Objective To evaluate the effectiveness and safety of autologous hemopoietic stem cell implantation for peripheral arterial disease (PAD). Methods Randomized controlled trials (RCTs) were identified from CBM (1978 to September 2010), CNKI (1979 to September 2010), MEDLINE (1950 to September 2010), Pubmed (1950 to September 2010), Embase (1970 to September 2010), and Cochrane l ibrary (issue 4, 2010). The papers of the RCTs of cl inical therapeutic studieson PAD treated by autologous hemopoietic stem cell implantation were included and analyzed according to the criteria of the Cochrane handbook. Results Eight RCTs involving 280 patients and 322 extremities were included, with majority of trials of low methodological qual ity. Meta-analysis indicated that autologous hemopoietic stem cell transplantation had an increased ulcer cure rate [RD=0.38, 95% CI= (0.25, 0.50)], a significant improvement in the ankle brachial index [MD=0.11, 95%CI= (0.04, 0.18)], transcutaneous oxygen tension [MD=7.33, 95%CI= (3.14, 11.51)], and pain-free walking distance [SMD=1.35, 95%CI= (0.90, 1.79)], a significant reduction in rest pain scores [MD= —1.70, 95%CI= (—2.15, —1.25)], and a significant benefit in terms of l imb salvage [RD= —0.19, 95%CI= (—0.31, —0.07)]. Only 2 trials reported the side effects of autologous hemopoietic stem cell transplantation, such as l imbs swell ing and concentrations of serum creatine phosphokinase increasing, and the long-term safety was not reported. Conclusion Based on the review, autologous hemopoietic stem cell transplantation may have positive effect on “no-option” patients with PAD. However, the evidence is not b enough due to the general low methodological qual ity, so we can not draw a rel iable conclusion about the effects of autologous stem cell transplantation for PAD at the moment. Further larger, randomized, double bl ind, placebo-controlled, and multicenter trials are needed.
Objective To evaluate the effectiveness and safety of sarpogrelate hydrochloride for patients with peripheral arterial disease (PAD). Methods The randomized controlled trials (RCTs) on PAD treated by sarpogrelate hydrochloride were identified from CBM (1978 to September 2011), CNKI (1979 to May 2011), PubMed (1950 to May 2011), EMbase (1970 to May 2011) and The Cochrane Library (Issue 3, 2011). According to the criteria of the Cochrane Handbook, two reviewers independently screened the studies, extracted and cross-checked the data, and assessed the methodological quality. Then meta-analysis was conducted by using RevMan 5.0 software. Results Nine RCTs involving 522 patients and 532 limbs were included, with low methodological quality in most trials. The results of meta-analyses indicated that compared with the conventional treatment, sarpogrelate hydrochloride could reduce the area of ulcers (MD= –3.22, 95%CI –3.99 to –2.45), and it could increase the ankle-brachial index (SMD=0.49, 95%CI 0.07 to 0.91), blood flow of dorsalis pedis artery (MD=0.16, 95%CI 0.09 to 0.23) and pain-free walking distance (MD=200.87, 95%CI 3.39 to 398.36). Five trials reported the adverse effects of sarpogrelate hydrochloride, most of which were mild gastrointestinal symptoms. Conclusion Based on the review, sarpogrelate hydrochloride may have positive effect on patients with PAD. However, the evidence is not b enough due to the general low methodological quality, so the reliable conclusion has to be drawn with more high quality studies in future.
Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method. Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed. Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died. Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.
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.