FromApril1990toDecember1996,15patientswithaortoiliofemoralorfemoralatheroscleroticocclusivediseaseweretreatedwithaortoprofundabypassgrafting:5patientswereperformedwithprofundoplasty;2patientsweretreatedwithprofundapoplitealarterybypass.Theexcellentresultsofthe19patientswereconfirmedafterameanfollowupperiodof24.5months.Twopatientshadimprovementafteroperation.Amputationwasperformedinonelimbafter6monthsofoperationbecauseofsevereinflammation.Theauthorsconsideredthattheprofundafemoralarteryplaysanimportantroleinaortofemoralarteryreconstruction.Itisagoodinfloworoutflowprovidingarterialbloodtoseverelyischemiclegswithocclusionofaortoiliosuperficial,iliosuperficialorsuperficialfemoralarteries.
【Abstract】 Objective To analyze the influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis. Methods Between January 2009 and December 2010, 59 patients (67 limbs) with chronic limb ischemia associated with acute thrombosis were treated. According to whether the no-reflow phenomenon occurred or not, the patients were divided into no-reflow group (19 patients, 21 limbs) and reflow group (40 patients, 46 limbs). Logistic regression was used to analyze the roles of ischemia time, ischemia extent, smoking, hypertension, cardiovascular and cerebrovascular disease, diabetes, surgical procedure, platelet count, fibrinogen (FBG), prostaglandin I2 (PGI2), and thromboxane A2 (TXA2) on no-reflow phenomenon after reperfusion. Results The results of the logistic regression analysis indicated that ischemia time (OR=7.196; 95%CI: 1.679-27.960), ischemia extent (OR=5.116; 95%CI: 1.399-109.338), smoking (OR=6.893; 95%CI: 3.704-2 291.003), diabetes (OR=3.864; 95%CI: 1.009-421.702), PGI2 (OR=7.985; 95%CI: 1.001-1.043), and TXA2 (OR=7.643; 95%CI: 1.011-1.065) were the high risk factors of no-reflow phenomenon. The levels of TXA2 and FBG in no-reflow group were significantly increased and the level of PGI2 was decreased, showing significant differences when compared with the reflow group (P lt; 0.05). However, no significant difference was found in the platelet count between 2 groups (P gt; 0.05). Conclusion Ischemia extent and ischemia time are the main influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis, and the patients combined with smoking or diabetes are high risk population of the no-reflow phenomenon. Postoperative patients with no-reflow phenomenon are at a hypercoagulable state in vivo, in which prostacyclin plays an important role.
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.
Objective To determine the clinical effect of sequence and cross bypass or combined with endovascular procedure for mutilevelarterial occlusive disease of lower extremity so as to investigate the credibletreatment for mutilevel arterial occlusive disease of lower extremity. Methods Between April 2004 and July 2005， 11 patients （14 limbs）underwent sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure. Among of them, 10 cases were male and 1 case was female, aging 62-79 years(mean 70.5 years), and including 8 cases of intermittent claudications (Fontaine stage Ⅱ), 3 cases of rest pain (Fontaine stage Ⅲ) and 1 case of toe ulcerwith gangrene (Fontaine stage Ⅳ). Colour Doppler ultrasonography showed that 14 lower limbswere diagnosed as having multilevel arterial occlusive disease and the preoperation and ankle brachial index(ABI) was 0.36±0.11 . Lower limb digital subtraction angiography(DSA) showed 3 cases of bilateral iliac artery stenosis，extrailiac artery occlusion and bilateral superficial femoral artery occlusions，1 case of right common iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions and 8 cases of unilateral extrailiac artery stenosis and superficial femoral artery occlusions. Postoperation tests of DSA,colour Doppler ultrasonography and ABI were done to observe cumulative patency rate after operation. Results The follow-up period was from 3 to 26 months(mean 14.5 months ). All patients survived. The symptoms of intermittent claudication and rest pain disappeard in all patients. ABI was improved by0.89±0.13 after procedure（Ｐlt;0.01）. The overall salvage rate of limb was 100%. DSA was performed from 3 to 280 days after operation, the overall primary graft patency rate was 92.86%（13/14）.Conclusion Sequence and cross bypass， thromboendarterectomy or combined with endovascular procedure in treatment of mutilevel occlusive disease of lower extremity was effective, less invasive and safe.
Objective To assess the effects and possible adverse reactions of traditional Chinese medicine (TCM) in treating arteriosclerosis obliterans. Methods Materials were collected with both electronic retrieval including EMbase (1978 to October 2009), OVID-MEDLINE (1950 to October 2009), Cochrane Controlled Trials Register (Issue 3, 2009), Current Controlled Trials, The National Research Register, CBM (1983 to September 2009), CNKI (1995 to September 2009), Wanfang Data (1994 to 2009), and VIP Data (1989 to 2009), and manual retrieval of related journals. All the retrievals were published before November 10, 2009 without limitation of languages. The quality of included studies was evaluated, and meta-analysis was conducted with RevMan 5.0.2 software. Results A total of 10 included studies were all randomized controlled trials, including 837 patients, and the sample size of each study was from 36 to 260 cases. Because both Chinese medicines and control drugs used in studies were different from each other, the effect size of each study can only be singley described and newly calculated. Most included studies showed that, the effects of TCM on cure rate, total effective rate and decrease of TC and TG were similar to that of aspirin, acipimox, prostaglandin E1; a few studies showed the effect of TCM was much better; one study on side effect showed that, TCM was less than western medicine. Conclusion The evidences of TCM effects in treating arteriosclerosis obliterans is quite limited, which has to be strengthened by more studies of high quality.
摘要:目的: 探讨动脉硬化闭塞症(ASO)和静脉血栓形成(VT)患者同型半胱氨酸(Hcy)变化。 方法 :通过循环酶法对34例非动脉硬化闭塞症(ASO)和静脉血栓形成(VT)患者(对照组),30例动脉硬化闭塞症(ASO)患者和26例静脉血栓形成(VT)患者血液中Hcy进行测定。 结果 :循环酶法测定HCY的批内平均变异系数为2．23％,批间平均变异系数为1．59％。34例对照组,〖WTBX〗t =1135,〖WTBX〗P =0266gt;005;动脉硬化闭塞症(ASO)组Hcy含量明显高于对照组(〖WTBX〗P lt;O．05),静脉血栓形成(VT)组Hcy含量高于对照组(〖WTBX〗P lt;0．O5)。 结论 :高同型半胱氨酸血症可能是动脉硬化闭塞症(ASO)和静脉血栓形成(VT)及复发的致病因素。可将同型半胱氨酸作为动脉硬化闭塞症(ASO)和静脉血栓形成(VT)及复发的重要指标。Abstract: Objective: TO syudy the changes of the Homocysteine about Atherosclerosis obliterans and Venous thrombosis patients. Methods : To measure the Hcy in the blood of 34 healthy cases both non ASO and non VT(the comparison group),30 cases of ASO patients and 26 cases of VT patients respectively by enzymatic cycling assay。〖WTHZ〗Results :The average variation coefficient of Hcy within the groups was 223% and among the groups was 159% measured by enzymatic cycling assay.In the 34 cases of comparison group,t=1135,P=0266gt;005,The content of Hcy in the blood of ASO patients group were significantly higher than the comparision group (Plt;005),and the content of Hcy in the blood of VT patients group were also higher than the comparison group (Plt;005). Conclusion : Hyper Hcy may be the pathogenic diathesis to form or to recrudesce ASO and VT.So we can treat Hcy as the significant index to form or to recrudesce ASO and VT.
Objective To explore the relationship between the structure and function of galectin-3， lipid metabolism disorders， and investigate the expression of galectin-3 in the occurrence and progress of lower limb arteriosclerosis block disease. Methods Related articles were reviewed. Results Galectin-3 participates in inflammatory reaction and lipid metabolism disorders， regulates the cell growth， differentiation， adhesion， apoptosis， and angiogenesis， and palys a role in the occurrence and progress of arteriosclerosis obliterans. Conclusion Galectin-3 is correlation with the occurrence， progress， and the prognosis of arteriosclerosis obliterans.
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 探讨下肢动脉硬化闭塞症继发血栓形成患者的有效治疗方法。方法 回顾性分析我院2005年6月至2009年5月期间收治的35例此类患者，11例重度者行急诊手术取栓和股动脉内膜剥脱术，其中截肢3例，二期行经皮球囊扩张血管成形术（PTA）和自体外周血干细胞移植术（APBSCT）4例。 轻中度者24例则先行解痉、扩血管、抗凝及溶栓治疗，二期在数字减影动脉造影术（DSA）下行PTA， 其中截趾4例，同期行APBSCT治疗 22例。结果 除死亡2例、急诊截肢3例以外，其余30例治疗后症状缓解，近、远期疗效满意，其中行APBSCT治疗的26例患者，其治疗后的间歇性跛行距离、皮温和踝/肱指数均较APBSCT治疗前明显改善，其差异均有统计学意义（均P=0.01）， CTA、MRA或DSA检查下肢动脉供血有所改善。结论 根据患者入院时下肢缺血的急、重程度而分别采用取栓及股动脉内膜剥脱术、药物以及后续的介入、APBSCT治疗后，近、远期疗效确切。早期及时和正确的处理是挽救患者肢体和生命的关键。