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PubMed2002

Platelet scintigraphy in the diagnosis of arteriosclerosis obliterans.

PURPOSE: We evaluated the efficacy of platelet scintigraphy using autologous platelets labeled with 111In-oxine, to assess the degree of arteriosclerotic activity in arteriosclerosis obliterans (ASO). METHODS: Thirty-three patients with clinical signs of ASO, seen between January 1996 and August 1999, were enrolled in this study. Scintigraphic imaging results were compared with the findings of contrast angiography in 26 patients, 17 of whom were taking antiplatelet and/or anticoagulant drugs during the platelet imaging study. RESULTS: Angiography demonstrated atherosclerotic lesions at 38 sites from the abdominal aorta to the popliteal arteries in 23 patients. There was an accumulation of platelets at 17 of these sites (45%) and at 6 other sites without definite angiographic abnormalities. Lesions that resulted in less than 50% stenosis were detected slightly, but not significantly, less often than lesions with higher degrees of stenosis and occlusion (50% vs 30%, P = 0.73). The frequency of true-positive scintigraphic results was statistically higher in patients not taking antithrombotic agents than in those taking antithrombotic agents (70% vs 32%, P = 0.02). CONCLUSIONS: Our results suggest that imaging with 111In-oxine-labeled platelets may be useful for evaluating the pathophysiologic characteristics of atherosclerotic lesions in patients with ASO.

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PubMed1998

[Cerebrovascular diseases in patients with arteriosclerotic aortic aneurysm and arteriosclerosis obliterans studied by carotid ultrasonography and by computed tomography of the brain].

To estimate the incidence of cerebrovascular diseases in arteriosclerotic aortic aneurysm (AA) and arteriosclerosis obliterans (ASO) and their characteristics, 92 patients with AA and 102 patients with ASO were studied with carotid ultrasonography and brain computed tomography (CT), and were compared with 49 patients with hypertension. The mean ages of the patients were 70 to 72 years old and all were male. Hypertension was common in the AA group: diabetes and cigarette smoking were common in the ASO group. Carotid plaque lesions seen on ultrasonography were significantly more common in the AA (66%) and ASO (85%) groups than in the patients with hypertension (39%). The mean carotid diameter was significantly greater in the AA group than in the other two groups. The mean wall thicknesses in the AA and ASO groups were greater than in the patients with hypertension. Computed tomography showed that low-density areas were also common in the AA group (56%) and ASO (53%) groups than in the patients with hypertension (24%). Most of the low-density areas were thought to be lacunae or dilated perivascular spaces in the subinsula and putamen. Moderately and highly severe periventricular lucencies were also common in the AA group. These findings indicate that carotid changes, seen in AA and ASO, reflected the characteristics of arterial lesions, and that arteriolosclerotic lesions were common in patients with AA and ASO. Therefore, cerebrovascular diseases should be taken into account in the management of patients with AA and ASO.

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PubMed2003

[Transplantation of autologous peripheral blood stem cells for the treatment of lower limb arteriosclerosis obliterans].

OBJECTIVE: To evaluate the clinical efficacy of mobilized autologous peripheral blood stem cells (PBSC) transplantation in a 48 years old patient with lower limb arteriosclerosis obliterans (ASO). METHODS: rhG-CSF 600 micro g/d for 5 days to mobilize stem cells. On the fifth day, PBSC were collected with a Version 4 blood-cells separator. Three hours late, the PBSC were intramuscularly injected into the ischemic areas of the two lower limbs (3 x 10(9) cells per limb). The clinical and laboratory findings were monitored every week for 3 months. Forty-four days after the implantation, left lower limb with severe ASO was given an additional implantation of the same number of cells as the first time. RESULTS: The peripheral blood CD(34)(+) cells were increased from 0.18% to 0.75% after 5 days of rhG-CSF mobilization. Three months after the first stem cell transplantation, severe pain lameness, local cool-feeling and ulcer were improved, and ABI increased from 0.49, 0.69 to 0.50, 0.85, the amplitude of blood flow and laser Doppler blood perfusion were also significantly improved (P < 0.01). At the same time, digital subtraction angiographic scores for new collateral vessel formation were showed as + 3(rich). No related complication or adverse effect were observed during the 3-month observation. CONCLUSION: Transplantation of mobilized autologous PBSC might be a simple, safe, and effective method for the treatment of ASO.

Arteriosclerosis Obliterans↗
PubMed1991

[Immediate results of reconstructive operations in arteriosclerosis obliterans of the iliac and femoral arteries].

The work generalizes the immediate results of restoration of the main and collateral blood flow in 240 patients with arteriosclerosis obliterans of the iliac and femoral arteries. The outcomes of surgical treatment were judged according to the clinical and ultrasonic evaluation of regional hemodynamics. The results were found to be good in 84 (35.0%), satisfactory in 104 (47.5%), and poor in 42 (17.5%) patients. The results of operations on the iliac and femoral arteries are shown separately, as well as the results of surgery in their combined lesions. Thromboses of the reconstructed arteries and prostheses were encountered in 10 (4.17%), hemorrhages in 8 (3.33%), wound infection in 16 (6.67%), and venous thromboses in 4 (2.5%) patients. For the prevention of thromboses of the deep veins the author claims dosed physical exercises on a constructed training apparatus to be advisable. Amputation of the extremity was carried out in 10 (4.17%) patients because surgical correction of the blood flow proved ineffective and specific complications occurred.

Adult↗
PubMed2004

Platelet activation markers, microparticles and soluble adhesion molecules are elevated in patients with arteriosclerosis obliterans: therapeutic effects by cilostazol and potentiation by dipyridamole.

We evaluated the plasma concentrations of platelet activation markers, microparticles and soluble adhesion molecules in patients with arteriosclerosis obliterans (ASO) and compared the beneficial effects of cilostazol alone and combination therapy of cilostazol and dipyridamole in these patients. There was a significant elevation of CD62P, CD63, PAC-1, annexin V, platelet-derived microparticles (PDMPs), sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 in the ASO patients compared with the controls. Platelet aggregation was decreased by 2 weeks of cilostazol monotherapy in the ASO patients. Adding dipyridamole to the cilostazol therapy for 2 weeks further reduced platelet aggregation. While treatment with cilostazol alone reduced levels of CD62P, CD63, PAC-1, annexin V, PDMP, and sP-selectin, the combination therapy reduced these parameters further. While sE-selectin and cell adhesion molecules did not change significantly after 2 weeks of combination therapy, they exhibited a remarkable decrease after 16 weeks of combination treatment. These findings suggest that platelets are activated in ASO patients, and cilostazol is effective to reduce platelet activation. Furthermore, dipyridamole may potentiate the beneficial effect of cilostazol in ASO patients. Combination use of both drugs may help to prevent the onset of cardiovascular complications in patients with ASO by activated platelets and PDMP.

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PubMed1995

MRA imaging of arterial patency in undialyzed uremic patients with arteriosclerosis obliterans.

Magnetic resonance angiography (MRA) was performed on 13 undialyzed patients with chronic renal failure (CRF) (serum creatinine concentrations: 4.0 +/- 0.6 mg/dL) who were suspected of having arteriosclerosis obliterans (ASO) due to symptoms and/or physical findings. In the 13 patients studied, MRA images of 10 patients exhibited stenosis or occlusion of iliac arteries, femoral arteries, a vertebral artery, or a carotid artery, indicating the presence of ASO. Four asymptomatic patients were diagnosed as having ASO by MRA. MRA showed ASO findings which were exactly the same as those shown by conventional angiography in one patient, suggesting that MRA is in good agreement with conventional angiography for evaluating arterial patency. Our study showed that MRA can reveal arterial patency in patients with CRF. MRA seems to be most suitable for patients with CRF to diagnose ASO, avoiding contrast nephropathy and acute deterioration of renal failure.

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PubMed1998

LDL apheresis for arteriosclerosis obliterans with occluded bypass graft: change in prostacyclin and effect on ischemic symptoms.

To study the mechanism of efficacy of low-density lipoprotein (LDL) adsorption for arteriosclerosis obliterans (ASO), eight ASO patients without indication for bypass surgery underwent LDL apheresis twice a week for 5 weeks and the change in prostaglandin 12 (PGI2) and thromboxane A2 (TXA2) due to LDL apheresis was measured. The concentration of 6-keto-PGF1alpha, a metabolite of PGI2, in systemic venous blood significantly increased from 10.4 +/- 1.8 to 42.0 +/- 10.6 pg/mL (P<0.05) after one session of LDL apheresis, while no significant change of TXB2, a metabolite of TXA2, was encountered. The ratio of 6-keto-PGF1alpha/TXB2 also rose dramatically from 0.213 +/- 0.044 to 0.522 +/- 0.128 (P<0.05). In five patients, the ischemic clinical symptoms improved and both the concentration of 6-keto-PGF1alpha and the ratio of 6-keto-PGF1alpha/TXB2 increased significantly, whereas in three patients there was no effect on clinical symptoms and neither parameter changed. These results suggest that elevated production of PGI2 from vascular cells due to LDL apheresis might contribute to improvement of ischemic symptoms.

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PubMed1987

31P in-vivo spectroscopic study by high-field whole-body MR system--an application to a case with arteriosclerosis obliterans.

31P in-vivo spectroscopy was performed by a 1.5-tesla whole-body MR system. The 31P spectrum for the calf muscle in a patient with arteriosclerosis obliterans having intermittent claudication was obtained every two minutes. When the spectrum after the workload was compared with that at rest, an increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr) were observed, resulting in a strong decrease in the PCr/Pi ratio. This method can measure the ischemic and recovery stages of energy metabolism in skeletal muscle noninvasively and continuously in addition to magnetic resonance imaging.

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PubMed2001

[Effect of sodium ferulate on leucocyte spontaneous activation and surface adhesion molecule expression in arteriosclerosis obliterans patients].

OBJECTIVE: To explore the effect of sodium ferulate (SF) on leucocyte spontaneous activation rate (LSAR) and the surface expression of adhesion molecule (SEAM) in patients with arteriosclerosis obliterans (ASO). METHODS: Forty-two patients with ASO were treated by SF, LSAR and SEAM in them were determined qualitatively before and after SF treatment, as well as in 36 healthy subjects for control. RESULTS: Therapeutic effect of SF in the treated 42 patients was short-term cured in 17 cases (40.5%), markedly effective in 21 (50%), effective in 2 (4.8%), ineffective in 2(4.8%), and the total effective rate being 95.2%. LSAR and SEAM in ASO patients before treatment was 14.84 +/- 7.54% and 47.94 +/- 13.48% respectively, which was obviously higher than 4.96 +/- 2.04% and 24.12 +/- 9.35% in healthy subjects (P < 0.01) respectively, but markedly reduced to 8.19 +/- 4.09% and 28.63 +/- 7.91% after SF treatment (P < 0.01). CONCLUSION: SF could not only obviously lower both LSAR and SEAM but also exert a good therapeutic effect on patients with ASO.

Adult↗
PubMed1978

Survival after arterial reconstruction in arteriosclerosis obliterans of the lower limbs. Follow-up after 10-20 years.

Cumulative survival rates were calculated for 144 patients subjected, 10-20 years previously, to vascular surgery for arteriosclerosis obliterans of the lower limbs. The five-, ten-, and fifteen-year survival rates were 71%, 49%, and 30% respectively, when calculated from the time of operation. The five-, ten-, fifteen, and twenty-year survival rates were 85%, 65%, 44%, and 23% respectively, when calculated from the onset of symptoms. This represents a considerable excess mortality, mainly among men, and mainly caused by arteriosclerotic diseases. However, the median survival time is 13 years from the onset of symptoms, and during this period it is of decisive importance, that patients with disabling symptoms get access to vascular surgical evaluation.

Adult↗
PubMed1996

[Atherectomy in patients with arteriosclerosis obliterans: angiographic follow-up study of 186 lesions in 146 patients].

Atherectomy (ATE) is a new catheter-mediated technique for the removal of atheroma in patients with arteriosclerosis obliterans (ASO). ATE was performed using 7-10 Fr. Simpson Peripheral Athero Track catheters at 186 sites in 146 patients, whose lesions involved 49 common iliac arteries, 66 external iliac arteries, 68 femoral arteries and three other arteries. The initial success rate was 94.1%. The mean percent of the diameter stenosis was reduced from 79.0 +/- 1.2% (mean +/- SD) to 22.7 +/- 1.0%. There were two cases of perforation that required surgical treatment (1.1%). The complication rate was 4.4%. The 0.5-, 1-, 2- and 3-year patency rates were 87.6%, 79.6%, 62.5% and 62.5%, respectively. The rate of long-term patency in each segment of arterial lesions revealed that the patency rate in the common iliac artery was significantly higher than the rates in the external iliac artery (p < 0.05) and femoral artery (p < 0.01). The patency rates for long lesions (> or = 2.0 cm) and occluded lesions were significantly (p < 0.01) lower than those for short lesions (< 2.0 cm). Diabetic patients had a higher re-stenosis rate than nondiabetic patients (p < 0.05). In conclusion, ATE is an effective new method for the treatment of patients with ASO.

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