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PubMed2005

[Perioperaive evaluation and management in vascular surgery especially for arteriosclerosis obliterans].

Perioperative cardiac event is relatively high in vascular surgery for arteriosclerosis obliterans (ASO), which is a major cause of postoperative death. ACC/AHA guideline and revised cardiac risk index (CRI) were advocated to assess risk factor stratification and to manage risk reduction. ACC/AHA guideline categorized all vascular procedures except carotid endarterectomy as high risk. Because almost all patients with ASO were aged and/or inactive, noninvasive testing was necessary in almost all patients by the stepwise bayesian strategy. Patients with revised CRI less than 1 point dominated about three fourths of all patients, whose prevalence and incidence of ischemic heart disease (IHD) were 2.5% and 1.3%, respectively. It seemed appropriate to apply noninvasive testing only for patients with revised CRI more than 2 points, and high risk indicated coronary angiography. Electrocardigrams obtained at baseline, immediately, and on the first 2 days after surgery appear to be cost-effective to diagnose IHD. Use of cardiac biomarkers was reserved for patients at high risk and those with clinical, or ECG evidence of myocardial infarction (MI). Beta-blockers or alpha-agonists were effective to reduce incidence of perioperative IHD. Although even optimal preoperative assessment and perioperative management, some patients will have perioperative MI.

Adrenergic alpha-Agonists↗
PubMed1986

Management alternatives of infrainguinal arteriosclerosis obliterans in the elderly.

An aggressive approach to limb salvage for infrainguinal arteriosclerosis obliterans in the elderly is recommended because of the generally poor rehabilitation and poor quality of life resulting from primary amputation. Profundaplasty, femoral-popliteal, and femoral-distal infrageniculate bypasses yield excellent results with minimum mortality.

Amputation, Surgical↗
PubMedDate not supplied

Effect of low-density lipoprotein apheresis on plasma endothelin-1 levels in diabetic hemodialysis patients with arteriosclerosis obliterans.

Endothelin (ET)-1 has been implicated in the pathogenesis of diabetes, arteriosclerosis, and chronic renal failure. We studied whether low-density lipoprotein (LDL) apheresis alters plasma ET-1 levels in diabetic hemodialysis patients with arteriosclerosis obliterans (ASO). Plasma ET-1 levels were measured in 30 healthy control subjects (Group A), 30 diabetes patients without ASO (Group B), 20 diabetes patients with ASO (Group C), 20 diabetes patients without ASO who were undergoing hemodialysis (Group D), and 6 diabetes patients with ASO who were undergoing hemodialysis (Group E). Hemodialysis patients were dialyzed three times weekly with a bicarbonate dialysate. Six diabetic hemodialysis patients with ASO underwent LDL apheresis once weekly for 10 weeks, and the change in plasma ET-1 levels due to LDL apheresis was measured. LDL apheresis resulted in a statistically significant decrease in levels of total cholesterol and LDL cholesterol. In addition, LDL apheresis improved clinical symptoms in all patients. Plasma ET-1 levels in Group E (15.0+/-1.9 pg/ml) were significantly higher than those in Groups A (1.0+/-0.6 pg/ml, P<.001), B (1.3+/-0.5 pg/ml, P<.001), C (5.6+/-1.0 pg/ml, P<.001), and D (10.4+/-1.6 pg/ml, P<.01). Plasma ET-1 levels decreased progressively and significantly after a single LDL apheresis began (9.4+/-1.0 pg/ml after 60 min, P<.001, and 6.0+/-1.0 pg/ml after 120 min, P<.001). These data suggest that ET-1 may be associated with arteriosclerosis and that LDL apheresis enhances peripheral microcirculation in part by reducing the production of ET-1 in diabetic hemodialysis patients with ASO.

Adult↗
PubMed1997

Insulin resistance and arteriosclerosis obliterans in patients with NIDDM.

OBJECTIVE: To investigate the risk factors for arteriosclerosis obliterans (ASO) in NIDDM, we measured insulin sensitivity and other risk factors including lipoprotein(a) [Lp(a)] in NIDDM patients with and without ASO. RESEARCH DESIGN AND METHODS: A case-control study in 100 patients with NIDDM, 35 with and 65 without ASO, was performed. Insulin sensitivity was assessed by the short insulin tolerance test's K index (KITT). Duration of diabetes, a history of smoking, prevalence of hypertension, prevalence of coronary artery disease (CAD), serum C-peptide, 24-h urinary C-peptide, serum lipids, and Lp(a) were compared in the two groups. RESULTS: Age, BMI, HbA1c, and fasting plasma glucose were comparable in the two groups. Patients with ASO were significantly more insulin resistant than patients without ASO (KITT 2.16 +/- 0.16 vs. 3.00 +/- 0.13%/min, P < 0.0001, respectively), had a longer duration of diabetes (10.3 +/- 1.2 vs. 7.5 +/- 0.8 years, P < 0.05), included a greater number of smokers (68.6 vs. 40.0%, P < 0.01), had a higher prevalence of CAD (60.0 vs. 16.9%, P < 0.01), and had a greater percentage of insulin therapy (48.6 vs. 29.2%, P < 0.05). However, urinary and serum C-peptide levels, serum lipids, and Lp(a) levels were comparable in the two groups. Multiple logistic regression analysis indicated that a history of smoking (odds ratio 3.70, P = 0.011), insulin resistance (odds ratio 3.68, P < 0.001), and an elevated Lp(a) level (odds ratio 1.03, P = 0.020) were independently related to ASO. When patients with CAD were removed from the logistic regression analysis, insulin resistance was most strongly related to ASO (odds ratio 20.9, P < 0.001). CONCLUSIONS: Patients with ASO were characterized by a higher prevalence of CAD, a greater percentage of smokers, a greater percentage of insulin therapy, and a higher insulin resistance than were patients without ASO. Insulin resistance, especially, may be the most powerfully related to ASO. Lp(a) may play a minor role in the development of ASO.

Aged↗
PubMedDate not supplied

The effect of Etofibrate (Lipo-Merz) on "in vitro" cellular immune response and on lipid parameters of men with myocardial infarction and with arteriosclerosis obliterans.

Earlier specific cell-mediated immune reactions and their modulation by different drugs were reported against human vascular antigens in patients with vascular diseases. Presently the effect of Etofibrate (Lipo-Merz) was studied on cellular immune reactions induced by human aorta with lipid plaques and on serum lipid parameters in 46 men with acute myocardial infarction and in 48 men with arteriosclerosis obliterans compared to 40 healthy controls. Leucocyte migration test and lymphocyte-mediated cytotoxicity were repeatedly investigated in the presence of human aortic extract with or without Etofibrate (2 micrograms/50 microliters). The degree of leucocyte migration inhibition and of lymphocyte-mediated cytotoxicity proved to be similar in hypherlipaemic and in normolipaemic groups. Etofibrate could decrease cellular immune reactions both in hyperlipaemic and normolipaemic patients, but its effect was more expressive in the hyperlipaemic than normolipaemic group. Three months later a reduction of cellular immune reactions was found mainly in normolipaemic patients. Ten patients with myocardial infarction and 10 arteriosclerosis obliterans patients were treated with Etofibrate (900 mg/day) for 12 weeks. After therapy, cholesterol, triglycerides, LDL concentrations were reduced, HDL level was increased and the rate of LDL:HDL decreased. Leucocyte migration inhibition and lymphocyte-mediated cytotoxicity were also diminished. This time the cellular immune reactions of treated patients were only slightly reduced "in vitro" by Etofibrate in contrast with non treated hyper- and normolipaemic patients in whom cellular immune reactions were decreased by Etofibrate similarly to the first determinations. On the basis of our observations Etofibrate may be useful in the therapy of arteriosclerotic vascular diseases with or without hyperlipaemia, because it could decrease the cellular sensitization against aortic tissue.

Adult↗
PubMed2000

[Ultrasonographic findings of carotid arteries in female patients with arteriosclerosis obliterans and aortic aneurysm].

To clarify carotid arterial changes in female patients with arteriosclerosis obliterans (ASO) and aortic aneurysm (AA), ultrasonographic (US) findings of the extra-cranial carotid arteries were studied in 26 patients with ASO (ASO group), and 31 patients with AA (AA group), compared to 38 controls (control group) with neither ASO nor AA. ASO was diagnosed with an ankle pressure index less than 0.9, while AA was done with computed tomography or angiography. Half of the patients with ASO were in stage II of the Fontaine clinical staging, and angiography, performed in 12, showed femoral arterial obstruction in 10. Most AA patients were abdominal aortic aneurysm. Using a high-resolution, real-time, B-mode US instrument, the diameter and wall thickness of the common carotids were measured bilaterally in the end-diastolic phase, and occlusive changes and plaque were estimated. As a risk factor for arteriosclerosis, hypertension, diabetes, hyperlipidemia, and cigarette smoking were assessed, in addition to the age, body height and weight. Mean ages of each group were 73 to 76.3 year-old. There was no significant difference between them in body height and weight. Diabetes, cigarette smoking, and cerebrovascular disease were frequent in the ASO group, whereas ischemic heart disease was frequent in the AA group. US findings revealed that carotid lesions were mostly plaque, and bilateral carotid lesions were significantly more frequent in the ASO and AA groups. The mean wall thickness of the carotids was greater in the AA and ASO groups, although dilated carotid arteries, namely arteriomegaly, was more frequent in the AA group than in the ASO and control groups. Stepwise regression analyses demonstrated that strong correlations were seen between carotid lesion and two variables [vessel diseases (ASO/AA) and cigarette smoking], between carotid diameter and three variables (age, AA, and wall thickness), and between the wall thickness and three variables (age, vessel diseases and diameter). These findings showed that atherosclerosis was not only frequent in female patients with ASO and AA, but arteriomegaly was characteristic in female patients with AA. Therefore, it suggested that circulatory disturbance in whole organs due to arteriosclerosis should be paid attention even in female patients with ASO and AA as well as male patients. Furthermore, it is considered that systemic fragility of the arterial media and ectasia could be present extensively in patients with AA.

Age Factors↗
PubMed1997

Heparin and exercise treatment in a patient with arteriosclerosis obliterans.

A 65-year-old man was admitted with a diagnosis of arteriosclerosis obliterans. He had a 3-month history of intermittent claudication of the right leg. Physical examination revealed absence of pulsation of the right posterior tibial artery. Contrast angiography of lower extremities showed several obstructive lesions below the right popliteal artery. As interventional and surgical approached were not indicated, the patient was treated with exercise with heparin pretreatment (5,000 IU). As a result, walk distance on a floor was increased from 400 m to 2,000 m, and repeat magnetic resonance angiography revealed increased flow to the right lower extremity. Thus, he was successfully treated with exercise and heparin pretreatment without any side effects.

Aged↗
PubMed1982

Systolic hypertension in arteriosclerosis obliterans of the lower limbs.

Hemodynamic parameters were measured in 24 patients with arteriosclerosis obliterans of the lower limbs (AOLL) in comparison with 16 normal subjects of same age. Systemic artérial compliance was estimated from a simple visco-elastic model. In patients with (AOLL), systolic pressure was significantly increased (P less than 0.001) while diastolic pressure remained within normal ranges. Arterial compliance was reduced (P less than 0.01) and was negatively correlated with systolic pressure (r = - 0.72). Intravenous administration of nitroglycerin significantly decreased systolic pressure (P less than 0.05) and increased arterial compliance (P less than 0.01) without any change in mean arterial pressure. The study provided evidence that, in patients with AOLL the reduced systemic arterial compliance contributes in the increase in systolic pressure largely.

Arteries↗
PubMed1996

[Risk factor, natural history and prognosis of the patients with arteriosclerosis obliterans].

A sufficient understanding of the risk factor and the natural history of arteriosclerosis obliterans, ASO, is essential for selecting the optimal treatment for this condition. Hypercholesterolemia, hypertension and cigarette smoking have been identified as independent major risk factors of ASO, and diabetics, obesity, hypertrigriceridemia, low HDL-cholesterol level, aging, gender, etc, as minor factors. The patients with ASO often have multiple risk factors, synergistically accelerating the disease progression. Recent objective studies on natural history of claudicants have demonstrated a more morbid prognosis, especially in the patients with disabling claudication, than that outlined by previous historical studies. Mortality rates for ASO patients in long-term follow-up have revealed to be significantly higher than those observed in control groups. The causes of death are mostly arteriosclerotic vascular disease, particularly coronary artery and cerebrovascular diseases, which indicate the significance of the systemic evaluation in treating patients with ASO.

Arteriosclerosis Obliterans↗
PubMed1993

[Arteriosclerosis obliterans that was improved by LDL apheresis].

We reported here a case of arteriosclerosis obliterans (ASO) in which clinical symptoms and signs were improved after repeated LDL apheresis. The patient was a 70-year-old man who was diagnosed as having ASO in 1989. Although drug treatment started for the arterial disease, such clinical manifestations as rubor and intermittent claudication were gradually worsening. In 1991, the patient was also found to have diabetes mellitus (DM), leading to admission for its treatment. Insulin therapy was initially required, but it finally became possible to maintain a good control of DM with diet therapy alone. Since hypercholesterolemia (402 mg/dl) was noted on admission, we began to give the patient pravastatin. In response to the medication, serum total cholesterol (TC) levels declined to 270 mg/dl, but no further improvement was obtained. We therefore decided to perform LDL apheresis on the patient, hoping the improvement of both ASO and hypercholesterolemia. After six series of LDL apheresis were performed during 4 weeks, ASO-related signs and symptoms (i. e., intermittent claudication) were remarkably improved, and serum TC levels were decreased below 200 mg/dl. Our experience in the present case suggested that this procedure would be useful as an effective choice of treatment for ASO, but further studies as to the indication and protocol of this therapeutic maneuver will be clearly needed.

Aged↗
PubMed2004

Low-density lipoprotein apheresis in a patient with arteriosclerosis obliterans and light chain deposition disease.

A 49-year-old women with arteriosclerosis obliterans (ASO) complicated with light chain deposition disease (LCDD) is described. Renal biopsy showed a diffuse mesangial nodular lesion and tubulointerstitial changes. Congo red and lambda light chain staining were negative; however, the kappa light chain was positive in both glomeruli and tubular basement membranes by immunostaining. Using electron microscopy, electron-dense materials were found within glomerular basement membrane, mesangium and tubular basement membrane. The patient had renal dysfunction and nephrotic syndrome with progressive skin ulcers in the left leg. The patient was diagnosed as ASO with LCDD. She received low-density lipoprotein (LDL) apheresis once weekly for 10 consecutive weeks. Serum total cholesterol and phospholipid levels were decreased, and serum creatinine and blood urea nitrogen levels also tended to decline after treatment. Urinary protein excretion was reduced markedly, and hypoalbuminemia was also improved. Ischemic symptoms including leg pain and leg coldness and numbness improved after apheresis. The walking distance increased on a treadmill. The skin temperature was increased from 33.8 degrees C to 35.5 degrees C after apheresis and the skin ulcers were also improved. Plasma nitric oxide (NO) levels were increased from 66.0 microM/l to 88.0 microM/l and plasma endothelin (ET)-1 levels were decreased from 14.5 pg/ml to 5.8 pg/ml after apheresis. LDL apheresis was effective in ameliorating hyperlipidemia, massive proteinuria, hypoalbuminemia and high serum creatinine levels in an LCDD patient with nephrotic syndrome. Furthermore, we showed beneficial effects of LDL apheresis on skin ulcers due to ischemia in an ASO patient complicated with LCDD.

Arteriosclerosis Obliterans↗
PubMed1997

[Cerebral infarction and asymptomatic arteriosclerosis obliterans in the elderly].

We examined the associations between cerebral infarction (CI), asymptomatic arteriosclerosis obliterans (ASO), and known risk factors for these diseases. The subjects were 67 elderly patients (11 men and 56 women, mean +/- SD age of 79.6 +/- 8.5 years). in 44 patients CI was diagnosed by CT scan; 23 were classified as having cortical infarction and 21 as having lacunar infarction. In 41 patients asymptomatic ASO was diagnosed by an ankle-pressure index (API) of less than 0.9. To identify risk factors for these diseases, we examined the association among these diseases and hypertension (blood pressure > or = 140/90 mmHg), hypercholesterolemia (total cholesterol concentration > or = 220 mg/dl), hypertriglyceridemia (triglyceride concentration > or = 150 mg/dl), low HDL-cholesterolemia (HDL-C concentration < 40 mg/dl), high LDL-cholesterolemia (LDL-C concentration > or = 150 mg/dl), and glucose intolerance (fasting blood sugar concentration > or = 110 mg/dl). The incidence of asymptomatic ASO in the subjects with CI was significantly higher than that in the subjects without CI (chi 2 test; p < 0.05, odds ratio 6.4), including cortical infarction (p < 0.05, odds ratio 8.9) and lacunar infarction (p < 0.05, odds ratio 3.8). Patients with lacunar infarction were more likely to have hypertension than were controls (p < 0.05). Cortical infarction was not associated with these risk factors. Both low HDL-C and high LDL-G were more common in patients with asymptomatic ASO than patients without asymptomatic ASO (p < 0.05). These results indicate that CI and asymptomatic ASO are strongly associated in the elderly, especially in subjects with cortical infarction, and that aging itself contributes to cortical infarction.

Aged↗