No abstract available.
Carotid Artery Diseases/*pathology ; Diabetes Mellitus, Type 2/*pathology ; Diabetic Retinopathy/*pathology ; Female ; Humans ; Male ; Peripheral Arterial Disease/*pathology

Peripheral arterial occlusive disease caused by atherosclerosis can present with intermittent claudication or critical limb ischemia. Proper diagnosis and management is warranted to improve symptoms and salvage limbs. With the introduction of new techniques and dedicated materials, endovascular recanalization is widely performed for the treatment of peripheral arterial occlusive disease because it is less invasive than surgery. However, there are various opinions regarding the appropriate indications and procedure methods for interventional recanalization according to operator and institution in Korea. Therefore, we intend to provide evidence based guidelines for interventional recanalization by multidisciplinary consensus. These guidelines are the result of a close collaboration between physicians from many different areas of expertise including interventional radiology, interventional cardiology, and vascular surgery. The goal of these guidelines is to ensure better treatment, to serve as a guide to the clinician, and consequently, to contribute to public health care.
Arterial Occlusive Diseases/radiography/*therapy ; Arteries/pathology ; Endovascular Procedures/*standards ; Humans ; Intermittent Claudication/radiography/therapy ; Limb Salvage/methods ; Lower Extremity/*blood supply ; Peripheral Arterial Disease/radiography/*therapy ; *Practice Guidelines as Topic ; Republic of Korea

OBJECTIVETo analyze the trends in treatments of lower extremity peripheral arterial disease and their prognosis in the recent 10 years.

METHODSClinical data of inpatients with lower extremity peripheral arterial disease who received surgical treatments in Xuanwu Hospital from January 2002 to December 2011 were analyzed retrospectively. Patients were stratified into two groups (group 1: from 2002 to 2006, group 2: from 2007 to 2011). The demographics, risk factors, clinical presentation, lesion anatomy, therapies, limb salvage and survival were observed. χ(2) test, Fisher exact test, and t test were used to compare the data between the two groups.

RESULTSFrom 2002 to 2006, 170 limbs (47.49%) underwent conventional bypass surgery, 72 limbs (20.11%) underwent endovascular interventions and the rest 116 limbs (32.40%) received stem cell treatment. While from 2007 to 2011, the percentages were 18.49%, 68.73%, 8.27%, respectively. Furthermore, gene-based drug appeared, 67 limbs (4.51%) underwent the new treatment. Former group had decreased limb salvage rates compared with latter group (87.15% vs. 93.41%, χ(2)=15.71, P=0.000). However, survival rates did not differ from the two groups (84.67% vs. 84.31%, χ(2)=0.02, P=0.880).

CONCLUSIONWith the appearance of new medical instruments and operating methods, the percentage of the patients with lower extremity peripheral arterial disease receive endovascular interventions increases, with a improved limb salvage rates.

Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; pathology ; Peripheral Arterial Disease ; diagnosis ; surgery ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Survival Rate ; Treatment Outcome ; Vascular Grafting ; Vascular Patency

OBJECTIVES: We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients. METHODS: We analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s. RESULTS: The association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT. CONCLUSIONS: BaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.
Aged ; Aged, 80 and over ; Ankle Brachial Index ; Carotid Artery Diseases/epidemiology/*pathology ; Confidence Intervals ; Diabetes Mellitus, Type 2/epidemiology/*pathology ; Diabetic Retinopathy/epidemiology/*pathology ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Peripheral Arterial Disease/epidemiology/*pathology ; Republic of Korea/epidemiology ; Risk Assessment ; Tunica Intima/pathology ; Tunica Media/pathology

BACKGROUNDThe recent onset or deterioration of lower extremity ischemia is highly associated with intravascular thrombus. Treatment of these thrombotic occlusions is challenging. Pulse-spray catheter directed thrombolysis (PS-CDT) refers to the technique of intermittent forcefully injecting the thrombolytic agent into the thrombus to fragment it and increase the surface area available for enzymatic action. This study was designed to evaluate the efficacy and safety of PS-CDT in patients with recent onset or deterioration of lower extremity ischemia.

METHODSFrom August 2008 to March 2009, 44 patients with acute or chronic lower extremity ischemia were recruited in this prospective study, which included 37 men and 7 women ranging from 15 to 83 years old (mean age (51.1 ± 17.4) years). PS-CDT through a multi-side-hole thrombolytic catheter by using urokinase was conducted in all patients. The progression of thrombolysis was assessed and graded by angiography. Adjunctive therapies were used to correct underlying lesions. The follow-up period was 12 months.

RESULTSIn the 44 patients, the average total dose of urokinase for each patient was (2 120 000 ± 1 100 000) IU (median 2 000 000 IU), with a median duration of lysis of 48 hours. The rate of initial technical success was 97.7%. The rate of clinically successful lysis was 81.8%. Early (≤ 30 days) and late (from 30 days to 12 months) amputation rates were both 4.5% (2/44). The overall amputation rate was 9.1% (4/44). No mortality was recorded during thrombolysis and follow-up period (12 months). No major bleeding or allergic reaction was seen during thrombolytic therapy. 11.4% had symptoms of distal embolization. The primary patency rate for the arteries that were clinically successfully thrombolyzed as compared with those that failed to lysis was 83.3% vs. 57.1%, respectively, at 1 year.

CONCLUSIONSPS-CDT, combined with adjunctive therapies, is associated with good safety and efficacy in recent-onset or deterioration of lower extremity ischemia. Successful thrombolysis may be accompanied by better outcomes.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheterization, Peripheral ; methods ; Female ; Fibrinolytic Agents ; administration & dosage ; therapeutic use ; Humans ; Ischemia ; drug therapy ; Lower Extremity ; pathology ; Male ; Middle Aged ; Peripheral Arterial Disease ; drug therapy ; Thrombolytic Therapy ; methods ; Urokinase-Type Plasminogen Activator ; administration & dosage ; therapeutic use ; Young Adult