Lower Extremity Arteriosclerosis Obliterans Research Articles

Low concentration of iodixanol used in CT angiography of lower extremity arteriosclerosis obliterans

To evaluate the clinical diagnostic value of low concentration of iodixanol used in CT angiography (CTA) of lower extremity arteriosclerosis obliterans (LEASO). 42 patients which were suspect diagnosed with LEASO were divided to A group (270 mgI/ml iodixanol, tube voltage 100 kV) and B group (350 mgI/ml iohexol, tube voltage 120 kV), 21 patients in each group. Measure the body mass index (BMI) before the CTA of lower extremity. CTA results were analyzed with the digital subtraction angiography (DSA) as the "gold standard". There were no statistical difference of age, gender, BMI and CT value of the bifurcation of profunda femoral artery and superficial femoral artery, upper segment of anterior tibial artery and posterior tibial artery between A and B group. The diagnostic sensitivity and specificity of A and B groups of CTA were 97.0%, 99.1% and 98.3%, 99.5% for occlusion. Regard artery more than moderate stenosis (include moderate stenosis) as the overall statistics, the diagnostic sensitivity and specificity of A and B groups of CTA were 99.2%, 99.3% and 99.1%, 99.3%, the accuracy were 92.9% and 93.0%, the positive predictive and negative predictive value were 96.9%, 99.3% and 96.6%, 99.3%, respectively. The kappa value of A and B groups of CTA and DSA consistency test were 0.930 and 0.927, respectively. The CTA with low concentration of iodixanol combine with low tube voltage can achieve superior conventional scanning imaging features, and has great clinical value in the diagnosis of LEASO, also is an effective method for the inspection, evaluation and follow-up.

Special issues in endovascular treatment of lower extremities arteriosclerosis obliterans

To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans. A total of 34 patients (43 limbs) with lower extremity arteriosclerosis obliterans undergoing endovascular treatment from July 2010 to July 2012 were analyzed. The cohort had Fontaine stage II b (n = 16), Fontaine stage III (n = 10) and Fontaine stage III (n = 8). Among them, the lesions were of TASC IIA (n = 4), TASC IIB (n = 8), TASC IIC (n = 9) and TASC IID (n = 13). All patients underwent percutaneous transluminal angioplasty (PTA) plus stents after computed tomographic angiography (CTA) or digital subtraction angiography (DSA). And 9 patients underwent femoral endarterectomy associated with endovascular treatment. The success rate of this technique was 100%. One iliac artery ruptured during endovascular surgery. One patient suffered intraoperatively from arterial perforation. One patient was amputated one week later. One patient had in-stent thrombosis at Week 3 post-treatment. One patient was amputated at Week 4 after endovascular treatment. Thirty patients (38 limbs) were followed up for 13.3 months. During the follow-up, 3, 4 and 4 limbs became occluded at Month 6, 12 and 24 post-treatment respectively. Endovascular treatment has an excellent early patency rate. Special issues should be properly handled during endovascular treatment.

Significance of the distribution of platelet-derived growth factor B chain in arteriosclerosis plaque in type-2 diabetic patients with arteriosclerosis obliterans of lower extremity

This study aims to explore the expression of platelet-derived growth factor (PDGF) in arteriosclerosis plaque on type 2 diabetes mellitus (DM) with arteriosclerosis obliterans (ASO) of the lower extremity. A total of 24 samples from 12 patients with lower-extremity ASO who underwent surgical treatment were collected in this study. Among these samples were 12 iliofemoral arterial plaques and 12 popliteal or distal arterial plaques. Immunohistochemistry staining was performed on the plaque intima to determine the expression level of platelet-derived growth factor receptors α and β. Reverse-transcription polymerase chain reaction was carried out to detect the mRNA level of the PDGF A and B chains. PDGFR-α and PDGFR-β were excessively expressed in lower-extremity arteriosclerosis plaques. The mean PDGF B chain mRNA level in the popliteal arterial plaques of ASO patients with type-2 DM was increased when compared with that in the iliofemoral arterial plaques. The PDGF B chain mRNA level was higher in the popliteal arterial plaques in type-2 DM with ASO than in iliofemoral artery plaques. This finding confirmed that the PDGF B chain has a key function in arteriosclerosis development. Key words: Arteriosclerosis obliterans, platelet-derived growth factor, type-2 diabetes.

MicroRNA-21 Regulates Vascular Smooth Muscle Cell Function via Targeting Tropomyosin 1 in Arteriosclerosis Obliterans of Lower Extremities

The goal of this study was to determine the expression signature and the potential role of microRNAs in human arteries with arteriosclerosis obliterans (ASO). The expression profiles of microRNAs in human arteries with ASO and in normal control arteries were determined by quantitative reverse transcription-polymerase chain reaction array. Among the 617 detected microRNAs, multiple microRNAs were aberrantly expressed in arteries with ASO. Some of these dysregulated microRNAs were further verified by quantitative reverse transcription-polymerase chain reaction. Among them, microRNA-21 (miR-21) was mainly located in arterial smooth muscle cells (ASMCs) and was increased by more than 7-fold in ASO that was related to hypoxia inducible factor 1-α. In cultured human ASMCs, cell proliferation and migration were significantly decreased by inhibition of miR-21. 3'-Untranslated region luciferase assay confirmed that tropomyosin 1 was a target of miR-21 that was involved in miR-21-mediated cellular effects, such as cell shape modulation. The results suggest that miR-21 is able to regulate ASMC function by targeting tropomyosin 1. The hypoxia inducible factor-1 α/miR-21/tropomyosin 1 pathway may play a critical role in the pathogenesis of ASO. These findings might provide a new therapeutic target for human ASO.

Preliminary clinical application of SilverHawk directional atherectomy device in arteriosclerosis obliterans of lower extremity

Objective To evaluate the clinical efficiency and seeurity of SilverHawk directional atherectomy device in treating arteriosclerosis obliterans of lower extremity.Methods Seyen patients with lower extremity ischemia were treated with SilverHawk directional atherectomy.The lesions length varied from 1.8 to 14.5 cm.Clinical symptoms(Fontaine classification)included 4 cases of grade Ⅱ b,1 case of grade Ⅲ,2 cases of grade Ⅳ.The ABI varied from 0.28 to 0.65.Patency was evaluated with color duplex sonography or CTA besides clinical examination during follow-up.Results Seven occlusive lesions were recanalizated successfully.The technical success(residual stenosis<30%)rate was 100%. Clinical symptoms were obviously improved or disappeared.The ABI varied from 0.82 to 1.18(P=0.002),and Fontaine classification included 6 cases of Ⅰ:1 case of Ⅱ a.Patency rate was 100%and the ABI varied from 0.75 to 1.14(P=0.938).Fontaine classifications keep consistent l-6 nonths after operation.Conclusion SilverHawk drectional atherectomy Was a safe and effective way for treatment of lower arteriosclerosis obliteran. Key words: Arteriosclerosis obliterans; Lower extremity; Atherectomy

The effects of different hydration strategies before endovascular treatments to the renal function of the arteriosclerosis obliterans patients

To compare the efficacies of different hydration strategies in protecting the renal function of the arteriosclerosis obliterans (ASO) patients undergoing endovascular treatments. 40 patients who underwent endovascular treatments for arteriosclerosis obliterans of lower extremities in the Vascular Surgery Department of PLA Hospital from January 2009 to October 2009 were divided into normal (serum creatinine < or = 110 micromol/L) and abnormal (serum creatine > 110 micromol/L) groups according to their baseline serum concentration of creatinine before treatments. Each group was treated by different hydration strategies 12 h before procedures. Changes of serum creatinine and creatinine clearance were measured 6, 24, 48 h after procedures to evaluate the changes of renal function and the effects of different hydration strategies. No contrast-induced nephropathy (CIN) was observed among the 40 patients. There are significant differences between normal saline hydration group and control group in the changes of serum creatinine and creatinine clearance 24 h and 48 h after exposure to contrast medium for the normal renal function patients (P < 0.05). For the patients pre-existing renal dysfunction, no significant difference was found between Sodium Bicarbonate + Saline group and Saline group in the changes of Scr and Ccr 6, 24, 48 h after exposure to contrast medium (P > 0.05). Sodium chloride provides a good efficacy for preventing the adverse effect of contrast medium to the renal function of the ASO patients. For the patients pre-existing renal dysfunction, Combination hydration with sodium bicarbonate is not more effective than normal saline alone in preventing contrast-induced renal dysfunction.

Therapeutic neovascularization by transplantation of mobilized peripheral blood mononuclear cells for limb ischemia

Autolougous transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized human peripheral blood mononuclear cells (PBMNCs) improves limb ischemia in patients with arteriosclerosis obliterans of lower extremities and with diabetic foot. However, the mechanism of action of PBMNCs remains elusive. Here, we studied comparatively the effects of the G-CSF-mobilized PBMNCs and CD34-depleted G-CSF-mobilized PBMNCs in an ischemia model of athymic nude mice. Fluorescence- labeled human PBMNCs [1 x 10(6)] were intramuscularly injected into the unilateral ischemic hindlimbs of mice. Laser Doppler imaging analysis revealed a significantly augmented blood perfusion at day 7, 14 and 28 after operation. The capillary density was also markedly increased and the rate of limb loss was significantly reduced in cell-transplanted groups when compared with those in PBS group. In comparison with G-CSF-mobilized PBMNCs, the therapeutic efficiency of G-CSF-mobilized PBMNCs deprived of CD34+ cells was impaired. Transplanted cells were found to accumulate around arterioles and scatter in capillary networks. Incorporation of transplanted cells into new capillaries was observed in the G-CSF-mobilized PBMNCs group, but was not detected in the group deprived of CD34+ cells. There was an elevated expression of VEGF in ischemic tissue. Colocalization of VEGF and transplanted mononuclear cells within adductor tissue was demonstrated. These findings indicate that G-CSF-mobilized PBMNCs promote vascular growth not only by incorporating into vessel walls but also by supplying angiogenic factors. The depletion of CD34+ cells attenuated the therapeutic efficiency of G-CSF-mobilized PBMNCs in response to ischemia-induced neovascularization.

Autologous transplantation of peripheral blood stem cells as an effective therapeutic approach for severe arteriosclerosis obliterans of lower extremities.

Treatment of severe arteriosclerosis obliterans of lower extremities (ASOLE) remains a clinical challenge. To develop a more effective approach, we evaluated the clinical efficacy of autologous transplantation of mobilized peripheral blood stem cells (PBSCs) in 5 patients with ASOLE. The patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF, 600 micro g/day) for 5 consecutive days. On day 5, PBSCs were collected, sorted from blood circulation of patients, and then intramuscularly injected into their ischemic lower limbs. A significant improvement of clinical manifestations including severe pain, skin temperature and ulcer, was observed, without obvious adverse effect. The patient's limb was successfully saved. Satisfactory remission was obtained 3 months after transplantation as shown by significant improvement in ankle-brachial pressure index (ABI), blood flow in personal vascular laboratory (PVL), laser Doppler blood perfusion, and the angio-graphic scores. Our data suggest for the first time that autologous transplantation of mobilized PBSCs provides a practical, safe, and effective method of treatment for lower limb ischemia.

Aortic calcification as a marker for arteriosclerosis obliterans of lower extremities in the elderly

Aortic calcification as a marker for arteriosclerosis obliterans of lower extremities in the elderly

Lipid and lipoprotein abnormalities in lower-extremity arteriosclerosis obliterans.

The prevalence of abnormal lipid and lipoprotein values was determined in 125 consecutive patients with lower-extremity arteriosclerosis obliterans, and the lipid and lipoprotein abnormalities in these patients were characterized. Only 13% of the patients had normal lipid/lipoprotein profiles. Forty-eight percent of patients had low levels of high-density lipoprotein cholesterol. High-density lipoprotein cholesterol values were lower in patients with concomitant coronary heart disease compared with those without heart disease. High-density lipoprotein cholesterol values were inversely related to weight, to triglyceride values, and to diabetes mellitus. Twenty-eight percent of patients had "desirable" total cholesterol levels (< 200 mg/dL), and 32% had low-density lipoprotein cholesterol values less than 130 mg/dL. Following National Cholesterol Education Program guidelines may be misleading in patients with documented lower-extremity atherosclerosis; therefore, complete lipid/lipoprotein profiles should be performed in these patients.

下肢閉塞性動脈硬化症に対するａｏｒｔｏ−ｆｅｍｏｒｏ−ｄｉｓｔａｌ ｂｙｐａｓｓ一期的手術の検討

下肢閉塞性動脈硬化症に対するａｏｒｔｏ−ｆｅｍｏｒｏ−ｄｉｓｔａｌ ｂｙｐａｓｓ一期的手術の検討

下肢閉塞性動脈硬化症血行再建例の遠隔成績 とくに自家血管と代用血管との比較

下肢閉塞性動脈硬化症血行再建例の遠隔成績 とくに自家血管と代用血管との比較

下肢閉塞性動脈硬化症血行再建術の遠隔成績と問題点 再建術式の選択

下肢閉塞性動脈硬化症血行再建術の遠隔成績と問題点 再建術式の選択

Relationships between arteriosclerosis obliterans of lower extremities and coronary artery disease

Relationships between arteriosclerosis obliterans of lower extremities and coronary artery disease

Fibrinolytic Activity and the Effects of Beta-Pyridylcarbinol (Ronicol) in Patients with Arteriosclerosis Obliterans

Twenty-one patients with arteriosclerosis obliterans of lower extremities were treated with beta-pyridylcarbinol (Ronicol) for five weeks. The long-term therapy with beta-pyridylcarbinol did not influence platelet aggregability. Activation of the fibrinolytic system was observed. This fibrinolytic effect of Ronicol was abolished in patients treated with aspirin. In most cases a slight clinical improvement was seen, manifested by elongation of pain-free walking distance and increased blood flow in affected limbs. It is concluded that the therapeutic effect of Ronicol in humans may be partly mediated by the release of endogenous prostacyclin.

PHLEBOTOMY FOR MODERATE ERYTHROCYTHEMIA. IMPROVEMENT IN PERIPHERAL CIRCULATION AND MYOCARDIAL FUNCTION IN PATIENTS WITH OBLITERATIVE ARTERIAL DISEASE OF THE LOWER EXTREMITIES.

Moderate erythrocythemia was a finding in 90 of 1,100 patients with arteriosclerosis obliterans of the lower extremities seen in a 10-year period. In some patients, the major arteries were occluded, while in others, these vessels were patent, but there were ischemic symptoms and signs in the distal portion of the extremities presumed to be due to obliteration of distal arteries and arterioles. These patients were without evidence of polycythemia vera; their hematocrit values were in the range of 47%-54%, usually considered high normal. Such moderate elevations plus the diminished caliber of vessels due to arteriosclerosis produced symptoms in excess of those expected from either condition alone. Reduction of hematocrit by phlebotomy improved the circulation. Laboratory studies before and after bloodletting substantiated the improvement in peripheral circulation and the efficiency of the heart as a pump, as shown by ballistocardiography.