment options like medication and vascularization have limited effects for “no-option” patients, and stem cell therapy is considered a viable option, although its application and efficacy have not been standardized. The objective of this review was to assess the safety and efficacy of autologous stem cell therapy in patients with ASO.

Clinical Profile and Outcomes in Surgically Treated COVID-19 Patients Presenting with Acute Limb Ischemia

Background: Acute limb ischemia (ALI) refers to a sudden decrease in blood flow to the limb which threatens its viability. Such a sudden event of decreased or absent arterial supply to the limb causes ischemia and poor perfusion outcomes. The most common causes of ALI include embolism and thrombosis. Others include acute on chronic peripheral arterial occlusive disease or major trauma. It is well known to us that COVID-19 is a hypercoagulable state. In this prothrombotic state, patients can also present with ALI, with clinical features of pain, paresthesia, pulselessness, pallor, poikilothermia, and paralysis of the affected limb. Such patients rapidly progress to severe stages of limb ischemia that need immediate treatment to save the limb. Thus, our study aims to revisit the clinical features and outcomes of procedures performed on such patients. Materials and Methods: This is a single-center, retrospective study. COVID patients with ALI who underwent any surgical procedure, from February 2021 to July 2021, were identified from the surgical operation theater's list of the hospital. Detailed information regarding these patients was obtained from the digital software of the hospital. Detailed computed tomography angiography findings were also obtained from the radiology department. A required statistical study was done. Results: Nineteen COVID patients presenting with ALI and requiring surgical treatment were identified during the study period of 6 months. A complete study of their clinical presentations, surgical procedures performed and the outcomes, is done. The study shows that the most common site affected was the lower limb (95%) with occlusion occurring mainly in the popliteal artery, i.e., the lower limb artery. Conclusion: Recognition of limb ischemia at an early stage, considering it as a symptom or complication of COVID-19, may allow for early and prompt diagnosis and treatment of this condition.

Propionyl-L-carnitine for intermittent claudication.

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. Intermittent claudication is a symptomatic form of PAD that is characterized by pain in the lower limbs caused by chronic occlusive arterial disease. This pain develops in a limb during exercise and is relieved with rest. Propionyl-L-carnitine (PLC) is a drug that may alleviate the symptoms of PAD through a metabolic pathway, thereby improving exercise performance. The objective of this review is to determine whether propionyl-L-carnitine is efficacious compared with placebo, other drugs, or other interventions used for treatment of intermittent claudication (e.g. exercise, endovascular intervention, surgery) in increasing pain-free and maximum walking distance for people with stable intermittent claudication, Fontaine stage II. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov trials register to July 7, 2021. We undertook reference checking and contact with study authors and pharmaceutical companies to identify additional unpublished and ongoing studies. Double-blind randomized controlled trials (RCTs) in people with intermittent claudication (Fontaine stage II) receiving PLC compared with placebo or another intervention. Outcomes included pain-free walking performance (initial claudication distance - ICD) and maximal walking performance (absolute claudication distance - ACD), analyzed by standardized treadmill exercise test, as well as ankle brachial index (ABI), quality of life, progression of disease, and adverse events. Two review authors independently selected trials, extracted data, and evaluated trials for risk of bias. We contacted study authors for additional information. We resolved any disagreements by consensus. We performed fixed-effect model meta-analyses with mean differences (MDs) and 95% confidence intervals (CIs). We graded the certainty of evidence according to GRADE. We included 12 studies in this review with a total number of 1423 randomized participants. A majority of the included studies assessed PLC versus placebo (11 studies, 1395 participants), and one study assessed PLC versus L-carnitine (1 study, 26 participants). We identified no RCTs that assessed PLC versus any other medication, exercise, endovascular intervention, or surgery. Participants received PLC 1 grams to 2 grams orally (9 studies) or intravenously (3 studies) per day or placebo. For the comparison PLC versus placebo, there was a high level of both clinical and statistical heterogeneity due to study size, participants coming from different countries and centres, the combination of participants with and without diabetes, and use of different treadmill protocols. We found a high proportion of drug company-backed studies. The overall certainty of the evidence was moderate. For PLC compared with placebo, improvement in maximal walking performance (ACD) was greater for PLC than for placebo, with a mean difference in absolute improvement of 50.86 meters (95% CI 50.34 to 51.38; 9 studies, 1121 participants), or a 26% relative improvement (95% CI 23% to 28%). Improvement in pain-free walking distance (ICD) was also greater for PLC than for placebo, with a mean difference in absolute improvement of 32.98 meters (95% CI 32.60 to 33.37; 9 studies, 1151 participants), or a 31% relative improvement (95% CI 28% to 34%). Improvement in ABI was greater for PLC than for placebo, with a mean difference in improvement of 0.09 (95% CI 0.08 to 0.09; 4 studies, 369 participants). Quality of life improvement was greater with PLC (MD 0.06, 95% CI 0.05 to 0.07; 1 study, 126 participants). Progression of disease and adverse events including nausea, gastric intolerance, and flu-like symptoms did not differ greatly between PLC and placebo. For the comparison of PLC with L-carnitine, the certainty of evidence was low because this included a single, very small, cross-over study. Mean improvement in ACD was slightly greater for PLC compared to L-carnitine, with a mean difference in absolute improvement of 20.00 meters (95% CI 0.47 to 39.53; 1 study, 14 participants) or a 16% relative improvement (95% CI 0.4% to 31.6%). We found no evidence of a clear difference in the ICD (absolute improvement 4.00 meters, 95% CI -9.86 to 17.86; 1 study, 14 participants); or a 3% relative improvement (95% CI -7.4% to 13.4%). None of the other outcomes of this review were reported in this study. When PLC was compared with placebo, improvement in walking distance was mild to moderate and safety profiles were similar, with moderate overall certainty of evidence. Although In clinical practice, PLC might be considered as an alternative or an adjuvant to standard treatment when such therapies are found to be contraindicated or ineffective, we found no RCT evidence comparing PLC with standard treatment to directly support such use.

Vascular Surgery in Japan: 2016 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2016, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 136,414 vascular treatments were registered by 1,070 institutions in 2016. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 21,653, 17,560, 4,983, 2,557, 846, 54,462 and 34,353, respectively. In the field of aneurysm treatment, 19,144 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 60.3% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,714 (9.4%) cases were registered as ruptured AAA. The operative mortality of ruptured and unruptured AAA was 15.7%, and 0.6%, respectively. 35.9% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 15.8%, and 15.3%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 9,303 cases, including 1,329 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 8,257 cases. The EVT ratio was gradually increased at 47.0%. The number of varicose vein treatment tremendously increased to 52,639, and 68.5% of the cases were treated by endovenous laser ablations (EVLA). Regarding other vascular operations, 32,779 cases of vascular access operations and 1,411 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and EVLA for varicose veins. (This is a translation of Jpn J Vasc Surg 2021; 30: 23–41.)

A meta-analysis of randomized controlled trials on therapeutic efficacy and safety of autologous cell therapy for atherosclerosis obliterans

ObjectiveAtherosclerosis obliterans (ASO) is a chronic occlusive arterial disease and the most common type of peripheral arterial disease. Current treatment options like medication and vascularization have limited effects for “no-option” patients, and stem cell therapy is considered a viable option, although its application and efficacy have not been standardized. The objective of this review was to assess the safety and efficacy of autologous stem cell therapy in patients with ASO. MethodsWe performed a literature search of published randomized controlled trials (RCTs) for patients with ASO receiving stem cell therapy without a revascularization option. PubMed, Embase, and the Cochrane Library were searched. This study was conducted by a pair of authors independently and audited by a third author. Data were synthesized with a random-effects model. ResultsA total of 630 patients in 12 RCTs were included. The results showed that cell therapy significantly improved total amputation (relative risk [RR], 0.64; 95% confidence interval [CI], 0.47-0.87; P = .004), major amputation (RR, 0.69; 95% CI, 0.50-0.94; P = .02), ankle-brachial index (mean difference [MD], 0.08; 95% CI, 0.02-0.13; P = .004), transcutaneous oxygen tension (MD, 11.52; 95% CI, 3.60-19.43; P = .004), and rest pain score (MD, −0.64; 95% CI, −1.10 to −0.17; P = .007) compared with placebo or standard care. However, current studies showed cell therapy was not superior to placebo or standard care in all-cause death (RR, 0.75; 95% CI, 0.41-1.36; P = .34) and ulcer size (MD, −8.85; 95% CI, −29.05 to 11.36; P = .39). The number of trials included was limited. Moreover, most trials were designed for “no-option” patients, and thus the results should be applied with caution to other patients with peripheral arterial disease. ConclusionsPatients with ASO can benefit from autologous cell therapy in limb salvage, limb blood perfusion, and rest pain alleviation.

Vascular Surgery in Japan: 2015 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2015, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 124,299 vascular treatments were registered by 1,038 institutions in 2015. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 22,041, 15,671, 4,779, 2,313, 857, 48,837, and 29,801, respectively. In the field of aneurysm treatment, 18,907 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 57.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,850 (9.8%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.0%, and 0.6%, respectively. 33.6% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 16.6%, and 14.5%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,230 cases, including 1,194 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 7,441 cases. The EVT ratio was gradually increased at 47.4%. Venous treatment including 47,046 cases with varicose vein treatments and 531 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 29,801 cases of vascular access operations and 1,511 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2020; 29: 161–179.)

Characteristics of Peripheral Arterial Disease Patients in Vascular and Endovascular Surgery Department Dr. Mohammad Hoesin General Hospital between January 2018 - December 2019

Background: Peripheral artery disease (PAD) is a chronic occlusive arterial disease of the extremities caused by atherosclerosis leading to stenosis or occlusion characterized by decreased blood flow to the limb, due to obstruction or narrowing of the blood vessels. PAD often underdiagnosed and poorly understood. ​​Median annual expenditure per individual for patients with PAD was $ 11.553 to $ 42.613 in the United States. The lack of data on PAD in South Sumatra was the based for investigators to conducting this study.&#x0D; Methods: This research is a retrospective descriptive study. The purpose of this study was to describe the characteristics of PAD patient based on the Rutherford classification. There are 33 cases in this study.&#x0D; Result: The dominant patient was male, the youngest age was 28 years old and the oldest age was 71 years, with a mean age of 55.8 years. Diabetes mellitus, stage 1 hypertension, LDL more than 100 mg/dL, ABI results that showed PAD, and stage 2 Rutherford were the dominant cases in the sample of this study.&#x0D; Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of peripheral arterial disease patient.

Sensitivity and Specificity of Ultrasonographic Compared with CT Angiography in Detecting Femoropopliteal and Infrapopliteal Arterial Lesions in Lower Extremity Arterial Disease in Dr. Mohammad Hoesin General Hospital Palembang

Background: Peripheral artery disease (PAD) is a chronic occlusive arterial disease of the extremities caused by atherosclerosis.1 It is estimated that 20-30% of the population worldwide suffered PAD.2 PAD is associated with a 1-year mortality and limb loss rate of 20%.7 Critical limb ischemia (CLI) is a late stage clinical presentation of PAD. Imaging of the entire artery is possible using CT angiography. However, CT angiography has its drawbacks because the contrast used can be nephrotoxic, the risk of allergies, expensive, and not all health services have it. Ultrasonographic’s (USG) sensitivity, specificity and accuracy were 96.55%, 61.53%, and 78.84% for detecting lower limb distal artery lesions.11 Ultrasonographic does not require the use of contrast, radiation, low cost and almost all health services have them.12 However, the Ultrasonographic examination has its limitations depending on the operator's capabilities. It is therefore necessary to conduct research that have never been previously studied in South Sumatra.&#x0D; Methods: This study is a diagnostic test study that examines the sensitivity and specificity of ultrasound in detecting LEAD artery lesions. The samples were 29 patients.&#x0D; Results: At the femoropopliteal level, the results obtained were 91% sensitivity and 86% specificity. At the infrapopliteal level, the results obtained were 95% sensitivity and 87% specificity.&#x0D; Conclusion: Ultrasonographic has high sensitivity and specificity in detecting LEAD’s lesions

Cost-benefit analysis of the use of invasive intraoperative hemodynamic control of the state of peripheral blood flow in endovascular or hybrid reconstruction of multisegment lesions in chronic arterial occlusive disease of the lower extremities

Objective: to evaluate the cost-benefit ratio of the use of invasive intraoperative hemodynamic control of peripheral blood flow during correction of multilevel lesions in chronic arterial occlusive disease of the lower extremities.Material and methods. We compared the cost of the in-hospital period of treatment among patients of 3 comparable groups: the patients of the first group underwent interventions under angiographic control, of the second — under invasive intraoperative hemodynamic control of the state of peripheral blood flow in addition to angiography, and in the patients of the third group invasive hemodynamic control of the state of peripheral blood flow was followed by pharmacological tests.Results. The use of the given method made it possible to correct the extent of the performed procedures of revascularization and to estimate the efficiency of the phases of the operation in real time. The result of interventions in the groups with hemodynamic control was a reliable increase of the ankle-brachial index (ABI index) values (p — 00001) in shorter length of segments after revascularization (p — 0.05). At the same time, the reduced extent of the correction resulted in saving 807 BYN per case.Conclusion. The use of invasive intraoperative hemodynamic control allows of reducing the extent of the reconstruction in multisegment lesions with the achievement of satisfactory clinical outcomes with lesser economic costs.

Factors associated with long-term graft patency after lower extremity arterial bypasses.

PurposeThis study was conducted to determine factors associated with long-term graft patency after lower extremity arterial bypass (LEAB).MethodsDatabase of LEABs for patients with chronic arterial occlusive disease (CAOD) at a single institution was retrospectively reviewed. To determine the factors we compared demographic, clinical, and procedural variables between 2 patient groups; group I (graft patency < 2 years) and group II (graft patency ≥ 5 years after LEAB) using univariable and multivariable analyses.ResultsAmong 957 LEABs, 259 limbs (group I, 125 limbs and group II, 134 limbs) in 213 patients were included for the analysis. On a univariable analysis, younger age (69 years vs. 66 years, P = 0.024), hypertension (60.8% vs. 74.6%, P = 0.017), claudication (51.2% vs. 70.9%, P = 0.001), absence of prior intervention (50.4% vs. 73.9%, P < 0.001), common femoral artery based bypass (57.6% vs. 70.1%, P = 0.035), above-the knee bypass (36.8% vs. 64.2%, P < 0.001), postoperative graft salvage procedure (3.2% vs. 14.8%, P = 0.001), and statin use (75.2% vs. 88.8, P = 0.004) were associated with long-term patency. On a multivariate analysis hypertension (odds ratio [OR], 1.91; P = 0.038), claudication (OR, 2.08; P = 0.032), no prior intervention (OR, 2.48; P = 0.001), vein graft (OR, 4.36; P = 0.001), above-the knee bypass (OR, 4.68; P < 0.001), and graft salvage procedures (OR, 7.70; P < 0.001) were identified as independent factors.ConclusionThese factors can be considered in decision making before treatment of patients with CAOD.

Importance of physical detraining in functional capacity of individuals with chronic peripheral arterial occlusive disease: a cross-sectional pilot study.

BackgroundPhysical training is a well-established strategy for rehabilitation of the functional capacity of individuals with chronic peripheral arterial occlusive disease (PAOD). However, some individuals quit training after participating in a physical training program, undergoing detraining. There is scant literature on the effects of physical detraining in individuals with PAOD and it is therefore important to investigate the effects of this phenomenon.ObjectivesThe objective of this article was to evaluate the effects of physical detraining on functional capacity in individuals with PAOD.MethodsCross-sectional study with 22 individuals. Participants were divided into two groups: a detraining group (DG) and a control group (CG). The distance covered in the 6-minute walk test (6MWTD) and the pain-free walking distance (PFWD) were evaluated. The PFWD is the distance covered until claudication begins, i.e., the distance covered without pain.ResultsMean age was 66 ± 8 in the DG and 67 ± 7 in the CG. There were no differences between the groups in either the 6MWTD or the PFWD (p = 0.428; p = 0.537, respectively).ConclusionsThe present pilot study allows us to conclude that the functional capacity of individuals with PAOD who participated in a physical training program and subsequently underwent detraining was not superior in relation to individuals who did not participate in a physical training program. The results of the present study serve to encourage maintenance of physical exercise, since physical training is no longer effective if detraining occurs.

Chronic lower extremity arterial occlusive diseases

Chronic lower extremity arterial occlusive diseases

Vascular Surgery in Japan: 2014 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2014, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 113,296 vascular treatments were registered by 1,002 institutions in 2014. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 21,085, 14,344, 4,799, 2,088, 1,598, 42,864, and 26,518, respectively. In the field of aneurysm treatment, 17,973 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 55.7% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,824 (10.1%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.1%, and 0.6%, respectively. 32.1% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 15.7%, and 18.0%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,020 cases, including 1,210 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 6,324 cases. The EVT ratio was gradually increased at 44.1%. Venous treatment including 41,246 cases with varicose vein treatments and 520 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 25,024 cases of vascular access operations and 1,322 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2020; 29: 15–31.)