Lower Limb Circulation Research Articles

Changes in Blood Volume and Oxygenation in Lower Limb Tissue in Patients Maintaining the Lithotomy Position Under General Anaesthesia.

To investigate the effect of the lithotomy position on lower limb circulation under general anaesthesia, near-infrared spectroscopy (NIRS) was used to measure changes in blood volume and oxygenation in thigh tissue in patients (n=35) under general anaesthesia in the lithotomy position. The NIRS measurement items, including total haemoglobin concentration (total-Hb), tissue haemoglobin index (nTHI), and tissue oxygenation index (TOI) in the thigh, were recorded for 60min, while the patients were in the lithotomy position. The correlation between changes in each measurement item and patient characteristics, elevation of the lower extremities, and cardiorespiratory indices were evaluated. Data obtained from 24 patients were analysed. The median values (quartile deviation) of changes in total-Hb, nTHI, and TOI during the 60-min period from baseline were+3.09 (1.99) μmol/L, +0.08 (0.03) a.u., and +2.25 (1.75) %, respectively, all of which were significantly increased (p<0.05). Regression analysis showed that no factor was significantly associated with the increase in any measurement item. The present results suggest that circulation in thigh tissue tends to shift towards hyperaemia during 60 min of general anaesthesia in the lithotomy position, regardless of patient background factors or changes in cardiorespiratory conditions.

Possible Assessment of Calf Venous Pump Efficiency by Computational Fluid Dynamics Approach.

Three-dimensional simulations of peripheral, deep venous flow during muscular exercise in limbs of healthy subjects and in those with venous dysfunction were carried out by a computational fluid-dynamics (CFD) approach using the STAR CCM + platform. The aim was to assess the effects of valvular incompetence on the venous calf pump efficiency. The model idealizes the lower limb circulation by a single artery, a capillary bed represented by a porous region and a single vein. The focus is on a segment of the circuit which mimics a typical deep vein at the level of the calf muscle, such as the right posterior tibial vein. Valves are idealized as ball valves, and periodic muscle contractions are given by imposing time-dependent boundary conditions to the calf segment wall. Flow measurements were performed in two cross-sections downstream and upstream of the calf pump. Model results demonstrate a reduced venous return for incompetent valves during calf exercise. Two different degrees of valvular incompetence are considered, by restricting the motion of one or both valves. Model results showed that only the proximal valve is critical, with a 30% reduction of venous return during calf exercise in case of valvular incompetence: the net flow volume ejected by the calf in central direction was 0.14 mL per working cycle, against 0.2 mL for simulated healthy limbs. This finding appeared to be consistent with a 25% reduction of the calf ejection fraction, experimentally observed in chronic venous disease limbs compared with healthy limbs.

Effect of Leg Exercise on the Lower Limb Circulation of Patients with Diabetes Mellitus: A Systematic Review

Introduction: Hyperglycemia is one of the typical symptoms of patients with diabetes mellitus. This systematic review aims to systematically review the research evidence related to the effects of leg exercise on increasing the value of the ankle-brachial index in patients with diabetes mellitus.Methods: This study used a systematic review with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We identified 85 articles from Scopus, 34 from Pubmed and 401 from ProQuest. The keywords used in the search were "Foot Exercise", "Buerger Allen Exercise" and "Diabetes Mellitus". The inclusion criteria for this study were 1) Interventions with a focus on the Buerger Allen Exercise and 2) papers published in English. The deadline for publication was between 2014 and 2019.Results: After going through the selection process, 8 articles were deemed to be relevant for inclusion in this systematic review. One effort to overcome the interference of lower limb circulation is through physical exercise in the form of leg exercises. The exercises that can be applied are Buerger Allen Exercises.Conclussion: The simplest examination that can be done to detect any interference with lower limb circulation is to measure the value of the Ankle Brachial Index (ABI)

Application of walking combined with Buerger exercise in patients with grade 0 diabetic foot

Objective To study the application of walking combined with Buerger exercise in the treatment of grade 0 diabetic foot. Methods Eighty patients with grade 0 diabetic foot were randomly divided into observation group and control group.The control group was trained by walking exercise.The observation group was trained by walking combined with Buerger exercise through 12 months of training.The changes of self-sensory symptoms, ABI and DAWV were observed. Results The self-sensory symptoms of the two groups were significantly decreased (observation group: markedly effective 15 cases, effective 19 cases; control group: markedly effective 5 cases, effective 23 cases). The effective rate of the observation group was higher than that of the control group(85% vs.70%, χ2=7.831, P<0.05). The ABI ratio of the two groups were higher than those before treatment, and the ABI ratio of the observation group was higher than that of the control group[(0.889±0.113) vs.(0.842±0.124), t=1.772 P<0.05]. The ratio of DAWV in the observation group was higher than that in the control group[(6.772±0.435)cm/s vs.(6.543±0.552)cm/s, t=2.061, P<0.05]. Conclusion Walking combined with Buerger exercise can improve the blood flow velocity and blood flow of the collateral circulation of the lower limbs of patients with grade 0 diabetic foot, and improve the self-sensory symptoms of peripheral neuropathy. Key words: Buerger exercise; Diabetic foot, grade 0; Ankle brachial index; Mean blood flow velocity, dorsalis pedis artery

Reconstruction of Traumatic External Iliac Artery Dissection Due to Vascular Clamping.

Traumatic external iliac artery dissection after renal transplant is a rare complication, but it should be urgently managed due to its devastating effects on graft and lower limb circulation. External iliac artery dissection is seen more in recipients with diabetes mellitus and comorbid disease. Recipients with external iliac artery dissection should be treated immediately by percutaneus angioplasty or surgical reconstruction. In this study, we reported the management of 2 kidney transplant cases with external iliac artery dissection due to vascular clamping of the artery. External iliac artery dissection was diagnosed by ultrasonography in both cases. After failed percutaneous interventional angioplasty, we reconstructed the external iliac artery dissection surgically and replaced the external iliac artery with polytetra-fluoroethylene grafts in both patients. Both patients were discharged with normal functioning grafts showing 0.9 and 0.8 mg/dL serum creatinine levels at month 3 posttransplant. Close monitoring of recipients after transplant is mandatory for early diagnosis and early management of external iliac artery dissection to prevent graft loss and preserve lower limb circulation. Routine Doppler ultrasonography is an inexpensive and useful tool for early diagnosis in cases of sudden cessation or decrease in urine. In cases of failed percutaneous interventional angioplasty, reconstruction with synthetic vascular grafts can be safely applied in external iliac artery dissection.

Quantitative Evaluation of Rehabilitation Effect on Peripheral Circulation of Diabetic Foot

Diabetes may cause different foot problems, which could easily lead to infection, ulcers, and increasing risk of amputation due to nerve or vascular injury. In order to reduce the risk of amputation, Buerger's exercise is frequently used for rehabilitation to improve the blood circulation in lower limbs. However, it is difficult to evaluate the rehabilitation efficiency with Buerger's exercise objectively. In this study, a novel non-invasively optical system is developed to non-invasively monitor the change of the foot blood circulation before and after long-term Buerger's exercise. Radial basis function neural network is also used for classifying the healthy and diabetic groups from the change of relative total hemoglobin (HbT) concentration and tissue oxygen saturation (StO2) and providing an index to evaluate the rehabilitation efficiency with Buerger's exercise. Finally, the experimental results show that the relative HbT concentration and StO2 in lower limbs corresponding to different groups are significantly different and could be used as the factors for the classification of healthy subjects and diabetic foot patients. Moreover, the tendency of the relative HbT concentration and StO2 rise after the long-term rehabilitation with Buerger's exercise.

下肢血管エコーで行う血流評価

高齢化や糖尿病の増加に伴い，末梢動脈疾患（peripheral arterial disease ; PAD）やPADに起因した下肢潰瘍患者が多くなり，下肢動脈の血流精査が診断や治療の評価に大変重要となってきている．血流検査は，患者への負担を最小限に，低侵襲で簡潔な検査になるよう，目的に応じて観察部位や評価項目を絞って施行していくのが理想である．最近では，多くの施設で導入されている血管エコーが注目されてきている．血管エコーは，低侵襲でリアルタイムに狭窄や閉塞などの病変を詳細に情報化することができるため，下肢虚血のスクリーニングや治療の経過観察など繰り返し評価に有用であると考えられている．血管エコーの評価項目には，血流波形，収縮期最大血流速度，血管径，プラーク，狭窄，閉塞，血流量，血管抵抗などがあり，目的に応じてさまざまな評価ができるため，必要な評価項目を事前に把握し，有用な検査にすることが重要である．

Gastric Rupture after Bag Mask Ventilation: A Review Under a Case Report

Introduction: Bag mask ventilation is considered a safe and effective ventilation method. Despite the high frequency of gastric distension, few cases of gastric rupture are reported in literature. Case report: A 50-year-old female firefighter, ASA 2, was admitted in to the Burn Unit due to 2nd/3rd grade burns (34% of body surface). On the 22nd day after admission, she underwent balneotherapy, under sedation and analgesia and in spontaneous ventilation. During the procedure, desaturation (SpO2 65%) and paradoxical respiratory abdominal movements were noticed. Very high pressures were immediately required for bag-mask ventilation and the bag was difficult to compress. A remarkable increase in abdominal perimeter was evident, leading to the compromise of lower limb circulation. The patient was intubated and a noradrenaline infusion started due to marked hypotension, unresponsive to fluids. Imaging studies revealed a left pulmonary atelectasis and a massive pneumoperitoneum. Emergent exploratory laparotomy demonstrated a gastric laceration in an ischemic mucosa area, which was corrected. The patient was extubated on the first post-operative day, with no further complications. Conclusion: Although bag mask ventilation is a routine practice, it is associated with several complications. Gastric rupture is an extreme rare complication of this technique. The higher incidence of curling ulcers in burned patients may have contributed to gastric rupture and this case stresses the need to consider this potentially lethal complication.

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2

INTRODUÇÃO: A alta incidência do Diabetes mellitus (DM) na população torna essa patologia alvo de muitas pesquisas. Uma das complicações do DM é a neuropatia periférica crônica caracterizada por atrofia e degeneração axonal e/ou alteração da célula de Schwann. A fisioterapia atua na estimulação da regeneração da fibra nervosa, o que reduz o risco de desenvolvimento do pé diabético. OBJETIVO: Identificar o comprometimento da sensibilidade nos membros inferiores (MMII) de diabéticos e verificar fatores que contribuíram para o desenvolvimento do pé diabético, como glicemia, hemoglobina glicada (HbA1c), tempo de diagnóstico, pressão arterial e antropometria. MATERIAIS E MÉTODOS: Os diabéticos foram avaliados na Associação dos Diabéticos de Bauru, participaram de entrevista e foram submetidos a antropometria, triagem pressórica e teste neurossensorial no Sistema Pontuação Clínica Toronto (SPCT). RESULTADOS: Os 68 pacientes (61,76% mulheres e 38,23% homens) tinham 62,93 ± 9,64 anos, apresentaram pressão sistólica de 132,54 ± 17,95 mmHg e diastólica 80,39 ± 11,35 mmHg, índice de massa corpórea 30,34 ± 5,80 kg/m², glicemia 149,20 ± 60,37mg/dL, HbA1c 7,72 ± 1,4%; tempo de diagnóstico de um a 34 anos. Dentre eles, 80,88% apresentavam sobrepeso; 72,06%, hipertensão arterial; 42,64%, dislipidemia; 14,7%, problemas renais; e 17,64%, vasculares. Pelo SPCT, 97,05% apresentavam neuropatia, 95,59% com simetria. Na avaliação, 57,35% apresentavam alteração sensitiva protetora; 60,29%, sensibilidade térmica; 26,47%, tátil; 17,64%, vibratória; 7,35%, dolorosa; e 1,47%, alteração cinestésica. Nos pés, 72,05% apresentavam pele ressecada; 64,70%, fissuras; 54,41%, calosidade; e 44,11%, micose; 50% referiram dor; 39,7%, dormência; 41,17%, parestesia; 27,94%, ataxia. Reflexos estavam ausentes ou diminuídos em 14,71% dos indivíduos; desses, 38,23% no Aquileu. Observou-se correlação positiva entre o SPCT com a glicemia e a circunferência abdominal e a hemoglobina glicada com a glicemia. CONCLUSÃO: Houve grande incidência de neuropatia simétrica; alteração de sensibilidade com presença de sinais clínicos, sintomas, arreflexia e hiporeflexia; e incidência de obesidade e hipertensão associadas. Faz-se necessário o acompanhamento da fisioterapia na avaliação da sensibilidade para prevenir, reduzir sintomas e melhorar a circulação sanguínea em MMII.

Region-specific vascular remodeling and its prevention by artificial gravity in weightless environment

Evidence from recent ground and spaceflight studies with animals and humans supports the notion that microgravity-induced vascular remodeling contributes to postflight orthostatic intolerance. In the vascular beds of lower body, such as in splanchnic and lower limb circulation, resistance vessels would undergo hypotrophy and decrement in myogenic tone and vasoreactivity. Thus, despite the concurrent sympathetic activation, the increase in peripheral vascular resistance would still be compromised while astronauts were re-exposed to Earth's 1-G gravity, since ~75% of the total vascular conductance lies below the heart. On the contrary, cerebral arteries would undergo hypertrophy and vasoreactivity enhancement due to adaptation to cerebral hypertension, which protects the down-stream microcirculation in the brain during spaceflight. However, the enhanced vasoreactivity of cerebral vessels might also aggravate postflight orthostatic intolerance, particularly after long-duration spaceflight. Animal studies have indicated that the underlying mechanisms may involve ion-channel remodeling in vascular smooth muscle cells and vascular NO-NOS and local renin-angiotensin system (L-RAS). Furthermore, vascular remodeling and associated ion-channel and L-RAS changes can be prevented by a countermeasure of daily short-duration restoring to normal standing posture. These findings substantiate in general the hypothesis that redistribution of transmural pressure along the arterial vasculature due to the removal of gravity might be the primary factor that initiates vascular remodeling in microgravity, and daily short-duration restoring its normal distribution by intermittent artificial gravity (IAG) can effectively prevent the vascular adaptation and hence postflight cardiovascular deconditioning. IAG might also be beneficial in maintaining vascular health during future long-duration space flight.

Arterio-venous gradients of endothelial progenitor cells reveal a complex kinetics in human limb ischemia

Ischemic recruitment of endothelial progenitor cells (EPCs) in involved in compensatory angiogenic in animal models, but this still needs to be substantiated in humans. We enrolled 12 patients, who underwent surgical correction of abdominal aortic aneurysm without atherosclerosis of leg arteries (n = 4) or lower limb atherosclerosis obliterans (AO; n = 8). We measured VEGF, SDF-1, lactate and CD34+ KDR+ EPCs in the arterial and venous circulation of lower limbs. We found that, irrespectively of AO stage and lactate production, there was no consistent arterio-venous gradient of EPC, VEGF and SDF-1. Notably, in 4/8 patients, EPCs were more abundant in the vein than in the artery. EPC gradient was directly correlated with VEGF gradient and inversely correlated with SDF-1 gradient. In conclusion, we failed to show any consistent gradient of EPCs across ischemic limbs in relation to severity of atherosclerosis obliterans, but we speculatively suggest that a bidirectional traffic of EPCs in and out the ischemic tissue might be regulated by VEGF and SDF-1.

The Anatomy and Physiology of the Venous Foot Pump

The presence of a venous pumping mechanism in the foot may be significant for venous return in the lower extremities. However, there has been a lack of conclusive research in the area to date and controversy still exists over the detailed anatomy and physiologic mechanism of the venous foot pump. A full understanding of the anatomy and physiology of the venous foot pump is essential for designing effective interventions for the prevention, treatment, and management of venous disease in the lower limbs. This article highlights and discusses the relevant literature relating to the anatomy and physiology of the venous foot pump. In addition, the plantar aspects of 10 cadaveric feet were dissected. These dissections revealed the presence of a previously unreported secondary deep plantar arch and/or deep system of venous connections in the foot and facilitated a more detailed description of the patterns of doubling and branching of the primary veins of the foot. The results of these dissections are discussed within the context of previous work in the field with the aid of detailed diagrams of the dissected feet and may provide a backdrop for the physiology of the venous foot pump and its potential role in lower limb circulation. This is discussed in the last section of the article, which also highlights existing controversy regarding the role of weight bearing and muscular contraction as the dominant mechanisms for venous pumping in the foot.

Depiction of residual emboli following pulmonary embolism with thrombotic scintigraphy

In the treatment of pulmonary embolism (PE), the presence of residual emboli is known to seriously affect the recurrence and prognosis. We attempted to depict the residual emboli in the subacute stage of PE using indium-111-oxine labeled platelet scintigraphy (In-plt). In-plt was performed on 22 patients with PE who showed an improvement according to lung perfusion scintigraphy. Their accumulation was assessed along with the blood coagulation ability measured on the same day. In addition, radioisotope venography (RI-veno) was performed simultaneously with In-plt to measure the circulatory findings in the lower limb for comparison. All patients received systemic heparin during the acute stage and received warfarin at the time of testing. Accumulation of In-pit was observed in 7 patients (32%), and positive signals were found in the lower limbs or pelvic cavity in all cases. Two patients were suspected of having poor lower limb circulation from their RI-veno findings, and these findings were largely consistent with the areas of In-plt accumulation. Some emboli persist after extensive anti-coagulation therapy. The use of In-pit is effective in determining the therapeutic measures and assessing the prognosis as this method allows us to clearly depict the existence of such emboli.

Angiographic and three-dimensional intravascular ultrasound analysis of combined intracoronary beta radiation and self-expanding stent implantation in human coronary arteries

This study tested the combination of vascular brachytherapy (VBT) and self-expanding Wallstent implantation in coronary lesions of patients at high risk for restenosis as assessed angiographically by quantitative coronary analysis and by 3-dimensional intravascular ultrasound analysis. Twenty-nine "de novo" lesions were managed with a self-expanding stent alone (n = 19) or with a self-expanding stent after beta-VBT (n = 10) in 27 patients who had been identified by high levels of plasma angiotensin-converting enzyme as being prone to myointimal growth after stent implantation. At 6 months, the increase in stent strut diameter was similar in the 2 groups by quantitative coronary analysis and 3-dimensional intravascular ultrasound (Delta mean stent strut diameter -0.33 +/- 0.3 vs -0.40 +/- 0.3 mm, p = 0.5; Delta stent area -11.8 +/- 6.1 vs -12.0 +/- 6.1 mm(2), p = 0.9; Delta stent volume -96.9 +/- 112 vs -83.5 +/- 73 mm(3), p = 0.7; for groups treated with VBT and self-expanding stents and only self-expanding stents, respectively). In-stent neointimal proliferation was decreased in the group treated with VBT and self-expanding stents (minimal luminal diameter 2.5 +/- 0.8 vs 1.88 +/- 0.8 mm, p = 0.04) by quantitative coronary analysis (minimal luminal area 6.7 +/- 2.5 vs 4.1 +/- 1.9 mm(2), p = 0.01), by intravascular ultrasound, and proliferation volume (84.6 +/- 66.4 vs 159.2 +/- 103.5 mm(3), p = 0.05) by 3-dimensional intravascular ultrasound. Positive vessel and luminal remodelings were observed in 50% of the group treated with VBT and self-expanding stents and in 11% of the group treated only with self-expanding stents (p = 0.02). The combined use of VBT and self-expanding stents is a novel approach that enlarges vascular lumen by preventing vessel constriction and neointimal proliferation. The feasibility and good results of this experimental approach suggest that the simultaneous use of these 2 technologies may be an interesting alternative for difficult vascular districts with high restenosis rates, such as peripheral circulation in the lower limbs.

Inflammation parallels severity of chronic venous insufficiency

Objective: This study was designed to assess the haemodynamic flow changes in patients with chronic venous insufficiency (CVI). Methods: Duplex scanning was used to evaluate prospectively the flow characteristics in the lower limb circulation and the number of enlarged lymph nodes in the groin of normal subjects, patients with CVI classes 2, 4, 5 and 6, and patients with acute cellulitis. Phasicity and continuous flow patterns were assessed in the venous system, while the arterial system was evaluated for tri-phasic flow, absence of flow reversal and absence of flow reversal with hyperaemic flow (increased peak systolic and end diastolic velocities). Additionally, the number and size of the groin lymph nodes around the saphenofemoral junction were recorded. Results: Patients with more severe class 4-6 CVI demonstrated an increased prevalence of abnormal flow patterns within the venous system of the leg compared to the normal phasic flow pattern seen in the absence of disease ( P &lt; 0.001). Within the arterial system, significant changes were also observed in all three arteries studied in the legs of patients with class 4-6 CVI ( P &lt; 0.001). For both the arterial and venous systems, no difference was noted between control limbs vs class 2 diseases or class 4-6 diseases vs cellulitis. With respect to the evaluation of inguinal lymph nodes, patients with class 2 disease were approximately four times as likely to have positive lymph nodes, and patients with more severe CVI were approximately 13 times as likely to have significant lymph nodes present. Conclusions: This study demonstrated that patients with more advanced stages of CVI had arterial and venous flow increases similar to those seen in an acute inflammatory condition such as cellulitis. These changes were most pronounced in the perforating and subcutaneous vessels in the leg.

An optimal inflow procedure for multi-segmental occlusive arterial disease: ilio-femoral versus aorto-bifemoral bypass

Treatment of chronic critical limb ischemia still remains one of the most serious problems of vascular surgery. Most often, chronic critical limb ischemia is caused by multi-segmental disease of arterial tree, involving both the aorto-femoral and infrainguinal vessels. In the majority of these cases, proper correction of aorto-iliac arteries is sufficient to restore the circulation in lower limbs. However, in 10–15% it is necessary to perform multi-segmental reconstructions. In these cases it is extremely important to choose the optimal inflow procedure. The aim of this retrospective study was to compare perioperative and long-term results of multi-segmental reconstructions, using aorto-bifemoral, unilateral ilio-femoral, and extra-anatomical bypass as inflow procedures. During the 10-year period (1984–1994), 4074 aorto-femoral reconstructions were performed for treatment of occlusive arterial disease. In 449 cases (11%), multi-segmental aorto-femoro-poplteal/tibial reconstructions were undertaken. Aorto-bifemoral bypasses was performed in 131, unilateral ilio-femoral bypasses in 288, and extra-anatomical bypasses in 30 cases. In 221 cases, the operations were performed in one stage, and in 228 cases a two-stage procedure took place. Postoperative mortality was 3.8% in the aorto-bifemoral bypass group, 1.3% in the unilateral ilio-femoral group, and 3,3% in the extra-anatomical group. Primary inflow graft patency rate after 12 months was 94.7% in the aorto-bifemoral bypass group, 94.1% in the unilateral ilio-femoral group, and 80% in the extra-anatomical group. Secondary inflow graft patency rate was 97.8% in the aorto-bifemoral bypass group, 96.2% in unilateral ilio-femoral group, and 96.7% in extra-anatomical group. The 5-year primary and secondary graft patency rates were 90.9% and 94.7% in the aorto-bifemoral bypass group, 88.5% and 93.4% in the unilateral ilio-femoral group, and 66.7% and 77.3% in the extra-anatomical group, respectively. Conclusion: Unilateral ilio-femoral bypass as an inflow procedure for treatment of multilevel occlusive arterial disease is as effective as aorto-bifemoral bypass, with lower perioperative mortality and morbidity rates. Extra-anatomical bypasses are, however, less effective.

An Optimal Inflow Procedure for Multi-Segmental Occlusive Arterial Disease: Ilio-Femoral versus Aorto-Bifemoral Bypass

Treatment of chronic critical limb ischemia still remains one of the most serious problems of vascular surgery. Most often, chronic critical limb ischemia is caused by multi-segmental disease of arterial tree, involving both the aorto-femoral and infrainguinal vessels. In the majority of these cases, proper correction of aortoiliac arteries is sufficient to restore the circulation in lower limbs. However, in 10–15% it is necessary to perform multi-segmental reconstructions. In these cases it is extremely important to choose the optimal inflow procedure. The aim of this retrospective study was to compare perioperative and long-term results of multi-segmental reconstructions, using aorto-bifemoral, unilateral ilio-femoral, and extra-anatomical bypass as inflow procedures. During the 10-year period (1984–1994), 4074 aorto-femoral reconstructions were performed for treatment of occlusive arterial disease. In 449 cases (11%), multi-segmental aorto-femoro-poplteal/tibial reconstructions were undertaken. Aorto-bifemoral bypasses was performed in 131, unilateral ilio-femoral bypasses in 288, and extra-anatomical bypasses in 30 cases. In 221 cases, the operations were performed in one stage, and in 228 cases a two-stage procedure took place. Postoperative mortality was 3.8% in the aorto-bifemoral bypass group, 1.3% in the unilateral ilio-femoral group, and 3,3% in the extra-anatomical group. Primary inflow graft patency rate after 12 months was 94.7% in the aorto-bifemoral bypass group, 94.1% in the unilateral ilio-femoral group, and 80% in the extra-anatomical group. Secondary inflow graft patency rate was 97.8% in the aorto-bifemoral bypass group, 96.2% in unilateral ilio-femoral group, and 96.7% in extra-anatomical group. The 5-year primary and secondary graft patency rates were 90.9% and 94.7% in the aorto-bifemoral bypass group, 88.5% and 93.4% in the unilateral ilio-femoral group, and 66.7% and 77.3% in the extra-anatomical group, respectively. Conclusion: Unilateral ilio-femoral bypass as an inflow procedure for treatment of multilevel occlusive arterial disease is as effective as aorto-bifemoral bypass, with lower perioperative mortality and morbidity rates. Extra-anatomical bypasses are, however, less effective.

Acute Effects of Thromboxane Dual Blocker (KDI-792) on Different Portions of Lower Limb Blood Flow—A Study Using Doppler Ultrasonography and Laser Doppler Flowmetry in Type 2 Diabetic Patients

The acute effects of a newly synthesized thromboxane dual blocker (KDI-792), a combined thromboxane synthase inhibitor and receptor antagonist, on lower limb circulation were examined using two-dimensional color and pulse Doppler ultrasonography and laser Doppler flowmetry. A randomized single-masked, placebo-controlled trial was performed on 36 type 2 diabetic patients with minimally impaired baseline flow. The anatomical cross-sectional area (CSA), maximum flow velocity (MFV) and flow volume index (FVI) in the right dorsal pedis artery (DPA) and right femoral artery (FA) were determined by Doppler ultrasonography before and 45 and 90 minutes after the administration of either 100 or 200 mg of KDI-792 to the dose groups or placebo to the control group. Periflux blood flow (PBF) in the right foot was determined simultaneously by laser Doppler flowmetry. Both CSA and MFV in the dose groups were significantly increased in both the FA and DPA. FVI was markedly increased from 21.4 ± 3.7 to 68.3 ± 26.8 in the DPA (M ± SD, P < 0.01) and from 365.4 ± 35.3 to 771.7 ± 75.7 in the FA (P < 0.01) in the 200 mg dose group. In the 100 mg dose group, FVI was markedly increased from 20.0 ± 8.7 to 68.3 ± 26.8 (P < 0.01) in the DPA and from 372.5 ± 130.0 to 677.5 ± 187.8 (P < 0.01) in the FA. PBF was also increased in both dose groups (from 4.15 ± 1.4 to 7.0 ± 4.0 ml/min/100 g tissue in the 200 mg dose group, P < 0.01), whereas there were no significant changes in either measurement in the control group. There were no significant changes in pulse rate or blood pressure after administration in either the dosage group or the placebo group. These and previous findings indicate that a single administration of KDI-792 markedly increases lower limb blood flow and might have a more potent vasodilating effect than that of prostaglandin I 2 derivatives.

Acute effect of beraprost sodium on lower limb circulation in patients with non-insulin-dependent diabetes mellitus-evaluation by color doppler ultrasonography and laser cutaneous blood flowmetry

The acute effects of beraprost sodium (sodium (±)-(1R ∗, 2R, 3aS ∗, 8bS ∗)-2, 3, 3a 8b-tetrahydro-2-hydroxy-l-((E)-(3S ∗)-3-hydroxy-4-methylI-octen-6-yny1] -1H-cyclopenta [b] bensofuran-5-butyrate), a stable analogue of prostaglandin I 2 which works as a vasodilator and anti-platelet agent, were investigated in patients with non-insulin dependent diabetes mellitus. Its effects on the dorsal pedis artery were examined using a new real-time two-dimensional Doppler ultrasonographic technique and by laser blood flowmetry. Before and 60 min after oral administration of beraprost sodium (Dolner ® 40 μg) and elastase (Elaszym ® 1800 U), the cross-sectional area (CSA) of the dorsal pedis artery and its blood flow index (BFI), calculated from the maximum flow velocity and area, were determined. Dermal microcirculatory blood volume (MBV) was also measured by laser blood flowmetry. In the beraprost sodium group, the CSA, BFI and MBV were significantly increased, while in the elastase group, no significant changes were observed. These result suggest that beraprost sodium has a beneficial effect on diabetic macro- and microangiopathy.

Effects of Beraprost Sodium on Lower Limb Circulation in NIDDM

Effects of Beraprost Sodium on Lower Limb Circulation in NIDDM