[Quality of life of patients with atherosclerotic lesion of lower extremity arteries as dependent on individual and typological properties of the patient personality]

Twenty men with atherosclerotic lesion of lower extremity arteries verified by contrast angiography and ultrasound Doppler were examined. The patients' age varied from 36 to 69 years (mean 57 years). Six patients had IIB ischemia, 13 presented with degree III and one patient had degree IV ischemia according to the R. Fontaine classification modified by A. V. Pokrovsky. The MOS SF = 36 questionnaire was used to estimate the quality of life of all the patients. The individual typological properties of the personality were defined using the psychodiagnostic test (PDT). A significant decrease of the patients' quality of life was revealed according to the scales: physical function, physical role, physical pain, general health condition. A correlation was recorded between the patient's age and the parameters of the "physical function scale" (r=-0.63; p<0.005). The individual typological properties of the personality exert an effect on five of the eight SF = 36 scales. A feedback was discovered between neurotism and mental health (r=-0.455; P<0.05), conscientiousness and the physical role (r=-0,487; p<0.05); a direct relationship was found between disinhibition and physical pain (r=0.451; p<0.05), general activity and physical pain (r=0.535; p<0.05). An indistinctly pronounced feed back manifested itself between the "neurotism" and "physical pain" scales (r=-0.409), "psychotism" end the "physical role", (r=-0.437), "introversion" and "vitality" (r=-0.408), "femininity" and the "emotional role" (r=-0.404), and a direct relationship was established between the scales "esthetic impressionability" and "vitality" (r=0.406).

Ultrasound visualization of the popliteotibial arterial segment

This work evaluates the diagnostic potential of color duplex scanning (CDS), as compared to contrast angiography, for visualization of the popliteotibial segment in patients with occlusive and stenotic lesions of lower extremity arteries. A total of 972 arterial segments were examined in 92 patients with combination of atherosclerosis obliterans and occlusion of the femoropopliteal segment and in 49 patients presenting with thromboangiitis obliterans and occlusion of the femorotibial or tibioplantar segments. The sensitivity of CDS for different segments of the femoropopliteal zone constitutes 75-96%, specificity 94-100%; the K index 0.82-0.89.

Cutting balloon angioplasty of the popliteal and infrapopliteal vessels for symptomatic limb ischemia

Options for lower limb percutaneous revascularization are limited especially for complex vessel obstruction. Cutting balloon angioplasty (CBA) has been described in the coronary literature as effective for complex disease. We analyzed our peripheral vascular database and report procedural outcomes along with the clinical success at a mean of 1-year follow-up in 73 patients with symptomatic lower limb ischemia undergoing CBA. CBA was successfully completed in all 73 patients (93 vessels; 100%) with predilation necessary in 4% of vessels. Severe intimal dissection or inadequate hemodynamic result necessitated in adjunctive stenting in 20%. There were no incidents of vessel perforation or surgical target vessel revascularization. One patient (1.5%) died during the periprocedural period due to renal failure. After mean follow-up of 1 year (6-21 months), 89.5% of threatened limbs were salvaged. CBA is a safe and feasible option for the treatment of popliteal and infrapopliteal vessels.

Lower skeletal muscle nutritive blood flow in older women is related to eNOS protein content

The relationship between muscle endothelial nitric oxide synthase (eNOS) content and nutritive flow was investigated in nonobese sedentary young (27.7 +/- 2.6 years) and older (56.6 +/- 2.1 years) women matched for body composition and (2)peak. A muscle biopsy was taken and nutritive blood flow was determined under resting conditions in the vastus lateralis of the quadriceps femoris muscle group. Muscle eNOS protein content correlated with muscle nutritive blood flow (r =.66, p <.05) and body mass index (r =.74, p <.05), but it did not correlate with VO(2)peak. Muscle eNOS content was 35% lower in young than in older women (266 +/- 36 vs 407 +/- 53 pg/mg total protein; p <.05). The mean ethanol outflow-to-inflow ratio was higher (indicating lower nutritive flow) in older and young women (.666 +/-.042 and.546 +/-.043, respectively: p <.05). Resting skeletal nutritive blood flow and muscle eNOS content was lower in older than in young women. A low muscle eNOS protein content may be linked to a low muscle nutritive blood flow in healthy women.

[Anticoagulant therapy in reconstructive surgery of femoro-popliteo-tibial segment]

The paper compares the administration of low molecular weight heparins (LMWH) and previously used conventional heparin for arterial reconstructions of femoro-popliteo-tibial segments. The data evidence of LMWH benefits for the given interventions. Authors review the latest publications devoted to this problem and analyze the potential and special features of simultaneous anticoagulant therapy and regional anesthesia.

[Some features of orthostatic venous hemodynamics of the lower extremities in healthy, subjects and patients with varicose disease according to duplex scanning data]

Duplex scanning of the subcutaneous, deep and perforating veins was performed to examine venous return and to establish the diagnosis of valvular venous insufficiency of the lower extremities in 32 clinically healthy subjects (64 extremities) and 38 patients suffering from varicose disease (VD), when the patient was in the horizontal and vertical position. It has been established that in VD patients, the diameter of the deep and subcutaneous veins is greater than that in healthy subjects. When the patient is in the vertical position, the venous lumen expands 1.5-fold on the average (1.6-fold in healthy subjects and 1.4-fold in VD patients) under the influence of orthoshtatic venous pressure (,the sum of hydrodynamic and hydrostatic pressure). The growth of the total venous pressure up to the design values in the distal segments of the lower extremities is removed not only by musculovenous pump (MVP) motion but also by the MVP of free standing (maintenance of body balance) as well as by the action of the arteriovenous pump (AVP). The frequency of recording the retrograde blood runoff at functional exerelse in healthy subjects when they are in the orthostatic position is dramatically reduced. This phenomenon may be related to the orthostatic dilatation of the great veins and tension of the cusps of the unchanged valves, which should be regarded as a functional component of the closing mechanism of the MVP, In YD patients when they are in the orthostatic position, the frequency of revealing the design valvular insufficiency (according to the duration of retrograde runoff) decreases in the deep and rises in the subcutaneous veins. Valvular insufficiency of the perforating veins of the leg was primarily recorded in the veins of Cockett. The data obtained indicate that examination of venous function of the lower extremities is desirable when the patients are in both horizontal and vertical position.

[Formation of compressive bandage after sclerotherapy for lower limb varices]

Invention concerns compressive sclerotherapy as a treatment modality for lower limb varices. Technical result of investigation is the development of compressive bandage that creates and maintains adequate level of limb compression both in supine position (during bed rest) and standing or walking. Technical result is achieved by formation of two compressive layers of elastic bandage. Highly expansible elastic bandage is used for the first layer aimed for fixation and compression of latex or foam pads at injection sites to create local compression of variceal nodes. Open toe elastic stocking (I compression class) is placed over the bandage to maintain adequate compression during bed rest. The second external layer consists of elastic bandage with moderate expansion (II compression class). It is placed over the first one from toes to thigh upper third and creates optimal compression in patient's vertical position. The patient is permitted to take it off or loose exclusively in supine position, to wash or refresh foot with wet towel, to change it with a new one.

Micro-venous valves in the superficial veins of the human lower limb

It is commonly believed that venous valves are not present in veins smaller than 2 mm in diameter. Venous valves, however, have been identified recently in small veins in several regions of the body. This study was undertaken to determine the size distribution of venous valves in the human lower limb micro-venous circulation. Vascular casts were made from six adult lower limbs and the sampled areas were viewed by scanning electron microscopy. In total, 2,376 valves were identified from 410 cm(3) of subcutaneous tissue. The vast majority (94%) of the valves were in veins less than 300 microm in luminal diameter, with 65% of the valves present in venous channels less than 100 microm in luminal diameter. The smallest valves identified were present in venous channels 18 microm in diameter. All valves were bicuspid and often associated with a tributary. Endothelial cells on the vein wall not associated with a valve were fusiform and arranged parallel to the long axis of the vessel, however, the endothelial cells on the luminal and valve sinus surfaces of the cusp were more polyhedral in shape and showed no obvious pattern of alignment. This study provides direct evidence to show that small superficial veins of the human lower limb do contain abundant venous valves and, for the first time, shows that the majority of these valves are present within venous channels less than 100 microm in luminal diameter.

Improvement in lower-extremity peripheral arterial disease by nocturnal hemodialysis

A 42-year-old man with end-stage renal disease (ESRD) was referred for conversion to nocturnal hemodialysis (NHD) therapy from conventional hemodialysis (CHD) therapy because of refractory intermittent claudication secondary to peripheral arterial disease (PAD). The patient was initiated on CHD therapy in 1976 and subsequently had undergone two unsuccessful renal transplantations. While on CHD therapy, his clinical course was complicated by worsening vascular and soft-tissue calcification. Extensive dystrophic soft-tissue calcification was noted bilaterally in his hands, lower extremities, and sacral region, requiring surgical excision. Lower-extremity arterial Doppler scans documented vascular calcification and a pronounced decrease in peripheral arterial flow bilaterally. After conversion to NHD therapy (7.5 h/session five times weekly), the patient became symptom free and had significant clinical improvements in (1) hemodynamics, measured by clinic blood pressure and two-dimensional echocardiography, (2) biochemical profile, and (3) a sustained improvement in arterial Doppler flow measured by duplex Doppler ultrasound. We conclude that NHD was able to improve lower-extremity PAD in our patient. Further observational and interventional studies are required to investigate the therapeutic potential of NHD for the treatment of PAD in patients with ESRD.

[Genetic engineering potential and perspectives in the management of critical ischemia]

The paper presents a new approach to management of lower limb critical ischemia which implements recent advances in molecular biology and genetic engineering technologies. A new original compound incorporating angiogenin gene was developed to activate neoangiogenesis processes after injection into living tissues. Experimental data evidence a potential efficacy of new method for complex management of critical ischemia.

[Comparative assessment of different methods of treatment of chronic critical ischemia of lower extremities in elderly and senile patients]

Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.

Ultrasound contrast-agent improves imaging of lower limb occlusive disease

OBJECTIVES

to evaluate if ultrasound contrast-agent infusion could improve duplex-ultrasound imaging of peripheral arterial disease (PAD) and increase the agreement with digital subtraction arteriography (DSA).

DESIGN

prospective and consecutive study.

MATERIAL

of 60 consecutive PAD patients, 15 were found to have an inconclusive duplex-ultrasound scan of the trifurcation and were included in the study. All 15 patients (53% male) were scheduled for DSA, all being candidates for vascular surgery due to claudication (n = 3, 20%), rest pain (n = 5, 33%) and tissue loss (n = 7, 47%).

METHODS

on the day before DSA, a duplex-ultrasound scan of the trifurcation was performed. If the duplex-ultrasound scan was found inconclusive, it was repeated during continuous ultrasound contrast-agent infusion. DSA was performed unaware of the duplex-ultrasound results and served as the gold standard.

RESULTS

after contrast-agent administration, the number of inconclusively diagnosed segments was significantly reduced by 26 (70%), from 37 to 11(p < 0.001). In 19 segments (73%) contrast-agent infusion changed the diagnosis in accordance with the DSA (p < 0.05). Values of sensitivity and positive predictive value were improved from 0.20 (0.04-0.62) to 0.47 (0.26-0.69) and 0.50 (0.10-0.91) to 0.80 (0.49-0.93), respectively. Specificity and negative predictive value were unchanged. Agreement between duplex-ultrasound and DSA were improved from poor (kappa = 0.18 (95% CI: 0-0.82)) to moderate (kappa = 0.45 (0.17-0.74)) (p = 0.44).

CONCLUSION

ultrasound contrast-agents improve the diagnostic ability of duplex-ultrasound when scanning difficult arterial segments in patients suffering from PAD.

[Hyperbaric oxygenation in the treatment regimen using Ilizarov technique in patients with open fractures]

The dynamics of clinico-physiological parameters in complex treatment of patients with open fractures of the extremities using hyperbaric oxygenation was analyzed in 22 patients with severe injuries with different degree of ischemia of the extremity, and 9 patients with scanty injuries of the soft tissues. It was shown that vasospasm was observed in patients with the initially normal microcirculation after a course of HBO treatment. In patients with no or initially low capillary blood flow the microcirculation was enlarged due to vasodilatation of the arterioles. No considerable effects of the course of HBO on the main blood flow was revealed. Recommendations are given on using the HBO therapy in management of patients with severe open fractures and osteosynthesis of the injured segment by the Ilizarov methods.

[New possibilities of extremity revascularization in chronic ischemia: neoangiogenesis induced by exposure to high-intensive laser (an experimental study)]

The present work analyzes the results of an experimental study concerned with the treatment of chronic extremity ischemia. The experiments were carried out on 29 mongrel dogs. Chronic ischemia of the right hind extremity was simulated in 24 dogs (the superficial femoral artery was ligated just beneath the iliac artery and over its whole length as were all its collaterals). The significance of extremity ischemia was confirmed clinically, angiographically and morphologically. In the first group (19 dogs), the ischemized extremity underwent one month later concurrent tunneling of the femoral muscles and bone perforation in the diaphysis and metaphysis by exposure to high-intensive laser (Nd: YAG laser). The second group (5 dogs) served as control to study the response to ischemia. There were examined the area of laser-induced injury, the internal diameter of the capillaries and the diameter of muscle fibers, the specific area of the surface of blood vessels in the muscle and connective tissue. By the 60th day after exposure to laser an appreciable difference was recorded in the control and experimental groups: in the experimental group, angiography revealed a much greater number of vessels in the zone of the ligated femoral artery. Microscopy showed vascularized scars with muscle type arteries, active proliferation of endotheliocytes, formation of a new vascular bed. It is assumed that the tunneling of the ischemized extremity muscles concurrently with osteotrephination by high-intensive laser substantially restores blood flow in the distal segments of the ischemized extremities. Intensive development of the vascular network in the areas of the tunneling of the ischemized muscles of the hind extremities by exposure to high-intensive laser allows to compare this modality with universally used revascularization osteotrephination.

[Effect of mild gravitational overload on the progression of lower limb arteriosclerosis obliterans]

The paper analyses the effect of mild gravitational overload (MGO) produced by patient's centrifugation in short-radius centrifuge in cranio-sacral orientation (+Gz) as a part of combined therapy for lower limb arteriosclerosis obliterans. Total 211 patients with I-II grade disease were divided into 3 groups: the first group (59 patients) was treated only by MGO, the second (100 patients) received both MGO and conventional conservative therapy, the third control group (52 patients) underwent conventional therapy only. The best clinical outcome was achieved in the 1st and 2nd groups. Pain-free walking distance increased 2-5-fold (vs 1.5 in control), mean volume blood flow velocity in different arterial beds increased 21-33% (vs 7.5% in control), index of regional perfusion - 25-29% (vs 10% in control), ankle-brachial index - 0.09-0.17 (vs 0.03 in control). Computer termography revealed recovery of leg and foot termographic picture in 86.67%, 92.59%, and 42.86% of cases in the 1st, 2nd and 3rd groups, respectively. Similarly, exercise tolerance measured by bicycle ergometry increased in the 1st and 2nd groups 1.5-1.9-fold (mean 60-85 s) and 1.3-fold (mean 37 s) in control. Thus mild gravitational overload has demonstrated clinical effectiveness in complex therapy of lower limb arteriosclerosis obliterans.

Accumulation of elements in the arteries and cardiac valves of Thai with aging

To elucidate whether the extent of element accumulation in the arteries and cardiac valves with aging was different between different races, the authors investigated the accumulation of elements in the arteries and cardiac valves of the Thai with aging and the relationships among elements in the cardiac valves. After ordinary dissection at Chiang Mai University was finished, 16 arteries and 4 cardiac valves were resected and element contents were determined by inductively coupled plasma-atomic emission spectrometry. In the 16 arteries, the average content of calcium was the highest in the site of the abdominal aorta ramifying into the common iliac arteries, and it decreased in the order internal iliac, coronary, abdominal aorta, common iliac, external iliac, superior mesenteric, inferior mesenteric, thoracic aorta, brachial, radial, common carotid, subclavian, ulnar, axillary, renal, and internal thoracic arteries. The average contents of phosphorus and magnesium in respective arteries were parallel with the average contents of calcium, except for the coronary artery. In comparison with the arteries of the Japanese, the trend of calcium accumulation in the arteries of the Thai was almost similar to that in the arteries of the Japanese, except for the coronary artery and thoracic aorta. The calcium accumulation in the coronary artery was much higher in the Thai than in the Japanese, whereas that in the thoracic aorta was lower in the Thai than in the Japanese. Regarding elements in the cardiac valves, the calcium content increased remarkably in the seventies in the aortic valve and in the nineties in the pulmonary valve, but it hardly increased in both the mitral and tricuspid valves with aging. The average content of calcium was the highest in the aortic valve, and it decreased in the order pulmonary, tricuspid, and mitral valves. Regarding the relationship among elements in the aortic valves, it was found that there were extremely significant direct correlations among the contents of calcium, phosphorus, and magnesium, whereas there were significant direct correlations between zinc and either calcium or phosphorus contents. Although significant correlations were found between sulfur and the other element contents in the aortic valves fo the Japanese, no significant correlations were found between them in the aortic valves of the Thai. In the mitral valves, extremely or very significant direct correlations were found among the contents of calcium, phosphorus, magnesium, and sulfur, with some exceptions that there were no significant correlations between phosphorus and either magnesium or sulfur contents. in addition, no significant correlation was found in the calcium content between the aortic valve and coronary artery in the same individuals.

Microtibial embolectomy

BACKGROUND

microtibial embolectomy is an important technique in cases of limb threatening acute arterial occlusion affecting native crural and pedal vessels. It is particularly useful when thrombolysis is contraindicated or ineffective as in "trash foot".

METHODS

in order to evaluate the efficacy of this technique, a retrospective case note review was carried out for patients undergoing microtibial embolectomy from 1990 to 1999. Data collected included the causes and degree of ischaemia, additional procedures required, vessel patency, limb salvage and complications encountered.

RESULTS

twenty-two limbs underwent exploration of the crural/pedal vessels with ankle level arteriotomies under local anaesthetic in 12 cases, general anaesthetic in nine and epidural in one. The causes of ischaemia were cardiac emboli (8), "trash foot" (7), emboli from aortic and popliteal aneurysms (3) and thrombotic occlusion of crural vessels (4). The vessel patency rate was 69% and limb salvage rate 62% (13/21) up to 5-years follow-up. Six of the seven cases with "trash foot" were salvaged while one required an amputation at 3-months post-operatively. The 30-day mortality was 22% (5/22).

CONCLUSIONS

microtibial embolectomy is effective in acute occlusion of the crural/pedal arteries including cases of "trash foot", offering limb salvage to a worthwhile proportion of cases.

[Surgical management of elderly and senile patients with critical lower extremity ischemia]

This paper describes an experience with examination and surgical treatment of 194 elderly (60-74 years); and senile (75 years and more) patients with critical lower extremity ischemia (CLEI) of atherosclerotic genesis. The patient group examined was marked by multiple coexistent pathology (primarily cardial)), appreciably increasing the risk of surgical intervention. The patients of both groups were provided altogether 345 operations. Because of remarkable concomitant pathology and compromised distal bed the greater part of patients underwent little traumatic non-reconstructive operations (56.5%); in many cases (41.3%), the necessary scope of intervention was divided into stages. On analysis of the results account was taken of the limited potential of performing in geriatric patients of prolonged operations as well as of the way of life of the overwhelming majority of old-group patients. The results were evaluated according to the scale suggested by the authors. The indicated treatment policy allowed to reach, the beneficial results in 80.1% of patients in the immediate period. In the long-term period (6 to 60 months), the positive results turned out stable in more than 70% of patients. This allows to recommend the approaches worked out for use in clinical practice for the treatment of geriatric patients presenting with CLEI.

[Prevention and prognosis of cardiac complications in patients following reconstruction of terminal aorta or lower limb arteries for atherosclerotic lesions]

The paper analyses several risk factors of cardiac postoperative complications in 284 patients with atherosclerosis of terminal aorta or lower limb arteries and correlation between preoperative management and intervention outcomes. Results of preoperative functional examination (transesophageal electric stimulation, echocardiography) and intraoperative monitoring of central hemodynamics were highly prognostic for cardiac complications. Causative analysis of cardiac complications enabled to develop a preventive strategy that has decreased the complication rate in 1.8 times.

[Thermography in diagnosis and treatment efficacy evaluation of lower limbs arterial diseases]

Possibilities of thermography for diagnosis of lower limbs arterial diseases and evaluation of treatment results were analyzed. Quantitative evaluation of infra-red imaging with detection of mean temperature, area of thermo-profile and thermographic index is proposed. Possibility of this method for detection of microcirculatory disorders in the limbs before clinical manifestation is demonstrated. Therefore thermography is a reliable method of early diagnosis. Thermography permits to perform qualitative and quantitative analysis of regional blood flow and microcirculation and consequently to use this method for evaluation of treatment efficacy.

Successful treatment of aortic endograft thrombosis with rheolytic thrombectomy

PURPOSE

To report the benefits of rheolytic thrombectomy for treating aortic endograft thrombosis.

METHODS

Of 40 patients who received the Ancure bifurcated endograft to treat abdominal aortic aneurysm (AAA) during a 9-month period, 6 (15%) patients (6 men; mean age 62.6 years, range 53-77) developed thrombosis of the endograft at an average of 9 weeks (range 1-20 months). Five patients were taking aspirin, and 3 were on warfarin therapy for atrial fibrillation. Immediately after angiography, rheolytic thrombectomy was used to remove the thrombus, followed by adjunctive procedures to treat the underlying pathology.

RESULTS

Causes were kinking or extrinsic compression of the graft limb in 5 cases and thrombosis of the surgical closure site in a common femoral artery. Mechanical thrombectomy was successful in restoring circulation in all cases; thrombolysis was used in 1. All 6 patients had additional stents placed in the graft limbs, re-establishing patency. There was no mortality or recurrent thrombosis in a follow-up that has extended to 26 months, but 1 patient required additional stenting for subsequent focal kinking of a graft limb above the previously implanted stent.

CONCLUSIONS

Rheolytic thrombectomy can safely and effectively treat endograft thrombosis after endovascular AAA repair. Additional thrombolytic agents, angioplasty, and stenting may be needed to correct the underlying causes of the thrombosis. Prophylactic stenting of iliac limbs at the time of implantation in patients with complex anatomy may prevent thrombosis of unsupported bifurcated endografts.

[Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency]

OBJECTIVE

To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency.

METHODS

Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins.

RESULTS

Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene).

CONCLUSION

C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.

Mid-term results of patients undergoing endovascular aortic aneurysm repair

BACKGROUND

The utilization of endovascular aneurysm repair (EAR) is increasing significantly; however, few papers have outlined mid-term outcomes.

METHODS

Patients undergoing EAR with an AneuRx endograft between September 1997 and May 2001 were evaluated. Mean follow-up was 20.7 +/- 11.9 (SD) months.

RESULTS

In all, 101 EAR devices were successfully deployed in 105 attempts. Four open conversions (2 acute, 2 delayed) were performed for complications of EAR. Technical, clinical, and 1 to 3 year continuing success rates were 75%, 73%, and 78% to 83%. When divided by the median date, significantly fewer patients in the later group required secondary procedures compared with the early group. Vascular insufficiency occurred in 12 patients; 11 were treated with a secondary procedure. For 9 type I and 9 type II persistent endoleaks, secondary procedures were attempted and successful in 10 patients. Of successful EAR deployments, including secondary interventions, 85% demonstrated no persistent leak, rupture, increase in aneurysm size, or migration at most recent follow-up.

CONCLUSIONS

EAR is successful in selected individuals; however, continuing follow-up is of paramount importance.

Predictors of residual venous obstruction after deep vein thrombosis of the lower limbs: a prospective cohort study

INTRODUCTION

Delayed thrombus regression after deep vein thrombosis (DVT) of the lower limbs is associated with increased risk of DVT recurrence. Predictors of residual venous occlusion are unknown. We hypothesized that obesity, which causes reduced fibrinolytic activity, can predict delayed thrombus regression.

MATERIALS AND METHODS

In a prospective cohort study, 98 patients with objective diagnosis of DVT underwent compression ultrasonography (CUS) after 6 and 12 months. Persistent occlusion was arbitrarily defined as a thrombus occupying, at maximal point of compressibility, more than 20% of the vein area in the absence of compression. The body mass index (BMI) and waist circumference were measured at baseline and at follow up to assess individual patterns of body fat distribution. Information on antithrombotic treatment, family history of varicose veins, cigarette smoking, concomitant disorders, the presence of known risk factors for DVT, the duration of anticoagulant treatment and the use of elastic stockings was collected.

RESULTS

Post-thrombotic recanalization was documented in 34 patients (34.7%) at 6 months and in 44 patients (44.9%) at 12 months. There was no difference in the mean BMI (p=0.469 at 12 months), in the prevalence of obesity (p=0.479) and visceral pattern of body fat distribution (p=0.239) between patients who did and did not show thrombus regression. The presence of a permanent risk factor for DVT was the only predictor of delayed thrombus regression (OR 11.0, 95% CI 1.359-61.978).

CONCLUSIONS

Despite consistent evidence of impaired fibrinolysis, obesity is not associated with persistent venous obstruction.

Clinical and hemodynamic significance of the greater saphenous vein diameter in chronic venous insufficiency

HYPOTHESIS

As the compliant greater saphenous vein (GSV) adjusts its luminal size to the level of transmural pressure, measurement of its diameter, reflecting the severity of hemodynamic compromise in limbs with GSV reflux, may simplify the hemodynamic criteria of patient selection for saphenectomy.

OBJECTIVE

To evaluate the clinical significance of GSV diameter determined in the thigh and calf as a marker of global hemodynamic impairment and clinical severity in a model comprising patients with saphenofemoral junction and truncal GSV incompetence.

DESIGN

A cohort study.

SETTING

University-associated tertiary care hospitals in Brazil and England.

PATIENTS

Eighty-five consecutive patients, aged 28 to 82 (mean, 46.2) years; 112 lower limbs with saphenofemoral junction and truncal GSV incompetence were investigated.

INTERVENTIONS

Clinical examination was followed by clinical, etiological, anatomical, and pathophysiological classification (CEAP), vein duplex, and air plethysmography. The GSV diameter was measured on standing at the knee, and at 10, 20, and 30 cm above and below the knee, and in the thigh and calf, respectively, using B-mode imaging. The venous filling index (VFI), venous volume (VV), and residual volume fraction (RVF) were measured by air plethysmography.

MAIN OUTCOME MEASURES

The GSV diameter was correlated with the VFI, VV, RVF, and CEAP. The value of the GSV diameter for predicting the presence of critical reflux (VFI >7 mL/s) or the absence of abnormal reflux (VFI <2 mL/s) was determined with receiver-operator curves.

RESULTS

The GSV diameter increased significantly overall with CEAP (P<.001) and also increased progressively with proximity to the saphenofemoral junction. The VFI, VV, and RVF increased significantly from CEAP(0) through CEAP(4-6); the VFI correlated well with VV, RVF, and CEAP (P<.001 for all). The GSV diameter at all 7 limb levels studied correlated well with VV (except at the distal calf), VFI, RVF, and CEAP (P< or =.009 for all). A GSV diameter of 5.5 mm or less predicted the absence of abnormal reflux, with a sensitivity of 78%, a specificity of 87%, positive and negative predictive values of 78%, and an accuracy of 82%. A GSV diameter of 7.3 mm or greater predicted critical reflux (VFI >7 mL/s), with an 80% sensitivity, an 85% specificity, and an 84% accuracy.

CONCLUSION

The GSV diameter proved to be a relatively accurate measure of hemodynamic impairment and clinical severity in a model of saphenofemoral junction and GSV incompetence, predicting not only the absence of abnormal reflux, but also the presence of critical venous incompetence, assisting in clinical decision making before considering greater saphenectomy.

Effects of supine intermittent compression on arterial inflow to the lower limb

HYPOTHESIS

Intermittent pneumatic compression will affect the arterial blood flow in the lower limb at moderate pressure, without requiring dependency.

DESIGN

Before-after trial.

SETTING

Vascular ultrasound unit of a university hospital.

PATIENTS

A volunteer sample of 19 healthy subjects without symptoms or history of vascular disease and 17 patients with peripheral arterial disease were studied. Six patients and 1 healthy volunteer were not included in the study group because of measurement difficulties or refusal when approached.

INTERVENTIONS

Common femoral artery blood flow velocities were measured with Doppler ultrasound during 10 minutes of intermittent compression of the calf and thigh at 60 mm Hg, while the subject was supine. The data were collected every 5 seconds from 4 minutes before to 4 minutes after the therapy period, and toe temperatures were also measured with an infrared radiometer.

MAIN OUTCOME MEASURES

Resting to postcompression percentage increases in flow velocity were measured, along with more representative measures of the total flow change during the intermittent compression period.

RESULTS

On compression, the blood flow velocity decreased slightly (15% in healthy subjects and 6% in patients) and increased on release (21% and 29%, respectively). Overall, blood flow did not decrease during therapy as expected (increases of 1% and 2%, respectively), and the toes of the patients warmed (by 2.2 degrees C).

CONCLUSIONS

This work confirms the initial hypothesis in both subject groups. There appears to be physiological justification for investigating intermittent compression as a therapy for patients with intermittent claudication and rest pain in the supine position as well as seated.

Declining-dose study of reteplase treatment for lower extremity arterial occlusions

PURPOSE

To prospectively determine the technical success and complication rates of three different reteplase dosing regimens during catheter-directed arterial thrombolysis.

MATERIALS AND METHODS

Prospective data were obtained from three groups of patients who underwent lower extremity arterial thrombolysis with three different regimens of reteplase: 0.5 U/h, 0.25 U/h, and 0.125 U/h. A total of 101 thrombosed lower extremity arterial occlusions in 87 patients were treated. A subtherapeutic intravenous heparin dose of 400-500 U/h was administered. All limbs were viable at presentation. Thrombolytic success was defined as 95% thrombolysis of the occluded artery or graft with restored distal antegrade flow. Thirty-day mortality and amputation rates were calculated. Bleeding complications and need for transfusions were recorded. Laboratory values recorded included fibrinogen level, platelet count, hematocrit level, hemoglobin level, and prothrombin time.

RESULTS

Thrombolytic success was achieved in 86.7% of patients in the 0.5-U/h dose group, 83.8% of patients in the 0.25-U/h dose group, and 85.3% of patients in the 0.125-U/h dose group. The major bleeding and transfusion rates were 13.3% in the 0.5-U/h dose group, 5.4% in the 0.25-U/h dose group, and 2.9% in the 0.125-U/h dose group. The 30-day amputation-free survival rates were 90% in the 0.5-U/h dose group, 97.3% in the 0.25-U/h dose group, and 94.1% in the 0.125-U/h dose group. Pre- and postprocedural fibrinogen levels and the fibrinogen nadir were not statistically different between the groups. No differences in total infusion times were found between the 0.5-U/h dose and 0.25-U/h dose groups. However, the infusion time in the 0.125-U/h dose group was significantly longer than in the other two groups (42 h vs 30 h; P <.05).

CONCLUSION

All dosing regimens were equally effective in the treatment of acute lower extremity occlusions. The infusion times were longer with the 0.125-U/h dose. Significantly fewer major bleeding complications were encountered with the 0.25-U/h and 0.125-U/h dose regimens than with the 0.5-U/h dose regimen.

Cardiac troponin I predicts short-term mortality in vascular surgery patients

BACKGROUND

Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury that predicts outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who have undergone vascular surgery. However, postoperative surveillance with cardiac enzymes is not routinely performed in these patients. We evaluated the association between postoperative cTnI levels and 6-month mortality and perioperative myocardial infarction (MI) after vascular surgery.

METHODS AND RESULTS

Two hundred twenty-nine patients having aortic or infrainguinal vascular surgery or lower extremity amputation were included in this study. Blood samples were analyzed for cTnI immediately after surgery and the mornings of postoperative days 1, 2, and 3. An elevated cTnI was defined as serum concentrations >1.5 ng/mL in any of the 4 samples. Twenty-eight patients (12%) had postoperative cTnI >1.5 ng/mL, which was associated with a 6-fold increased risk of 6-month mortality (adjusted OR, 5.9; 95% CI, 1.6 to 22.4) and a 27-fold increased risk of MI (OR, 27.1; 95% CI, 5.2 to 142.7). Furthermore, we observed a dose-response relation between cTnI concentration and mortality. Patients with cTnI >3.0 ng/mL had a significantly greater risk of death compared with patients with levels < or =0.35 ng/mL (OR, 4.9; 95% CI, 1.3 to 19.0).

CONCLUSIONS

Routine postoperative surveillance for cTnI is useful for identifying patients who have undergone vascular surgery who have an increased risk for short-term mortality and perioperative MI. Further research is needed to determine whether intervention in these patients can improve outcome.

[Revascularized osteo-trepanation in the treatment of chronic occlusion of the lower extremities arteries]

The results of operation of revascularized osteotrepanation (ROT) in complex of treatment of 43 patients with chronic occlusion of the lower extremities arteries were analyzed. Stable clinical effect after application of ROT in patients with the ischemia II stage persisted during 40 months, III stage--25 months, "high" amputation of lower extremity in patients with IV stage ischemia was performed in 3.5-7 months. ROT is operation of choice in patients with distal form of ischemia of lower extremity, as well as while presence of contraindications for performance of reconstructive operation on main arteries.

Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy

PURPOSE

To evaluate the use of adjunctive mechanical thrombectomy (MT) with pharmacologic catheter-directed lower extremity venous thrombolysis.

MATERIALS AND METHODS

Catheter-directed thrombolysis with adjunctive MT was used to treat 28 symptomatic limbs in 20 patients (22 procedures) with lower extremity deep vein thrombosis (DVT) between August 1997 and July 2001. Procedural success, major bleeding, thrombolytic infusion time, and total thrombolytic agent dose were recorded.

RESULTS

Procedural success was achieved in 23 of 28 limbs (82%). Fifteen patients (18 limbs) received iliac vein stents. Major bleeding was observed after three of 22 procedures (14%) and resulted in transfusion in two patients and endometrial ablation in the third patient. Mean per-limb infusion time was 16.8 hours +/- 12.8. Mean per-limb total doses were lower than those reported in published studies of DVT thrombolysis: 2.67 million U +/- 1.60 urokinase, 18.4 mg +/- 10.7 tissue plasminogen activator, and 13.8 U +/- 6.9 reteplase. Venographic analysis demonstrated minimal thrombus removal (26.0% +/- 24.1) when using MT alone, compared with substantial thrombus removal (62.0% +/- 24.9) when using MT after pharmacologic thrombolytic agents had been administered (P =.006).

CONCLUSION

The use of adjunctive MT to augment pharmacologic catheter-directed DVT thrombolysis provides comparable procedural success and may reduce the required thrombolytic dose and infusion duration.

[Application of polarized light in purulent-septic surgery]

Influence of polarized light on general state and healing of wounds and trophic ulcers in 57 patients with obliterating atherosclerosis of lower extremities, chronic venous insufficiency of extremities, purulent postoperative complications, purulent-septic complications in patients with diabetes mellitus was analyzed. Main mechanisms of the polarized light action in "Bioptron" apparatus were enlighted, effective schemes of its usage were determined.

The rationale and evidence for the treatment of lower-extremity deep venous thrombosis with thrombolytic agents

This article presents the rationale and evidence for the treatment of lower-extremity deep venous thrombosis (DVT) with thrombolytic agents. DVT is a common condition that has both acute and chronic complications. Standard treatment including anticoagulation therapy and compression stockings may not be entirely adequate, because a significant proportion of patients eventually develop severe post-thrombotic syndrome (PTS). Thrombolytic agents offer a potential advantage because they may reduce residual vein stenosis and valve damage. The authors performed a systematic review of published randomized trials evaluating thrombolytic agents for DVT. The authors determined that thrombolysis therapy results in greater lysis and complication rates than does anticoagulation alone. The authors also found that PTS incidence is lower in patients treated with thrombolytics. However, several methodological flaws limit the conclusions with respect to reduction in PTS. Therefore, the authors conclude that although the lysis rate is greater for thrombolytic agents, they cannot be recommended routinely for DVT treatment.

[Compression syndromes in chronic venous insufficiency of lower extremities]

Results of examination and surgical treatment of 77 patients with severe forms of chronic venous and lymphovenous insufficiency of lower extremities were analyzed. The compression syndrome concept and its role in pathogenesis of severe forms of chronic venous and lymphovenous insufficiency of lower extremities were determined. There was elaborated the tactics of complex treatment of patients, application of which had permitted to achieve the trophic ulcers healing in 98% operated patients, previously considered noncurable.

Electrical foot stimulation and implications for the prevention of venous thromboembolic disease

BACKGROUND

Venous stasis caused by immobility is an important risk factor for deep vein thrombosis following surgery and lower limb trauma, in bed-ridden medical patients, and in high-risk long distance air travelers. A safe and convenient method for reducing venous stasis would be useful in patients while in hospital and after discharge during their rehabilitation.

SUBJECTS AND METHODS

49 healthy subjects aged 51-76 were seated for 4 hours during which they received mild electrical stimulation of the calf, or sole of the foot (plantar muscles). Popliteal and femoral venous blood flow velocities were measured via doppler ultrasound. The non-stimulated lower extremity served as the simultaneous control. Subjects completed a questionnaire regarding their acceptance and tolerance of the electrical stimulation.

RESULTS

There was a significant increase in venous femoral and popliteal blood flow for both calf (p < 0.035, p < 0.003), and plantar muscles (p < 0.0001, p < 0.009) on the stimulated side compared to the unstimulated side. The magnitude of the effect was similar for calf and plantar muscle stimulation. Subjects did not find the experience uncomfortable, and would use an electrical stimulator if told by their physician that they were at risk for developing blood clots.

CONCLUSIONS

Mild electrical stimulation of the feet, as well as the calf, is a safe effective and convenient method for counteracting venous stasis and therefore has the potential to reduce the risk of deep vein thrombosis and pulmonary embolism for subjects who are immobilized.

Treatment of acute occlusion of peripheral arteries

Acute lower-extremity peripheral arterial occlusion is responsible for a wide variety of complications culminating in limb loss or death. The real incidence of acute limb ischemia (ALI) in the general population is not well known even though recent epidemiological data estimated that it occurs in 14 out of a population of 100,000 and that it accounts for 10-16% of the vascular workload. The two main causes of acute occlusion of peripheral arteries are: (i) embolism and (ii) thrombosis, which usually occurs in cases of severe atherosclerotic stenoses. Arterial flow can be restored through operative revascularization or pharmacological dissolution of thrombus. Immediate surgical revascularization is indicated in the profoundly ischemic limb. Catheter embolectomy is also usually preferred for emboli to a non-atherosclerotic limb. Catheter-directed thrombolysis has become a commonly employed technique in the treatment of ALI. It may offer definitive treatment without the need of major surgery in a significant subset of patients with acute occlusion of a native leg artery or a bypass graft. A number or reports from individual centers and three large prospective studies, which compared intra-arterial thrombolysis to surgical intervention, suggest that thrombolytic therapy may be an appropriate initial treatment of ALI, provided that the limb is not immediately or irreversibly threatened. Using this approach, the underlying lesions can be further defined by angiography, and the percutaneous or surgical revascularization procedure can be performed. However, severe bleeding is still a non-rare complication of intra-arterial thrombolysis and the risk of intracranial hemorrhage is 1-2%.

Catheter-directed thrombolysis in deep venous thrombosis with use of reteplase: immediate results and complications from a pilot study

PURPOSE

To prospectively determine the thrombolytic success and complication rates of catheter-directed thrombolytic infusions in deep vein thrombosis (DVT) with use of reteplase.

MATERIALS AND METHODS

After approval by the institutional review board, prospective, detailed data were obtained for 25 consecutive patients with acute and chronic DVT of the upper or lower extremity (seven upper extremity; 14 lower extremity; four vena cava). Infusion rates were 1.0 U/h in five patients and 0.5 U/h in the remaining 20. Subtherapeutic heparin doses of 300-400 U/h were administered. Thrombolytic success was defined as 95% thrombolysis with return of antegrade flow. Data, including complications such as bleeding, need for transfusions, and laboratory values (fibrinogen, platelets, hematocrit, hemoglobin, and prothrombin time) were obtained throughout the infusions.

RESULTS

The total dose of reteplase administered ranged from 2.5 to 42 U (median, 16.5 U). The total infusion time ranged from 0.3 to 84 hours (median, 29 h). Thrombolytic success was achieved in 92% of patients. Endovascular stent placement and/or percutaneous transluminal angioplasty were required in 52% of patients to ensure maintenance of patency. Pre- and postprocedural average fibrinogen levels were 340 mg/dL and 315.3 mg/dL, respectively. The lowest mean fibrinogen levels for the two dose groups were 265.86 mg/dL for the 0.5 U/h group and 314.18 mg/dL for the 1.0 U/h group. The lowest fibrinogen level during the procedure was 252.3 mg/dL (range, 35 to >700). There were only two instances of fibrinogen levels that decreased to below 90 mg/dL: 35 mg/dL and 43 mg/dL. Thrombolytic failures occurred in two patients: one with acquired immune deficiency syndrome in a hypercoagulable state and one with a major bleeding complication. This was the only patient with a bleeding complication (4%). Hemorrhage occurred from the site of a previous mediastinal biopsy-which should have rendered her ineligible for the study-performed 18 hours before the thrombolysis. If thrombolysis had not been attempted in this patient, the complication rate would have been 0%.

CONCLUSION

Although there are reports of thrombolytic therapy in peripheral vascular occlusive disease, this study is one of the first to evaluate thrombolytic drugs in the deep venous system exclusively. Reteplase was found to be effective in the thrombolytic treatment of acute and chronic DVT.

Surgical and endovascular treatment of lower extremity venous insufficiency

Lower extremity venous insufficiency is a highly prevalent condition. Now it is understood that telangiectasias, reticular varicosities, and true varicose veins are physiologically similar and etiologically identical. The four main influences causing these abnormalities are heredity, female sex, gravitational hydrostatic forces, and hemodynamic muscular compartment pressure. There are clear indications and goals for intervention. A cornerstone in the treatment of venous insufficiency is elimination of sources of venous hypertension. One of these is the refluxing greater saphenous vein. Minimally invasive saphenous ablation can be achieved by radiofrequency energy and laser light energy. These new techniques eliminate the psychologic barrier to treatment caused by the term "stripping" and allow the objectives of surgery to be achieved with minimal invasion and quick recovery. Endovenous techniques show great promise. They provide minimal invasion, often under local anesthesia and intravenous sedation, thereby eliminating the need for general anesthesia. Objectives of venous insufficiency have been established and the endoluminal minimally invasive techniques developed in recent years appear to accomplish their goals.

Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis

BACKGROUND AND OBJECTIVES

Delayed thrombus regression after a first episode of deep vein thrombosis (DVT) of the inferior limbs has been implicated in the development of the post-thrombotic syndrome. Whether normalization of vein segments involved in the index DVT has prognostic significance with respect to the probability of DVT recurrence or new thrombosis is currently unknown. In this study, we prospectively monitored thrombus regression in consecutive patients with symptomatic and asymptomatic DVT. Factors affecting normalization rates and the relationship between previous normalization and DVT recurrence or new thrombosis were explored.

DESIGN AND METHODS

One hundred and seventy-nine patients with a first episode of symptomatic DVT of the lower limbs (38 with cancer) and 104 patients with DVT occurring after hip replacement surgery were serially monitored by real time B-mode compression ultrasonography (C-US) over a period of 12 months (months 1, 3, 6 and 12). C-US normalization of popliteal and femoral venous segments was arbitrarily assigned to be residual thrombus occupying, at maximum compressibility, less than 40% of the vein area in the absence of compression.

RESULTS

In patients with no DVT recurrence or new thrombosis, C-US normalization was observed at 12 months in 100% of 99 patients with post-operative DVT, in 59% of 134 cancer-free symptomatic DVT outpatients and in 23.3% of 30 symptomatic DVT outpatients with cancer (p = 0.0001). Independent negative effects on the probability of C-US normalization were observed for younger age (p <0.05), for the outpatient presentation of the index DVT (p 0.017), for DVT involving the entire femoro-popliteal axis (p 0.05), and for the presence of cancer (p 0.05). DVT recurrence or new thrombosis was observed in 5 patients with post-operative DVT (4.8%), in 7 cancer-free patients with symptomatic DVT (5.0%) and in 8 patients with cancer (21.1%). Only 4 of these patients had shown normalization of their index DVT prior to the event. The presence of cancer was the only significant predictor of DVT recurrence and/or new thrombosis occurring within 3 months from the index DVT (OR = 4.90, p = 0.002). The absence of previous C-US normalization was the only predictor of recurrence or new thrombosis occurring after 3 and 6 months from the index DVT (OR 5.26, p 0.027).

INTERPRETATION AND CONCLUSIONS

Absence of C-US normalization after a first episode of DVT appears to be a factor favoring recurrence or new thrombosis and may be relevant to the optimal duration of oral anticoagulant treatment.

Reteplase infusion in the treatment of acute lower extremity occlusions

PURPOSE

Reteplase, a recombinant tissue plasminogen activator, has been used in the treatment of acute coronary occlusion. Experience is accumulating regarding its use in the treatment of peripheral vascular disease. Increased experience with this thrombolytic agent may show that it can be an appropriate alternative agent to currently employed plasminogen activators.

MATERIALS AND METHODS

Over the course of six months, reteplase was used to treat 18 patients with peripheral arterial occlusions, confined to the lower extremities. The agent was infused via "pulse-spray" catheters. Fifteen patients were started on 0.5 U/h. Concurrent heparin therapy was used at 500 U/h in 16 of 18 patients.

RESULTS

The average total dose of reteplase infused was 13.3 units. It ranged from 6.2 to 41.5 units. The average duration of infusion was 26.9 hours with a range of 12-44 hours. Clinical success, defined as restoration of sufficient patency to reestablish limb function and resolution of pain in the symptomatic extremity was 89% (16 out of 18). Hemorrhagic complications occurred in five patients and were major in one patient (5%). No patient experienced intracranial hemorrhage.

CONCLUSION

Increased experience with the use of reteplase in the treatment of acute lower extremity occlusions is accumulating. The safety and efficacy profile in our group appears satisfactory and compares to other studies. However, definite conclusions must await the results of controlled comparisons of different reteplase infusion regimens and controlled comparison to other thrombolytic agents.

Markers of inflammation and hypercoagulability in diabetic and nondiabetic patients with lower extremity ischemia

Lower extremity ischemia is one aspect of atherosclerosis, a disease associated with both inflammation and hypercoagulability. Many recent studies have focused on a diversity of mechanisms by which inflammation can promote blood clotting. However, it has not been proven that inflammation can actually trigger clinically relevant thrombus formation in vivo. The purpose of the study was to determine the plasma levels of markers of inflammation and their possible association with markers for coagulability with special emphasis on the difference between patients with and without diabetes. Forty-six patients, 20 diabetics and 26 without diabetes scheduled for lower extremity revascularisation were examined by preoperative blood sampling. A strong positive correlation between C-reactive protein (CRP) and fibrinogen was found, particularly in diabetics. A high fibrinogen level was not associated with other markers of hypercoagulability, Thrombin-Antithrombin (TAT), Prothrombin Fragment 1+2 (F 1+2) and D-dimer although the latter three correlated with each other. There was also a correlation between von Willebrand antigen (vWF) and CRP, also in this case the relationship was dependent on the findings in patients with diabetes. It is concluded that there is a difference between diabetic and nondiabetic patients with lower limb ischemia with the former showing stronger signs of inflammation.

Acute effect of beraprost sodium on lower limb circulation in patients with non-insulin-dependent diabetes mellitus-evaluation by color Doppler ultrasonography and laser cutaneous blood flowmetry

The acute effects of beraprost sodium (sodium (+/-)-(1R*, 2R, 3aS*, 8bS*)-2, 3, 3a 8b-tetrahydro-2-hydroxy-1-[(E)-(3S*)-3-hydroxy-4-methyl-I- octen-6-ynyl] -1H-cyclopenta [b] bensofuran-5-butyrate), a stable analogue of prostaglandin I2 which works as a vasodilator and anti-platelet agent, were investigated in patients with non-insulin dependent diabetes mellitus. Its effects on the dorsal pedis artery were examined using a new real-time two-dimensional Doppler ultrasonographic technique and by laser blood flowmetry. Before and 60 min after oral administration of beraprost sodium (Dolner 40 micrograms) and elastase (Elaszym 1800 U), the cross-sectional area (CSA) of the dorsal pedis artery and its blood flow index (BFI), calculated from the maximum flow velocity and area, were determined. Dermal microcirculatory blood volume (MBV) was also measured by laser blood flowmetry. In the beraprost sodium group, the CSA, BFI and MBV were significantly increased, while in the elastase group, no significant changes were observed. These result suggest that beraprost sodium has a beneficial effect on diabetic macro- and microangiopathy.