The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage.
Angioplasty, Balloon/*methods ; Diabetic Foot/*therapy ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/*therapy ; *Tibial Arteries

The popliteal artery is a relatively short vascular structure, but acute occlusion can decrease blood flow into the lower extremities and cause subsequent critical limb ischemia, amputation, and even mortality. Further, peripheral artery disease patients frequently have combined cardio-cerebrovascular disease. Here, we report a rare case of sudden bilateral thrombotic total occlusion in the popliteal arteries of a patient with dilated cardiomyopathy and left ventricular thrombi. This patient has been successfully managed by endovascular therapy and subsequent intra-arterial thrombolytic therapy.
Amputation ; Angioplasty ; Cardiomyopathy, Dilated ; Extremities ; Humans ; Ischemia ; Lower Extremity ; Mortality ; Peripheral Arterial Disease ; Popliteal Artery ; Thromboembolism ; Thrombolytic Therapy

Peripheral arterial disease (PAD) shows increasing morbidity and mortality. Clinical manifestations of PAD, such as intermittent claudication, rest pain and nonhealing ulcer, contribute to impaired quality of life, and ischemic stroke caused by PAD can be life-threatening. Unfortunately, PAD patients often receive suboptimal treatment, and pathogenesis of the disease is still unclear. Over the past decade, the evolving technology and interdisciplinary collaboration have enabled improvement of diagnosis and treatment for PAD. This review makes a brief summary of the current status and progress in genetics research on PAD, which included candidate gene studies, linkage analyses, genome-wide association studies, and applications and development prospects of epigenetics, mitochondrial DNA and other new technologies.
Animals ; DNA, Mitochondrial ; genetics ; Genetic Predisposition to Disease ; genetics ; Genome-Wide Association Study ; methods ; trends ; Genotype ; Humans ; MicroRNAs ; genetics ; Peripheral Arterial Disease ; genetics ; therapy ; Polymorphism, Single Nucleotide ; Risk Factors

OBJECTIVETo observe the effects of moxibustion and treadmill exercise on transcutaneous oxygen tension and exercise capacity in lower limbs of peripheral arterial disease (PAD).

METHODSTotally 58 mild-to-moderate PAD patients were assigned to the control group (18 cases), the moxibustion group (20 cases), and the treadmill exercise group (20 cases) by random digit table. Patients in the control group received conventional drug therapy for 12 weeks. Patients in the moxibustion group and the treadmill exercise group additionally received moxibustion [at Zusanli (ST36), Sanyinjiao (SP6), Yongquan (KI1)] and treadmill exercise respectively, once per day, 5 times per week for 12 weeks in total. Ankle-Brachial Index (ABI) , transcutaneous oxygen tension (TcPO₂), 6-min walking test (6MWT), and walking impairment questionnaire (WIQ) were assessed before and after treatment.

RESULTSCompared with the control group and the same group before treatment, there was no statistical difference in ABI in the moxibustion group and the treadmill exercise group (P > 0.05). But TcPO₂, 6MWT, and WIQ were obviously elevated (P < 0.01). Besides, 6MWT and WIQ assessment of the treadmill exercise group were better than that of the moxibustion group (P < 0.01) after intervention.

CONCLUSIONMoxibustion and treadmill exercise could improve the exercise capacity and TcPO₂of lower limbers in PAD patients.

Exercise Test ; Exercise Therapy ; Exercise Tolerance ; Humans ; Lower Extremity ; physiopathology ; Moxibustion ; Oximetry ; Oxygen ; blood ; Peripheral Arterial Disease ; therapy ; Surveys and Questionnaires ; Walking

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

BACKGROUND AND OBJECTIVES: Peripheral arterial disease is a risk factor for foot ulcers and amputation in diabetic patients. Percutaneous intervention of an obstructed lower limb artery is one of the treatments for diabetic foot;however, few data are available on this treatment and its effectiveness. The aim of this study was to investigate atherosclerotic obstruction in lower limb arteries and to evaluate the feasibility and effectiveness of percutaneous intervention in salvaging a lower limb with diabetic foot. SUBJECTS AND METHODS: Fifty-two consecutive subjects (mean age:64) with diabetic foot underwent angiography of the lower limbs. In patients with significant narrowing (diameter stenosis >50%), percutaneous intervention was performed. Angiographic success was defined as restoration of distal blood flow with residual stenosis less than 30%. During follow-up, bypass surgery was performed when clinically indicated in some patients and the state of diabetic foot was evaluated. RESULTS: Forty-nine patients (94%) showed atherosclerotic narrowings in lower limb arteries and 34 of them (65%) had significant lesions. Among those 34 subjects, interventions were carried out in 30 cases (balloon angioplasty in 11, stenting in 18, and intra-arterial thrombolytic therapy in 1). In the other 15, intervention was not indicated. Twenty-six (86%) of the 30 procedures were angiographically successful. During the follow-up (7+/-6 months), 12 subjects (57%) experienced wound healing with or without forefoot amputation or bypass surgery, whereas 3 had major amputation. Four patients died during the period. CONCLUSION: The majority of patients with diabetic foot had atherosclerotic obstruction in lower limb arteries. Percutaneous intervention may salvage limbs and reduce the rate of major amputation in patients with diabetic foot.
Amputation ; Angiography ; Angioplasty ; Arteries* ; Arteriosclerosis ; Constriction, Pathologic ; Diabetic Foot* ; Extremities ; Follow-Up Studies ; Foot Ulcer ; Humans ; Lower Extremity* ; Peripheral Arterial Disease ; Risk Factors ; Stents ; Thrombolytic Therapy ; Wound Healing

The ultimate objective of dyslipidemia management is to prevent and treat atherosclerotic cardiovascular diseases. It is important to combine lifestyle modification together with medication. To determine whether to start drug therapy, comprehensive consideration should be given to both the risk status for atherosclerotic cardiovascular disease and low density lipoprotein cholesterol levels. Drug treatment can be initiated according to whether the patients have coronary artery disease, ischemic cerebral infarction, peripheral artery disease, atherosclerotic artery diseases (abdominal aortic aneurysm, carotid artery stenosis), or diabetes, as well as the number of atherosclerotic risk factors (smoking, hypertension, low high density lipoprotein cholesterol level, family history of premature coronary artery disease, and age). Statin is the first-choice drug for the treatment of hypercholesterolemia. The first goal for drug therapy is to lower the low density lipoprotein cholesterol and the secondary goal is to lower the non-high density lipoprotein cholesterol level. Secondary causes of dyslipidemia should be considered and corrected before starting any medication. These recommendations are based on the new treatment guideline 2015 of Korean Society of Lipidology and Atherosclereosis and Korean Medical Association.
Aortic Aneurysm ; Arteries ; Cardiovascular Diseases ; Carotid Arteries ; Cerebral Infarction ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Drug Therapy ; Dyslipidemias* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Hypertension ; Life Style ; Lipoproteins ; Peripheral Arterial Disease ; Risk Factors

BACKGROUND: This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. METHODS: Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 microg) was administered orally 3 times daily (120 microg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. RESULTS: There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. CONCLUSIONS: Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.
Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Diabetes Complications/*drug therapy/physiopathology ; Epoprostenol/*analogs & derivatives/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/complications/*drug therapy ; Platelet Aggregation Inhibitors/*therapeutic use ; Prospective Studies ; Statistics, Nonparametric

OBJECTIVETo analyze the etiology, characteristics, and treatment outcomes of peripheral arterial disease (PAD) in patients under 45 years old.

METHODSOne hundred and ninety-three cases under 45 years old with PAD were included from January 1999 to January 2009. The demography, etiology, surgical data, treatment outcomes of these patients were evaluated and analyzed. Among these patients, males are 171 cases. The age was 13 to 44 years old (average age 35 years old) and the average time between onsets of PAD to admission was 3.6 months. In the 138 patients who underwent surgical interventions, 30 patients had serologically proven thrombophilia, 50 patients without thrombophilia had other definite reasons but not Burger's disease. A total of 116 cases underwent open operations, 17 cases were received endovascular interventions and 5 cases underwent combinative treatments.

RESULTSAmong the 193 patients, 140 cases (72.5%) had definite reasons. Forty patients (28.6%) were diagnosed with congenital or acquired hypercoagulability in the 140 cases. The thrombophilia group had poorer primary patency (70.0% vs. 92.0%, P = 0.010) and secondary patency (83.3% vs. 98.0%, P = 0.016) than non-thrombophilia group and more likely to underwent second revascularization because of recurrent thrombosis within 30 days after operations. After 16 months follow-up, the patients with thrombophilia had lower primary patency (65.0% vs. 75.7%, P = 0.392) and secondary patency (80.0% vs. 91.9%, P = 0.192) than the ones without thrombophilia and the rate of amputation was higher in thrombophilia group (15.0% vs. 5.4%, P = 0.222) but, these didn't achieve statistical significance.

CONCLUSIONSA high prevalence rate of thrombophilia is found in patients less than 45 years old with PAD requiring revascularization. Thrombophilia may have contributed to early postoperative thrombosis of the vascular procedure. So the screening and medical therapy to thrombophilia in young adults with PAD should be reinforced before surgical treatment.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Ischemia ; diagnosis ; etiology ; therapy ; Lower Extremity ; blood supply ; Male ; Peripheral Arterial Disease ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures ; Young Adult

BACKGROUND AND OBJECTIVES: We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea. METHODS: This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis. RESULTS: This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p < 0.001) compared to deterioration/maintain stage II–IV. CONCLUSIONS: Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.
Adult ; Angiography ; Ankle Brachial Index ; Arteries ; Aspirin ; Comorbidity ; Constriction, Pathologic ; Diagnosis ; Drug Therapy ; Extremities ; Humans ; Hyperlipidemias ; Hypertension ; Ischemia ; Korea ; Linear Models ; Male ; Orthopedics ; Peripheral Arterial Disease ; Prospective Studies ; Quality of Life ; Smoking Cessation ; Ultrasonography