Lower Extremity Arterial Occlusion Research Articles

To investigate the role of the AAC-8 scoring in predicting restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with DCB

Objective: To investigate the role of the Abdominal Aortic Calcification-8 (AAC-8) scoring system in predicting restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with drug-coated balloon (DCB). Methods: In this retrospective study, 62 patients who underwent dilatation and angioplasty with DCB for lower limb atherosclerotic obliterans (ASO) were enrolled from September 2018 to June 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them who aged (73.9±11.3) years, 37 were males and 25 were females. Patients were divided into two groups according to the condition of the lower extremity arteries after dilatation and angioplasty with DCB: recurrence group (n=26) and patency group (n=36). Logistic regression was used to analyze the factors associated with restenosis or occlusion of lower extremity arteries after dilatation and angioplasty with DCB. The predictive value of the AAC-8 score for restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB was analyzed using the receiver operating characteristic curves (ROC curves). Results: The postoperative follow-up was 16.30 (10.97, 24.10) months in the patency group and 9.03 (6.98, 15.31) months in the recurrence group. The results of multifactorial logistic regression analysis showed that an elevated AAC-8 score (OR=1.388, 95%CI: 1.067-1.806, P=0.015) was an associated factor of restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB. The ROC curve analysis showed that the area under the curve (AUC) of the AAC-8 score for predicting restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB was 0.687 (95%CI: 0.550-0.824, P=0.013), with a cut-off value of 5.5 points, a sensitivity of 65.4% and a specificity of 69.5%. Conclusions: Elevated AAC-8 score is associated with restenosis or occlusion of the lower extremity arteries after dilatation and angioplasty with DCB. When the cut-off value is 5.5, the AAC-8 score predicts restenosis or occlusion of the lower extremity arteries after DCB dilation and angioplasty with a sensitivity of 65.4% and a specificity of 69.5%.

The effect of traditional Chinese medicine fumigation and washing combined with Western medical care on resting pain in elderly males with lower extremity arterial occlusion

The effect of traditional Chinese medicine fumigation and washing combined with Western medical care on resting pain in elderly males with lower extremity arterial occlusion

Serum magnesium level and cardiac valve calcification in hemodialysis patients

IntroductionCardiac valve calcification is closely related to cardiovascular disease. The aim of this study was to investigate the magnesium level and cardiac valve calcification in hemodialysis patients.MethodsA cross-sectional study was conducted in 105 maintenance hemodialysis patients with complete follow-up data from June 2020 to May 2021 in Beijing Tsinghua Changgung Hospital, Tsinghua University. Baseline data, including sex, age, primary disease, liver and kidney function, electrolytes and parathyroid hormone, were recorded. According to their echocardiograms, patients were divided into a cardiac valve calcification group and a noncardiac valve calcification group, and the correlations between valve calcification and clinical data were analyzed.ResultsOf 105 patients under hemodialysis, 60 (56.6%) were male, with an average age of 62.1 ± 13.5 years and a mean dialysis duration of 58.8 ± 45.4 months. The majority of primary renal diseases were diabetic nephropathy (55, 51.9%). Approximately 64.8% of the 105 maintenance hemodialysis patients had cardiac valve calcification, and 35.2% were in the noncardiac valve calcification group. The independent t test and the chi-square test analysis showed that the cardiac valve calcification group had older age, higher smoking rate, diabetes mellitus, lower extremity arterial occlusion, coronary heart disease, and coronary artery calcification ratio but lower parathyroid hormone, serum calcium, serum magnesium, albumin, prealbumin, and high-density lipoprotein cholesterol levels (P < 0.05). Logistic regression analysis showed that age, diabetes mellitus, coronary artery calcification, lower serum magnesium, lower serum calcium, and lower parathyroid hormone levels were associated with valve calcification.ConclusionThe presence of cardiac valve calcification was associated with age, calcium, phosphorus and lower magnesium level. These factors we should pay more attention in clinical practice.

Differences between Lower Extremity Arterial Occlusion vs. Stenosis and Predictors of Successful Endovascular Interventions.

Background and Objectives: In patients with peripheral artery disease, there is insufficient understanding of characteristics that predict successful revascularization of the lower extremity (LE) chronic total occlusions (CTOs) and baseline differences in demographic, clinical, and angiographic characteristics in patients with LE CTO vs. non-CTO. We aim to explore these differences and predictors of successful revascularization among CTO patients. Materials and Methods: Two vascular centers enrolled LE-CTO patients who underwent endovascular revascularization. Data on demographics, clinical, angiographic, and interventional characteristics were collected. LE non-CTO arterial stenosis patients were compared. A total of 256 patients with LE revascularization procedures were studied; among them, 120 had CTOs and 136 had LE stenosis but no CTOs. Results: Aspirin use (Odds ratio, OR: 3.43; CI 1.32-8.88; p = 0.011) was a positive predictor whereas a history of malignancy (OR: 0.27; CI 0.09-0.80; p = 0.018) was a negative predictor of successful crossing in the CTO group. The CTO group had a higher history of myocardial infarction (29.2 vs. 18.3%, p = 0.05), end-stage renal disease (19.2 vs. 9.6%, p = 0.03), and chronic limb-threatening ischemia as the reason for revascularization (64.2 vs. 22.8%, p < 0.001). They were more likely to have advanced TransAtlantic Inter-Society Consensus (TASC) stages, multi-vessel revascularization procedures, longer lesions, and urgent treatment. Conclusions: The use of aspirin is a positive predictor whereas a history of malignancy is a negative predictor for successful crossing in CTO lesions. Additionally, LE-CTO patients have a higher incidence of comorbidities, which is expected given their higher disease burden. Successful endovascular re-vascularization can be associated with baseline clinical variables.

Abstract No. 362 Texture analysis of arterial graft thrombus on CT angiography: correlation with age of thrombus and implication on catheter directed thrombolysis

Catheter-directed thrombolysis (CDT) is the widely utilized treatment for patients with acute occlusion of lower extremity arteries and bypass grafts. The success and dose of tissue plasminogen activator (tPA) required is influenced by age of thrombus, which is primarily assessed by clinical parameters. The aim of this study is to investigate the potential role of utilizing quantitative texture analyses in determining the age of thrombus in relation to patients’ clinical profiles, further predicting the dose of required thrombolytic agent.

Comparison of resting/postexercise ankle-brachial index and transcutaneous partial pressure of oxygen for noninvasive diagnosis of peripheral artery disease in type 2 diabetes mellitus

Background: Type 2 diabetesType 2 diabetes mellitus (T2DM) is a strong risk factor for peripheral artery disease (PAD) and PAD diagnosis in T2DM may indicate coexisting coronary artery disease as well. Postexercise ankle brachial index (ABI) and transcutaneous partial pressure of oxygen (TcPO2) have not been evaluated for PAD diagnosis among Indian T2DM patients. This study aimed to evaluate the performance of resting + postexercise(R + PE) ABI and R + PE-TcPO2 for PAD diagnosis among T2DM patients at increased PAD risk, using colour duplex ultrasound (CDU) as reference standard. MethodsThis prospectively conducted diagnostic accuracy study involved T2DM patients at increased PAD risk. R-ABI≤0.9 or PE-ABI decline >20% from resting value in those with R-ABI between 0.91 and 1.4, R–TcPO2 <30 mm Hg or PE decline of TcPO2 to <30 mm Hg in those with R–TcPO2 ≥30 mm Hg, CDU showing >50% stenosis or complete occlusion of lower extremity arteries constituted PAD. ResultsAmong 168 patients enrolled, R + PE-ABI diagnosed PAD in 19(11.3%), R + PE-TcPO2 in 61 (36.3%) and 17 (≈10%) had PAD finally confirmed by CDU. Sensitivity, specificity, PPV and NPV of R + PE-ABI for PAD diagnosis were 82.3%, 96.7%, 73.7% and 98% and that of R + PE-TcPO2 were 76.5%, 68.2%, 21.3% and 96.2%, respectively. PE-ABI increased the sensitivity of ABI by ≈ 18% and had 100% PPV for PAD. When both ABI and TcPO2 (R + PE tests) were normal, PAD could be safely excluded in 88% of patients. ConclusionPE-ABI should be routinely employed and TcPO2(R/PE) is unreliable as a stand-alone test for PAD detection among moderate to high risk T2DM patients.

Peripheral arterial occlusion due to COVID-19: CT angiography findings of nine patients

BackgroundReports have indicated an association of large vessel peripheral arterial occlusion in the setting of Coronavirus Disease 2019 (COVID-19). While prior investigations have mostly focused on venous or cerebral arterial occlusions, we examined patients presenting exclusively with peripheral arterial extremity occlusions to investigate for any predisposing factors in this subset of COVID-19 patients. Materials and methodsThis is a retrospective study of COVID-19 patients with peripheral arterial occlusions presenting to a multi-hospital health care system in New York City between February 1st, 2020 and April 30th, 2020. Patient data and computed tomography angiography (CTA) exams in this subset were then collected and analyzed. ResultsFor the months of February, March, and April 2020, we identified 9 patients (ages 37–93 yrs) at our health care system who underwent extremity CTA for large vessel upper or lower extremity arterial occlusion and were diagnosed with COVID-19. Patient medical histories and clinical parameters were evaluated to identify common risk factors including obesity, hypertension, hyperlipidemia, and diabetes. Patients presented with increased inflammatory markers including ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as increased D-dimer. ConclusionOur findings suggest patients with COVID-19 and comorbidities presenting with elevated inflammatory markers and D-dimer may be at increased risk of large vessel peripheral arterial occlusion.

Diagnostic Value of CT Value of Arterial Angiography in Femoral Artery Obstructive Disease

Objective: To compare the changes of CT values of distal femoral artery and radial artery obstructive lesions and whether CTA showed the diagnosis of complete occlusion of lower extremity arteries by CT angiography and DSA. Materials and Methods: A total of 50 consecutive patients with femoral artery and radial artery occlusion were enrolled and retrospectively studied, aged 32–83 years, mean 68.5 ± 8.7 years old; 35 males and 15 females, reverse descending The sign was defined as the contrast fill gradient in the distal lumen of the vascular occlusion site, which was characterized by a progressive increase in the CT value of the distal lumen of the obstructed lesion from proximal to distal. DSA was used as the criterion to statistically analyze the incidence of CT angiographic inverse descending signs and collateral circulation in chronic complete obstructive lesions and partial obstructive lesions of the femoral artery and radial artery, and statistical analysis was performed. Results: The rates of reversed CT values in the chronic total occlusion group and the partial occlusion group were 76.9% (20/26) and 20.8% (5/24), respectively. The signs of reverse degeneration were significantly more common in the chronic complete occlusion group (X2 = 13.1). P &lt; 0.05). The incidence of peripheral collateral circulation in the chronic occlusion group and partial obstruction group was 80.8% (21/26) and 29.2% (7/24), respectively. The incidence of collateral circulation in the chronic complete occlusion group was significantly higher than that in the partial occlusion group. Blocking group (X2 = 13.5, P &lt; 0.05). The sensitivity of CT and angiographic collateral signs for the diagnosis of chronic complete occlusion of the femoral artery and radial artery was 92.3%, and the specificity was 70.8%. Conclusions: The inverse degeneration of CT values and the signs of CTA collateral circulation have a high specificity for the diagnosis of chronic complete occlusion of the femoral artery and radial artery, and help to identify partial occlusion of the femoral artery and radial artery and chronic complete occlusion.

Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes.

ObjectivesTo evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia.MethodsFrom 2009 to 2017, 52 patients (44 men, eight women, mean 67.2 years) underwent combined treatment for acute thrombotic occlusion of lower extremity arteries. The patients presented with acute limb ischemia and we selectively perform combined treatment in the cases with challenging clinical considerations (e.g. various spectrum of thrombus, underlying atherosclerotic lesions). Combined treatment included cutdown of common femoral artery, thrombectomy using a Fogarty balloon catheter, balloon angioplasty, stenting, and catheter-introduced thrombus fragmentation and aspiration. Patients’ medical records were retrospectively reviewed and follow-up data were collected. The technical and clinical success rates and limb salvage were assessed. The Kaplan-Meier method was used to analyze primary patency rates and overall survival rates. Univariate analyses were performed to determine the factors related to clinical outcomes.ResultsTechnical and clinical success rate was 90.4% and 80.8%, respectively. The mean follow-up duration was 26.5 ± 25.8 months. Primary patency was 91.4%, 86.1%, and 74.6% at six months, 1-, and 2-year, respectively. Limb salvage without amputation was 88.5% (46/52). The overall survival rates at six months, 1-, and 3-year were 82.6%, 80.2, and 56.9%, respectively. The 30-day mortality was 5.8% (3/52). Univariate analysis showed that percutaneous transluminal angioplasty (PTA) type (balloon versus stent) was related to clinical failure.ConclusionsCombined treatment can be effective and safe for ALI patients even under challenging clinical conditions.

Opportunities of using gene therapy in patient with non-reconstructable critical limb ischemia in proximal reocclusion

The aim of the study: to evaluate the effect of complex treatment on "no-option” patients with aortoiliac reocclusion using a plasmid-based with VEGF165 gene therapy in the 3-year follow-up study. Material and methods. In total, 3 patients with Leriche's syndrome in stage III, IV of chronic lower limb ischemia (according to the classification of Fontaine-Pokrovsky) were treated and observed in the 3-year follow-up study. All patients were men, the average age was 58 years. All patients underwent surgical reconstruction of the aortoiliac segment. In the period from 1 to 3 years after the initial intervention, there was a reocclusion of the aortoiliac segment. Based on the results of angiography, these patients were classified as non-reconstructable due to total occlusion of lower extremity arteries. All patients received standard conservative treatment in combination with gene therapy. Endpoints of the study: the survival rate, the limb salvage rate. Results: During 3-year follow-up two patients are alive, one dead due to unrelated with Leriche's syndrome reasons, the limb salvage rate was 100 %.

Early versus late thrombolysis in acute arterial occlusion of lower extremity

BackgroundAcute arterial occlusion in lower extremity is an urgent condition which occurs when there is an abrupt interruption of blood flow into an extremity. Reperfusion through early intervention can increase limb salvage and decrease mortality. There was no common agreement when is the best to start thrombolysis in treating acute arterial occlusion. This study was designed to study the efficacy of an early thrombolysis compared with a late thrombolysis. MethodWe identified all patients discharged from the Gwangju Veterans hospital with a diagnosis of acute arterial occlusion between 2006 and 2014. 72 patients were eligible, and every patient had treated with catheter-directed thrombolysis on the day or 1day after admission. Among them, 42 patients had undergone an early thrombolysis (less than 7days after the onset of symptoms) and the other 30 patients had undergone a late thrombolysis (more than 7days after the onset of symptoms). The primary outcome was amputation rate at 6months. The secondary outcomes were all cause mortality at 6months and increase of ankle brachial index (ABI). ResultsAmputation rate at 180days in the early thrombolysis group was 7.1% as compared with 30% in the late thrombolysis group. All cause mortality at 6months and increase of ABI were not different between two groups. In multivariable Cox-regression analysis, late thrombolysis was independent predictor of amputation at 6months. ConclusionEarly thrombolysis was superior in preventing amputation than late thrombolysis.

English

Objective: The objective is to analyse the changes of haemodynamic and Doppler ultrasonography spectrum in the proximal arterial occlusion of lower extremities, and to explore the value of spectrum Doppler ultrasonography in the diagnosis of lower extremity arterial occlusive disease. Methods: Thirty-four patients (thirty-nine occlusion arteries) were examined with two-dimensional ultrasound combined with colour Doppler flow imaging (CDFI), and the results were compared. Result: The waveform shape in the artery proximal to the occlusion shows that blood flow velocity becomes slower, and diastolic reverse wave slowly disappears. Systolic waveform records a steep upstroke, a slow downstroke and a shoulder on the downstroke. The appearance of the shoulder on the downstroke is earlier than the diastolic upward wave. The differences of peak systolic velocity, acceleration time, deceleration time, systolic acceleration, deceleration, diastolic reverse flow velocity, systolic acceleration time/systolic duration and systolic deceleration time/systolic duration in the proximal occlusion segment compared with the control group are statistically significant (p < 0.05). Conclusion: Artery occlusion can lead to haemodynamic response and spectrum waveform change. Timely discovery of the changes of the spectrum can be of clinical significance in the diagnosis of lower extremity arterial occlusive disease.

The impact of infrainguinal endovascular interventions on the results of subsequent femoro-tibial bypass procedures: A retrospective cohort study

Background: Endovascular recanalization has become the accepted first-line treatment strategy for most lower extremity arterial occlusions, especially in patients with critical limb ischemia (Rutherford 4–6). Prior endovascular interventions have been described as risk factors for the outcome of subsequent lower extremity bypass surgery. The effect on subsequent tibial and peroneal bypasses is controversial. We analyzed the impact of prior endovascular lower extremity revascularization procedures on the short- and mid-term results of femoro-tibial and femoro-peroneal bypasses. Methods: A retrospective analysis was conducted of all patients who had undergone tibial or peroneal bypass surgery after prior endovascular interventions (PEI-Group, n = 40) of the same extremity in our department from October 2007 to October 2012. We compared this group with a group of patients who had received a tibial or peroneal bypass as primary revascularization procedure (BF-Group, n = 93) during the same period of time because primary endovascular therapy had been deemed unfeasible in those cases. Indication in all cases was critical limb ischemia; the median age was 78 years (range 50–90 years), 45.1% were diabetics, and 42.9% were female. The graft material was autologous vein in 80 cases and HePTFE in 53 cases. Endpoints of the analysis were primary and secondary patency rates, limb salvage and survival at 2 years postoperatively. Results: At 2 years overall primary patency was 68.4%, secondary patency was 69.5%, limb salvage was 83.6% and survival was 62.6%. Primary patency for the BF-Group was 74.3% vs. 55.1% for the PEI-Group (P = .310) at 2 years; secondary patency was 74.6% vs. 59.1% (P = .268). Prior endovascular intervention did not have any significant effects on limb salvage (83.7% vs. 83.6%; P = .470) or survival rates (61.0% vs. 65.0%; P = .258) at the 2-year mark, either. There were no significant differences in graft occlusion, death and major amputation rates within the first 30 postoperative days. Except for male gender, there were no significant differences in risk factors and indications between the two groups. Conclusions: Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia.

The application of non-invasive arteriosclerosis detection methods in early diagnosis for young type 2 diabetic patients with lower extremity arterial disease

Objective To investigate the clinical value of non-invasive atherosclerosis detection technology for the early diagnosis of young type 2 diabetic patients with lower extremity vascular disease .Methods 78 young patients with type 2 diabetes（ T2DM group） and 80 cases in the healthy control group were detected some indicators , including upstroke time（UT）%,mean artery pressure（%MAP）,the pulse wave speed（baPWV） and ankle-brachial index（ABI） by Omron arteriosclerosis detector.Those items were comprehensively used to evaluate the diabetes patients of lower extremity vascular disease .Results There were statistically significant differences in UT ,%MAP, baPWV and ABI between the T2DM group and the control group（t=4.218,8.798,-3.392,5.136,all P〈0.01）. ABI of 6 patients was less than 0.9.Moreover,five of these 6 patients examined by color Doppler ultrasound had arte-rial plaque formation.As to patients of ABI 〉0.9,2 cases of them were promoted lower extremity arterial stenosis and occlusion,and then they were certified by color Doppler ultrasound .Conclusion Non-invasive atherosclerosis detec-tion technology has better accuracy to the diagnosis of young type 2 diabetes patients with atherosclerosis ,and may find patients with blocked arteries earlier ,provide better value for early clinical intervention . Key words: Diabetes mellitus, type 2; Arteriosclerosis; Middle aged; Early diagnosis

Pharmacotherapy in diabetics with arterial occlusion of lower extremity

糖尿病患者是下肢动脉病变(又称周围动脉病变,PAD)的高危人群.一项在美国基层医院的大型横断面研究,前瞻性评估年龄≥70岁或年龄在50～69岁有吸烟或糖尿病史的患者的PAD的发生率,结果显示该人群中PAD检出率为29％[1].我国50岁以上的合并至少1项心血管危险因素的糖尿病人群中的临床研究证实,约有20％合并PAD[2].PAD是全身动脉硬化的一个标志,不仅发病率高,死亡率也高,PAD患者5年病死率为70％ ～ 80％.70％以上的PAD患者合并心、脑血管病变.2007年跨大西洋周围动脉诊疗的多学会专家共识及2010年中国2型糖尿病防治指南均指出:PAD的治疗目的包括改善患者下肢缺血症状以及降低患者的发生心血管事件的风险.对于体力活动明显受限的患者,治疗的主要目标是缓解症状,改善运动耐量,主要的内科药物如下。

Clinic significances of the penile brachial index in the diagnosis of erectile dysfunction

ObjectiveTo review the clinic significances of the penile brachial index (PBI) in the diagnosis of vascular erectile dysfunction.MethodsFifty four patients complaining for erectile dysfunction at least 3 months, 25–55 years...

Relationship between syndrome differentiation of traditional Chinese medicine and vascular endothelial function in patients with diabetic arterial occlusion of lower extremities

To investigate the relationship between syndrome differentiation of traditional Chinese medicine (TCM) and characteristic changes of vascular endothelial function in patients with diabetic arterial occlusion (DAO) of lower extremities. Forty patients with DAO were selected as trial group. Twenty patients among them were attributed to blood stasis syndrome (group A1), and the others were attributed to syndrome of pathogenic dampness-heat attacking the lower limb (group A2) according to syndrome differentiation type of TCM. Patients with diabetes (group B), arteriosclerosis obliterans (group C) and healthy people (group D) were observed as the control groups, respectively. There were 20 cases in each group. Endothelium-dependent dilation (EDD) and endothelium-independent dilation (EID) were measured by high resolution ultrasound in the 100 subjects and the changes of vascular tension factors were also studied. The results showed that EDD in group A was reduced significantly as compared with that in the groups B, C and D. The levels of vascular contractile factors such as endothelin-1 (ET-1) and thromboxane B2 (TXB2) in group A were higher than those in the groups B, C and D, while the levels of vascular dilatory factors such as nitric oxide (NO) and 6-keto-prostaglandin F1alpha(6-Keto-PGF1alpha) were declined significantly as compared with those in the groups B and D. Linear correlation analysis showed that EDD was correlated positively with the levels of NO and 6-Keto-PGF1alpha, while the levels of ET-1 and TXB2 had negative correlation with EDD. EDD and EID in group A2 were declined significantly as compared with those in group A1. Our findings indicate that endothelial dysfunction may play an important role in the pathogenesis of DAO and may be associated with syndrome differentiation of TCM.

Transcription factor decoys for the prevention of vein bypass graft failure.

Failure of vein bypass grafts, performed for either coronary or lower extremity arterial occlusions, is a common clinical problem that incurs significant morbidity and mortality. Vein grafts provide a unique opportunity for genetic interventions, since the target tissue is available for manipulation ex vivo prior to implantation, and prior to the onset of the pathophysiologic events that lead to graft disease. Smooth muscle cell proliferation is a hallmark of neointimal hyperplasia in vein grafts and arteries, and is an attractive target for molecular therapy. Gene blockade strategies can be accomplished by delivery of small oligodeoxynucleotides (ODN) that target specific mRNAs ('antisense') or that competitively inhibit transcription factors ('decoys'). Transcription factors are attractive targets for molecular therapy since they influence the expression of a large number of genes involved in a coordinated cellular program. An ODN decoy approach has been developed targeting the transcription factor E2F, which is critically involved in cell cycle progression. Brief (10 minute) incubation of the ODN in solution, using non-distending pressure, results in efficient delivery of the ODN to >80% of cells in the vein wall. Preclinical studies in a rabbit model of vein grafting and hypercholesterolemia demonstrated a marked reduction in neointima formation, as well as prolonged resistance to graft atherosclerosis. Phase I/II studies conducted in lower extremity and coronary bypass patients have demonstrated safety and feasibility, and have also suggested possible efficacy. Large, randomized multicenter, phase III trials are currently under way to evaluate the efficacy of E2F decoy treatment on preventing vein bypass failure in both peripheral and coronary grafting procedures. These studies herald the arrival of a new class of molecular agents into the armamentarium of cardiovascular therapies.

Blood Coagulation and Fibrinolysis Activation during Sudden Arterial Occlusion of Lower Extremities – an Association with Ischemia and Patient Outcome

We compared hemostatic and fibrinolytic plasma markers in 41 patients having acute or subacute occlusion of lower limb arteries with 20 patients suffering stable peripheral arterial occlusive disease (PAOD). During occlusion, the amount of thrombin-antithrombin III (TAT) complex was five-fold higher compared with stable PAOD, being 16 micrograms/l [95% confidence interval (CI) 11-21 micrograms/l] vs 3 micrograms/l (95% CI 2-4 micrograms/l), p < 0.003. Similarly, D-dimer was over four-fold (p = 0.0001), while tissue plasminogen activator and plasminogen activator inhibitor-1 (PAI-1) antigens were about two-fold (p = 0.02 and p < 0.003, respectively) higher than in PAOD. Coagulation and fibrinolysis markers were increased most in patients with recent symptom onset, which mainly represented embolus rather than thrombosis. The marker levels assessing coagulation and fibrinolysis were related with myoglobin and CK, indicators of skeletal muscle damage. Finally, increased TAT, PAI-1 antigen, and myoglobin concentrations associated with poor outcome.

Thyrocardiotoxic Embolic Syndrome

Embolic occlusion of lower extremity arteries caused by hyperthyroidism-induced atrial fibrillation occurs rarely. Severe end organ damage may be prevented by aggressive medical and surgical intervention. Subtle signs of hyperthyroidism should be sought when arterial occlusion and atrial dysrhythmia are discovered. About 25% of thyrotoxic patients have atrial fibrillation, and up to 40% of this subgroup have systemic emboli; thus, 3% to 10% of all thyrotoxic patients may have systemic emboli. This estimation supports the recommendation for anticoagulation in all hyperthyroid individuals with atrial fibrillation.