Objective To evaluate the cl inical effect of percutaneous transluminal angioplasty (PTA) and PTA and stenting (PTAS) in treating multilevel arteriosclerosis obl iterans (ASO) of lower extremities. Methods Between January 2007 and October 2009, 29 cases of multilevel ASO of lower extremities were treated with PTA or PTAS. There were 17 males and 12females with an average age of 71 years (range, 56-83 years). The cl inical manifestations were l imbs numb with cold sensation, intermittent claudication (lt; 100 m), and 19 patients had rest pain. According to Fontaine stages classification, there were 7 cases of stage II, 14 cases of stage III, and 8 cases of stage IV. Concomitant diseases included hyperl ipidemia in 13 cases, diabetes in 6 cases, hypertension in 12 cases, chronic heart failure in 5 cases, chronic obstructive pulmonary disease in 3 cases, cerebral infarction in 5 cases, and toe ulcer in 15 cases. The preoperative ankle/brachial index (ABI) was 0.28 ± 0.13. Results In 3 cases of below knee lesions for the guide wire puncturing through the artery wall, 1 case gave up, and 2 cases continued recanal ized other arteries without serious bleeding compl ications. After operation, cerebral infarction occurred in 1 case, pulmonary infection in 2 cases, and groin puncture site hematoma in 2 cases. All patients were followed up 3 to 36 months. Limb skin temperature was significantly improved, and intermittent claudication disappeared or claudication distance lengthened, rest pain disappeared or significantly reduced in 27 patients (30 l imbs). The wound of amputee achieved good heal ing in 2 cases (2 l imbs). In 27 patients undergoing endovascular treatment, the postoperative ABI was 0.72 ± 0.19, showing significant difference when compared with the preoperative one (P lt; 0.05). Conclusion The PTA and PTAS treatment for multilevel ASO of lower extremities is a safe and effective option, and the short-term effect is good. Different treatments should be chosen according to the location and length of vascular occlusion.
目的 评价盐酸沙格雷酯治疗慢性下肢动脉闭塞症的有效性和安全性。方法 对根据临床症状、下肢三维血管重建（CTA）或血管造影检查诊断为慢性下肢动脉硬化闭塞症的32例患者，采用盐酸沙格雷酯（100 mg/片）治疗，1片/次，3次/d，餐后口服，连续4周。用药24个月后观察患者临床症状的改善情况，分析盐酸沙格雷酯的治疗效果。结果 用药24个月期间，失访3例，获访29例。综合疗效显效6例，良好15例，改善5例，无效3例，总有效率为89.7% （26/29）。治疗前后患者的凝血系统和临床生化各指标比较差异均无统计学意义（P＞0.05）。用药后3例（10.3%）患者出现轻度恶心和胃部不适，2例（6.9%）患者出现轻度皮疹，其余患者均无不良反应出现。安全性评价安全没问题24例，稍有问题5例。结论 盐酸沙格雷酯可以改善慢性下肢动脉硬化闭塞症患者的临床症状。
目的探讨盐酸沙格雷酯治疗2型糖尿病合并下肢动脉硬化闭塞症（ASO）患者的临床疗效。 方法笔者所在医院科室2011年2月至2012年2月期间采用盐酸沙格雷酯治疗了64例2型糖尿病合并ASO住院患者，用药方法为100 mg/次，3次/d，连续用药3个月。比较患者用药前后临床症状与体征、踝肱指数（ABI）、足背动脉血流量、凝血功能等指标的变化。 结果治疗后患者主观感觉下肢麻木、冷感、疼痛等症状均有不同程度的改善；间歇性跛行距离〔（620.26±16.76）m比（236.28±18.43）m〕、ABI〔0.86±0.04比0.50±0.08〕及足背动脉血流量〔（32.5±16.8）mL/min比（21.1±10.2）mL/min〕均较治疗前好转（P<0.05）；空腹血糖〔（6.18±1.23）mmol/L比（8.32±1.58）mmol/L〕、糖化血红蛋白〔（6.88±0.45）%比（7.26±0.26）%〕及低密度脂蛋白〔（3.02±0.26）mmol/L比（3.31±0.30）mmol/L〕也明显改善（P<0.05）；而治疗前后的凝血酶原时间、血小板计数、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酐及尿素氮的差异均无统计学意义（P>0.05）。综合疗效显著24例，有效38例，无效2例，总有效率为96.9%。用药后有3例患者出现轻度胃部不适症状，余无任何不良反应及药物过敏发生。 结论盐酸沙格雷酯在2型糖尿病合并ASO患者的临床治疗中安全有效。
ObjectiveTo investigate the therapeutic evaluation of catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular in the treatment of lower extremity atherosclerotic occlusive disease (ASO). MethodsClinical data of 64 ASO patients who were treated in our hospital from June 2011 to October 2014 were analyzed retrospectively. These patients were divided into two groups according to the therapies:33 patients were treated by catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular (combination group), and the other 31 patients were only treated by multiple minimally invasive techniques of endovascular (intervention group). Comparison of the clinical indexes was performed between the 2 groups, including vascular patency rate, stent implantation rate, operation time, ankle-brachial index (ABI), saturation of blood oxygen (SO2) of toes, temperature of foot skin, amputation rate, and hospitalization expense. ResultsIn the same group (combination group and intervention group), compared with the time point of before operation, the clinical indexes of the ABI, SO2 of toes, and temperature of foot skin were higher after operation (P<0.05). At the same time point of before or after operation, there were no significant difference between the 2 groups in ABI, SO2 of toes, and temperature of foot skin (P>0.05). The vascular patency rate of combination group was higher than that of intervention group[97.0% (32/33) vs. 83.9% (26/31)], P<0.05. But the stent implantation rate[18.2% (6/33) vs. 64.5% (20/31)], amputation rate[3.0% (1/33) vs. 16.1% (5/31)], operative time[(2.0±0.5) h vs. (4.0±1.1) h], and hospitalization expense of patients who got successful limb salvage[(8 500±1 200) yuan vs. (34 000±2 100) yuan] of combination group were all lower or shorter than those of intervention group (P<0.05). After operation, there were no complication happened in the patients who got successful limb salvage of combination group (n=32) and intervention group (n=26). In postoperative 6 months, the lower extremity arteries in patients who got successful limb salvage of combination group and intervention group were all examined by color ultrasonography, and they were unblocked. The lower extremity arteries of the patients with stent implantation in the 2 groups suffered with no obvious stenosis or occlusion. ConclusionsCatheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular can become one of the surgical treatment methods for ASO, which characterized by minimally invasive operation, effective treatment, and low cost.
ObjectiveTo systematically review the efficacy and safety of different drugs for the treatment of intermittent claudication in patients with peripheral arterial disease. MethodsThe PubMed, Scopus, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) of intermittent claudication due to peripheral arterial disease from database inception to December 31st, 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. ResultsA total of 36 studies were included, which involved vasodilators (i.e., cilostazol), lipid-lowering agents (i.e., atorvastatin), antiplatelet drugs (i.e., sarpogrelate), and other types of medicine (i.e., L-carnitine and allopurinol). The results of meta-analysis showed that the effects of simvastatin, bencyclane, and ramipril were superior to cilostazol and other drugs in improving PFWD, among which bencyclane was the most efficient. Besides, simvastatin and ramipril were also superior to cilostazol and other drugs in improving MWD (P<0.05). However, there was no statistically significant difference between cilostazol and other drugs (P>0.05). In terms of adverse events, iloprost was inferior to other drugs, while sulodexide was better tolerated. ConclusionBencyclane is a preferred choice to improve PFWD for the treatment of IC due to PAD, simvastatin and ramipril to improve MWD; however, their safety is poor. Overall, sulodexide and L-carnitine are ideal medicines for IC. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Main iliac artery disease is a common lesion that leads to arteriosclerosis and occlusion of the lower limbs. Effective treatment of complex main iliac artery disease has always been a difficult problem. The author’s team successfully treated a patient with long segment iliac artery occlusive disease from the left common iliac artery to the opening of the left femoral artery (118 mm) with Gore viabahn VBX balloon dilated intravascular covered stent and viabahn covered stent, and be reported.
ObjectiveTo explore the risk factors affecting occurrence of arteriosclerosis obliterans (ASO) for patients with type 2 diabetes mellitus (T2DM) and to develop a nomogram predictive model for these risk factors. MethodsA case-control study was conducted. The patients with T2DM accompanied with ASO and those with T2DM alone, admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2022, were retrospectively collected according to the inclusion and exclusion criteria. The basic characteristics and relevant laboratory test indicators of two groups were compared. The multivariate logistic regression analysis was used to identify the risk factors for the occurrence of ASO in the patients with T2DM, and then a nomogram predictive model was developed. ResultsThe study included 119 patients with T2DM alone and 114 patients with T2DM accompanied with lower extremity ASO. The significant differences were observed between the two groups in terms of smoking history, white blood cell count, neutrophil count, lymphocyte count, platelet count, systemic immune-inflammation index, systemic inflammatory response index (SIRI), high-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), apolipoprotein α (Apoα), serum cystatin C, free-triiodothyronine (FT3), total triiodothyronine, free triiodothyronine / total triiodothyronine ratio, fibrinogen (Fib), fibrinogen degradation products, and plasma D-dimer (P<0.05). Further the results of the multivariate logistic regression analysis revealed that the history of smoking, increased levels of Fib and SIRI value increased the probability of occurrence of ASO in the patients with T2DM [OR (95%CI) = 2.921 (1.023, 4.227), P=0.003; OR (95%CI) =2.641 (1.810, 4.327), P<0.001; OR (95%CI) = 1.020 (1.004, 1.044), P=0.018], whereas higher levels of ApoA1 and FT3 were associated with a reduced probability of occurrence of ASO in the patients with T2DM [OR (95%CI) = 0.231 (0.054, 0.782), P=0.018; OR (95% CI) = 0.503 (0.352, 0.809), P=0.003]. The nomogram predictive model based on these factors demonstrated a good discrimination for predicting the ASO in the T2DM patients [area under the receiver operating characteristic curve (95%CI) =0.788 (0.730, 0.846)]. The predicted curve closely matched the ideal curve (Hosmer-Lemeshow goodness-of-fit test, χ2= 5.952, P= 0.653). The decision curve analysis showed that the clinical net benefit of intervention based on the nomogram model was higher within a threshold probability range of 0.18 to 0.80 compared to no intervention or universal intervention. ConclusionThe analysis indicates that T2DM patients with a smoking history, elevated Fib level, and reduced levels of ApoA1 and FT3 should be closely monitored for ASO risk. The nomogram predictive model based on these features has a good discriminatory power for predicting ASO in T2DM patients, though its value warrants further investigation.