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PubMedDate not supplied

Effect of elastase on primary graft patency after femoralpopliteal arterial bypass for arteriosclerosis obliterans: a randomized, controlled study.

METHODS: Studies were carried out on 104 limbs with femoralpopliteal bypasses for arteriosclerosis obliterans (ASO). They were randomized to a group receiving elastase (10800 EL. U. P.O. per day) with an antiplatelet drug (Elastase group, 58 patients) or a group receiving only the antiplatelet drug (Control group, 46 patients). The follow-up period ranged from 24 to 36 months after operation at 22 institutions across Japan. RESULTS: The cumulative graft patency rate was higher in the Elastase group than the Control group, but the difference lacked statistical significance. When autogenous saphenous veins were used, the cumulative graft patency rate was significantly higher in the Elastase group than the Control group. CONCLUSIONS: The present study suggests that elastase is effective in maintaining graft patency in femoralpopliteal arterial bypass when an autogenous saphenous vein is used as a graft.

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PubMed2006

Autoperipheral blood mononuclear cell transplantation improved giant ulcers due to chronic arteriosclerosis obliterans.

We report the case of a 74-year-old man with Fontaine stage IV chronic arteriosclerosis obliterans who had been suffering from inveterate giant skin ulcers on the dorsum and heel of the right foot. As conventional medical treatments had not improved these ulcers and surgical treatment was considered unfeasible, amputation of the right lower limb below the knee appeared to represent the only option. The patient was admitted to Tottori University Hospital to attempt a new angiogenic therapy using auto-mononuclear cell transplantation to avoid amputation. On admission, neither right ankle blood pressure nor transcutaneous partial pressure of oxygen at the right toe were detectable. The patient had a history of multiple cerebral infarctions, and collection of mononuclear cells from bone marrow was considered too difficult, so collection of peripheral blood mononuclear cells was selected. Transcutaneous partial pressure of oxygen and skin temperature in the treated limb started to improve from 2 weeks after implantation. Ulcer size was recognizably reduced by 1 month after treatment. Partial auto-skin implantation on the right heel was performed 2 months after treatment, and the giant skin ulcer was finally completely covered. No adverse effects were noted during follow-up lasting 1 year. These results suggest that peripheral blood mononuclear cell implantation may offer a suitable alternative rescue therapy for patients with critical limb ischemia whose general condition is not good.

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PubMed2001

Effects of sarpogrelate hydrochloride on adenosine diphosphate- or collagen-induced platelet responses in arteriosclerosis obliterans.

To evaluate the effects of the 5-HT2 receptor antagonist sarpogrelate hydrochloride (sarpogrelate) on platelet responses in arteriosclerosis obliterans (ASO), we examined platelet aggregation and its relationships to platelet-derived growth factor (PDGF), soluble P-selectin (sP-selectin), and transforming growth factor-beta 1 (TGF-beta1). Circulating plasma levels of PDGF and sP-selectin in 13 patients with ASO after 1 week of medication with sarpogrelate were significantly lower than those before medication. In contrast, circulating plasma levels of TGF-beta1 after medication were significantly higher than those before medication. When platelet-rich plasma obtained from ASO patients after medication was stimulated with adenosine diphosphate (ADP) or collagen, platelet aggregation was suppressed compared with rates before medication. Significant decreases in levels of PDGF, sP-selectin and TGF-beta1 released from platelets in response to 5 micromol/l ADP and 1 microg/ml collagen after taking of sarpogrelate were found. There were close correlations between platelet aggregation and respective molecules released from platelets. In conclusion, since platelet activation is involved in pathogenesis of thrombotic disease, sarpogrelate may suppress the development of obstructive arteriosclerosis. PDGF and TGF-beta1, as well as sP-selectin, appear to be useful markers for clinical evaluation of anti-platelet drugs.

Adenosine Diphosphate↗
PubMed1980

Arteriosclerosis obliterans and associated risk factors in insulin-dependent and non-insulin-dependent diabetes.

The prevalence of arteriosclerosis obliterans (ASO) of the legs was determined by a battery of noninvasive tests in 141 insulin-dependent and 289 non-insulin-dependent diabetic subjects and in 64 other subjects. The prevalence of detectable ASO ranges from 18% in the younger IDDM group to 41% in the diet-treated NIDDM group. The prevalence of ASO increases 7.5% per decade, appears to increase 6.5% in the age-adjusted IDDM group, 9% in males, 19% in those with hypertension, and 12% in smokers. No consistently significant correlations with fasting glucose, glycosylated hemoglobin, or obesity were found. After accounting for the effect of smoking, the increased risk for ASO in males becomes nonsignificant.

Adolescent↗
PubMed2000

[Effect of ligustrazine injection on vascular endothelial cell of the patients with arteriosclerosis obliterans].

OBJECTIVE: To study the effect of ligustrazine injection (LI) on vascular endothelial cell of the patients with arteriosclerosis obliterans (ASO) and explore the new pathway of investigating effective vascular protective agents in Chinese medicinal herbs. METHODS: Forty-six patients with ASO in the LI group treated by LI were observed, their circulating endothelial cells (CEC) were detected quantitatively before and after treatment. The results were compared with the CEC of 53 cases of healthy persons (control group) in the same period. RESULTS: In the LI group, the immediate cure rate was 45.7% (21 cases), markedly effective rate 36.9% (17 cases) and the effective rate 17.4% (8 cases). The CEC of patients before treatment was 4.39 +/- 1.76/0.9 microliter, which was significantly higher than that of the healthy persons (1.53 +/- 0.42/0.9 microliter). It could be reduced after treatment, along with the improvement of symptoms and signs, to 2.43 +/- 0.87/0.9 microliter, P < 0.01. CONCLUSION: LI in treating ASO not only displays extraordinary effect, but also has good effect in curing the damage of endothelial cells.

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PubMed2005

[Preoperative care of microcirculatory vessels in patients with lower limb arteriosclerosis obliterans].

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

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PubMedDate not supplied

Lipid and lipoprotein abnormalities in lower-extremity arteriosclerosis obliterans.

The prevalence of abnormal lipid and lipoprotein values was determined in 125 consecutive patients with lower-extremity arteriosclerosis obliterans, and the lipid and lipoprotein abnormalities in these patients were characterized. Only 13% of the patients had normal lipid/lipoprotein profiles. Forty-eight percent of patients had low levels of high-density lipoprotein cholesterol. High-density lipoprotein cholesterol values were lower in patients with concomitant coronary heart disease compared with those without heart disease. High-density lipoprotein cholesterol values were inversely related to weight, to triglyceride values, and to diabetes mellitus. Twenty-eight percent of patients had "desirable" total cholesterol levels (< 200 mg/dL), and 32% had low-density lipoprotein cholesterol values less than 130 mg/dL. Following National Cholesterol Education Program guidelines may be misleading in patients with documented lower-extremity atherosclerosis; therefore, complete lipid/lipoprotein profiles should be performed in these patients.

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PubMed1997

[Clinical study on treatment of arteriosclerosis obliterans using huangqi tongmai decoction].

OBJECTIVE: To test and verify the effects of Huangqi Tongmai Decoction (HQTMI) regulating blood lipid in treating arteriosclerosis obliterans (ASO). METHODS: Thirty-two cases of ASO was treated with HQTMD for two months. The drug was in water decoction, oral taken. RESULTS: Compared with the blood lipid level before treatment, the high density lipoprotein of cholesterol (HDL-C) was increased, the low density lipoprotein of cholesterol (LDL-C), atherogenic index (AI) was decreased (P < 0.01). The serum total cholesterol (TC), triglyceride (TG), very low density lipoprotein of cholesterol (VLDL), apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB100) were all changed (P < 0.05). apoA1/apoB100 ratio increased. CONCLUSION: HQTMD could regulate blood lipid. This method was effective in treating ASO.

Adult↗
PubMed1987

Some haemorheological factors in patients with arteriosclerosis obliterans after treatment of trental.

Erythrocytes deformability, plasma cAMP, 6-keto-PGF1 alpha, TXB2 levels and fibrinolytic activity in patients suffering from arteriosclerosis obliterans before and after Trental were studied. Trental improved the deformability of red cells and resulted in an enhancement of diminished cAMP level in plasma and increased the fibrinolytic activity. The improvement of deformability observed after Trental could depend upon the influence of a higher cAMP level in plasma on the erythrocyte membrane. The increase of cAMP level seems to be the result of the inhibiting effect of Trental on phosphodiesterase and of higher fibrinolytic activity.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

[Lipoproteins (A) after a history of myocardial infarction, arteriosclerosis obliterans, hypertension and hyperlipidemia].

Serum lipoprotein(a) concentration in men with hypertension, arteriosclerosis obliterans, hypercholesterolemia and after myocardial infarction was measured using Laurell's immunoelectrophoresis. Lp(a) distribution and mean serum concentrations did not differ significantly from the controls, with the exception of a group of premature myocardial infarction (age below 45), in which high values were more frequent.

Adult↗
PubMed1987

Systolic hypertension in patients with arteriosclerosis obliterans of the lower limbs.

Intraarterial blood pressure, brachial artery compliance and diameter, and pulse wave velocity were determined in 20 patients with arteriosclerosis obliterans of the lower limbs (AOD) in comparison with 10 age- and sex-matched controls. With the same mean arterial pressure as in controls, patients with AOD exhibited a significant increase in systolic pressure and decrease in diastolic pressure, resulting in an increase in pulse pressure. While brachial artery diameter and pulse wave velocity remained nearly within the normal range, arterial compliance was significantly reduced and was negatively correlated with the level of pulse pressure. The study provided evidence that: atherosclerotic modifications in patients with AOD are associated with an increase in pulse pressure, which predominates on the increase in mean arterial pressure, increased pulse pressure is related to decreased arterial compliance, which reflects intrinsic modifications of the viscoelastic properties of the arterial wall.

Adult↗
PubMed1996

The clinical features and treatment of arteriosclerosis obliterans with diabetes.

The objective of this study was to clarify the differences, if any, in the clinical features between diabetic and nondiabetic patients with arteriosclerosis obliterans (ASO) and to select the optimal treatment for diabetic patients with ASO. The 171 patients with ASO studied were classified into nondiabetic and diabetic groups. Each group was subdivided into an intermittent claudication (IC) group and ulcer and necrosis (ULC) group. The frequency of complications with cardiac and cerebral vascular diseases and risk factors of arteriosclerosis were analyzed. Ankle and brachial blood pressure and ankle/brachial pressure index (API) were measured, and blood rheological parameters of filterability using Nuclepore filter membrane and viscosity of whole blood and plasma were measured. Three indexes of walking distance were measured by our ASO-Treadmill protocol to evaluate quantitatively the effect of treatment. There were 95 diabetic patients with ASO and 76 nondiabetic patients. Of the nondiabetic patients, 81 had IC and 14 had ULC, and of the diabetic patients, 63 had IC and 13 had ULC. The diabetic group showed more frequent complications with coronary heart disease (56.5 vs. 25.6%), but the two groups showed the same frequency of cerebrovascular diseases (30%). The diabetic ULC subgroup showed higher fasting plasma glucose than the diabetic IC subgroup. The API of the ULC subgroup was significantly lower than that of the IC subgroup in the nondiabetic patients, whereas that of the ULC subgroup was not significantly lower than that of the IC subgroup in the diabetic patients. Stenotic lesions of arteriography in both the nondiabetic and diabetic ULC subgroups demonstrated a tendency toward multisegmental and below-knee lesions compared with the two IC subgroups. For blood rheology-related factors, the diabetic ASO subgroup demonstrated a significantly elevated fibrinogen level compared with the normal control value, for patients of average age. After walking exercise treatment, a significant increase in the walking distance was obtained. After treatment with Cilostazol, prostaglandin I2 analog, and LDL apheresis, the rheological indexes were significantly improved, while the API did not change. We conclude that therapeutic improvement of blood rheological properties would be effective for prolongation and improvement of the quality of life for diabetic patients with ASO.

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PubMed1989

[Distribution of lipoprotein fractions in men with arteriosclerosis obliterans].

The fasting serum total cholesterol, triglyceride, LDL-cholesterol, VLDL-cholesterol and HDL-cholesterol were determined in fifty male patients with arteriosclerosis obliterans (ASO) confirmed by angiography. Twenty five of the patients were hyperlipidemic and significantly elevated concentration of atherogenic lipoproteins could be demonstrated compared to age matched control group of healthy subjects (n = 20). The HDL-cholesterol level in the patient group was significantly decreased even if comparing normolipemic patients to controls. In the postprandial phase of cholesterol loading (600 mg) the serum total cholesterol, LDL-cholesterol and HDL-cholesterol levels did not change in both groups. A marked increase in serum total triglyceride, VLDL-cholesterol and VLDL/HDL-cholesterol ratio was detected and the differences between the two groups regarding these lipoprotein fractions were increased. The importance of cholesterol-rich VLDL in ASO and its relationship to familial dysbetalipoproteinemia are discussed.

Adult↗
PubMedDate not supplied

Six year experience with wrinkled ePTFE vascular prostheses for arteriosclerosis obliterans.

From November 1986 to January 1993, 97 wrinkled ePTFE prosthetic vascular grafts were implanted in 90 peripheral arterial reconstructions for 87 patients with arteriosclerosis obliterans (ASO) (79 men and 8 women). Grafts used in this series were 54 Vitagraft and 33 Technograft. Initial results for a period of as long as 6 years are summarized here. Forty-four (45.3%) grafts were implanted anatomically, and the remaining were extra-anatomically routed. The mean age of patients in the anatomic bypass group was 64.7 years, and that of patients in the other group was 71.4 years. Twenty-three (43.3%) grafts in the extra-anatomic group were anastomosed sequentially. Mean follow-up periods for each group were 32.4 months and 30.9 months, respectively. None of nine late deaths during the follow-up period was graft related. There was one primary obstruction in the anatomic group; in the extra-anatomic groups, primary graft occlusion occurred in four grafts. In addition, one perigraft seroma and one pseudoaneurysm requiring surgical repair were seen. Cumulative event free ratio for this group was 80.8% at 72 months. These results reveal that the wrinkled ePTFE graft is clinically applicable to arterial reconstruction for ASO with satisfactory long-term patency, even in extra anatomic sequential bypasses.

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