It is necessary to study further syndrome differentiation based treatment of peripheral vascular disease. In order to improve the clinical effect and reduce the rate of amputation, early diagnosis and early intervention are important. Meanwhile, treatment of Chinese medicine should be combined with necessary surgical intervention. It should be important to supplement some details about blood stasis syndrome and activating blood and dissolving stasis therapy of peripheral vascular disease. The application of various Chinese medicine external therapies should not be ignored, especially promoting granulation and wound healing therapy.
Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Peripheral Vascular Diseases ; therapy ; Research ; Syndrome ; Wound Healing

BACKGROUNDSarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions.

METHODSThis prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure.

RESULTSThere was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05).

CONCLUSIONSAspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.

Aged ; Arterial Occlusive Diseases ; drug therapy ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Peripheral Vascular Diseases ; drug therapy ; Popliteal Artery ; drug effects ; pathology ; Serotonin Antagonists ; therapeutic use ; Succinates ; therapeutic use ; Ticlopidine ; analogs & derivatives ; therapeutic use

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amputation ; economics ; Cerebrovascular Disorders ; epidemiology ; Cohort Studies ; Comorbidity ; Conservative Treatment ; Costs and Cost Analysis ; Diabetes Mellitus ; economics ; Diabetic Foot ; economics ; epidemiology ; therapy ; Female ; Foot Deformities, Acquired ; economics ; epidemiology ; therapy ; Foot Injuries ; economics ; epidemiology ; therapy ; Health Care Costs ; Hospitalization ; economics ; Humans ; Hypertension ; epidemiology ; Joint Diseases ; economics ; epidemiology ; therapy ; Length of Stay ; economics ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; epidemiology ; Peripheral Vascular Diseases ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Wound Infection ; economics ; epidemiology ; therapy ; Young Adult

BACKGROUNDDespite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy.

METHODSBetween June 2007 and October 2009, 16 860 patients aged 50 - 80 years with established history of atherosclerotic vascular disease (coronary heart disease (CHD), atherosclerotic cerebrovascular disease (CVD), or peripheral arterial disease (PAD)) from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics.

RESULTSAmong the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients (61% vs. 10% vs. 22% respectively) and decreased significantly with time from initial diagnosis. Simvastatin (mainly 20 mg) and atorvastatin (mainly 10 mg) each accounted for about 40% of total statin use.

CONCLUSIONSIn urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.

Aged ; Aged, 80 and over ; Atherosclerosis ; drug therapy ; Atorvastatin Calcium ; Cerebrovascular Disorders ; drug therapy ; Coronary Artery Disease ; drug therapy ; Cross-Sectional Studies ; Female ; Heptanoic Acids ; therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Peripheral Vascular Diseases ; drug therapy ; Pyrroles ; therapeutic use ; Secondary Prevention ; methods ; Simvastatin ; therapeutic use

PURPOSE: To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS: Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography. RESULTS: The average number of injections was 3.31 +/- 1.25 in the bevacizumab group and 3.44 +/- 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group (p = 0.03) and by 0.19 in the ranibizumab group (p = 0.01). Average FCT decreased from 322 +/- 62.48 microm to 274 +/- 40.77 microm in the bevacizumab group (p = 0.02) and from 338 +/- 50.79 microm to 286 +/- 36.93 microm in the ranibizumab group (p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. CONCLUSIONS: Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Choroid/*blood supply ; Choroid Diseases/diagnosis/*drug therapy/physiopathology ; Dose-Response Relationship, Drug ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fovea Centralis/pathology ; Fundus Oculi ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Peripheral Vascular Diseases/diagnosis/*drug therapy/physiopathology ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity

OBJECTIVETo assess the efficacy and safety of two arterial closure devices, Angioseal and Perclose, in patients undergoing coronary angiography and invasive interventions.

METHODSFrom January 2001 to April 2011, 997 inpatients underwent coronary angiography and interventions with arterial closure using Perclose (486 cases) or Angioseal (511 cases). The time to ambulation and hemostasis, major vascular complications and deployment success rate with the two devices were compared.

RESULTSThe time to hemostasis was significantly shorter in Angioseal group than in Perclose group (3∓0.9 min vs 10.8∓4.8 min, P<0.001), but the time to ambulation was comparable between the two groups (6.4∓1.2 h vs 6.3∓0.7 h, P>0.05). The incidences of vascular complications showed no significant differences between the two groups (4.5% vs 3.7%, P>0.05), and none of the cases in either group developed femoral artery thrombosis or low limb embolism following the procedures. The deployment success rate was comparable between the two groups (97.8% vss 98.6%, P>0.05), and deployment failure was associated mainly with mishandling and design defect of the devices.

CONCLUSIONSAngioseal and Perclose are both effective and safe for arterial closure with reduced hemostasis and ambulation time and low incidences of vascular complications. Angioseal appears to have better performance than Perclose in shortening the hemostasis time and is easier to handle.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; China ; Coronary Angiography ; adverse effects ; Coronary Disease ; diagnostic imaging ; therapy ; Female ; Femoral Artery ; surgery ; Hemostatic Techniques ; instrumentation ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; etiology ; Retrospective Studies

BACKGROUNDIliac vein compression syndrome (IVCS), the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.

METHODSBetween January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.

RESULTSThe stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.

CONCLUSIONSEndovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

Adolescent ; Adult ; Angioplasty, Balloon ; Female ; Humans ; Iliac Vein ; pathology ; Male ; Middle Aged ; Peripheral Vascular Diseases ; pathology ; therapy ; Phlebography ; Stents ; Young Adult

OBJECTIVE: We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients. MATERIALS AND METHODS: We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for stenoocclusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter. RESULTS: At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2; n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05). CONCLUSION: We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint.
Aged ; Aged, 80 and over ; Alloys ; Angiography ; Arterial Occlusive Diseases/radiography/*therapy/ultrasonography ; Chi-Square Distribution ; Female ; Fluoroscopy ; Humans ; Korea ; Leg/blood supply ; Male ; Middle Aged ; Peripheral Vascular Diseases/radiography/*therapy/ultrasonography ; *Popliteal Artery ; Prosthesis Failure ; Retrospective Studies ; *Stents ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Duplex ; Vascular Patency

OBJECTIVE: To determine the effect of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). METHODS: Eleven patients (11 eyes) with PCV who were diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT) were given PDT. The changes of best corrected visual acuity (BCVA), fundus photography, FFA and ICGA before and after the PDT were compared. Follow-up time varied from 6 to 30 months. RESULTS: One month after the PDT, the BCVA was stable in 3 eyes, increased in 1 line in 3 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 3 eyes. FFA and ICGA showed no leakage in 5 eyes, leakage reduced in 3 eyes, and slight leakage in 3 eyes. At the last follow-up, the BCVA was stable in 5 eyes, increased in 1 line in 2 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 2 eyes. FFA and ICGA showed no leakage in 6 eyes, leakage reduced in 3 eyes, and slight leakage in 2 eyes. No severe systemic or local adverse effect was found during or after the PDT, except that 1 eye had vitreous hemorrhage 2 months after the PDT. CONCLUSION PDT may stop or reduce leakage of the lesion, facilitate the absorption of hemorrhage, edema and exudates, and stabilize or increase the patients' visual acuity. It could be a choice for PCV.
Adult ; Aged ; Choroid ; blood supply ; pathology ; Choroid Diseases ; drug therapy ; Choroidal Neovascularization ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; diagnosis ; drug therapy ; Photochemotherapy ; Photosensitizing Agents ; adverse effects ; therapeutic use ; Porphyrins ; therapeutic use ; Verteporfin ; Visual Acuity

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
Acute Disease ; Age Factors ; Aged ; Cerebrovascular Disorders/etiology ; Diabetes Mellitus/etiology ; Female ; Heart Failure/etiology ; Hospital Mortality ; Humans ; Hyperlipidemias/etiology ; Hypertension/*complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality/therapy ; Peripheral Vascular Diseases/etiology ; Predictive Value of Tests ; Registries ; Sex Factors