Atherosclerosis-related diseases have increasingly become health concerns with the increased living conditions and aging.Globally,about 200 million people have suffered from arteriosclerosis obliterans(ASO),which can even be life-threatening in some cases.The past seven decades have witnessed the rapid advances in the treatment of ASO,which has developed from surgery to endovascular interventions including plain balloon angioplasty,bare metal stent placement,drug-coated balloon,and drug-eluting stent.However,the roles of these new techniques for femoral-popliteal lesions,especially their real-world clinical outcomes and indications,remain unclear.This article reviews the latest evidences on the use of drug-eluting devices in treating femoral-popliteal arteriosclerosis obliterans.
Angioplasty, Balloon ; Arteriosclerosis Obliterans ; therapy ; Drug-Eluting Stents ; trends ; Humans ; Popliteal Artery ; pathology ; Stents ; Treatment Outcome

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.
Angiography ; Arteries ; Chungcheongnam-do ; Follow-Up Studies ; Head ; Humans ; Knee ; Knee Joint ; Korea ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Pathology ; Popliteal Artery* ; Retrospective Studies ; Seoul ; Tibial Arteries ; Tomography, X-Ray Computed ; Transplants

Adult ; Arterial Occlusive Diseases ; diagnosis ; Constriction, Pathologic ; diagnosis ; Humans ; Male ; Martial Arts ; Muscle, Skeletal ; pathology ; Pain ; diagnosis ; Peripheral Vascular Diseases ; diagnosis ; Popliteal Artery ; physiopathology ; Singapore

OBJECTIVETo evaluate the efficacy of endovascular repair of popliteal artery aneurysm (PAA) and to summarize the clinical experience and lessons.

METHODSA clinical data of 9 PAA cases (males 8, females 1, age range 55-84) undergoing endovascular repair from October 2006 to December 2014 at Zhongshan Hospital Fudan University were retrospectively analyzed. CT angiography was made in all of the 9 cases preoperatively, and 10 PAA were included in the analysis. Of the 9 cases, 6 cases were symptomatic. The mean diameter of PAA was 3.9 cm (range, 2.1-8.2).

RESULTSThe technique successful rate of endovascular repair was 10/10. The preoperative complications were 2/10, including one case suffered hematoma in the arterial puncture site and 1 case with distal artery embolization. The mean follow-up was 33 months (range, 3-87). During the follow-up, 2 cases received the secondary intervention and drug thrombolysis because of the stent distal thrombosis. The stent-graft primary patency at 1 year was 78.8% (95% CI: 48%-91%). One case suffered stent fracture, and one case died of brainstem hemorrhage 15 months post endovascular repair of PAA.

CONCLUSIONSEndovascular treatment of PAA is safe and effective in perioperative and midterm follow-up. However, individual endovascular strategy and postoperative complications in the long-term follow-up should be payed more attention.

Aged ; Aged, 80 and over ; Aneurysm ; surgery ; Angiography ; Embolization, Therapeutic ; Endovascular Procedures ; Female ; Humans ; Male ; Middle Aged ; Popliteal Artery ; pathology ; surgery ; Postoperative Complications ; Retrospective Studies ; Stents ; Treatment Outcome ; Vascular Patency

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

OBJECTIVETo assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of occlusive diseases in the long segment of the infrapopliteal artery.

METHODSThe clinical data of 50 patients with occlusive diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and after the operation were compared between the two groups.

RESULTSThe technical success rate was 100% in the 50 patients, who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased from 0.31 ± 0.12 before the treatment to 0.47 ± 0.09 at 24 h, 0.56 ± 0.06 at 1 week, 0.63 ± 0.07 at 3 months, 0.58 ± 0.06 at 6 months, and 0.49 ± 0.03 at 12 months after the treatment, and the skin temperature increased from 28.13 ± 2.45 before the operation to 33.87 ± 1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively, showing significant improvements after the operation (P<0.05). ABI, skin temperature and the patency rate were similar between the two groups at each of the postoperative time points (P>0.05).

CONCLUSIONRetrograde puncture SIA is safe and effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low complication rate after the failure of antegrade SIA.

Angioplasty ; Ankle Brachial Index ; Arterial Occlusive Diseases ; surgery ; Femoral Artery ; pathology ; Humans ; Popliteal Artery ; pathology ; Retrospective Studies

Angioplasty ; Humans ; Male ; Middle Aged ; Popliteal Artery ; pathology ; surgery ; Vascular Diseases ; surgery ; therapy

With fragments of brittle materials including glasses, ceramics, metals, plastics, and stones, various wounds can be formed by accident or homicide. We experienced two cases with fatal injury from shattering of brittle materials accidentally. In the first case, a woman died from the left subclavian artery transection by a projected fragment from a mug shattering. In the second case, a man pilfer died of the right popliteal artery and vein transection by fragments from shattering of a glass bottle. We represented these cases to adress it in depth the significance of deaths associated with fatal injuries caused by shattered fragments of brittle materials on the viewpoints of forensic pathology.
Ceramics ; Eyeglasses ; Female ; Forensic Pathology ; Glass ; Homicide ; Humans ; Metals ; Plastics ; Popliteal Artery ; Subclavian Artery ; Veins

Child ; Growth Plate ; blood supply ; physiopathology ; surgery ; Humans ; Male ; Popliteal Artery ; pathology ; Salter-Harris Fractures ; Tibia ; blood supply ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed

Thrombosis is one of the important complications of nephrotic syndrome. The mechanism of vascular thrombosis in nephrotic syndrome is under debate, but the hypercoagulable state is regarded as a predisposing factor to that. Most of vascular thrombosis in nephrotic syndrome have occurred in veins. Arterial thrombosis is relatively uncommon and often related with steroid or diuretic use. We experienced a case of bilateral popliteal arterial occlusion due to femoral arterial thrombosis as the first presentation of nephrotic syndrome. A 59-year old male patient was admitted with complaints of pain on left lower extremity for five days. The diagnosis of thrombosis in left popliteal artery was made by arterial angiography. The emergent thrombolytic therapy and anticoagulation was performed. During anticoagulation, another episode of bilateral popliteal arterial occlusion was occurred once again. He had heavy proteinuria, and renal pathology revealed minimal change disease. There was no recurrence of thrombosis for 1 year after treatment with steroid and warfarin.
Angiography ; Causality ; Diagnosis ; Humans ; Lower Extremity ; Male ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Popliteal Artery ; Proteinuria ; Recurrence ; Thrombolytic Therapy ; Thrombosis* ; Veins ; Warfarin