Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Jingbo , LIU Zhengjun , LIN Zhiqi.

Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;

Corresponding author：

Keywords：

Atherosclerosis; Arteriosclerosis obliterans of lower extremity; Early diagnosis; Artery detection; Ankle brachial index

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Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.
Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO.
Conclusion Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.

Citation： LU Jingbo,LIU Zhengjun,LIN Zhiqi.. Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 690-693. doi: Copy

1.	王玉琦, 史振宇. 我国血管外科的现状与展望 [J]. 中国普外基础与临床杂志, 2008; 15(6): 387389.
2.	陈斌, 董智慧, 符伟国, 等. 性别对下肢动脉硬化性闭塞症的影响分析 [J]. 中华外科杂志, 2008; 46(7): 534536.
3.	管珩, 刘志民, 李光伟, 等. 50岁以上糖尿病人群周围动脉闭塞性疾病相关因素分析 [J]. 中华医学杂志, 2007; 87(1): 2327.
4.	Mutirangura P, Ruangsetakit C, Wongwanit C, et al. Atherosclerosis obliterans of the lower extremities in Thai patients [J]. J Med Assoc Thai, 2006; 89(10): 16121620.
5.	Zhou J, Austin RC. Contributions of hyperhomocysteinemia to atherosclerosis: Causal relationship and potential mechanisms [J]. Biofactors, 2009; 35(2): 120129.
6.	Utsumi K, Kawabe M, Hirama A, et al. Effects of selective LDL apheresis on plasma concentrations of ICAM1, VCAM1 and Pselectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis [J]. Clin Chim Acta, 2007; 377(12): 198200.
7.	赵泉, 邓靖宇, 罗开元, 等. 血管内皮细胞在动脉粥样硬化中的损伤机理 [J]. 中国普外基础与临床杂志, 2004; 11(4): 325327.
8.	Shval’b PG, Kalinin RE. Antioxidant activity and functional endothelium characteristics before and after the operation in patients with atherosclerosis obliterans [J]. Khirurgiia (Mosk), 2009; (1): 5355.
9.	Shval’b PG, Kalinin RE. Certain biochemical alterations in the blood of patients with atherosclerosis obliterans of the lower limb arteries [J]. Angiol Sosud Khir, 2007; 13(3): 3437.
10.	Iskra M, Barakiewicz D, Majewski W, et al. Serum magnesium, copper and zinc concentration changes in lower limb ischemia and postoperative treatment [J]. Magnes Res, 2005; 18(4): 261267.
11.	Fleck CA. Measuring ankle brachial pressure index [J]. Adv Skin Wound Care, 2007; 20(12): 645646, 648649.
12.	MacDonald E, Froggatt P, Lawrence G, et al. Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index? [J]. J Clin Monit Comput, 2008; 22(5): 381384.
13.	Mukherjee D, Cho L. Peripheral arterial disease: considerations in risks, diagnosis, and treatment [J]. J Natl Med Assoc, 2009; 101(10): 9991008.
14.	Nichols WW, Denardo SJ, Wilkinson IB, et al. Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform [J]. J Clin Hypertens (Greenwich), 2008; 10(4): 295303.
15.	Noon JP. The arterial pulse wave and vascular compliance [J]. Prog Cardiovasc Nurs, 2009; 24(2): 5358.
16.	Khoshdel AR, Carney SL, Nair BR, et al. Better management of cardiovascular diseases by pulse wave velocity: combining clinical practice with clinical research using evidencebased medicine [J]. Clin Med Res, 2007; 5(1): 4552.
17.	DeLoach SS, Townsend RR. Vascular stiffness: its measurement and significance for epidemiologic and outcome studies [J]. Clin J Am Soc Nephrol, 2008; 3(1): 184192.
18.	Liu Z, Hesse C, Curry TB, et al. Ambulatory arterial stiffness index is not correlated with the pressor response to laboratory stressors in normotensive humans [J]. J Hypertens, 2009; 27(4): 763768.
19.	Safar ME. Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension [J]. Ther Adv Cardiovasc Dis, 2008; 2(1): 1324.
20.	Celermajer DS, Sorensen KE, Gooch VM, et al. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis [J]. Lancet, 1992; 340(8828): 11111115.
21.	Korkmaz H, Onalan O. Evaluation of endothelial dysfunction: flowmediated dilation [J]. Endothelium, 2008; 15(4): 157163.
22.	Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1 010 patients [J]. Am Heart J, 2004; 147(3): 489493.
23.	高海青. 动脉功能早期检测技术的临床应用前景 [J]. 中华老年医学杂志, 2007; 26(5): 325327.
24.	刘艳萍. 下肢动脉粥样硬化性闭塞症的彩色多普勒超声诊断价值 [J]. 实用心脑肺血管病杂志, 2008; 16(5): 4445.
25.	Watanabe R, Nakanishi K, Ochi S, et al. Assessment of lower limb artery disease by ultrasound imaging [J]. Rinsho Byori, 2007; 55(2): 159169.
26.	NguyenThanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness [J]. Am J Cardiol, 2009; 104(10): 13831388.
27.	Ogasawara N, Komatsu S, Ropers D, et al. Detecting vulnerable plaque of arteriosclerosis obliterans by multidetectorrow computed tomography－comparing with VH (virtual histology)intravascular ultrasound [J]. Int J Cardiol, 2008; 127(2): e33e35.
28.	袁飞, 刘银社, 董少义, 等. 64层螺旋CT对下肢动脉硬化闭塞症的诊断价值 [J]. 中国医学影像技术, 2008; 24(11): 17671770.
29.	Yu T, Zhu X, Tang L, et al. Review of CT angiography of aorta [J]. Radiol Clin North Am, 2007; 45(3): 461483, viii.
30.	兰文婧, 谷艳英, 王大伟, 等. 3DCEMRA在下肢动脉硬化闭塞症中的诊断价值 [J]. 中国老年学杂志, 2006; 26(7): 882884.
31.	Debrey SM, Yu H, Lynch JK, et al. Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and metaanalysis [J]. Stroke, 2008; 39(8): 22372248.
32.	Yamada T, Ohta T, Ishibashi H, et al. Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs-comparison with other noninvasive diagnostic methods [J]. J Vasc Surg, 2008; 47(2): 318323.
33.	刘亮, 李小鹰, 赵秀梅, 等. 激光多普勒血流图像仪检测老年下肢动脉硬化闭塞症的临床疗效 [J]. 中华老年心脑血管病杂志, 2003; 5(6): 368370.
34.	刘亮, 李小鹰, 曹剑, 等. 甲襞微循环综合定量法评价前列腺素E1对老年下肢动脉硬化闭塞症的临床疗效 [J]. 军医进修学院学报, 2005; 26(3): 196197.
35.	Sugimoto I, Ohta T, Ishibashi H, et al. Transcutaneous carbon dioxide tension for the evaluation of limb ischemia [J]. Surg Today, 2009; 39(1): 913.

1. 王玉琦, 史振宇. 我国血管外科的现状与展望 [J]. 中国普外基础与临床杂志, 2008; 15(6): 387389.
2. 陈斌, 董智慧, 符伟国, 等. 性别对下肢动脉硬化性闭塞症的影响分析 [J]. 中华外科杂志, 2008; 46(7): 534536.
3. 管珩, 刘志民, 李光伟, 等. 50岁以上糖尿病人群周围动脉闭塞性疾病相关因素分析 [J]. 中华医学杂志, 2007; 87(1): 2327.
4. Mutirangura P, Ruangsetakit C, Wongwanit C, et al. Atherosclerosis obliterans of the lower extremities in Thai patients [J]. J Med Assoc Thai, 2006; 89(10): 16121620.
5. Zhou J, Austin RC. Contributions of hyperhomocysteinemia to atherosclerosis: Causal relationship and potential mechanisms [J]. Biofactors, 2009; 35(2): 120129.
6. Utsumi K, Kawabe M, Hirama A, et al. Effects of selective LDL apheresis on plasma concentrations of ICAM1, VCAM1 and Pselectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis [J]. Clin Chim Acta, 2007; 377(12): 198200.
7. 赵泉, 邓靖宇, 罗开元, 等. 血管内皮细胞在动脉粥样硬化中的损伤机理 [J]. 中国普外基础与临床杂志, 2004; 11(4): 325327.
8. Shval’b PG, Kalinin RE. Antioxidant activity and functional endothelium characteristics before and after the operation in patients with atherosclerosis obliterans [J]. Khirurgiia (Mosk), 2009; (1): 5355.
9. Shval’b PG, Kalinin RE. Certain biochemical alterations in the blood of patients with atherosclerosis obliterans of the lower limb arteries [J]. Angiol Sosud Khir, 2007; 13(3): 3437.
10. Iskra M, Barakiewicz D, Majewski W, et al. Serum magnesium, copper and zinc concentration changes in lower limb ischemia and postoperative treatment [J]. Magnes Res, 2005; 18(4): 261267.
11. Fleck CA. Measuring ankle brachial pressure index [J]. Adv Skin Wound Care, 2007; 20(12): 645646, 648649.
12. MacDonald E, Froggatt P, Lawrence G, et al. Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index? [J]. J Clin Monit Comput, 2008; 22(5): 381384.
13. Mukherjee D, Cho L. Peripheral arterial disease: considerations in risks, diagnosis, and treatment [J]. J Natl Med Assoc, 2009; 101(10): 9991008.
14. Nichols WW, Denardo SJ, Wilkinson IB, et al. Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform [J]. J Clin Hypertens (Greenwich), 2008; 10(4): 295303.
15. Noon JP. The arterial pulse wave and vascular compliance [J]. Prog Cardiovasc Nurs, 2009; 24(2): 5358.
16. Khoshdel AR, Carney SL, Nair BR, et al. Better management of cardiovascular diseases by pulse wave velocity: combining clinical practice with clinical research using evidencebased medicine [J]. Clin Med Res, 2007; 5(1): 4552.
17. DeLoach SS, Townsend RR. Vascular stiffness: its measurement and significance for epidemiologic and outcome studies [J]. Clin J Am Soc Nephrol, 2008; 3(1): 184192.
18. Liu Z, Hesse C, Curry TB, et al. Ambulatory arterial stiffness index is not correlated with the pressor response to laboratory stressors in normotensive humans [J]. J Hypertens, 2009; 27(4): 763768.
19. Safar ME. Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension [J]. Ther Adv Cardiovasc Dis, 2008; 2(1): 1324.
20. Celermajer DS, Sorensen KE, Gooch VM, et al. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis [J]. Lancet, 1992; 340(8828): 11111115.
21. Korkmaz H, Onalan O. Evaluation of endothelial dysfunction: flowmediated dilation [J]. Endothelium, 2008; 15(4): 157163.
22. Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1 010 patients [J]. Am Heart J, 2004; 147(3): 489493.
23. 高海青. 动脉功能早期检测技术的临床应用前景 [J]. 中华老年医学杂志, 2007; 26(5): 325327.
24. 刘艳萍. 下肢动脉粥样硬化性闭塞症的彩色多普勒超声诊断价值 [J]. 实用心脑肺血管病杂志, 2008; 16(5): 4445.
25. Watanabe R, Nakanishi K, Ochi S, et al. Assessment of lower limb artery disease by ultrasound imaging [J]. Rinsho Byori, 2007; 55(2): 159169.
26. NguyenThanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness [J]. Am J Cardiol, 2009; 104(10): 13831388.
27. Ogasawara N, Komatsu S, Ropers D, et al. Detecting vulnerable plaque of arteriosclerosis obliterans by multidetectorrow computed tomography－comparing with VH (virtual histology)intravascular ultrasound [J]. Int J Cardiol, 2008; 127(2): e33e35.
28. 袁飞, 刘银社, 董少义, 等. 64层螺旋CT对下肢动脉硬化闭塞症的诊断价值 [J]. 中国医学影像技术, 2008; 24(11): 17671770.
29. Yu T, Zhu X, Tang L, et al. Review of CT angiography of aorta [J]. Radiol Clin North Am, 2007; 45(3): 461483, viii.
30. 兰文婧, 谷艳英, 王大伟, 等. 3DCEMRA在下肢动脉硬化闭塞症中的诊断价值 [J]. 中国老年学杂志, 2006; 26(7): 882884.
31. Debrey SM, Yu H, Lynch JK, et al. Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and metaanalysis [J]. Stroke, 2008; 39(8): 22372248.
32. Yamada T, Ohta T, Ishibashi H, et al. Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs-comparison with other noninvasive diagnostic methods [J]. J Vasc Surg, 2008; 47(2): 318323.
33. 刘亮, 李小鹰, 赵秀梅, 等. 激光多普勒血流图像仪检测老年下肢动脉硬化闭塞症的临床疗效 [J]. 中华老年心脑血管病杂志, 2003; 5(6): 368370.
34. 刘亮, 李小鹰, 曹剑, 等. 甲襞微循环综合定量法评价前列腺素E1对老年下肢动脉硬化闭塞症的临床疗效 [J]. 军医进修学院学报, 2005; 26(3): 196197.
35. Sugimoto I, Ohta T, Ishibashi H, et al. Transcutaneous carbon dioxide tension for the evaluation of limb ischemia [J]. Surg Today, 2009; 39(1): 913.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage

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