Arteriosclerosis Obliterans ; surgery ; Humans ; Lower Extremity

Angioplasty ; methods ; Arteriosclerosis Obliterans ; surgery ; Humans ; Stents

Arteriosclerosis Obliterans ; surgery ; Graft Occlusion, Vascular ; therapy ; Humans ; Lower Extremity ; blood supply ; Stents

Arteriosclerosis obliterans (ASO) of the lower extremities is a common peripheral vascular disease. Its incidence gradually increased in China in recent years. ASO may severely affect the quality of life, and even be fatal. This article summarizes the author's own experiences, along with literature review, with an attempt to discuss the therapeutic principles, indications, and strategies of the surgical therapy for ASO of the lower extremities.
Arteriosclerosis Obliterans ; surgery ; China ; Humans ; Lower Extremity ; blood supply ; Vascular Surgical Procedures ; methods

OBJECTIVE: To explore the relationship between activity of plasma heparin cofactor II (HC II) and the incidence of in-stent restenosis aft er the intervention of arteriosclerosis obliterans in lower extremity. METHODS: A total of 62 patients with arteriosclerosis obliterans in lower extremity underwent femoropopliteal stent implantation. They were divided into 2 groups: A high HC II activity group (≥100%, n=40) and a low HC II activity group (<100%, n=22). All patients filled in follow up tables and conducted body examination. Possible risk factors resulting in restenosis were collected. Patients were followed up for 6 months after femoropopliteal stent implantation. RESULTS: Baseline clinical characteristics were not significantly different between the 2 groups. The degree and incidence of angiographic restenosis at the end of the 6th month after the implantation in the high HC II activity group were all significantly lower than those in the low HC II activity group (P<0.05). Multivariate analysis demonstrated that high plasma HC II activity was an independent factor in reducing the incidence of angiographic restenosis (OR=0.982, P=0.048, 95%CI, 0.966, 0.998). CONCLUSION High plasma HC II activity is an independent factor in reducing the degree of in-stent restenosis. The lower the plasma HC II activity, the severer the degree of in-stent restenosis.
Arteriosclerosis Obliterans ; surgery ; Constriction, Pathologic ; Heparin Cofactor II ; metabolism ; Humans ; Incidence ; Lower Extremity ; Risk Factors ; Stents

Arteries ; surgery ; Arteriosclerosis Obliterans ; surgery ; Bioprosthesis ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; Humans ; Lower Extremity ; blood supply ; surgery

Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Arteriosclerosis Obliterans ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Humans ; Male

OBJECTIVETo report and evaluate the clinical results of surgical treatment for long-segment iliofemoral arteriosclerosis obliterans, including external iliac-popliteal (EIP) and femoral-deep femoral (FDF) crossover bypass surgeries.

METHODSFrom July 1995 to December 2009, 85 patients (61 male, 24 female, aged from 64 to 91 years, mean age 75 years) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were involved in this research. According to Fontaine classification, the 85 patients could be graded as 62 class IIb-III patients (72.9%), and 23 class IV patients (27.1%). In CT angiography or DSA examinations, the 85 patients were grouped into EIP (n = 49) and FDF (n = 36) surgical groups on the basis of visualizations in the affected deep femoral, supra-knee/infra-knee popliteal arteries. The healing time of ulcers and toe amputation wound, ankle-brachial index, and blood flow velocity in the affected limb together with accumulative patency rates in 1, 3 and 5 years and limb salvage rates in 3 and 5 years were analyzed.

RESULTSNone of the 85 patients died or had extremity amputated in perioperatively. Seventy-four patients (87.1%) had been followed up from 2 to 13 years (mean 5.7 years). Postoperative ankle-brachial index of FDF and EIP groups was 0.55 ± 0.11, and 0.94 ± 0.13 (t = -21.88, P = 0.000). Postoperative velocity of popliteal artery blood flow in FDF and EIP groups was (32 ± 9) cm/s, and (48 ± 4) cm/s (t = 16.76, P = 0.000); velocity of anterior or posterior tibial artery was (22 ± 7) cm/s, and (42 ± 4) cm/s (t = 10.50, P = 0.000). The primary and secondary patency rates of FDF and EIP groups were 87.8% and 88.3%, 80.7% and 81.2%, 68.4% and 57.4% at 1, 3 and 5 years, respectively. Limb salvage rates of FDF and EIP groups were 87.6% and 88.6%, 76.7% and 71.3%, at 3 and 5 years, respectively. There were no statistically significant differences in 1, 3, and 5 years' cumulative secondary patency rate and limb salvage rate between FDF and EIP groups.

CONCLUSIONSAs extra-anatomic bypass surgeries, FDF and EIP are both determined to be alternative procedures for unilateral common iliac-superficial femoral artery occlusive disease, especially suitable for high-risk patients. EIP group patients have better clinical outcomes than those in FDF group.

Aged ; Aged, 80 and over ; Arteriosclerosis ; surgery ; Arteriosclerosis Obliterans ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Femoral Artery ; surgery ; Humans ; Iliac Artery ; surgery ; Limb Salvage ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To evaluate the role of Rotarex mechanical thrombectomy system in treating instent restenosis of peripheral artery disease (PAD). METHODS: The clinical data of 7 in-stent restenosis (ISR) cases of lower extremity PAD from June 2017 to Dec 2018 were retrospectively analyzed. There were 5 males and 2 females and the mean age was (70.0±7.6) years from 59.0 to 76.0 years. All the cases were treated by Rotarex mechanical thrombectomy system. In the 7 cases, time interval from the previous stent implantation to ischemia recurrence was 1.0 to 72.0 months, and the median time was 6.0 months. The period from ischemia recurrence to endovascular therapy was 3 days to 2 years, and the median time was 62 days. Rotarex mechanical debulking catheter and percutaneous transluminal angioplasty (PTA) were used in all the cases, and the stent was used only when it was necessary. Anticoagulation was used for 24 hours after procedures and then antiplatelet agents were used as usual. Doppler ultrasonography was taken during the followed-up. RESULTS: All the 7 cases were successful in technology, 3 of which were implanted with new stents for the fracture of the old ones. while for the other four cases, no new stent was implanted. The ankle-brachial index (ABI) increased from 0.31±0.08 to 0.86±0.08 after treatment (t=-12.84, P < 0.001). Thrombectomy was applied urgently in one case because of acute thrombosis in the stent, and the result was good. There was no other complications in hospital. All the patients were followed up for 5.0-22.0 months, and the median time was 14.0 months. No death and amputation occurred during the follow-up. One patient stopped antiplatelet agents because of gastrointestinal bleeding, which resulted in acute thrombosis. in-stent restenosis reappeared in 3 cases. CONCLUSION Debulking using Rotarex catheter is safe and effective in treating in-stent restenosis of PAD, especially in reducing stents implantation, but is not good at dealing with old thrombus and proliferating intima, and can do nothing about fractured stents and hyperplasia of intima, so it needs to be combined with stents and drug coated balloons.
Aged ; Arteriosclerosis Obliterans/surgery* ; Coronary Restenosis ; Female ; Femoral Artery ; Humans ; Lower Extremity ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Stents ; Thrombectomy ; Treatment Outcome

OBJECTIVETo explore the mid-term surgical results of arterial revascularization for femoro-popliteal arterial occlusive disease (lesion type C and D).

METHODSFrom January 2005 to February 2009, 191 arterial bypass had been performed on 170 patients (21 cases bilateral). There were 108 male and 62 female, age ranged from 45 to 85 years old with an average of 67 years old. The operative indication was claudication in 78 cases, rest pain in 62 cases, ischemic ulcer in 19 cases, and distal tissue necrosis in 11 cases. Arterial angiography were performed on all cases. According to TASC II document, type C lesions were seen in 127 limbs, type D lesions were seen in 64 limbs. Autogenous greater saphenous vein bypass in situ were done on 15 limbs, autogenous greater saphenous vein bypass reversed in 20 limbs, revascularization with artificial prosthesis in 128 limbs, composite grafts consisting of a prosthetic conduit with a distal venous segment in 28 limbs.

RESULTSThere were no 30-day mortality. Follow-up periods ranged 6 to 36 months with an average of (24 + or - 6) months. Seventy-three cases were lost during follow-up periods, follow-up rate was 57% (109/191). Primary patency rate was 84.4% (92/109). The patency rate was 88.2% with artificial prosthesis, 70.8% with greater saphenous vein (in situ or reversed). Secondary patency rate was 89.9%.

CONCLUSIONSArterial revascularization with artificial prosthesis is main treatment for diffused superficial femoral artery occlusive disease (TASC II type C and D lesion) with satisfied surgical results.

Aged ; Aged, 80 and over ; Arteriosclerosis Obliterans ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Femoral Artery ; surgery ; Humans ; Male ; Middle Aged ; Popliteal Artery ; surgery ; Retrospective Studies ; Saphenous Vein ; transplantation ; Treatment Outcome