Blood zinc levels in patients with arteriosclerosis obliterans, thromboangiitis obliterans and Takayasu's disease.

Serum zinc concentration was measured by atomic absorption spectrophotometry in 30 normal males, 17 normal females, 20 patients with arteriosclerosis obliterans, 26 patients with thromboangiitis obliterans, 40 patients with Takayasu's disease. The mean serum zinc concentration was 93.9 +/- S.E.4.0 mug/100 ml in the normal male controls, 75.1 +/- 3.3 mug/100 ml in patients with arteriosclerosis obliterans without ulcers (P less than 0.05) and 79.2 +/- 6.5 mug/100 ml in patients with thromboangiitis obliterans without ulcers. Serum zinc concentration showed to be more decreased in patients with these diseases who had ulcers. The mean serum zinc concentration was 77.9 +/- 4.0 mug/100 ml in the normal female controls, 71.8 +/- 5.1 mug/100 ml in patients with Takayasu's disease who had never been treated with steroids and 59.1 +/- 2.7 mug/100 ml in patients with this disease who had been treated with this drug (P less than 0.01). The zinc level was significantly lower in CRP positive patients with Takayasu's disease than in CRP negative patients (P less than 0.05).     

Extra-Anatomical bypass for arteriosclerosis obliterans

Between April, 1981, and May, 1991, 40 patients underwent extra-anatomical bypass surgery for 49 lesions. Thirty-six men and 4 women with a mean age of 68 years (range 48–81) presented with symptoms of aortoiliac occlusive diseases caused by atherosclerosis. Patients were followed up for 44 months (range 1 to 121 months) after surgery. The operative mortality rate was 2.5% (1/40) and there were 4 late deaths. Hypertension, cardiac disease (history of ischemic heart disease and abnormal ECG), cerebrovascular disturbance, and diabetes mellitus were common concomitant preoperative diseases. Forty-nine percent of the limbs (24/49) were classified as Fontaine’s class II, 32.7% (16/49) as class III, and the remaining 18.4% (9/49) as class IV. Surgical procedures were axillofemoral bypasses on 53.1% of the lesions (26/49) and femorofemoral bypasses on the other 46.9% (23/49). Graft materials consisted of expanded polytetrafluoroethylene (EPTFE) (31/49), Dacron (13/49), and modified human umbilical veins (5/49). The ten-year cumulative patency rate was 95% in the femorofemoral bypass group and 88% in the axillofemoral bypass group. The anticoagulant (coumarin derivatives) was given at the first postoperative day, and it was continued as long as possible. No complications were recognized regarding this therapy. The value of the thrombo test was maintained between 20% and 40% during the follow-up period. The extra-anatomical bypass grafting was considered to be a beneficial alternative surgery to anatomical bypass in elderly and high-risk patients. Postoperative anticoagulant therapy may contribute to the patency of grafts.     

Usefulness of the Symphony Nitinol Stent for arteriosclerosis obliterans.

The Symphony Peripheral Stent is a self-expanding stent made of thermal memory Nitinol wire. Stents were implanted in 39 lesions of 32 patients (26 men, 6 women) with atherosclerosis obliterans (ASO). The ankle-arm index (AAI), and vessel diameters evaluated by quantitative angiography were compared before and 6 months after treatment. Symphony Peripheral Stent implantation significantly improved the AAI from 0.50+/-0.4 to 0.9+/-0.2 (p<0.01), the minimum lumen diameter (MLD) from 2+/-1.5 to 5+/-1.4 mm (p<0.01) and percent diameter stenosis (% DS) from 69+/-20% to 16.5+/-8% (p<0.01). Re-evaluation of 33 of the 39 lesions 6 months after treatment revealed a low restenosis rate of 15%, an AAI of 0.8+/-0.3, MLD of 4.5+/-2 mm and %DS of 30+/-22%, so the Symphony Peripheral Stent is thus a promising choice for patients with ASO.     

Clinical diagnosis and course of arteriosclerosis obliterans]

The great diagnostic importance of the clinical heart and circulation state as well as of the simple clinical functional tests in comparison to the apparative bloody and unbloody diagnostics is emphasized. Concerning the course the unfavourable prognosis is elaborated on the basis of the survival rates and the appearance of cardiovascular complications. The role of the essential prognostic influence factors, such as age of manifestation, concomitant diseases and long-term therapy is proved by instances. It is referred to the favourable effect of the prolonged treatment with anticoagulants on the prognosis quoad vitam and to the retardation of the cardiovascular progressing. The long-term dispensary care is generally recommended.     

Modern aspects of the physiopathology of arteriosclerosis obliterans]

In a shortened survey new points of view concerning the pathophysiology of disturbances of the peripheral arterial blood supply are discussed. Here the author deals in short with the new hypothesis of the atherogenesis, according to which on the basis of a lesion of the endothelium an aggregation of thrombocytes with following stimulation of the smooth muscle cells of the media develops. The haemodynamic changes by vascular stenoses and obstructions with the possibilities of their recognition are discussed in detail, in which especially examinations under load and phasic measurements of flow are taken into consideration.     

Simultaneous occurrence of arteriosclerosis obliterans and venous diseases]

It is reported on the pathophysiological peculiarities which may appear in the coincidence of the two vascular diseases. As therapy the fibrinolysis with Awelysin should always be taken into consideration.     

定向斑块旋切治疗下肢股浅动脉硬化闭塞症

目的探讨定向斑块旋切治疗下肢股浅动脉硬化闭塞症的临床效果。方法选择下肢股浅动脉硬化闭塞症患者42例,随机分为观察组和对照组,各21例。观察组采用TurboHawk定向斑块旋切系统治疗,对照组采用球囊扩张及支架植入术治疗。收集数据,观察比较两组的治疗效果。结果观察组术后临床症状、踝臂指数改善情况与对照组差异无显著性(P>0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后随访,观察组术后再狭窄率与对照组差异无显著性(P>0.05)。结论定向斑块旋切在治疗下肢股浅动脉硬化闭塞症中可以获得与球囊扩张、支架植入相似的通畅率,是一种安全、实用、有效的方法。