Remote ischemic preconditioning impairs ventricular function and increases infarct size after prolonged ischemia in the isolated neonatal rabbit heart

OBJECTIVES

Remote ischemic preconditioning (rIPC) reduces myocardial injury in adults and children undergoing cardiac surgery. We compared the effect of rIPC in adult and neonatal rabbits to investigate whether protection against ischemia-reperfusion injury can be achieved in the newborn heart by (1) in vivo rIPC and (2) dialysate from adult rabbits undergoing rIPC.

METHODS

Isolated hearts from newborn and adult rabbits were randomized into 3 subgroups (control, in vivo rIPC, and dialysate obtained from adult, remotely preconditioned rabbits). Remote preconditioning was induced by four 5-minute cycles of lower limb ischemia. Left ventricular (LV) function was assessed using a balloon-tipped catheter, glycolytic flux by tracer kinetics, and infarct size by tetrazolium staining. Isolated hearts underwent stabilization while perfused with standard Krebs-Henseleit buffer (control and in vivo rIPC) or Krebs-Henseleit buffer with added dialysate, followed by global no-flow ischemia and reperfusion.

RESULTS

Within the age groups, the baseline LV function was similar in all subgroups. In the adult rabbit hearts, rIPC and rIPC dialysate attenuated glycolytic flux and protected against ischemia-reperfusion injury, with better-preserved LV function compared with that of the controls. In contrast, in the neonatal hearts, the glycolytic flux was lower and LV function was better preserved in the controls than in the rIPC and dialysate groups. In the adult hearts, the infarct size was reduced in the rIPC and dialysate groups compared with that in the controls. In the neonatal hearts, the infarct size was smaller in the controls than in the rIPC and dialysate groups.

CONCLUSIONS

Remote ischemic preconditioning does not protect against ischemia-reperfusion injury in isolated newborn rabbit hearts and might even cause deleterious effects. Similar adverse effects were induced by dialysate from remotely preconditioned adult rabbits.

[Detection rates of atherosclerosis by carotid versus lower limb ultrasonography in newly diagnosed type 2 diabetics]

OBJECTIVE

To compare the detection rates of atherosclerosis by carotid versus lower limb ultrasound in newly diagnosed type 2 diabetics and analyze the relationship between atherosclerosis and cardio-cerebrovascular events.

METHODS

A total of 148 newly diagnosed type 2 diabetics were recruited. Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound. Diabetic atherosclerosis was defined as the presence of either carotid or lower extremity plaques in any of the above-mentioned arterial segments. A kappa value was computed to document the agreement between isolated carotid (or lower limb) atherosclerosis and diabetic atherosclerosis. The prevalence of cardio-cerebrovascular events was compared among different distribution types of atherosclerosis.

RESULTS

According to the diagnostic criteria, the prevalence of diabetic atherosclerosis was 66.2% in the newly diagnosed type 2 diabetes. Based on carotid or lower extremity ultrasound, the prevalence of diabetic atherosclerosis was 27.0% and 62.2% respectively in newly diagnosed type 2 diabetes. The kappa values for the agreement between carotid/lower limb atherosclerosis and diabetic atherosclerosis were 0.32/0.91 (95% confidence interval 0.22-0.42 for carotid vs 0.84-0.98 for lower extremity). The combination of carotid and lower extremity arterial atherosclerosis was associated with a significantly increased detection rate of cardio-cerebrovascular events (26.5%) versus those with either carotid or lower extremity arterial atherosclerosis (0% and 10.3% respectively).

CONCLUSION

The combination of carotid and lower extremity ultrasonography can more accurately reflect the atherosclerotic lesions in type 2 diabetes. Due to a higher prevalence of cardio-cerebrovascular events, type 2 diabetics with both carotid and lower extremity atherosclerosis should be managed more aggressively to reduce the risk of cardio-cerebrovascular events.

[Study on the correlation of lower extremity arterial vessels by ultrasonography and atherosclerosis detection indicators]

OBJECTIVE

To examine the correlation between lower extremity artery ultrasound and arteriosclerosis detection indicators, including ankle-brachial index (ABI) and Cardiac Ankle Vascular Index (CAVI).

METHODS

According to the level of lower extremity arterial disease by ultrasonography, 320 patients were divided into 3 groups (normal group, mild lesions group and severe lesions group). Comparative analysis of the difference of arteriosclerosis detection indicators among the groups, including ABI and CAVI . To analyze the correlation of two test results and explore the risk factors of lower extremity atherosclerotic lesions.

RESULTS

To compare ABI among the three groups, the differences were statistically significant (P < 0.05 ) . Lower extremity arterial disease was negatively correlated with ABI and positively correlated with CAVI (P = 0.000 ). Using Logistic regression analysis: age, gender, diabetes, pulse pressure is the impact of lower extremity arterial disease risk factors.

CONCLUSION

ABI and CAVI can be used as reliable indicators for the screening of artery stenosis, occlusion and atherosclerosis, combined with color Doppler ultrasonography can improve the diagnosis rate of lower extremity arterial disease.

Low levels of a natural IgM antibody are associated with vein graft stenosis and failure

BACKGROUND

All humans have natural, protective antibodies directed against phosphorylcholine (PC) epitopes, a common inflammatory danger signal appearing at sites of cell injury, oxidative stress, and on bacterial capsules. In large human cohorts, low levels of anti-PC IgM were associated with a significantly increased risk of stroke or myocardial infarction. However, it is not known if these antibodies protect against the premature closure of arterial reconstructions.

METHODS

A prospective, observational study of patients undergoing elective, infrainguinal, autogenous vein bypasses for atherosclerotic occlusive disease of the legs was conducted. Clinical data were recorded prospectively, and preoperative levels of anti-PC IgM measured with the CVDefine kit from Athera Biotechnologies (Solna, Sweden). The principal clinical end point was the loss of primary patency (loss of graft flow, or any intervention for stenosis). Patients were followed regularly by duplex ultrasound at 1, 3, 6, 12, 18 months, and yearly thereafter.

RESULTS

Fifty-six patients were studied, for an average of 1.3 years. Indications for surgery were claudication (33.9%), ischemic rest pain (17.9%), and ischemia with ulceration or gangrene (48.2%). Seventeen (30.4%) patients experienced loss of primary patency (10 graft occlusions, seven surgical or endovascular revisions of graft stenoses). Kaplan-Meier survival analysis showed that the quartile of patients with the lowest anti-PC IgM levels had significantly worse primary graft patency (log-rank test, P = .0085). Uni- and multivariate Cox proportional hazards analysis revealed that the preoperative anti-PC IgM level was an important predictor of graft failure. Patients with IgM values in the lowest quartile had a 3.6-fold increased risk of graft failure (95% confidence interval: 1.1-12.1), even after accounting for other significant clinical or technical factors such as indication for surgery, site of distal anastomosis, or vein graft diameter.

CONCLUSIONS

A naturally occurring IgM antibody directed against the proinflammatory epitope PC may be protective against vein graft stenosis and failure, through anti-inflammatory mechanisms. Measurement of this antibody may be a useful prognostic indicator, although larger studies of more diverse populations will be needed to confirm these results. The biological actions of anti-PC IgM suggest it may be useful in developing immunotherapies to improve bypass longevity.

[Anatomic study and clinical application of thinned posterior tibial artery perforator flap]

OBJECTIVE

To explore the feasibility and therapeutic effect of thinned posterior tibial artery free perforator flap for the reconstruction of soft tissue defects at dorsum of hands.

METHODS

Six fresh adult lower limbs specimens were injected with red latex via arterial cannula and dissected. The number, distribution, branches, and outer diameter of posterior tibia artery perforators were observed. Based on the anatomic study, the perforator flaps were designed to reconstruct soft tissue defects at dorsum of hands and wrists. The redundant fat on the flaps was removed, but preserving the nutrient vascular system. 11 flaps were used with the size ranging from 2 cm x 5 cm to 10 cm x 14 cm.

RESULTS

43 skin perforators of posterior tibial artery were observed in six lower limbs, 29 perforators with the outer diameter is greater than 0.5 mm when they threading over the deep fascia plane, on average every 4.8 bundles of sides. The mean outside diameter of perforating artery is (1.8 +/- 0.5) mm, and the length is (44 +/- 15) mm. 6 perforators were founded both in the second and fifth zone which could be used for anastomosis for its better diameters. All flaps survived completely without any complication at donor sites. 7 cases were followed up for 3-12 months. Both satisfactory functional and cosmetic results were achieved with a soft and thinned appearance.

CONCLUSIONS

The thinned posterior tibial artery free perforator flap has a reliable blood supply and good appearance. It is very suitable for the reconstruction of small or medium-sized defects at the dorsum of hands and wrists.

Age dependent influence of external temperature on the pathogenesis of idiopathic lower extremity deep vein thrombosis

AIM

The aim of the present study was to investigate the relationship between the incidence of idiopathic lower extremity deep vein thrombosis (DVT), age, location of the thrombus, and changes of temperature.

MATERIAL AND METHOD

During the two year period between May 2009 and April 2011, inclusive, 124 consecutive patients were diagnosed as having idiopathic lower extremity DVT at the Vascular Surgery Clinic, Clinical Center of Nis, Serbia.

RESULTS

In patients younger than 45 years, the increase in average daily temperature with 1 degree C 7 days before the event took place was associated (p 0.05) with a decrease of the risk of occurrence of idiopathic DVT of the lower limbs of 3.6% (0.4 6.7%) as well as DVT above the knees (p 0.01) of 4.7 % (1.3 8.0%). In patients of the age of 45 years and over the age of 45 years the increase of average daily temperature with 1 degree C 7 days before the event took place was associated (p 0.01) with the increase of the risk of occurrence of DVT below the knees of 9.4% (3.3 15.9%).

CONCLUSION

According to the results of this study, one can conclude that the influence of external temperature change on DVT incidence and location is based on age.

Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger?

Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.

[Insertion of double inferior vena cava filter in patients with deep venous thromboembolism]

OBJECTIVE

To explore the characteristic, diagnosis and treatment of deep venous thromboembolism (DVT) patients with congenital double inferior vena cava.

METHODS

Retrospective analyses were conducted for the indications, filter types and efficacies of vena cava filter insertion in 7 hospitalized DVT patients with congenital double inferior vena at our hospital from 2006 to 2012.

RESULTS

All of them had definite indications for vena cava filter insertion. Temporary and permanent vena caval filters were implanted in one subject while retrievable vena caval filters in another five subjects. One retrievable filter was replaced by a permanent filter due to excessive thrombus entrapped in filter. Other temporary or retrievable filters were extracted successfully. All subjects were prescribed postoperatively with oral anticoagulants. The follow-up period was 1-72 months. No recurrent DVT or pulmonary embolism occurred.

CONCLUSION

The complications of double inferior vena cava in DVT subjects are often misdiagnosed due to its low incidence rate and a lack of clinical manifestations. Fatal pulmonary embolism after implantation may be due to an inappropriate location of filter implant. If implanted in a proper position, satisfactory outcomes ensue.

[Roles of short form-36 health survey scale in the evaluation of quality of life in patients with deep vein thrombosis]

OBJECTIVE

To explore the roles of short form-36 health survey scale in the evaluation of deep vein thrombosis (DVT) patients.

METHODS

A total of 179 DVT patients were recruited from Department of Vascular and Thyroid Surgery, First Affiliated Hospital, Xinjiang Medical University from June 2009 to March 2013. They were surveyed with short form-36 health survey scale. Then the feasibility, reliability, validity, responsibility, ceiling effect and floor effect were analyzed.

RESULTS

Feasibility analysis: completion time was (10.4 ± 2.9) min and finishing rate 100%. Reliability analysis: all split-half reliability coefficients and Cronbach's α were above 0.8. all internal consistency coefficients were above 0.6. Validity analysis: all Pearson coefficients were above 0.6. Two principal components were extracted by factor analysis and it accounted for 67.011% of total variance. After maximal variance rotation, two common factors were generated. And it was almost the same with the theoretic structural assumption of scale. Responsibility analysis: all score of every degree at post-treatment were higher than at pre-treatment. And it was statistically significant (P < 0.01). Ceiling and floor effects: there was remarkable ceiling effect on role physical (RP) and emotional role (RE) (24.81%, 36.62%). Remarkable floor effect on RP was 31.76%.

CONCLUSION

Short form-36 health survey scale is satisfactory in the evaluation of quality of life among DVT patients. But specific items need further improvement.

[Value of color Doppler ultrasound in the examination of prethrombotic state]

OBJECTIVE

To explore the clinical value of color Doppler ultrasound in patients with prethrombotic state (PTS).

METHODS

From October 2011 to November 2012, a total of 201 patients were diagnosed with PTS. There were 95 males and 106 females with an average age of 52 years (range: 15-78). They were divided into intervention and observation groups on the basis of drug intervention. And the relevant literatures were reviewed and the images of color Doppler ultrasound before and after treatment compared.

RESULTS

Before treatment, blood flow peak rates of common femoral, popliteal and calf intermuscular veins were (0.16 ± 0.03), (0.14 ± 0.03) and (0.13 ± 0.02) m/s; after treatment, (0.19 ± 0.03), (0.17 ± 0.03) and (0.15 ± 0.01) m/s respectively. The peak flow increased and sluggish flow decreased or disappeared in 152 PS patients. It indicated a relief or an obvious resolution of hypercoagulable state. And the symptom of lower extremity soreness was greatly relieved. Among 49 patients without drug intervention, severe full-lumen storm floating occurred in 12 cases. And 8 of them suffered deep vein thrombosis within 2 weeks. The incidence of thrombus was 66.7%.

CONCLUSION

Color Doppler ultrasound may detect and assess PTS effectively so as to guide effective interventions.

[Clinical analysis of patients with lower extremity deep venous thrombosis complicated with inferior vena cava thrombus]

OBJECTIVE

To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences.

METHODS

The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively.

RESULTS

All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases.

CONCLUSION

Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

[Postconditioning can reduce long-term lung injury after lower limb ischemia-reperfusion]

INTRODUCTION

Operation on the infrarenal aorta could cause ischemic-reperfusion (IR) injury in local tissues and remote organs (e.g. the lung).

OBJECTIVES

Our aim was to reduce long-term lung damage, after lower limb IR with postconditioning.

MATERIALS AND METHODS

Male Wistar rats underwent 180 minutes of bilateral lower limb ischemia. Animals were divided into three groups: Sham-operated, IR, Postconditioned (PostC) and further to two subgroups according to reperfusion time: 24 h and 72 h. Serum free radical and IL-6 levels, histological changes, Wet/Dry (W/D) ratio, tissue myeloperoxidase (MPO) activity and Hsp72 levels were investigated.

RESULTS

Postconditioning can reduce histological changes in the lung. Free radical levels are significantly lower in PostC groups than in IR groups (42.9 ± 8.0 vs. 6.4 ± 3.4; 27.3 ± 4.4 vs. 8.3 ± 4.0 RLU%; p < 0.05). IL-6 level (238.4 ± 31.1 vs. 209.1 ± 18.8; 190.0 ± 8.8 vs. 187.0 ± 14.9 pg/ml) and Hsp72 expression did not show any significant difference. Compared to the IR group, lung MPO activity did not change in the PostC groups. W/D ratio in PostC groups is significantly lower at all measured time-points (68% vs. 65%; 72% vs. 68%; p < 0.05).

CONCLUSION

Postconditioning may reduce long-term damages of the lung after lower limb ischemic-reperfusion injury.

Drug eluting stents in the treatment of below the knee arterial occlusive disease

The use of endovascular techniques for the treatment of occlusive arterial disease below the knee has gained widespread acceptance and is considered by many as the first line treatment for patients with critical limb ischaemia. Tibial angioplasty and stenting have a high rate of technical success and are relatively low risk procedures, which has widened their applicability to include treatment for the elderly and those with comorbidities unsuitable for open bypass surgery. Despite these advantages the durability of the percutaneous revascularisation remains inferior to that of open surgery for diffusely diseased arteries. In the search to improve their long term performance we have sought to investigate the role of coronary drug eluting stents (DES) in the tibial vasculature in the hope that they may reduce recurrent stenosis, the leading threat to interventional patency. Ample data now exists in the form of registries and randomised trials designed to evaluate the use of DES in the crural arteries below the knee. This article reviews this body of research, explores the use of these devices in more complex lesions, speculates on their future development and examines their cost-effectiveness.

[Impact of the combined application of elastic bandaging of the lower extremities and autohemotransfusion on biochemical indices of the blood and severity of endogenous intoxication in patients with concomitant cardiovascular insufficiency]

Venous congestion in abdominal inner organs in surgical diseases in patients with heart insufficiency may additionally impact biochemical indices of the blood and severity of endogenous intoxication (EI). Basing on the data obtained in the investigations, th was established, that the lower extremities bandaging promotes exit of the blood from depot, where it resides in a concentrated state in cellular and biochemical aspects. It promotes more effective accomplishment of hemodilution as well as reduction of the EI severity in taking of the autologous blood.

[The application of popliteal vein anatomy study and valve construction procedure]

OBJECTIVE

To analyze anatomy data of popliteal veins (PV), with the purpose of selection of popliteal venous valves construction segment via venography, and to evaluate the surgical results.

METHODS

From February 1998 to November 2010, after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases, 102 patients (69 male and 33 female patients, aged from 48 to 71 years, mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures. Doppler ultrasound, continuous dynamic venography, and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre- and postoperatively. Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.

RESULT

In the 102 patients, 93.7% patients had one pair of valves in popliteal vein (PV), locating in the distal 1/3 segment of PV, with gastrocnemius veins (GV) joining with PV above PV valves. Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs. 150.2 ml/min, t = 8.979, P < 0.001). The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H(2)O vs. (15 ± 3) cm H(2)O, 1 cm H(2)O = 0.098 kPa, t = 8.049, P < 0.001). VCSS score was significantly lower after the surgery ((34 ± 15) cm H(2)O vs. (41 ± 14) cm H(2)O, t = 59.780, P < 0.001). Pre- and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs. 1.8 ± 1.0, t = 59.780, P < 0.001). Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%, and a 3.7% ulcer recurrent rate.

CONCLUSIONS

Popliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection, which stayed proximal to the communications of GV and PV. Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.

[Vacuum-assisted closure as a treatment modality for infrainguinal vascular prosthetic graft infection: our experience and take-home message]

INTRODUCTION

Infection of the prosthetic graft represents one of the biggest challenges for practising vascular surgeons. The patient is jeopardized with possible future limb loss or, in the most serious cases, even death due to this complication. The incidence in the infrainguinal area amounts to a maximum of 6% of all arterial surgical procedures.

MATERIAL AND METHODS

Between January 2010 and December 2011, the authors performed a total of 689 vascular surgical reconstructions, of which 311 were performed in the infrainguinal area where 7 cases (2.25%) of graft infection occurred.

RESULTS

None of the patients died or lost a limb due to this complication. Two patients with an infected infrainguinal prosthetic graft were successfully treated with vacuum-assisted closure (VAC) system.

CONCLUSION

The prosthetic vascular graft infection is the most feared complication in vascular surgery. The generally recognized principles of the traditional surgical approach are well-known and widely accepted. However, in selected cases of infrainguinal vascular prosthetic infection, both the affected limb and the patent graft may be saved and successfully treated with the use of vacuum-assisted closure.

[The possible uses of balneotherapy in treating chronic venous insufficiency of lower limbs]

The Chronic Venous Insufficiency (CVI) of inferior limbs is a widespread disease, with an increasing incidence as a consequence of longer life expectance, life-style, obesity, smoking, use of drugs as oestrogens and progestins and working conditions. Medical therapy is still lacking for evidence of efficacy, and compression therapy is useful only in preventing a worsening of this condition. Surgical treatment is the only radical therapy effective for the advanced phases of the disease. In this context spa balneotherapy can be considered as a possible chance to improve some subjective and objective symptoms of CVI of inferior limbs, and to prevent worsening of this condition. The authors performed a review of the relevant scientific literature concerning the treatment of CVI of inferior limbs with mineral water balneotherapy, in order to evaluate its effects on objective and subjective symptoms and its effectiveness to prevent further worsening. We searched the PubMed/Medline, Cochrane Library, Embase, Web of Science databases for articles published between 1990 and 2011 on this topic. To this end, the authors selected few clinical-controlled and case-controlled studies; patients affected from CVI of inferior limbs were treated with balneotherapy at health spas with sulphureous, sulphate, salsojodic or salsobromojodic mineral waters. Baths in mineral waters were often associated with idromassotherapy and vascular pathway. Effects of spa balneotherapy are related to some aspecific properties, like hydrostatic pressure, osmotic pressure and water temperature, partly related with specific chemico-physical properties of the adopted mineral water. The controlled clinical studies on spa therapy showed significant improvement of subjective (such as itch, paresthesias, pain, heaviness) and objective symptoms (namely edema and skin discromias). These studies suggest that spa balneotherapy may give a good chance of secondary prevention and effective therapy of CVI of inferior limbs, but also that it needs of other clinical controlled trials.

Critical appraisal of surgical revascularization for critical limb ischemia

Peripheral artery disease is growing in global prevalence and is estimated to afflict between 8 and 12 million Americans. Its most severe form, critical limb ischemia (CLI), is associated with high rates of limb loss, morbidity, and mortality. Revascularization is the cornerstone of limb preservation in CLI, and has traditionally been accomplished with open surgical bypass. Advances in catheter-based technologies, coupled with their broad dissemination among specialists, have led to major shifts in practice patterns in CLI. There is scant high-quality evidence to guide surgical decision making in this arena, and market forces have exerted profound influences. Despite this, available data suggest that the expected outcomes for both endovascular and open surgery in CLI are strongly dependent on definable patient factors such as anatomic distribution of disease, vein quality, and comorbidities. Optimal patient selection is paramount for maximizing benefit with each technique. This review summarizes some of the existing data and suggests a selective approach to revascularization in CLI, which continues to rely on vein bypass surgery as a primary option in appropriately selected patients.

[Special issues in endovascular treatment of lower extremities arteriosclerosis obliterans]

OBJECTIVE

To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans.

METHODS

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.

RESULTS

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.

CONCLUSION

Endovascular treatment has an excellent early patency rate. Special issues should be properly handled during endovascular treatment.