Occlusive Disease Of Lower Limbs Research Articles

Effects of Liposomal Simvastatin Nanoparticles on Vascular Endothelial Function and Arterial Smooth Muscle Cell Apoptosis in Rats with Arteriosclerotic Occlusive Disease of Lower Limb via P38 Mitogen-Activated Protein Kinase Nuclear Factor Kappa-B Pathway.

This article prepared a simvastatin-NLCs for the treatment of arteriosclerotic occlusive disease of lower limbs. Taking the size distribution, polydispersity coefficient, encapsulation efficiency and drug loading of simvastatin-NLCs as evaluation indicators, various prescription factors of simvastatin- NLCs were investigated. The in vitro release behavior and stability of simvastatin-NLCs were also investigated. A hyperlipidemia rat model was established using high-fat diets. SD rats fed ordinary diet were set as normal control groups. 20 rats, 20 in the simvastatin group and 20 in the simvastatin nanocarrier group. After 5 weeks of drug intervention, the rats were sacrificed and the aorta was taken to determine the smooth muscle cell apoptosis rate. Studies have shown that simvastatin nanocarriers can more effectively reduce blood lipids in hyperlipidemia rats, increase the rate of smooth muscle cell apoptosis in hyperlipidemia rats, and delay the onset of atherosclerosis.

Aberrant configuration of femoral vessels as cause of arterial occlusive disease

Variations in the branching pattern of femoral and profunda femoris arteries have clinical implications while performing various diagnostic imaging procedures as well as during surgeries that are performed in the femoral triangle. Awareness about these variations aid surgeons during preoperative clinical evaluation for surgical and interventional revascularization of the ileo-femoral and femoro-popliteal segments, in open canulation of femoral artery for cardiopulmonary bypass, in radiological interventions for A-V malformations, and in salvage operations for traumatic limb ischemia. Here we report an aberrant configuration of profunda femoris artery which presented as a case of arterial occlusive disease of lower limb. On surgical exploration, Profunda femoris artery was found originating on the medial aspect of left common femoral artery high up in the inguinal region as compared to its usual lower and lateral origin. There was atheromatous occlusion of superficial femoral artery from its origin upto distal femoral metaphysis. In case of occlusion of the superficial femoral artery, the profunda femoris artery forms an effective collateral bed between the ileo-femoral segment and the popliteal artery and its branches. The clinical implications associated with these variations in therapeutic and diagnostic interventions is been discussed along with relevant literature review. Further study is necessary to identify aberrant configuration of femoral vessels as a cause of arterial occlusive disease in the lower limbs.

Clinical value of CT angiography and MR angiography in the diagnosis of arteriosclerotic occlusive disease of lower limb

Objective To study the value of CT angiography(CTA) and three dimensional contrast enhanced magnetic resonance angiography(3D CE-MRA) in the diagnosis of arteriosclerotic occlusive disease (ASO) of lower limb and evaluate arterial stenosis. Methods Thirty-eight patients clinically suspected ASO were studied with CTA and3D CE-MRA,twenty-two patients underwent DSA at the same time. The degree of seriousness of the stenosis shown by various imaging techniques were analyzed respectively. Results Using the DSA images as the standard reference, the sensitivity and specificity of CTA were 97.3% ,99. 1%, and MRA both were 100.0% in detecting the segments occluded. With regard the detection of segments that had more than moderate stenosis ,the sensitivity and specificity of CT were 99.3% ,97.6% ,and MRA were 97.9% ,96.4%. The degree of seriousness of the stenosis shown by MRA was overestimated than CTA on the segments that had more than moderate stenosis(x2 =5.80,P ＜0. 05). Conclusion CTA and 3D CE-MRA were reliable method in diagnosis of ASO. Key words: Arteriosclerosis obliterans; Tomography, spiral computed; Magnetic resonance angiography

Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion

Based on recent literature data, subintimal arterial angioplasty, its indications and contraindications, methods and techniques, treatment results, and perspectives are introduced in this article. During the last two decades, with increasing human lifespan, more and more frequently a combination of progressive chronic lower limb ischemia, which is caused by occlusive disease, and severe condition occurs. In such cases, patients cannot be operated on. In Europe and the United States of America, patients undergo subintimal angioplasty. It is a minimally invasive technique for the treatment of lower limb occlusive disease, when without tissue incision, under local anesthesia, blood flow through damaged artery is normalized. Thus, the occlusion is removed without surgery, patient's quality of life is improved, and survival is increased.

Diagnosis and Management of Ischemic Nephropathy

Analysis of the Third National Health and Nutrition Examination Survey (1988 to 1994) suggests that chronic kidney disease (CKD) is a major public health problem (1). Approximately 11% of the US population has CKD. Roughly half have a GFR <60 ml/min per 1.73 m2 with or without kidney damage (stages 3 to 4), and half have exclusively kidney damage as manifested by microalbuminuria (stages 1 to 2) (2). It is widely recognized that the prevalence of stage 5 CKD is also increasing at a rapid rate, and it is estimated that the number of patients who have ESRD may reach 2.24 million by 2030 (3). Evidence to establish reduced GFR as an independent risk factor for cardiovascular disease (CVD) mortality has emerged. Analysis of data from several population-based epidemiologic studies (4,5) demonstrates poorer outcomes regarding stroke, myocardial infarction, and congestive heart failure (CHF) in patients with even mild compromise of kidney function. The morbidity of this group of patients constitutes an economic burden both directly in terms of resource utilization and indirectly through loss of productivity and impaired quality of life (2). Atherosclerotic renovascular disease (ARVD) can result in renovascular hypertension. However, ARVD is an increasingly recognized cause of CKD (6,7). In this article, we focus mainly on ARVD or renal artery stenosis (RAS) secondary to atherosclerosis as a cause of ischemic nephropathy. ARVD is a disease of aging, and several studies have shown its strong association with extrarenal atherosclerotic disease (8–10). Patients with ARVD seem to be at a much greater risk for cardiovascular death than for progressing to renal replacement therapy (11). Whether renal revascularization can benefit renal and cardiovascular outcomes has not been established. Atherosclerosis is the cause of approximately 90% of RAS in adults who are older …

Infrainguinal revascularization in the diabetic patient.

This article reviews the epidemiological, anatomical and physiological background to infrainguinal arterial reconstruction in the diabetic patient. There is no firm evidence in the literature for the existence of a surgically significant occlusive 'small-vessel' disease in diabetic patients, either as an aetiological component in the pathogenesis of diabetic foot lesions or as a factor limiting the success of infrainguinal bypass grafting. Recent published results of infrainguinal vascular reconstruction in patients with diabetes are reviewed. These are encouraging; early aggressive treatment of lower-limb occlusive disease may be warranted in the diabetic patient.

Serum Apolipoprotein AI Levels in Atherosclerotic and Diabetic Patients

Objective: to evaluate the association between Apolipoprotein AI (ApoAI), Apolipoprotein B100 (ApoB) and the presence of lower limb atherosclerotic occlusive disease.Materials and methods: serum lipids, lipoprotein fractions, ApoAI, ApoB and Lp(a) were measured in 52 patients (28 diabetics and 24 non-diabetics) with lower limb occlusive disease. They were evaluated according to patients' glucose and compared with those in 75 healthy controls.Results: there was a significant decrease in HDL-cholesterol and ApoAI serum levels (p=0.000001) and an increase in Lp(a) (p=0.000001) in patients as compared to controls. No difference was observed in total cholesterol, non HDL-cholesterol or triglycerides. Multiple regression analysis revealed a significant association between low ApoAI (or HDL) levels and the disease as well as between high Lp(a) levels and the disease.ApoAI (p=0.0003), HDL-cholesterol (p=0.00005) and total cholesterol (p=0.01) levels were significantly lower in diabetic patients compared to non-diabetic patients. Lp(a) levels did not correlate with fasting glucose concentration. Multiple regression analysis revealed a significant association between low ApoAI (or HDL) levels and diabetes.Conclusion: decreased ApoAI appears to be a main component of the dyslipidaemic serum profile observed in patients with atherosclerotic occlusive disease of the lower extremities. Increased Lp(a) levels is an independent risk factor. Decreased HDL-cholesterol is also involved in the dyslipidaemic profile.

Influence of length of time on dialysis before grafting on kidney transplant results.

The outcome of kidney transplantation was evaluated in 246 nondiabetic, CsA-treated recipients of primary cadaver transplant, divided into 4 groups according to length of time on dialysis: group < or = 2, 0-24 months; group 2-5, 25-60 months; group 5-15, 61-180 months; group > 15, over 180 months. The 4 groups did not differ in graft survival, proteinuria (g/die), or estimated GFR values at 1, 2, 3, 4, and 5 years after grafting. They did not differ in the frequency of cataract, hip osteonecrosis, tumors, or posttransplant diabetes mellitus at 3 years after grafting. Ocular hypertone (p < 0.02), tendon ruptures (p < 0.001), arterial occlusive disease of lower limbs (p < 0.01), cholelithiasis (p < 0.05), and chronic hepatitis--which occurred only in anti-HCV and/or HBs Ag-positive patients--(p < 0.001), were more frequent in group > 15, and in all these cases but ocular hypertone a linear trend of increasing frequencies with increasing dialytic age was statistically significant. Group 5-15 had the lowest patient survival (p < 0.02). Moreover, a progressive decline of patient survival with increasing dialytic age was noted in groups < or = 2, 2-5, and 5-15. Unexpectedly, group > 15 had remarkably good survival, and this finding denies the hypothesis of a purely linear decline of patient survival after transplantation with increasing dialytic age.

Laser-Assisted Balloon Angioplasty: Analysis of 132 Clinical Cases

From September, 1987, to September, 1988, 132 laser endarterectomies with or without balloon angioplasty were performed on 113 patients who presented with lower limb occlusive disease. Overall success rate as determined by intra operative angiogram and Doppler measurements signifying a patent lumen was 80% (106 laser-assisted procedures). In 26 procedures (20%), laser-assisted balloon angioplasty was unsuccessful. Complications associated with 132 laser thromboendarterectomies were arterial spasm (9.1%), perforation requiring surgery (3.0%), and thrombosis in the first forty-eight hours (1.5%) following the procedure. There was no limb loss, stroke, myocardial infarction, or death associated with this procedure.

Results of vascular surgery in younger versus older patients

We reviewed the results of reconstructive surgery at the aortoiliac and femoropopliteal levels in two age groups. Although patency rates were similar, when failure occurred, the amputation rate in the group under age 50 was almost three times that in the group over age 60. Practical application can be made in the preoperative preparation of the younger patient presenting with lower limb occlusive disease. More research of arteriosclerosis in the young is needed.