We report 72 non-diabetic patients with obliterant atherosclerosis, stadium II, (intermittent claudication). The medium age of these patients was 62 +/- 4.5 years old. They were randomly included into four groups. Three were treated with Ozone: one of them by endovenous way, other intramuscular way, and the last one by rectal way; meanwhile, in the fourth group the patients were submitted to conventional medical treatment (control group). In the three ozone-groups there weren't differences when they were compared between then. But there was a significant improvement in comparison with the control group. The claudication distance in the treadmill increased to the 2.5 km/hour. Ankle/arm pressure rates hadn't significant differences, this corroborates the ozone action on the microcirculation. The least uncomfortable, the more harmless and the more economic way was the rectal way.

BACKGROUND:

Limb ischemia is a major complication in patients who are receiving hemodialysis (HD). In this study, distinctive features and factors affecting the outcome of HD patients with limb ischemia are identified.

METHODS AND RESULTS:

One hundred and eighty consecutive symptomatic limb ischemic patients who were or were not receiving HD and who successfully underwent surgical bypass grafting (bypass, n=75) or endovascular angioplasty (percutaneous transluminal angioplasty (PTA), n=105) were retrospectively compared at our hospital. The endpoint of this study was amputation of the ischemic leg or death. Median follow up was 2.25 years. The amputation-free survival of HD patients was significantly lower than that of non-HD patients (P<0.0001). In the bypass group, the amputation-free survival of HD patients was significantly lower than that of non-HD patients (P=0.0002), even if the graft was patented or not (P=0.77). In contrast, in the PTA group, the amputation-free survival of HD patients was lower than that of non-HD patients (P=0.03), and with a significantly lower patency rate (P=0.0004). Predictors of amputation-free survival differed between HD and non-HD patients; predictors were diabetes mellitus and gender in HD patients, while they were Fontaine classification and hyperlipidemia in non-HD patients. The infectious death rate was higher in HD patients than in non-HD patients (53% vs 22%, P<0.05).

CONCLUSIONS:

This study clearly showed a poorer prognosis in HD patients than in non-HD patients especially after bypass surgery, even if the the graft was patented or not.

Objective: To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity. Methods: The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range:4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient's operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results: All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment(t=-25.160,P<0.01).The Rutherford stages decreased from (M(IQR)) 3(1) to 1(1(Z=-6.825,P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions: Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

BACKGROUND:

The impact of intracranial arteriosclerosis on dementia remains largely unclear.

METHODS:

In 2339 stroke-free and dementia-free participants (52.2% women, mean age 69.5 years) from the general population, we assessed intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC) as proxy for arteriosclerosis. Associations with dementia were assessed using Cox models. In addition, indirect effects through cerebral small vessel disease (cSVD) and subcortical brain structure volumes were assessed using causal mediation analyses.

RESULTS:

During a median of 13.4 years (25th-75th percentiles 9.9-14.5) of follow-up, 282 participants developed dementia. Both ICAC presence (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.32]) and volume (HR per standard deviation: 1.19, 95% CI.: 1.01-1.40) increased dementia risk. For VBAC, severe calcifications increased dementia risk (HR for third vs first volume tertile: 1.89, 95% CI.: 1.00-3.59). These effects were mediated partly through increased cSVD (percentage mediated for

ICAC:

13% and

VBAC:

24%).

DISCUSSION:

Intracranial arteriosclerosis increases the risk of dementia.

A double blind trial of an isoxsuprine enantiomer against a placebo in the management of various symptoms of cerebral arteriosclerosis is reported. The results are supported by statistical analysis and point to the favorable therapeutical action of the drug. It is suggested that this is attributable to improved tissue oxygenation.

Arteriosclerosis is characterized by stiffening of arteries. The incremental elastic modulus (Einc) measurement is a good marker of arterial wall stiffness. Metabolic, inflammatory and hemodynamic alterations cause structural changes and vascular complications in end stage renal disease. The aim of the present study was to evaluate the factors that may affect the development of arteriosclerosis by measurement of Einc in hemodialysis (HD) patients. Thirty-two patients (16 men; 16 female) on chronic HD with a mean age of 42.2 +/- 19.3 (range: 15-80) were included in the study. The carotid Einc was measured to determine arteriosclerosis by high-resolution echo-tracking system (Acuson Aspen, Acuson Corp., Mountain View, California, USA). Einc measurement was calculated from transcutaneous measurements of common carotid arterial (CCA) internal diameter and wall thickness and carotid pulse pressure. Common carotid compliance and distensibility were determined from changes in carotid artery diameter during systole and simultaneously measured carotid pulse pressure. Common carotid artery stuffiness (Einc) was influenced by age, systolic blood pressure (SBP), pulse pressure (PP), calcium (Ca) and alkaline phosphatase (ALP). The distensibility of CCA was correlated with age, SBP, diastolic blood pressure (DBP), PP, Ca, ALP, and parathormone (PTH). The inflammatory parameter, hs-CRP, was increased with Einc. The mean Einc measurement was found significantly increased in patient receiving vitamin D. In conclusion, the stiffening of carotid artery in HD patients is related not only to hemodynamic changes (increased SBP, PP) but also to metabolic (increased Ca) and to inflammation (increased hs-CRP). Carotid Einc is accepted independent risk factor for cardiovascular mortality. Because of the positive correlation between Einc and serum Ca, vitamin D and Ca containing phosphorus (P) binders should be used carefully.

It has become increasingly important to manage anesthesia depending on the severity of the arteriosclerotic disease. The objective of the present study is to evaluate the effects of propofol anesthesia by taking into account vascular compliance and the site specificity of arteriosclerosis. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were estimated non-invasively by simultaneously measuring electrocardiogram, phonocardiogram, sphygmogram, and the blood pressure in the extremities. PWV represents the speed at which a pulse wave travels from the heart to a peripheral artery, and is calculated based on the length of time for a pulse wave to travel between two measurement points. Increased PWV indicates reduced elasticity of the arterial wall. In the present study, PWV was measured at the following segments: baPWV (brachium to ankle), hbPWV (heart to right brachium), hcPWV (heart to carotid artery) and haPWV (heart to ankle). ABI represents the ratio of systolic pressure in the ankle over that in the brachium, and is used for diagnosis of obstructive arteriosclerosis. Using these parameters, the degree of arterial obstruction and stiffness can be assessed within a short period of time, and facilitates to determine the severity of arteriosclerosis. PWV was used as an index to determine the severity of preoperative arteriosclerosis. Subjects were divided into the following three groups to determine the effects of general anesthesia on PWV at each segment: high PWV group (baPWV of 1,600 cm/s or above, Group 1), low PWV group (Group 2) and normal group (Group 3) (Table 1-3). PWV was measured before surgery and immediately after anesthesia induction: 10 minutes after endotracheal intubation following the administration of 2 μug/kg of fentanyl, 2 mg/kg of propofol (10 mg/kg/h) and 0.14 mg/kg of vecuronium. Each parameter was compared before surgery and after anesthesia induction. The results were as follows: 1. PWV, ABI and sphygmogram were useful preoperative tools because the preoperative PWV, blood pressure (BP), pulse pressure (PP) and carotid artery pressure (Esys) for Group 1 were significantly higher than those for Groups 2 and 3 (P < 0.01) (Table 3). 2. The presence or absence of preoperative arteriosclerosis markedly affected the effects of general anesthesia on the circulatory system. With regard to changes in each parameter before surgery and after anesthesia induction, in Group 1, the following parameters decreased significantly; PWV at all segments, SBP, Esys, PP (P<0.01), DBP and ABI (P<0.05); and in Group 2, the following parameters decreased significantly: baPWV, hbPWV, haPWV, SBP, PP (P<0.01), and DBP (P<0.05). However, no significant changes were seen in Group 3 (Fig. 1-1, 1-2). 3. The degree of change after anesthesia induction for each parameter was compared among the three groups: The decrease in baPWV (P<0.05), hcPWV and haPWV (P<0.01) was significantly greater for Group 1, but there were no significant inter-group differences in hbPWV, DBP, HR (heart rate) or ABI (Fig. 2-1, 2-2). 4. In Group 1, decrease in PWV at each segment was as follows: hcPWV>baPWV=haPWV>hbPWV. However, in Groups 2 and 3, decrease in PWV was comparable among the segments. Our findings suggest that propofol-induced general anesthesia lowers PWV differently at different areas of the body depending on the characteristics of arterial elastic fibers. In addition to morphological or pathophysiological changes, environmental and psychological factors may increase blood and pulse pressures and affect arteriosclerotic vascular compliance.

AIM:

We aimed to determine the current status of the medical expenses for the treatment of arteriosclerosis obliterans (ASO) and evaluate the cost effectiveness of the medical practices employed in ASO treatment in Japan.

METHODS:

We performed a prospective observational study using 140 ASO patients. The cost of the medical practices comprised the costs of outpatient treatment, pharmacological agents, and hospitalization. To compare the average monthly costs, the patients were divided into preintervention, postintervention, or conservative-therapy groups. To compare the total costs and effectiveness of each treatment, the patients who had first visited our division during the study period were classified into surgery, endovascular-revascularization (EVR), or conservative-therapy groups. The adverse reactions of the 4 most popular agents for ASO were investigated, and bleeding events were assessed specifically.

RESULTS:

The average monthly costs for outpatient treatment and pharmacological agents were yen 168,002 in conservative cases, yen 149,871 in preoperation cases, and yen 128,527 in postoperation cases. The mean total costs were yen 5,407,950 in conservative cases, yen 7,375,290 in surgical cases, and yen 2,631,650 in EVR cases. The average change of the gauge in clinical status was 0.57 in conservative cases, 2.13 in surgical cases, and 2.25 in EVR cases. Warfarin induced more bleeding complications than the other agents.

CONCLUSION:

The costs of pharmacological agents represented much of the medical costs in any treatment groups.

OBJECTIVE:

To assess the effect of inferior mesenteric artery reimplantation on perfusion of the mucosa of the sigmoid colon in patients undergoing aortobifemoral reconstruction for arteriosclerotic disease.

DESIGN:

Random control study.

SETTING:

University hospital.

SUBJECTS:

8 Men and 2 women with peripheral vascular disease and angiographically patent superior and inferior mesenteric arteries.

INTERVENTIONS:

Patients were randomised to have the inferior mesenteric artery reimplanted in the Y-graft or not. Sigmoid perfusion was measured with a tonometer and expressed as the intramucosal pH (pHi) during operation (baseline) and for four days afterwards.

MAIN OUTCOME MEASURES:

Measurements of pHi, arterial blood gases, and acid base balance, and signs of ischaemia of the gut.

RESULTS:

In both groups the pHi was reduced after clamping the aorta, but returned to baseline on the first postoperative day. One patient had a cardiac arrest from which he was resuscitated and his pHi measurements were subsequently low.

CONCLUSION:

pHi does seem to reflect changes in the circulation of the sigmoid mucosa. Even if the inferior mesenteric artery is patent, reimplantation is only rarely indicated in patients undergoing aortobifemoral reconstruction.

Objective: To investigate the efficacy of sinivastatin and aspirin as well as blood pressure controlling therapy for carotid atherosclerosis in patients with hypertension. Methods: 162 patients with essential hypertension and carotid atherosclerosis were randomized into two groups. 82 cases In the treatment group, were treated with simvastatin and aspirin as well as antihypertensive drugs; while 80 cases in the control group were treated with antihypertensive drugs alone. Intima-media thickness (IMT) of carotid arterial, carotid plaques score, blood pressure and the serum lipids were measured before and once a year after treatment for 3 years. Results: Mean IMT of carotid artery and carotid plaques score were (1.01 ± 0.12) mm and 3.8 ± 2.5 respectively in the treatment group 1 year a fter treatment, showed no difference from that before treatment. But they were (0.80 ± 0.16) mm, 2.6 ± 1.6 and (0.80 ± 0.20) mm, 2.5 ± 1.2 after 2 and 3 years respectively, which were reduced significantly compared with that of before treatment. The IMT and internal diameter ratio was also reduced significantly after treatment. Overall incidence of cardio-and cerebro-vascular events in the treatment group were 10.90% and 4.87% during the 3 years follow-up period, which were significantly lowered compared to the control group. Conclusion: Long-term simvastatin and aspirin therapy could effectively delay and reverse the progression of carotid arteriosclerosis in patients with hypertension and prevent cardio-and cerebro-vascular events when combined with antihypertensive drugs.