老年下肢血管介入治疗后再狭窄的影响因素

目的分析老年下肢动脉硬化闭塞症(ASO)患者经皮腔内血管成形术(PTA)后再狭窄的影响因素。方法回顾性分析2018年1月至2019年10月泸州市西南医科大学附属医院血管外科符合条件的98例老年下肢ASO患者的临床资料,对比不同性别、年龄、血管内支架植入状况、病变部位、残余狭窄、Rutherford分级患者的再狭窄发生率,对比发生与未发生再狭窄患者的踝肱指数与超敏C反应蛋白(hs-CRP)、糖化血红蛋白(GHb)水平。结果膝下血管病变患者的再狭窄发生率明显高于膝上血管病变患者,血管内支架植入患者的再狭窄发生率明显低于未植入患者,发生再狭窄患者的hs-CRP、GHb水平明显高于未发生再狭窄患者,差异均有统计学意义(均P0.05);多项Logistic回归分析结果显示,膝下血管病变、hs-CRP过表达、GHb过表达是下肢ASO患者PTA治疗后再狭窄的危险因素(OR1,P0.05),血管内支架植入是下肢ASO患者PTA治疗后发生再狭窄的保护因素(OR1,P0.05)。结论下肢ASO患者PTA治疗后再狭窄的发生与膝下血管病变、hs-CRP过表达、GHb过表达有密切关系,对于有上述危险因素的下肢ASO患者在PTA围术期应积极给予合理干预,而PTA联合血管内支架植入有利于减少再狭窄发生。     

经皮腔内血管介入治疗老年下肢动脉硬化闭塞症的疗效及其影响因素分析

目的探讨经皮腔内血管成形术(PTA)联合血管内支架置入术(PTAS)治疗老年下肢动脉硬化闭塞症(ASO)的临床疗效及其影响因素分析。方法选取我院收治的老年单侧下肢ASO患者84例,所有患者采用PTA或联合PTAS进行介入治疗,检测患者高敏C反应蛋白(hs-CRP)水平,观察手术成功率及术后1、6、12个月踝肱指数(ABI)、血管开通率。结果手术成功率为92.86%。与术前比较,术后1个月患者hs-CRP水平[(2.72±0.64)mg/L vs (5.31±1.53)mg/L]及RutherfordⅣ级(33.33%vs 7.14%)、Ⅴ级(14.29%vs 2.38%)、Ⅵ级(11.90%vs0)比例明显降低(P0.05,P0.01)。术后1、6、12个月ABI和血管开通率较术前明显升高(P0.05),且术后1、6、12个月ABI呈明显升高趋势(P0.05)。logistic回归分析显示,年龄是疗效的危险因素(95%CI:0.801～0.993,P=0.037)。术前hs-CRP是术后再狭窄的危险因素(95%CI:1.053～4.174,P=0.035)。结论经皮腔内介入治疗下肢ASO效果显著,年龄是影响手术效果的主要因素,术前hs-CRP是术后再狭窄的危险因素。     

下肢动脉粥样硬化闭塞支架术后再狭窄研究进展

下肢动脉硬化闭塞症(ASO)是由动脉粥样硬化引起动脉狭窄、闭塞性疾病。血管内支架成形术作为一种微创、安全及有效的方法,近年来已广泛应用于股腘动脉ASO治疗,但术后支架内再狭窄(ISR)发生率高,严重影响患者临床预后。支架内再狭窄问题依然是支架应用所面临的主要问题。文章对支架置入后再狭窄的发生机制、危险因素及最新的治疗进展做一综述,对支架内再狭窄防治具有一定的意义。     

黄芪通脉汤对闭塞性动脉硬化症患者血管内皮功能的影响

目的研究黄芪通脉汤对闭塞性动脉硬化症(ASO)患者血管内皮功能的影响。方法通过高分辨超声检测30名健康查体者(对照组)及34例ASO患者(ASO组)治疗前后内皮依赖性舒张功能(EDD)及非内皮依赖性舒张功能(EID)的变化,并测定内皮素-1(ET-1)、血栓素B2(TXB2)、一氧化氮(NO)及6-酮-前列腺素F1α(6-Keto-PGF1α)的浓度变化。结果ASO组EDD较对照组明显降低,ET-1、TXB2水平高于对照组,NO、6-Keto-PGF1α水平低于对照组。经黄芪通脉汤治疗后,ASO患者EDD明显改善,ET-1、TXB2水平降低,NO、6-Keto-PGF1α水平升高。结论内皮功能障碍在ASO的发病中起着重要作用,黄芪通脉汤能明显改善ASO患者血管内皮功能。     

代谢综合征与下肢动脉硬化闭塞症

代谢综合征的各个组分,如糖尿病、原发性高血压（高血压）、血脂紊乱、肥胖均为动脉粥样硬化血管疾病的危险因素,因此．下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）是代谢综合征患者常见的动脉粥样硬化血管疾病之一。ASO患者发生心肌梗死、卒中的风险较肢体相关事件（如下肢溃疡、坏疽或截肢）的风险更高,     

单核细胞/高密度脂蛋白比值与2型糖尿病合并下肢动脉硬化闭塞症的相关性分析

目的探讨单核细胞/高密度脂蛋白比值(MHR)与2型糖尿病(T2DM)合并下肢动脉硬化闭塞症(ASO)的相关性。方法选取2017年2月至2019年1月我院收治的340例T2DM患者作为研究对象,根据MHR四分位数将患者分成4组:A组(n=85):MHR0. 61×10~9; B组(n=85):MHR为(0. 61～0. 90)×10~9; C组(n=85):MHR为(0. 91～1. 17)×10~9; D组(n=85):MHR1. 17×10~9。单因素分析4组患者基线资料,对差异有统计学意义的单因素行Logistic回归分析,分析MHR与ASO相关性,探讨ASO独立危险因素并建立其预测模型。应用ROC曲线评价MHR对ASO的诊断效能。结果 A组、B组、C组及D组患者ASO发生率分别为21. 18%、24. 70%、47. 06%及56. 47%,4组ASO发生率差异有统计学意义(P0. 001)。4组患者在体质指数、MHR、病程、单核细胞、空腹血糖、糖化血红蛋白(Hb A1c)、血清肌酐、血尿素氮、踝肱指数(ABI)、同型半胱氨酸(Hcy)、血尿酸(SUA)、空腹胰岛素、载脂蛋白A1、载脂蛋白B、稳态模型胰岛素抵抗指数(HOMA-IR)、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇(LDLC)等指标差异有统计学意义(P0. 05)。Logistic回归分析表明,MHR、Hcy、HOMA-IR、LDLC、HbA1c和SUA是ASO发生的独立危险因素(P0. 05)。Pearson相关分析显示,MHR与ABI呈负相关关系(r=-0. 742,P0. 001)。ROC曲线显示,MHR诊断ASO的临界值为0. 91×10~9,灵敏度为79. 53%,特异度为81. 22%,曲线下面积为0. 815。结论 MHR是T2DM患者合并ASO发生的独立危险因素,其与ASO呈正相关关系,对ASO预测、评估有一定的价值。     

Hs-CRP、Hcy、β_2-MG和UA水平在老年高血压合并下肢动脉硬化闭塞症患者中的风险评估价值

目的 探讨老年原发性高血压合并下肢动脉硬化闭塞症(ASO)患者高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、β2-微球蛋白(β2-MG)和尿酸(UA)水平的变化及临床意义。方法选取2017年1月至2019年5月承德医学院附属医院收治的老年原发性高血压患者150例作为单纯高血压组,老年原发性高血压合并下肢ASO患者150例为高血压合并ASO组,另外选取同期健康体检者100名作为对照组,根据踝臂指数(ABI)又将高血压合并ASO组分为轻度组、中度组和重度组,比较各组hs-CRP、Hcy、β2-MG和UA水平,并采用Pearson相关分析各指标与ABI的相关性,采用二元logistic回归分析ASO发生的相关危险因素。结果 高血压合并ASO组和单纯高血压组的血清hs-CRP、Hcy、β2-MG和UA水平均高于对照组,高血压合并ASO组的上述血清指标水平均高于单纯高血压组,差异均有统计学意义(均为P0. 05)。随着ASO病情严重程度增加,血清hs-CRP、Hcy、β2-MG和UA水平逐渐升高,轻、中和重度组间比较差异均有统计学意义(均为P0. 05)。Pearson相关分析显示,血清hs-CRP、Hcy、β2-MG、UA与ABI均负相关;二元logistic回归分析显示,hs-CRP、Hcy、β2-MG和UA水平升高均是ASO发生的独立危险因素(均为P0. 05)。结论 Hs-CRP、Hcy、β2-MG和UA水平的升高与老年原发性高血压合并下肢ASO相关,是预测老年高血压患者发生外周血管病变风险较敏感的指标。     

动脉硬化性闭塞症的药物治疗现状和动向

在东方,人们的食物结构日趋欧美化和平均寿命延长使动脉硬化性闭塞症(ASO)发病率增高。本病多属慢性疾病,治疗比较困难,又常有多种“危险因素”。所以,人们一直在不断探索较为有效、简便安全的治疗方法。 目前,新的血管重建手术相继出现,但仍有约70％的没有手术指征和手术失败的病例仍需药物治疗。本文结合近年来国外部分文献,对本病的药物治疗部分综述如下。     

下肢动脉硬化闭塞症多层螺旋CT成像与血管腔内治疗的效果

目的 探讨多层螺旋CT血管造影术(MDCTA)对下肢动脉硬化闭塞症(ASO)的诊断价值及评估血管腔内治疗.方法 回顾性分析56例下肢ASO患者的MDCTA检查和数字减影血管造影(DSA)检查资料.以DSA为金标准,分析MDCTA对下肢血管狭窄程度诊断的准确性.对狭窄闭塞血管段分别用两种方法进行血管腔内治疗可行性评估.结果 通过MDCTA和DSA两种检查方法共评价了1960段血管,两种方法对下肢动脉狭窄程度评价无统计学差异,W=12.343,P=0.137.两种方法对235段重度狭窄或闭塞血管腔内治疗可行性评估具有高度的一致性,k=0.899.结论 MDCTA是诊断下肢ASO准确的检查方法,MDCTA可以取代DSA用于评估血管腔内治疗的可行性.     

开放手术治疗下肢动脉硬化闭塞症90例

下肢动脉硬化闭塞症(ASO)是血管外科常见疾病,在美国现约有800～1000万人受动脉硬化闭塞症的困扰,而且在全世界其受累人群有增加的趋势[1].针对ASO的复杂性和治疗难度等问题,泛大西洋介入学会协议(Trans Atlantic Inter-Society Consensus,TASC)制订了周围动脉疾病(Peripheral Arterial Disease,PAD)的诊治原则[2].2007年TASCⅡ在原有基础上结合最新的研究报告与指南信息,更新了ASO的分级标准[3],是迄今比较全面的论述ASO诊治的指南性文件.虽然随着近年来腔内治疗技术的发展,越来越多的ASO患者接受腔内治疗,但是针对TASC C、D级的病变,手术治疗仍是不可忽视的治疗手段.我科对2009年6月至2010年9月收治的FontaineⅢ、Ⅳ期及严重间歇性跛行,且属于TASC C、D级的腹股沟ASO患者,采用手术治疗并分析临床效果.     

Study design of SEASON registry: prospective Surveillance of cardiovascular Events in an Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN )SEASON)

Antiplatelet therapy is widely performed for arteriosclerosis obliterans (ASO) to relieve ischemic symptoms and prevent cardiovascular events. However, the overall rate of cardiovascular events in patients with ASO under treatment with antiplatelet agents has not been fully investigated in Japan. The SEASON registry is a nationwide observational prospective cohort study designed to compile data from over 2,000 institutions across Japan, whose aims are to (1) understand the current status for the management of ASO and clarify the incidence of cardiovascular events in patients with ASO undergoing antiplatelet therapy, and (2) compare the effectiveness of sarpogrelate, a 5-HT(2A) receptor antagonist, in decreasing the event rate with those of other antiplatelet agents [UMIN ID: UMIN000003385]. The registry will recruit approximately 10,000 patients receiving antiplatelet therapy (8,000 patients for sarpogrelate and 2,000 for other antiplatelet agents), and the patients will be followed every 6 months during a two-year follow-up period. The investigators plan to report all cardiovascular events and exacerbations of ASO. Analysis focusing on the sarpogrelate-treated subgroup will also be performed. Exploratory analysis will be performed to determine the clinical characteristics of the patients and to elucidate the relationships between risk factors and cardiovascular events. The SEASON registry is the first attempt to create a nationwide database regarding the incidence of cardiovascular events in 10,000 ASO patients in Japan. In addition, it ultimately may enable us to conclude that sarpogrelate prevents cardiovascular events. Information on the severity and risk factors in ASO patients in the clinical settings will be applicable to epidemiological analysis.     

85例老年患者下肢动脉血管成像技术检查结果分析

目的 评价16层螺旋CT下肢动脉成像在诊断老年患者下肢动脉硬化闭塞症合并其它不同基础疾病中的临床价值.方法 对85例临床疑似下肢动脉硬化的老年患者行16层螺旋CT下肢动脉血管成像（CT angiography,CTA）扫描,以容积再现（volume rendering,VR）,最大密度投影（maximum intensity projection,MIP）以及曲面重建（curved reformate,CR）技术重建.按糖尿病、高血压病因分组,比较下肢动脉CTA检查结果.结果 CTA检查可以清晰显示双下肢动脉及主要分支病变的部位、范围及侧枝循环.49例血管不同程度钙化患者中,高血压组、糖尿病合并高血压组较糖尿病组下肢动脉管壁钙化的病例出现更多（P＜0.05）.43例不同程度的下肢动脉狭窄及闭塞患者中,糖尿病合并高血压组较高血压组、糖尿病组的闭塞病例出现更多（P＜0.05）.结论 糖尿病合并高血压组患者的下肢动脉硬化闭塞症表现较糖尿病组及高血压组患者更为严重.对存在易患因素的老年人群,尤其是同时具有高血压和糖尿病病因者,下肢动脉CTA检查具有筛选价值.     

老年住院患者下肢动脉硬化闭塞症与心脑血管疾病的相关性

目的 探讨下肢动脉硬化闭塞症(ASO)与冠心病和脑卒中的相关性。方法 回顾性分析2013年10月至2021年3月在首都医科大学附属北京世纪坛医院血管外科住院的587例老年下肢ASO患者的临床资料。调查住院患者冠心病和脑卒中患病率。分析Fontaine缺血分期、踝肱指数(ABI)与冠心病和脑卒中的相关性。采用SPSS 26.0 统计软件进行数据分析。相关性分析采用Spearman相关分析。结果 587例下肢ASO患者合并冠心病、脑卒中、冠心病和脑卒中患病率分别32.20%(189/587)、13.12%(77/587)及17.21%(101/587)。下肢Fontaine缺血分期与冠心病(r=7.57)及脑卒中(r=3.57)的发生呈正相关(均P<0.01)。Fontaine缺血分期与合并心脑血管疾病种类数呈正相关(r=0.13;P=0.02)。合并冠心病与无冠心病患者[0.30(0.00,0.55)和0.68(0.50,0.80)]、合并脑卒中与无脑卒中患者[0.40(0.15,0.62)和0.60(0.20,0.75)]的ABI数值比较,差异有统计学意义(均P<0.01)。ABI值与合并心脑血管疾病种类数呈负相关性(r=-0.48;P<0.01)。结论 老年下肢动脉硬化闭塞症患者心脑血管疾病发生率高。下肢缺血越重,发生心脑血管疾病风险越高。     

Prevalence of asymptomatic arteriosclerosis obliterans and its relationship with risk factors in inhabitants of rural communities in Japan: Tanno-Sobetsu study

OBJECTIVES: Since arteriosclerosis obliterance in the legs (ASO) causes deterioration of the prognosis of the elderly, prevention of ASO is important for maintenance of their quality of lives. We studied the prevalences of ASO in rural communities in Japan. METHODS AND RESULTS: We measured the ratio of systolic blood pressure in the leg to that in the arm (ABI) using a new device, Form PWV/ABI, in 1398 subjects of both sexes. Subjects with ABI values below 0.9 were considered to have ASO. The prevalence of ASO was 2.7% in all of the subjects, 1.0% in subjects under the age of 60 years, and 3.4% in subjects aged 65 years or more. Multiple regression analysis showed that ABI was correlated with plasma level of total cholesterol in men. There were no significant differences of the mean age, mean fasting plasma glucose level and percentage of patients who smoked between the ASO group and non-ASO group in each sex. Mean cholesterol level in our subjects is lower than the reported levels in Europeans and Americans. The prevalence of ASO increased with increase in the number of risk factors in individual subjects. CONCLUSIONS: Among the atherosclerotic risk factors, age and total cholesterol seem to be more important risk factors of ASO than others.     

Evolution of risk factors influencing early mortality of the arterial switch operation.

OBJECTIVES: The present study was undertaken to determine the independent risk factors for early mortality in the current era after arterial switch operation (ASO). BACKGROUND: Prior reports on factors affecting outcome of the ASO demonstrated that abnormal coronary arterial patterns were associated with increased risk of early mortality. As diagnostic, surgical and perioperative management techniques continue to evolve, the risk factors for the ASO may have changed. METHODS: All patients who underwent the ASO at Children's Hospital, Boston between January 1, 1992 and December 31, 1996 were included. Hospital charts, echocardiographic and cardiac catheterization data and operative reports of all patients were reviewed. Demographics and preoperative, intraoperative and postoperative variables were recorded. RESULTS: Of the 223 patients included in the study (median age at ASO = 6 days and median weight = 3.5 kg), 26 patients had aortic arch obstruction or interruption, 12 had Taussig-Bing anomaly, 12 had multiple ventricular septal defects, 8 had right ventricular hypoplasia and 6 were premature. There were 16 early deaths (7%), with 3 deaths in the 109 patients considered "low risk" (2.7%). Coronary artery pattern was not associated with an increased risk of death. Compared with usual coronary anatomy pattern, however, inverted coronary patterns and single right coronary patterns were associated with increased incidence of delayed sternal closure (p = 0.003) and longer duration of mechanical ventilation (p = 0.008). In a multivariate logistic regression model using only preoperative variables, aortic arch repair at a separate procedure before ASO and smaller birth weight were independent predictors of early mortality. In a second model that included both pre- and intraoperative variables, circulatory arrest time and right ventricular hypoplasia were independent predictors of early death. CONCLUSIONS: The ASO can be performed in the current era without excess early mortality related to uncommon coronary artery patterns. Aortic arch repair before ASO, right ventricular hypoplasia, lower birth weight and longer intraoperative support continue to be independent risk factors for early mortality after the ASO.     

心脏永久性起搏器术后上肢深静脉血栓形成的危险因素分析

目的 调查和分析心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的相关危险因素,为临床预防提供理论依据.方法 研究分析97例心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的危险因素,单因素分析采用x2检验,有统计学意义的因素代入多因素非条件logistic回归分析进行分析.结果 临时起搏器置入（OR=6.314）、房颤病史（OR=2.583）、感染（OR=8.368）、吸烟（OR=1.639）、心功能≥NYHAⅢ级（OR=1.972）为心脏永久性起搏器置入术后患者上肢深静脉血栓形成的危险因素.抗凝治疗（β=-1.761;OR=2.169）是心脏永久性起搏器置入术后患者上肢深静脉血栓形成的保护因素.结论 临时起搏器置入、房颤病史、感染、吸烟、心功能≥NYHAⅢ级是心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的独立危险因素.     

Correlation of arteriosclerosis obliterans of the lower extremity with coronary artery disease

To ascertain the correlation between arteriosclerosis obliterans (ASO) of the lower extremities and coronary artery disease (CAD), 69 patients with lower extremity ASO were observed. Based on clinical symptoms, the patients were categorized as group A: 52 with intermittent claudication and group B: 17 with angina pectoris. All patients underwent angiography of both lower extremities and the heart. Results were as follows: 1. In group A, 33 patients had significant coronary stenosis with single (16 cases), double (12 cases) and triple (five cases) vessel disease. Sixteen patients had histories of myocardial infarction and two had vasospastic angina. In group B, 15 patients had significant coronary stenosis with single (five cases), double (six cases) and triple (four cases) vessel disease including two cases involving the left main trunk. Six patients had histories of myocardial infarction and two had vasospastic angina. 2. Electrocardiography revealed that 37 patients in group A and 14 patients in group B had abnormal ECGs as abnormal Q waves and ST-T changes. However, 10 patients in group A and three patients in group B had significant coronary stenosis despite their normal ECGs. 3. According to the sites of stenotic lesions, all 69 patients with ASO were classified in four types; as diffuse, pelvic, ilio-femoral and femoral. The incidence of CAD did not differ among these four types. 4. In group A, 38 patients experienced revascularization of ASO; 36 cases by bypass grafting, and two by percutaneous transluminal angioplasty (PTA). Ten patients received cardiac revascularization including three cases with coronary artery bypass graft (CABG) and seven cases with percutaneous transluminal coronary angioplasty (PTCA). In group B, 13 patients received revascularization of ASO with bypass grafting. Eleven patients had coronary revascularization including seven cases with CABG and four cases with PTCA. 5. Fourteen of the 69 patients received revascularization for both ASO and CAD. In conclusion, there is a highly significant coincidence of CAD in patients with ASO, and CAD is often silent. These data indicate that routine coronary angiography is necessary for detecting and preventing CAD in all patients with ASO. Coronary artery revascularization, especially PTCA, can be indicated prior to lower extremity revascularization.     

Diagnosis of arteriosclerosis obliterans by impedance technique with special reference to relative blood flow of the lower extremity

Simultaneous recordings of impedance cardiography of the chest and impedance plethysmography of the lower extremity were performed on 105 limbs with or without arteriosclerosis obliterans (ASO) documented by angiography. The ratios of blood flow to the lower extremity--leg stroke volume/cardiac stroke volume--(LSV/CSV) were 11.2 +/- 3.3% in normal male subjects, 11.1 +/- 5.5% in normal female subjects, and 3.1 +/- 1.2% in lower extremities with ASO, respectively. The normal value (range) for LSV/CSV calculated from the normal groups by the percentile method was between 4.9% and 17.8%, and the diagnostic accuracy of this value was 100% for sensitivity and 97.5% for specificity. LSV/CSV is a good index for the diagnosis of ASO and makes it possible to minimize error when expressed as an absolute value.     

Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters

An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.