下肢动脉疾病行64层螺旋CT血管造影的对照研究

目的通过与数字减影血管造影(DSA)的对照,确定64层螺旋CT血管造影(CTA)在诊断下肢动脉病变中的价值。方法选择行下肢动脉64层螺旋CTA及DSA检查的患者24例,DSA与64层螺旋CTA检查间隔时间2周。CT重建采用最大密度投影、容积重建及多平面重建技术。DSA采用步进跟踪造影技术,分段DSA进行下肢血管检查,将64层螺旋CTA与DSA结果进行比较。结果 DSA显示34条共170段下肢动脉,69段血管存在狭窄性病变,CTA诊断血管高估8段,低估8段。以DSA检出血管狭窄程度≥50%为阈值,64层螺旋CTA对下肢动脉狭窄程度诊断的敏感性97.1%,特异性96.0%,准确率97.2%,阳性预测值94.4%,阴性预测值97.9%。结论 64层螺旋CTA是下肢动脉闭塞性病变评估的可靠方法,对下肢动脉硬化闭塞性病变的术前评估、诊断和筛选有较大的帮助,可为制订介入治疗方案提供可靠依据。     

血管内超声在下肢动脉腔内治疗中的应用分析

目的:探讨血管内超声(IVUS)在下肢动脉闭塞病变患者腔内血管重建术中的应用价值.方法:回顾性分析2019年7月至2020年7月于中南大学湘雅二医院血管外科接受IVUS和数字减影血管造影(DSA)指导下腔内技术治疗的24例下肢动脉闭塞病变患者术前、术中情况和术后随访数据,比较IVUS和DSA对血管准备后残余狭窄和夹层程...     

高龄患者行多血管造影术的可行性探讨

目的:评价高龄患者行多血管x线血管造影术的安全性及可行性。方法:前瞻性收集102例,平均年龄(77．6 ±12．3)岁,怀疑冠心病,经股动脉途径在一次检查中,先后行选择性左、右冠状动脉,颈动脉,椎动脉,左心室, 腹主动脉,肾动脉,髂动脉及下肢动脉造影患者的资料进行总结。结果:(1)94例患者在一次检查中,先后行选择 性左、右冠状动脉,颈动脉,椎动脉,左心室造影(5次注射造影剂),有的还追加了选择性肾动脉、髂动脉及下肢 动脉造影。平均造影时间(72．3±32．8)min;平均x线透视时间为(21．3±13.2)min;平均消耗造影剂(170．7± 40．2)ml。仅3例(3．2%)术后出现皮下血肿,无严重合并症,肾功能无明显改变;(2)血管造影诊断冠状动脉狭 窄89％,颈动脉狭窄59．4％,肾动脉狭窄29．4％,下肢动脉狭窄22．6％。结论:高龄老年一次性完成冠状动脉及周 围血管的多血管造影是安全可行的,可明显提高多动脉血管病变的诊断率。     

数字减影血管造影术前和术后蛛网膜下腔出血患者双侧大脑中动脉流速和搏动指数的变化

目的探讨应用经颅多普勒(TCD)监测蛛网膜下腔出血病人数字减影血管造影(DSA)术前、术后大脑中动脉流速(Vm)和搏动指数(PI)的变化。方法 30例蛛网膜下腔出血的病人在DSA术前和术后立刻进行TCD检查。在DSA中使用非离子型水溶性碘造影剂;同时测定两侧大脑中动脉M1段的Vm和PI。结果 Vm和PI在造影前后均无统计学差异(P>0.05)。结论血管造影能够用来检查蛛网膜下腔出血病人的血管痉挛情况,同时也能够引起血管痉挛,部分原因可能是因为造影剂对血管的影响。     

CTA诊断糖尿病下肢动脉临床分期及下肢动脉狭窄程度的应用价值

目的 探讨CT血管造影(CTA)诊断糖尿病下肢动脉临床分期及下肢动脉狭窄程度的应用价值.方法 将2019年4月—2021年6月该院收治的糖尿病下肢动脉疾病患者98例作为研究对象,分别对其实施CTA检查与数字减影血管造影(DSA)检查,将DSA检查结果作为诊断金标准,对CTA诊断糖尿病下肢动脉狭窄程度及对膝下动脉狭窄程度...     

糖尿病足血管内介入治疗临床意义

对19例血管节段性狭窄者行介入治疗(13例经皮血管内球囊成形术，6例血管腔内支架植入术)，术后6月血管造影复查。结果：19例行血管内介入治疗者下肢动脉血供均得到明显改善，通过控制血糖、局部换药等治疗措施，糖尿病足部溃疡愈合较快，近期疗效令人满意。结论：DSA检查可以准确了解血管阻塞部位及程度，糖尿病足下肢动脉血管内介入治疗疗效满意，可以降低患者的病残率。     

双能量减影CT血管造影在老年人下肢动脉闭塞性病变中的应用

目的探讨双能量减影CT血管造影(DE-CTA)在老年人下肢动脉闭塞性病变(LEASO)诊治中的应用价值。方法回顾性分析135例老年LEASO的临床及DE-CTA资料,其中58例进行了数字减影血管造影(DSA)下肢动脉检查并同时行单侧或双侧介入治疗,22例介入术后进行DE-CTA复查,8例复查后转外科手术。DE-CTA后处理采用双能量减影软件,重建采用最大密度投影(MIP)及容积重建(VR)技术。将DE-CTA结果与DSA进行比较。结果 DE-CTA与DSA有良好的一致性。DE-CTA对下肢动脉狭窄判断的敏感性为98.53%,特异性为97.19%,准确性为97.87%,阳性预测值为97.33%,阴性预测值为98.45%。结论 DE-CTA可以作为老年人LEASO诊断及随访的首选检查方法,并为临床治疗提供可靠的影像学依据。     

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.     

三维动态增强磁共振血管成像在老年人糖尿病下肢动脉疾病诊断中的应用

目的 探讨三维动态增强磁共振血管成像(3D DCE-MRA)在诊断老年糖尿病患者下肢动脉疾病中的临床价值.方法 对35例临床确诊为糖尿病下肢动脉闭塞性疾病的老年患者行3D DCE-MRA检查,计算机后处理得到下肢动脉血管树,并与其下肢动脉数字减影血管造影(DSA)结果 进行对照,分析3D DCE-MRA临床应用价值.结果 35例患者均获得清晰的下肢血管树图像.3D DCE-MRA对血管0～4级狭窄检出敏感度、特异度、阳性预测值和阴性预测值分别为:0级:76%、83%、77%和82%;1级:80%、82%、87%和95%;2级:84%、90%、96%和71%;3级:89%、91%、93%和98%;4级:92%、96%、97%和94%.两种检查方法对于下肢动脉5级狭窄检出结果差异无统计学意义.血管狭窄级别和3D DCE-MRA检出敏感度、特异度显著相关.结论 3D DCE-MRA评价在下肢动脉病变中血管分级、狭窄部位、程度等方面,与动脉DSA检查效果相同,为一种诊断老年人糖尿病下肢动脉闭塞性疾病简便、可靠、无创的检查方法.     

多层螺旋CT血管造影对糖尿病患儿下肢动脉病变的诊断价值

目的探讨多层螺旋CT血管造影对糖尿病患儿下肢动脉病变的诊断价值。方法选取2012年7月—2014年10月该院收治的40例经DSA(数字键影血管造影)确诊的糖尿病下肢动脉病变患儿作为研究对象,所有患儿均给予下肢血管彩超、多层螺旋CT血管造影检查,对3项检查结果进行比较,分析多层螺旋CT血管造影的临床价值。结果 40例患儿经CTA检查后确定阳性者37例,未见假阳性者,同比DSA,符合率为92.5%;经彩照检查确定阳性者25例,同比DSA,符合率为62.5%。结论多层螺旋CT血管造影对糖尿病患儿下肢动脉病变具有较高的诊断准确性,是值得临床使用和选择的筛查手段。     

Outbreak of beriberi in an Indian population of the upper Amazon region, Roraima State, Brazil, 2008

Edema, parasthesias, and paresis affected 10 residents of an Indian community in Roraima state; three died. Mining with mercury occurs locally; caxirí, a traditional alcoholic drink, is consumed daily. We conducted a 1:2 unmatched case-control study; a case was an Indian from Uiramutã county (population of 9,127) who presented ≥ 1 of lower extremity edema, paresthesias, paresis, or weakness. Controls were asymptomatic Indians randomly selected from the population. We identified 90 cases (prevalence of 1%) and 180 controls; all were enrolled. Among cases, 79% were male, and the median age was 31 years. Ethnicity was Macuxí, and 49% had income. Cases had lower extremity edema (85%), upper extremity paresthesias (84%), and lower extremity weakness and pain (78%). Risk factors were male sex (odds ratio [OR] = 6.8; P < 0.001), age 31–40 years (OR = 5.63; P < 0.001), and consumption of caxirí (OR = 2.7; P < 0.003). Mercury exposure was not a risk. Thiamine therapy produced complete rapid clinical recovery in all cases, confirming the diagnosis of beriberi. We recommend surveillance, thiamine supplementation, and nutritional intervention.     

下肢静脉造影对老年人下肢静脉疾病的诊断价值

目的探讨下肢静脉造影对老年人下肢静脉疾病的诊断价值及老年人下肢静脉疾病的特点。方法对36例疑有下肢静脉疾病、年龄≥60岁的老年人进行常规或数字减影下肢静脉造影。根据造影表现进行分析。结果36例老年病例共55侧肢体下肢静脉造影均获成功,其中54侧为阳性。根据X线表现分类:静脉阻塞性病变30侧(54.5%),静脉逆流性病变23侧(41.8%),静脉瘤样病变1侧(1.8%)。深静脉血栓形成及形成后再通为主要表现。结论下肢静脉造影对老年人下肢静脉疾病的诊断及分类具有重要价值。本组病例中老年人下肢静脉疾病以下肢静脉阻塞性疾病居多。     

自体外周血干细胞移植治疗62例缺血性下肢血管病的临床研究

目的　观察自体外周血干细胞(PBSC)移植治疗缺血性下肢血管病的临床疗效及相关影响因素。方法　62例自愿接受自体PBSC移植的患者中糖尿病足34例,动脉硬化闭塞症22例,血栓闭塞性脉管炎4例,结节性多动脉炎1例,雷诺病1例。发生足部溃疡或坏疽38例,合并感染14例。累及双下肢病变52例,其中3例患者移植前已行一侧肢体截肢术;单肢病变10例,共移植111条下肢。全部患者均给予重组人粒细胞集落刺激因子450~600μg/d,皮下注射,行PBSC动员5d,第6天用血细胞分离机采集单个核细胞(MNC),总量82~148ml,MNC数量(7182~2246)×109/L。将MNC悬液按3cm×3cm距离进行缺血肢体移植术,术后第1天至6个月定期观察各项指标综合评估。结果　PBSC移植后7~30d54例(871%)疼痛有不同程度的缓解,7~30d56例(903%)患肢冷感明显改善,4~16周16例(400%)溃疡或足趾坏疽好转,感染得到控制;踝肱指数12例(343%)有不同程度的改善,26例(423%)经皮氧分压改善,5例数字减影下肢动脉造影结果显示新侧支血管形成明显增加。2例糖尿病足合并脑梗死患者在干细胞动员期间症状加重,经治疗好转,其余患者未出现并发症和明显不良反应。结论　自体PBSC治疗缺血性下肢血管病是一种安全、有效的手段,尤其对于下肢动脉没有流出道的患者有特殊意义,可使一部分患者免除截     

单核细胞/高密度脂蛋白胆固醇比值对下肢动脉狭窄的诊断价值

目的探讨外周血单核细胞/高密度脂蛋白胆固醇比值(MHR)对下肢动脉狭窄的诊断价值。方法选取2018年8月—2020年8月在中山大学附属第八医院就诊的连续性病例311例,根据下肢动脉狭窄程度不同将患者分为4组:(1)对照组(n=65):下肢动脉正常;(2)轻度病变组(n=77):30%≤下肢动脉狭窄<50%;(3)中度病变组(n=60):50%≤下肢动脉狭窄≤75%;(4)重度病变组(n=109):下肢动脉狭窄>75%或闭塞。计算MHR。收集并比较4组患者临床资料、实验室检查结果。分析患者发生下肢动脉狭窄的影响因素及MHR对下肢动脉狭窄的诊断价值。结果 4组之间年龄、MHR、高敏C反应蛋白、血红蛋白、高密度脂蛋白胆固醇、血清肌酐(SCr)、血尿酸、血同型半胱氨酸、高血压病史及糖尿病病史比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄、高MHR、高SCr和糖尿病病史是患者发生下肢动脉狭窄的危险因素(P<0.05)。根据多因素Logistic回归模型所得预测概率作ROC曲线,曲线下面积为0.953;当预测概率取0.86时,诊断下肢...     

Long-term follow-up of upper and lower extremity vasculitis related to giant cell arteritis: a series of 36 patients

We conducted this retrospective study to determine the prevalence of giant cell arteritis (GCA) in patients exhibiting nonatherosclerotic upper and/or lower extremity arterial involvement and to evaluate the clinical features and long-term outcome of those patients.From January 1997 to March 2008, 36 consecutive patients in the Department of Internal Medicine at the University of Rouen medical center received a diagnosis of symptomatic upper/lower extremity vasculitis related to GCA. In the 36 patients, upper/lower extremity vasculitis preceded the initial GCA diagnosis in 7 patients (19.4%), it was identified in association with GCA in 13 patients (36.1%), and it developed after the onset of GCA in the remaining 16 patients (44.4%). GCA clinical manifestations were severe resulting in ischemic complications of the extremities in 10 patients (27.8%). GCA-related large-vessel involvement was located in the upper extremity alone in 21 patients (58.3%), the lower extremity alone in 7 patients (19.4%), and both the upper and lower extremities in 8 patients (22.2%).Arterial involvement in GCA patients with upper extremity vasculitis was distributed in the subclavian (55.6%), axillary (47.2%), and brachial (22.2%) arteries. In patients with lower extremity vasculitis, involvement included the internal iliac artery (11.1%), common femoral artery (13.9%), superficial femoral artery (33.3%), deep femoral artery (5.6%), and popliteal and anterior tibial arteries (5.6%). Aortic localizations were common in GCA patients with upper/lower extremity vasculitis (68.9% of cases).All patients were given steroid therapy at a median daily dose of 1 mg/kg initially. Reconstructive study was performed in 10 patients (27.8%): venous bypass graft (n = 6), angioplasty (n = 1), thromboendarteriectomy (n = 2), or thrombectomy (n = 1); 2 other patients with extremity ischemia underwent amputation. The median observation time was 32 months; the outcome of upper/lower extremity vasculitis was disappearance of clinical symptoms (44.4%), improvement of clinical manifestations (44.4%), and deterioration of clinical manifestations (11.1%). At last follow-up, the median daily dose of prednisone was 6 mg. Steroid therapy could be discontinued in 12 patients (33.3%).We found that upper/lower extremity vasculitis is not uncommon in patients with GCA, and may be present in the early acute phase of GCA. Nevertheless, because upper/lower extremity vasculitis occurs during the course of GCA, yearly clinical vascular examinations may be adequate to screen for upper/lower extremity vasculitis at an early stage in GCA patients. Early diagnosis of GCA-related upper/lower extremity vasculitis is crucial, and can result in decreased severe ischemic complications. Because aortic localizations were common, GCA patients with upper/lower extremity vasculitis should undergo routine investigations for underlying life-threatening aortic complications (aortic ectasia/aneurysm). We also suggest that patients exhibiting aortic complications should undergo routine clinical vascular examination to detect upper/lower extremity vasculitis.     

Four-year lower extremity disability trajectories among African American men and women

BACKGROUND: We examined 4-year lower extremity disability trajectories. METHODS: Nine hundred ninety-eight African American men and women 49-65 years old were evaluated at baseline and at four annual follow-ups. Lower extremity disability was the number of difficulties with nine standard activities of daily living (ADL), instrumental ADLs (IADL), and lower body function items. Mixed-effect models were used. RESULTS: The 9-item lower extremity disability measure had factorial validity and high reliability (alpha > 0.88). The mean baseline lower extremity disability score was 2.43, and at the subsequent follow-ups it was 2.23, 2.35, 2.60, and 2.70. The mixed-effect model included significant random intercept and aging effects. Fixed factors with the largest effect sizes (all p < or =.001) were physical performance (-0.238 lower extremity disabilities per point on the Short Physical Performance Battery [SPPB]), fear of falling (1.094), poor or fair self-rated health (0.735), self-reported arthritis (0.659), clinically relevant levels of depression symptoms (0.641), body mass index (0.047 per kg/m(2) unit), aging (0.082 per year), and asthma (0.558). CONCLUSIONS: To improve lower extremity disability trajectories among African Americans, interventions should focus on improving SPPB scores. In addition, fear of falling, poor or fair self-rated health, and clinically relevant levels of depression symptoms should be considered potential intervention candidates warranting further evaluation.     

Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease

Background: Previous studies of multidetector CT (MDCT) of the lower extremities for the detection of peripheral vascular disease showed high diagnostic accuracy but were performed with older generation systems. Objective: The purpose of this study was to evaluate the diagnostic accuracy of 64 MDCT for the detection of hemodynamically significant disease within the lower extremity peripheral vasculature as compared to digital subtraction angiography (DSA). Methods: Twenty‐eight consecutive patients with symptomatic lower extremity intermittent claudication and an abnormal ankle‐brachial index (ABI; less than 0.9) were evaluated by both 64 MDCT and DSA. Axial images were acquired with a 64 multidetector general electric light speed VCT scanner. Images were analyzed using a GE Advantage workstation (AW 4.3) capable of advanced image processing and manipulation. The aorto‐iliac and lower extremity arteries were divided into 15 segments per limb (30 segments per patient). Eight hundred forty segments were analyzed in a blinded fashion by physicians with level III CT certification. Segments were classified as grade I (<10% stenosis), grade II (10–49%), grade III (50–99%), and grade IV (occlusion). Results: For all segments evaluated, the overall diagnostic accuracy for detecting grade III and IV lesions was 98% with a sensitivity of 99% and a specificity of 98%. For the aorto‐iliac segments, the diagnostic accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the femoro‐popliteal segments, the overall accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the infra‐popliteal segments, the overall accuracy was 98% with a sensitivity of 97% and a specificity of 99%. One segment could not be visualized by MDCT compared to 49 segments that could not be visualized by DSA. Conclusions: This study demonstrates excellent diagnostic accuracy of 64 MDCT in the detection of hemodynamically significant disease of the lower extremities. More segments are visualized using 64 MDCT than DSA, allowing more complete visualization of the vascular tree. CT angiography should be considered in the diagnostic evaluation of symptomatic patients with peripheral vascular disease. © 2009 Wiley‐Liss, Inc.     

主动脉夹层患者神经系统症状的临床分析

 目的 总结主动脉夹层患者神经系统症状的特点。方法 对865例临床诊断为主动脉夹层的患者进行回顾性分析,包括临床症状、体征以及影像学资料。结果 225例（26.0%）患者出现神经系统症状,最常见症状为头晕（56例,6.5%）,其次为晕厥（49例,5.7%）,一侧下肢感觉障碍47例（5.4%）,单一下肢瘫27例（3.1%）,昏迷22例（2.5%）,截瘫19例（2.2%）,头痛13例（1.5%）,偏瘫9例（1.0%）。其中5例以神经系统症状为首发表现,包括晕厥2例,眩晕1例,头痛2例。A型主动脉夹层患者更易出现神经系统表现（34.6%比14.7%）,其中晕厥、昏迷、偏瘫、截瘫、下肢感觉障碍等症状的发生显著高于B型主动脉夹层。结论 主动脉夹层患者合并神经系统症状常见,A型主动脉夹层患者更常见。     

老年2型糖尿病患者肌肉量减少与动脉粥样硬化的相关性分析

目的:探究老年2型糖尿病患者肌量减少与动脉粥样硬化的相关性。方法:选择年龄≥60岁的2型糖尿病患者322例,根据四肢骨骼肌指数(ASMI)分为肌量减少组(152例)与非肌量减少组(170例)。入组对象均进行体格检查、双能X线骨密度仪检查、颈部及下肢动脉超声检查、实验室检查。结果:在纳入的322例患者中,合并肌少症49例...     

2型糖尿病患者下肢血管病变及斑块形成的超声表现与冠状动脉粥样硬化形成的相关性研究

目的探究2型糖尿病患者下肢血管病变及斑块形成的超声表现与冠状动脉粥样硬化形成的相关性。方法该研究选取2018年4月—2020年4月纳入的240例经过下肢动脉血管和冠状动脉血管彩色超声检查的2型糖尿病患者,根据下肢动脉血管超声结果将患者分为下肢血管疾病(LEAD)组(n=126)和非LEAD组(n=114),根据冠状动脉血管彩色超声检查结果和询问病史将患者分为冠状动脉粥样组(n=111)和非冠状动脉粥样组(n=129)。分析2型糖尿病患者下肢血管病变及斑块形成的超声表现与冠状动脉粥样硬化形成的相关性。结果非LEAD组中冠状动脉粥样发生率为28.95%(n=33),LEAD组中下肢动脉硬化患者44例,冠状动脉粥样发生率为36.36%(n=16),下肢动脉狭窄<50%或者管道存在斑块患者59例,冠状动脉粥样发生率为61.02%(n=36),下肢动脉狭窄大于50%或管道闭塞患者23例,冠状动脉粥样发生率为78.26%(n=18)。LEAD组三种级别患者于非LEAD组患者比较,差异有统计学意义(P<0.05)。使用Logistic多元逐步回归分析冠状动脉粥样硬化的影响因素显示,冠状动脉粥样硬化的独立影响因素是LEAD和T2DM病程糖尿病病程。在单变量分析中,T2DM患者在合并下肢动脉病变时,冠状动脉粥样患病风险不明显。在超声提示的不同程度下肢动脉病变中,未校正模型中,存在下LEAD患者冠状动脉粥样风险均显著提高。在纠正其他混杂因素(年龄、糖尿病病程、血脂水平)后,下肢血管狭窄率<50%或存在斑块(OR:5.949,95%CI:2.628~18.172,P<0.001)和下肢血管狭窄率>50%或血管阻塞(OR:15.165,95%CI:7.286~38.579,P<0.001)具有明显的相关性。结论2型糖尿病患者下肢血管超声检测对发现并提示冠状动脉粥样具有一定"预警"意义。