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Abstract:Angioplasty and perfusion of the distal limb is the key points of the treatment of arteriosclerosis obliterans of lower extremities. The way of angioplasty includes open vascular operations and endovascular treatment. Endovascular treatment represents the high and new technology, which has gradually become the first choice of its treatment, even under some complex conditions. The endovascular treatment can achieve better clinical outcome and make less trauma. In this article, we reviewed the current situation and prospect of endovascular treatment for arteriosclerosis obliterans of lower extremity.

Abstract:Objective To observe the technical success rate and short-term clinical outcomes of percutaneous transluminal angioplasty (PTA) in treatment of critical lower limb ischemia in stroke patients with limb dysfunction. Methods Clinical data of 280 consecutive stroke patients with Fontaine Ⅲ?Ⅳ stages and limb dysfunction (326 limbs) admitted in our hospital from January 2008 to December 2014 were collected and retrospectively analyzed. All these patients were treated with PTA. Technical success rate, incidences of complications, clinical efficacy, ankle-brachial index (ABI), and vascular restenosis were observed and evaluated. Results There were 342 PTA performed in 280 patients (326 limbs), and technical success rate achieved 94.8% (309/326). No serious complications occurred. Clinical symptoms were obviously improved after successful PTA. The ABI was significantly increased from 0.26±0.24 before operation to 0.72±0.29 postoperatively, with significant difference (P＜0.05). For the 210 patients (242 limbs) who were followed up for average 27 months (ranging from 3 to 90 months), the ABI was 0.65±0.26 and 0.54±0.31 respectively in 6 and 12 months after treatment, significantly improved than before treatment. Duplex ultrasound imaging showed that the cumulative restenosis ratio was 35.9% in 1 year after operation, and 70 patients of them (28.9%) received reintervention due to recurrence of symptoms. Conclusion PTA is a good approach for lower limb peripheral arterial disease, with higher technical success rate, lower incidence of complications, and exact curative effect, and is the first choice for the disease. Because of the limited functional exercise in the stroke patients with limb dysfunction, they had a higher incidence of restenosis. Further research is needed to improve the surgery success rate and postoperative vascular patency for the occlusive lesions.

Abstract:Objective To determine the effect of subclinical hypothyroidism (SHT) on diabetic macrovascular diseases in the elderly with type 2 diabetes mellitus. Methods Among the 368 type 2 diabetic subjects who admitted in our department from June 2013 to June 2015, 35 subjects complicated with SHT (aged over 60 years) and 35 matched subjects without SHT were selected and enrolled in this study．Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), left ventricular ejection fraction (LVEF), and E/A ratio [left ventricular early diastolic mitral flow velocity (E) to left ventricular end diastolic mitral flow velocity (A)] and ankle-brachial index (ABI) were compared between the 2 groups in order to determine the effect of SHT on diabetic macrovascular diseases. Results The serum levels of thyroid stimulating hormone (TSH, P＜0.001) and TC (P＝0.002) were significantly higher, while LVEF was obviously lower (P＝0.043) in the SHT group than in the euthyroid group. But there were no remarkable differences in the the E/A ratio and ABI between the 2 groups (P＞0.05). Conclusion Subclinical hypothyroidism may cause left ventricular systolic dysfunction in the elderly with type 2 diabetes mellitus, but its effect on diabetic macrovascular diseases needs further investigation.

Abstract:Objective To summarize our experience in the therapeutic options for femoral artery pseudoaneurysms (FAP). Methods Clinical data of 53 FAP patients admitted in our department from March 2005 to May 2015 were collected and retrospectively analyzed. Thirty-eight cases (71.7%) were iatrogenic injury, 8 (15.1%) were Bechest’s disease, 4 (7.5%) and 3 (5.7%) were due to trauma and infection. The cohort received surgical therapy, endovascular treatment and ultrasound-guided thrombin injection (UGTI). Results UGTI was performed on 17 cases (32.1%), with a success rate of 88.2%. Open surgery was carried out on 27 cases, with an overall complication rate of 37.0%, and no perioperative death was observed. Endovascular treatment was performed on 9 cases (17.0%), with a success rate of 100.0%, and no perioperative complication was observed. During the follow-up, the overall 3-year cumulative patency rate was 94.3%, and 3-year overall survival rate was 94.0%. Conclusion UGTI is the optional method for uncomplicated FAP. Surgical treatment still remains irreplaceable for complicated FAP, but the perioperative complication rate is quite high. Endovascular treatment can be employed for the pseudoaneurysms located far from the femoral artery bifurcation or the critically ill patients in emergency.

Abstract:Objective To evaluate the clinical safety and efficiency of endovascular treatment for subclavian artery stenosis or occlusion. Methods Totally 38 patients suffering from symptomatic subclavian artery stenosis or occlusion in our department from January 2011 to August 2015 were recruited in this study. They were 27 males and 11 females, at a mean age of (66.2±10.8) years. All of them presented the neurological symptoms such as dizziness, and some were accompanied by symptoms of upper limb ischemia. Percutaneous transluminal angioplasty and stent implantation were applied to them. Their clinical data and outcomes were collected and analyzed to evaluate the efficiency of the treatment. Results There were 36 cases successfully receiving balloon-expandable stent implantation. Their right- and left-arm blood pressure discrepancies were improved after treatment. The preoperative neurological symptoms were improved or disappeared in 33 patients after the procedures, but unchanged in 2 patients. Cerebral infarction occurred in 1 case during the interventional procedure, and the patient was recovered after thrombolysis and rehabilitation training. The operation did not succeed in 2 cases, and they were given conservative treatment. There were 3 patients having restenosis and 1 having stent fractured during the follow-up. Conclusion Under strict indications, endovascular intervention is safe, effective and easy to operate in the treatment of subclavian artery stenosis or occlusion with neurological symptoms.

Abstract:Objective To determine the effect of percutaneous transluminal renal angioplasty with stent placement (PTRAS) in the treatment of atherosclerotic renal artery stenosis (ARAS). Methods A total of 48 ARAS patients admitted in our department from July 2010 to July 2013 were enrolled in this study. According to the pre-operative estimated glomerular filtration rate (eGFR), they were divided into group A [eGFR＜60ml/(min·1.73m2), n＝20] and group B [eGFR≥60ml/(min·1.73m2), n＝28], and all underwent PTRAS. Results There were 52 stents placed in the 48 ARAS patients. In 24 months of follow-up, their systolic and diastolic blood pressure were significantly reduced after operation (P＜0.05). The patients of group A had their eGFR obviously increased when compared with the rate before surgery (P＜0.05). Conclusion PTRAS is a safe and effective procedure for ARAS patients. It can effectively reduce blood pressure, and even improve the renal function for those whose renal function has already been mildly or moderately impaired.

Abstract:Objective To summarize our experience in treating the elderly patients suffering from critical acute lower extremity arterial embolism (CALEAE) and determine the role of continuous veno-venous haemodiafiltration (CVVHD) in improving the prognosis of these patients after arterial embolectomy. Methods Clinical data of 47 elderly patients suffering from CALEAE admitted in our department from June 2008 to May 2015 were collected in this study. According to the intentions of the patients or their families for taking CVVHD, they were divided into treatment group (n＝21) and control group (n＝26). Their clinical data, length of stay, hospital mortality, especially postoperative renal function were compared between the 2 groups. Results There were more patients having peripheral cyanosis and muscle stiffness in the treatment group vs the control group before embolectomy (P＜0.05). The times of the serum levels of potassium, creatinine and urea nitrogen recovering to normal levels were significantly shorter in the patients of the treatment group than in the control group (P＜0.05). The treatment group had remarkably shorter length of stay [(13.5±1.6) vs (18.2±2.1)d, P＝0.043] and lower hospital mortality (9.5% vs 19.2%, P＝0.027). Conclusion CVVHD can shorten the recovery duration, obviously reduce the mortality and length of stay, and improve the prognosis for the elderly patients suffering from CALEAE after operation.

Abstract:Objective To observe the clinical efficiency of endovascular treatment for Trans-Atlantic Inter-Society Consensus (TASC) type C occlusion of superficial femoral artery (SFA) or more than 70% stenosis and the outcomes in 1 year’s follow up, and investigate the relevant factors of in-stent restenosis (ISR). Methods Clinical data of 58 cases(58 limbs) suffering from TASC type C occlusion of SFA or more than 70% stenosis in our hospital from May 2011 to May 2014 were collected and retrospectively analyzed. All of them received endovascular balloon dilatation and stent implantation. According to whether there was any occlusion or more than 70% stenosis in 1 year postoperatively, the patients were divided into patency group and re-occlusion group. Clinical data were compared and analyzed between the 2 groups. Results No perioperative death was found in the 58 patients. Out of 58 limbs there were 6 limbs not getting patency, with a patency rate of 89.7%. In 1 year’s follow-up, there were 41 cases with complete follow-up, and 30 of them were accordingly assigned to the patency group and the other 11 to the re-occlusion group. There was significant difference in ankle-brachial index between the 2 groups [(0.55±0.16) vs (0.41±0.24), P＜0.05]. Though there were no significant differences in the ratio of smokers and Fontaine stage between them, the P value was comparatively smaller, which might suggest that the 2 indices were associated with ISR. Conclusion Endovascular treatment is safe and effective in the treatment of TASC type C occlusion of SFA. The severity of vascular disease is associated with restenosis.

Abstract:Objective To compare the efficacy of revascularization of profound femoral artery versus superficial femoral artery on TASC type D arteriosclerosis obliterans. Methods Clinical data of 45 cases of TASC type D arteriosclerosis obliterans admitted in our hospital from January 2007 to December 2010 were collected and retrospectively analyzed. Sixteen patients received endovascular balloon dilation combined with stent implantation into superficial femoral artery, and another 16 patients underwent similar revascularization but into profound femoral artery. The efficacy variables including ankle-brachial index (ABI), amputation rate in 3 years after surgery, and the relief of symptoms were used to evaluate the efficacy of the 2 approaches in the 32 cases. Results Revascularization resulted in significant increases in ABI in the 2 groups (P＜0.05), with the post-operative value of the superficial femoral artery group obviously higher than that of the other group (P＜0.05). There were no significant differences in the numbers of patients having claudication in less than 200 m and undergoing amputation in 3 years after surgery (P＞0.05). Conclusion For the patients with TASC type D arteriosclerosis obliterans but iliac artery patency, revascularization of either superficial or profound femoral arteries is an effective treatment to relieve symptoms and enhance blood flow of the ischemic limb. Stent implantation into the superficial femoral artery is more superior in short-term blood supply for distal limb.

Abstract:Objective To observe the clinical outcome of ozone autologous blood transfusion therapy combined with vacuum-assisted closure(VAC) therapy in the treatment of diabetic foot ulcer. Methods A total of 28 patients with diabetic foot ulcer admitted in Heilongjiang Provincial Hospital from August 2014 to August 2015 were enrolled in this study. They were all treated by above-mentioned therapy. Transcutaneous oxygen partial pressure (TcPO2), total cholesterol (TC), triglycerides (TG), thromboxane B2 (TXB2), and 6-keto-prostaglandin F1α (6-k-PGF1α) were measured before and after treatment. Results The levels of TG, TC and TXB2 were declined, while that of TcPO2 and PGF1α was increased after the treatment when compared with before treatment (P＜0.01) . Conclusion Above-mentioned therapy achieves significant outcome in treatment of diabetic foot ulcer, and is worth further investigation.

Abstract:Objective To determine the feasibility and efficacy of endovascular treatment for atherosclerosis obliterans (ASO) of lower extremity. Methods Clinical data of 132 patients (136 limbs) with ASO of lower extremity undergoing endovascular treatment in the Department of Vascular Surgery of Baoding Second Hospital from June 2009 to June 2013 were collected. The endovascular treatment techniques, perioperative characteristics, clinical outcome, complications and follow-up results were analyzed. Results Our technical success rate was 98.5%(134/136), the incidence of complications was 5.15%(7/136), and no peri-operative death was observed in the cohort. The ankle-brachial index (ABI) was increased from 0.45±0.13 pre-operatively to 0.84±0.15 after treatment (P＜0.001). The primary patency rates were 93.28%(125/134), 88.06%(118/134) and 65.91%(91/132) at 6, 12 and 24 months, respectively. The secondary patency rates were 92.54%(124/134) and 68.94%(91/132) at 12 and 24 months, respectively. The limb salvage rate was 100.00%(132/132) at 24 months after surgery. Conclusion Endovascular treatment is an approach of high success rate and few complication for ASO of lower extremity.

Abstract:Objective To investigate the efficacy of endovascular treatment with angioplasty for infrapopliteal arterial occlusive disease (including thromboangiitis obliterans, arteriosclerosis obliterans, and diabetic foot). Methods Clinical data of 40 cases (40 limbs) of infrapopliteal arterial occlusive disease hospitalized in our hospital from March 2008 to July 2014 were collected and retrospectively analyzed. They all were treated by percutaneous transluminal angioplasty (PTA) for balloon dilatation of the stenotic or occlusive vessels. Results Angiographic success was achieved in 39 limbs (postoperative rate of stenosis＜20%), and the clinical success and initial opening rate was 97.5% (39/40). Limb preservation rate was 95%(38/40), and the limb salvage rate was 97.5%(39/40). The complications in the cohort was arterial perforation (2 cases), hematoma in the puncture site (1 case), and acute myocardial infarction (1 case). After the operation, symptoms such as pain, ulcers and intermittent claudication were improved in the 39 patients. The ankle-brachial index (ABI) was increased from 0.32±0.27 before the operation to 0.86±0.19 at day 10 after the treatment, with statistically significant difference (P＜0.01). The ABI was 0.80±0.20 and limb preservation rate was 95% (38/40) in 12 months after the operation. Conclusion PTA is a safe and effective approach for infrapopliteal arterial occlusive disease.

Abstract:Objective To analyze the correlation of brachial-ankle pulse wave velocity (baPWV) with the risk of lower limb arteriosclerosis in morning hypertensive patients in order to provide reference data for early prevention of arteriosclerosis in them. Methods According to the results of 24-hour ambulatory blood pressure monitoring, 100 patients with morning hypertension admitted in our hospital from November 2010 to November 2015 were randomly enrolled in the study. Color Doppler ultrasonography was used to observe lower extremity limb arteriosclerosis and measure baPWV and ankle-brachial index. Then the patients were accordingly divided into 4 groups, namely, normal group, and mild, moderate and severe arteriosclerosis groups. Medical history, biochemical indicators, and ambulatory blood pressures were analyzed for the correlation of risk for lower limb arteriosclerosis with baPWV. Results The patients having diabetes, hyperlipidemia, coronary heart disease and history of cerebral infarction had more severe lower limb arteriosclerosis (P＜0.05). Parameters as mean 24-hour systolic blood pressure(24hSBP), mean daytime SBP(dSBP) and night SBP(nSBP) had no obvious correlation with the severity of atherosclerosis (P＞0.05), but mean 24h diastolic blood pressure(24hDBP), mean daytime diastolic blood pressure (dDBP), and mean night DBP(nDBP) had the correlation (P＜0.05). Conclusion Morning hypertension is closely related to lower extremity atherosclerosis. baPWV can be regarded as a simple and effective indicator to assess the early arterial stiffness in the patients with morning hypertension. The hardening of the arteries is correlated to DBP but not to SBP.

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Abstract:Infected aortic aneurysm (IAA) are very rare, and those caused by Brucella are extremely rare. The conventional treatment for IAA is wide debridement of necrotic tissue, establishment of vascular bypass, and perioperative antibiotic treatment. But in recent years, much evidence showed that endovascular treatments were gradually applied as alternatives to open surgery, and the treatments have good outcomes. To summarize our treatment experience of endovascular repair for infected abdominal aorta aneurysm, we reported a case of a 76-year-old male patient and reviewed the articles concerning this disease. The patient had no primitive infectious source (area), and mainly presented fever, abdominal pulsatile mass and waist and abdomen pain. Preoperative peripheral blood culture suggested Brucella infection, and doxycycline treatment was effective. CT angiography displayed a pseudoaneurysm of the distal abdominal aorta. After admission, he underwent endovascular repair treatment followed by sensitive antibiotic therapy, and then was followed up regularly. We also reviewed other cases in the previously published data to summarize the experience on endovascular treatment for Brucella-related abdominal aortic aneurysm, that is, endovascular repair of coated stent graft combined with antibiotic therapy. The patient was followed up for 4 months, and he has normal vital signs at the end of follow-up. On the condition of strict preoperative blood pressure and infection control, and postoperative long-term antibiotic therapy, endovascular treatment is a feasible approach to treat Brucella-caused IAA.

Abstract:Objective To analyze the reasons associated with ticagrelor withdrawal and the impact on clinical outcomes in ticagrelor-treated patients with coronary artery disease (CAD). Methods Totally 642 consecutive CAD patients treated by ticagrelor and aspirin in the Department of Cardiology, Chinese PLA General Hospital from January 2014 to July 2015 were recruited. The incidence and the reasons of ticagrelor withdrawal were recorded and analyzed during the hospitalization, at discharge, as well as 3-month after discharge. In the patients treated by percutaneous coronary intervention (PCI), the occurrence of ischemic events [including major ischemic events (cardiovascular death, non-fatal myocardial infarction, ischemic stroke, defined or probable stent thrombosis, coronary revascularization) and secondary ischemic events (readmission of unstable angina)] and bleeding events [including Thrombolysis In Myocardial Infarction trial (TIMI) defined major and minor bleedings] were followed up for 6 months. Results Ticagrelor withdrawal occurred in 164 patients (25.55%), with 42 patients (25.61%) in-hospital, 7 patients(4.27%) at discharge and 115 patients (70.12%) after discharge, respectively. The distributions of ticagrelor withdrawal were 78.05% in unstable angina, 13.41% in ST-elevation myocardial infarction (STEMI), 4.27% in non-STEMI, 4.27% in stable CAD, respectively. The reasons for ticagrelor withdrawal in-hospital and at discharge were mainly attributed to ticagrelor-related dyspnea (32.65%), bleeding (22.45%) and PCI for non-complex coronary lesions (18.37%). Drug unavailability (68.70%) and cost consideration (16.52%) were the major reasons for ticagrelor withdrawal after discharge. Besides 10 dead patients, other patients with ticagrelor withdrawal undertook the alteration of the antiplatelet therapy under the guidance of physicians, with 153 switched to clopidogrel on top of aspirin treatment, 1 to aspirin alone. After 6-month follow-up in PCI patients (n＝499), compared with patients under continuous ticagrelor treatment, patients withdrawing ticagrelor had a higher risk of major ischemic events (4.58% vs 0.82%, HR 6.62, 95%CI 1.17?37.36, P＝0.032) and composited ischemic events (11.45% vs 4.89%, HR 2.46, and 95%CI 1.03?5.89, P＝0.043). No significant difference was found for the risk of composited bleeding events between these patients (16.03% vs 17.12%, HR 0.92, and 95%CI, 0.49?1.73, P＝0.795). Conclusion About one third of ticagrelor treated CAD patients undertake the ticagrelor withdrawal during hospitalization, discharge and within 3 months after hospitalization. Ticagrelor withdrawal in-hospital and at-discharge might be attributed mainly to ticagrelor-related dyspnea, bleeding and non-complex lesions for PCI. Drug unavailability and cost consideration might be the main reasons for out-hospital ticagrelor withdrawal. Ticagrelor withdrawal within 3-months in PCI treated CAD patients might be correlated with increased risk of major and composited ischemic events.

Abstract:Objective To investigate the clinical characteristics and coronary artery lesions of patients with ventricular septal rupture (VSR) after acute myocardial infarction (AMI) in order to provide theoretical evidence for early identification of these patients at high risk. Methods A total of 2 544 consecutive cases of AMI hospitalized in Chinese PLA General Hospital from January 1995 to January 2010 were enrolled in this study, and those having VSR were assigned into VSR group (n＝40), and 120 randomly sampled cases without VSR were assigned into control group (n＝120). Then their clinical and coronary angiographical characteristics were analyzed. Results The VSR group had significantly higher ratio of female patients (62.5% vs 36.4%, P＜0.01), and obviously older age [(66.85±10.92) vs (60.79±12.65) years, P＜0.01] than the control group. The serum levels of C-reactive protein (CRP), D-dimer, serum creatinine (SCr), and troponin T (TnT) were significantly higher, while hemoglobin (Hb), hematocrit (Hct) and red blood cells count (RBC) were obviously lower in the VSR group (P＜0.05). Conclusion Female, senior age, higher levels of CRP, D-dimer, SCr and TnT, and lower values of Hb, Hct and RBC are risk factors for VSR in AMI patients.