Severe Lower Extremity Arterial Disease Research Articles

Adipose Derived Stromal Vascular Fraction and Mesenchymal Stem Cells Improve Angiogenesis in a Rat Hindlimb Ischaemia Model

This study aimed to investigate the effect of human adipose tissue derived stromal vascular fraction (AD-SVF) and mesenchymal stem cells (AD-MSCs) on blood flow recovery and neovascularisation in a rat hindlimb ischaemia model. SVF was isolated using an automated centrifugal system, and AD-MSCs were obtained from adherent cultures of SVF cells. Rats were divided into four groups of six rats each: non-ischaemia (Group 1); saline treated ischaemia (Group 2); SVF treated ischaemia (Group 3); and AD-MSC treated ischaemia (Group 4). Unilateral hindlimb ischaemia was induced in Sprague-Dawley rats via femoral artery ligation. Saline, SVF, or AD-MSCs were injected intramuscularly into the adductor muscle intra-operatively. Cell viability was calculated as the percentage of live cells relative to total cell number. Blood flow improvement, muscle fibre injury, and angiogenic properties were validated using thermal imaging and histological assessment. The viabilities of SVF and AD-MSCs were 83.3% and 96.7%, respectively. Group 1 exhibited no significant temperature difference between hindlimbs, indicating a lack of blood flow changes. The temperature gradient gradually decreased in SVF and AD-MSC treated rats compared with saline treated rats. In addition, only normal muscle fibres with peripherally located nuclei were observed in Group 1. Groups 3 and 4 exhibited significantly fewer centrally located nuclei, indicating less muscle damage compared with Group 2. Regarding angiogenic properties, CD31 staining of endothelial cells showed similar patterns among all groups, whereas expression of vascular endothelial growth factor, as a crucial angiogenesis factor, was enhanced in the SVF and AD-MSC treated groups. SVF and AD-MSCs improved blood flow and neovascularisation in a rat hindlimb ischaemia model, suggesting their potential ability to promote angiogenesis. Further extensive research is warranted to explore their potential applications in the treatment of severe lower extremity arterial disease.

The Impact of Atrial Fibrillation on One-Year Mortality in Patients with Severe Lower Extremity Arterial Disease.

Atrial fibrillation (Afib) is associated with the presence of lower extremity arterial disease (LEAD), but its effect on a severe LEAD prognosis remains unclear. We investigated the association between Afib and clinical outcomes. We retrospectively enrolled consecutive severe LEAD patients undergoing percutaneous transluminal angioplasty between 1 January 2013 and 31 December 2018. Patients were divided according to the history of any type of Afib and followed for at least one year. The primary outcome was all-cause mortality. Secondary outcomes were cardiac-related mortality and major adverse cardiovascular events (MACEs). The study included 222 patients aged 74 ± 11 years (54% male), and 12.6% had acute limb ischemia. The Afib group had significantly higher rates of all-cause mortality (42.9% vs. 20.1%, p = 0.014) and MACEs (32.1% vs. 14.4%, p = 0.028) than the non-Afib group. Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, p = 0.029) and MACEs (adjusted HR: 2.338, 95% CI: 1.054–2.188, p = 0.037). The other factors associated with all-cause mortality included acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, p = 0.001), Rutherford classification, and heart rate. Afib was significantly associated with increased risks of one-year all-cause mortality and MACEs in patients with severe LEAD. Future studies should investigate whether oral anticoagulants benefit these patients.

Endovascular interventions may save limbs in elderly subjects with severe lower extremity arterial disease.

Endovascular interventions may save limbs in elderly subjects with severe lower extremity arterial disease.

Percutaneous transluminal angioplasty associated with a comparable risk of mortality in old patients with severe lower extremities arterial disease

Abstract Background Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients. Purpose We investigated the effect of age ≥85 vs <85 years on prognoses in LEAD patients. Methods We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs). Results The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005). Conclusion Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different. Funding Acknowledgement Type of funding sources: None. Study outcomes in LEAD patients

Severity of tibio peroneal arterial disease: A marker for coronary artery disease

In patients with peripheral arterial disease, coronary artery disease (CAD) is more frequent in those with distal than with proximal occlusion. The severity of distal tibioperoneal lesions, however, has not been extensively evaluated as a predictor for severe CAD. This study was designed to investigate whether such an association exists. From January 1992 to December 1993, this case-control study compared the frequency and severity of CAD in two groups: the study group (34 patients) with severe tibioperoneal arterial disease without any of the crural arteries being completely patent; the control group (34 patients) with milder disease of the same segments with at least one crural artery completely patent. In both groups the lower limbs were angiographically evaluated. CAD was assessed by myocardial scintigraphy or coronary arteriography. The two groups were comparable regarding age and number of risk factors (p=NS). Severe CAD was more frequently found in the study group than in the controls (p < 0.001). The relative risk was seven times higher in the study group, with an odds ratio of 7.35 (confidence interval 2.03–28.2). CAD is much more frequent in patients with severe lower extremity arterial disease than in those with less advanced disease. The severity of distal disease appears to be a highly specific marker for identifying patients at higher risk.

Severity of Tibio Peroneal Arterial Disease: A Marker for Coronary Artery Disease

In patients with peripheral arterial disease, coronary artery disease (CAD) is more frequent in those with distal than with proximal occlusion. The severity of distal tibioperoneal lesions, however, has not been extensively evaluated as a predictor for severe CAD. This study was designed to investigate whether such an association exists. From January 1992 to December 1993, this case-control study compared the frequency and severity of CAD in two groups: the study group (34 patients) with severe tibioperoneal arterial disease without any of the crural arteries being completely patent; the control group (34 patients) with milder disease of the same segments with at least one crural artery completely patent. In both groups the lower limbs were angiographically evaluated. CAD was assessed by myocardial scintigraphy or coronary arteriography. The two groups were comparable regarding age and number of risk factors (p=NS). Severe CAD was more frequently found in the study group than in the controls (p < 0.001). The relative risk was seven times higher in the study group, with an odds ratio of 7.35 (confidence interval 2.03–28.2). CAD is much more frequent in patients with severe lower extremity arterial disease than in those with less advanced disease. The severity of distal disease appears to be a highly specific marker for identifying patients at higher risk.