ObjectiveTo discuss the effectiveness of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. MethodsBetween March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were male, aged from 63 to 82 years with an average of 74.2 years. The disease duration of ASO was 1.5-22.0 months (mean, 10.5 months). All cases were severe unilateral iliac arterial occlusion, including 5 cases of the left side and 4 cases of the right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASO and 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontaine criteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral artery bypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in the other 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per 6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. ResultsThe incision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was no obvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissue of foot wound was growing quickly after tibial bone transverse transporting, and the wound was reduced after 2-3 weeks. All the 9 patients were followed up 12-32 months (mean, 19 months). The ankle brachial index was 0.67±0.09 at 2 months postoperatively, which was significantly higher than that before operation (t=17.510, P=0.032). All the feet ulcer wounds healed and the healing time was 6.7-9.4 weeks (mean, 7.7 weeks). During follow-up, color Doppler ultrasound or CT examination revealed grafted blood vessel patency. The external fixator was removed at 12-14 weeks after operation. One case died of sudden myocardial infarction at 14 months after operation, and there was no lymphatic leakage. The patency rate of femoral-femoral bypass was 100% at 1 year after operation. The tibial transverse bone grafting healed with tibia at 4-6 months after operation. At last follow-up, the effective rate was 100%. ConclusionFemoral-femoral artery bypass grafting combined with transverse tibial bone transporting is an effective method in the treatment of lower extremity ASO or combined with diabetic foot.
ObjectiveTo evaluate the safety and efficiency of SilverHawk plaque excision in treatment of sympto-matic infrapopliteal arterial occlusive disease (IPAD). MethodsThe clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were 29 males and 25 females. The age was (65.8±4.5) years, the period was (25.1±3.3) months. All the patients were Fontaine gradeⅡb-Ⅳ. The patients were divided into plaque excision group (n=9) and angioplasty group (n=45) according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups. Results①There were no significant differences in the gender, age, complications, ankle brachial index (ABI), outflow tract score, lesion length, and other clinical data between the 2 groups (P > 0.05).②The technical success rate had no significant difference between the plaque excision group and the angioplasty group[100% (9/9) versus 86.7% (39/45), P=0.574]. Six cases were failed because the guide wire could not pass through the diseased segment in 4 cases and there were 2 cases of serious residual stenosis in the angioplasty group.③There was no significant difference in the incidence of vascular complications between the 2 groups[11.1% (1/9) versus 11.1% (5/45), P=1.000].④The follow-up results:One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 groups (P> 0.05). The ABI and ABI average improvement also had no significant significances between the 2 groups (P > 0.05). ConclusionPlaque excision is a safe and acceptable method to treat symptomatic IPAD, and its efficacy is better than angioplasty.
FromApril1990toDecember1996,15patientswithaortoiliofemoralorfemoralatheroscleroticocclusivediseaseweretreatedwithaortoprofundabypassgrafting:5patientswereperformedwithprofundoplasty;2patientsweretreatedwithprofundapoplitealarterybypass.Theexcellentresultsofthe19patientswereconfirmedafterameanfollowupperiodof24.5months.Twopatientshadimprovementafteroperation.Amputationwasperformedinonelimbafter6monthsofoperationbecauseofsevereinflammation.Theauthorsconsideredthattheprofundafemoralarteryplaysanimportantroleinaortofemoralarteryreconstruction.Itisagoodinfloworoutflowprovidingarterialbloodtoseverelyischemiclegswithocclusionofaortoiliosuperficial,iliosuperficialorsuperficialfemoralarteries.
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.
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 using 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, blood, thyroid hormones, and other relevant indicators of the paitents in 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. ResultsThere were 119 patients with T2DM alone and 114 patients with T2DM accompanied with lower extremity ASO in this study. 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, FT3/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 Fib level and SIRI value increased the probabilities of ASO occurrence 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 reduced probabilities of ASO occurrence in the patients with T2DM [OR (95%CI)=0.231 (0.054, 0.782), P=0.021; OR (95%CI)=0.503 (0.352, 0.809), P=0.002]. The nomogram predictive model based on these factors demonstrated a good discrimination for predicting the ASO occurrence 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 clinical decision analysis curve 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. ConclusionsThe analysis results indicate that T2DM patients with a smoking history, elevated Fib level and SIRI value, as well as decreased ApoA1 and FT3 levels should be closely monitored for ASO risk. The nomogram predictive model based on these features has a good discriminatory power for ASO occurrence in T2DM patients, though its value warrants further investigation.
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.
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。
ObjectiveTo compare the efficacy of three surgical approaches, including percutaneous transluminal angioplasty (PTA), PTA+bare metal stent (BMS), and Rotarex+PTA+drug coated balloon (DCB), in treating femoropopliteal artery lesions in arteriosclerosis obliterans (ASO), and to explore the prognostic factors of femoropopliteal artery lesions in ASO. MethodsA retrospective analysis was conducted on 314 patients with femoropopliteal artery lesions in ASO who were treated in the Department of Vascular and Thyroid Surgery in the First Affiliated Hospital of Xinjiang Medical University from March 2018 to March 2024. inverse probability of treatment weighting was used to balance the baseline characteristics of the three groups. The clinical examination, imaging examination, and ankle-brachial index (ABI) results of the three groups at 3 months, 12 months, and 24 months after surgery were compared. Log-rank test was used to compare the incidence of all-cause mortality (ACM) and major adverse limb events (MALEs) among the three groups, and Cox proportional hazards regression model was used to analyze the prognostic factors of femoropopliteal artery lesions in ASO. ResultsA total of 314 patients with ASO femoropopliteal artery lesions were enrolled, comprising 153 cases in the PTA group, 89 cases in the PTA+BMS group, and 72 cases in the Rotarex+PTA+DCB group. After inverse probability of treatment weighting based on propensity scores, baseline characteristics were balanced across all groups (all P>0.05). Postoperative follow-up results demonstrated the following patency rates: at 3 months, 58.4% (87/149) for the PTA group, 79.5% (66/83) for the PTA+BMS group, and 87.5% (63/72) for the Rotarex+PTA+DCB group; at 12 months, 78.0% (60/79), 68.3% (43/63), and 80.0% (44/55), respectively; and at 24 months, 98.1% (52/53), 89.7% (35/39), and 100.0% (43/43), respectively. The Rotarex+PTA+DCB group exhibited significantly superior patency rates, claudication distances, ankle-brachial index (ABI), and Rutherford classification compared to both the PTA and PTA+BMS groups at 3 months (P<0.05). Furthermore, the Rotarex+PTA+DCB group showed lower incidence of ACM/MALEs compared to the other two groups (χ2=18.70, P<0.001). Survival analysis revealed that the Rotarex+PTA+DCB group had significantly better survival outcomes compared to the PTA+BMS group (χ2=14.27, P<0.001) and the PTA group (χ2=3.92, P=0.016). Cox proportional hazards regression analysis identified elevated red cell distribution width (RDW) as an independent risk factor for ACM/MALEs following endovascular therapy in ASO patients, with a relative risk of 1.006 [95%CI (1.002, 1.011), P=0.006]. ConclusionsThe Rotarex+PTA+DCB demonstrate superior outcomes compared to both the PTA and PTA+BMS in terms of patency rate, claudication distance, ABI, and Rutherford classification at 3 months postoperatively, along with the better survival. Furthermore, elevated RDW may serve as a prognostic factor for adverse outcomes in patients with ASO femoropopliteal artery lesions.