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PubMedDate not supplied

Increased pulse pressure in patients with arteriosclerosis obliterans of the lower limbs.

Brachial blood pressure, ankle systolic pressure, calf blood flow before and after postocclusive reactive hyperemia, and treadmill exercise results were determined in 16 patients with arteriosclerosis obliterans disease (AOD) of the lower limbs. These values were compared with values from 16 controls matched for age and sex. For the same mean arterial pressure in controls, pulse pressure was significantly higher and resting calf blood flow, slightly lower in patients with AOD. Resting calf blood flow was positively correlated with mean arterial pressure and pulse pressure in patients with AOD but not in controls. In AOD patients, reduced walking distance was strongly and positively correlated with "vascular bed reserve" expressed as the ratio between peak blood flow after postocclusive reactive hyperemia and resting calf blood flow. Correlation studies indicated that the higher the pulse pressure, the more reduced the walking distance and the more altered the vascular bed reserve. The study provided evidence that: increased pulse pressure, rather than increased mean arterial pressure, is a characteristic feature of patients with AOD, and the pulsatile component of blood pressure, which reflects the alteration of the buffering function of large arteries, might influence the reductions in walking distance and vascular bed reserve observed in patients with AOD.

Adult↗
PubMed2001

[Incidence and severity of coronary artery disease in patients with acute aortic dissection: comparison with abdominal aortic aneurysm and arteriosclerosis obliterans].

OBJECTIVES: The incidence and severity of coronary artery disease were studied in patients with acute aortic dissection (AAD), and compared with coronary artery disease in patients with abdominal aortic aneurysm (AAA) or arteriosclerosis obliterans (ASO). METHODS: A total of 71 patients(42 males, 29 females, mean age 61.4 +/- 10.0 years) with AAD, undergoing coronary angiography between 1988 and 1999, were studied including 38 patients with open communication type and 33 patients with thrombosed type. According to the Stanford classification, 18 patients were type A and 53 patients were type B. Patients with AAD following Marfan syndrome or chest trauma were excluded from the study. Selective coronary angiography was performed in age- and sex-matched patients with AAA(n = 57; 42 males, 15 females, mean age 63.9 +/- 4.6 years) or ASO (n = 95; 66 males, 29 females, mean age 62.4 +/- 9.4 years). Coronary artery disease was defined as > or = 75% stenosis (left main trunk lesion of > or = 50% stenosis) by multidirectional imaging. RESULTS: Significant coronary artery disease was demonstrated in 14 patients with AAD (19.7%), 25 patients with AAA (43.9%), and 49 patients with ASO (51.5%). The incidence of coronary artery disease was significantly lower in the AAD group than in the other two groups (p < 0.05). One-vessel disease was present in approximately 70% of the patients with AAD and coronary artery disease. In contrast, multivessel disease was observed in approximately 50% of patients with AAA and ASO. Classification of the patients with AAD according to the blood flow in the false lumen showed coronary artery disease was more highly associated with the thrombosed type [10 (30.3%) of 33 patients] than the open communication type [4 (10.5%) of 38 patients]. Multivariate logistic regression analysis of the patients with AAD showed coronary artery disease was associated with a high serum total cholesterol level (p = 0.025) and the thrombosed type (p = 0.043). CONCLUSIONS: The incidence of coronary artery disease was significantly lower among patients with AAD than among age- and sex-matched patients with AAA or ASO. Coronary artery disease developed in 30% of the patients with the thrombosed type of AAD, although the prognosis seemed to be good.

Acute Disease↗
PubMed2004

The effect of Liple on physical and emotional quality of life in the treatment of arteriosclerosis obliterans.

AIM: The purpose of this study was to determine the effect of treatment with prostaglandin E1, Liple, on both the physical and emotional health-related quality of life (QOL) of patients with arteriosclerosis obliterans (ASO). METHODS: Treatment with Liple was evaluated using the before and after treatment results obtained using the SF-36, a QOL questionnaire, and an assessment of symptoms by a physician. The study was designed as a non-randomized before and after treatment study without comparison groups, and the study was conducted from May 1999 to July 2001 at 473 facilities located within Japan targeting patients with ASO. No intervention other than the administration of Liple was performed, and no restrictions were placed on the dose amount or administration interval for Liple. RESULTS: The results suggest that there was a significant improvement in patients' symptoms after treatment with Liple. CONCLUSIONS: Both physical and emotional QOL also improved after administration of Liple compared to baseline, based on the results of the SF-36 and assessment of symptoms by a physician.

Adolescent↗
PubMed1985

Hemodynamic effect of cilostazol on increasing peripheral blood flow in arteriosclerosis obliterans.

The novel synthetic antithrombotic drug, cilostazol (6-[4-(1-cyclohexyl-1H-tetrazol-5-yl)butoxy]-3,4-dihydro-2(1H)-qui nolinone, OPC-13013) was orally administered in a dose of 200 mg/day to 4 patients with arteriosclerosis obliterans (ASO) in the lower extremities to evaluate the hemodynamic effects of the drug. After 2 weeks of treatment, tissue blood flow through the pedal vessels was measured in 8 legs by the venous occlusion method using a strain-gauge plethysmograph. The flow measured during reactive hyperemia was shown to have significantly increased from 5.04 +/- 1.90 to 9.05 +/- 4.77 ml/min/100 g tissue (p less than 0.05, t-test), the rate being 80.68 +/- 66.61% of the initial level. The drug was, therefore, considered to have high clinical potential in the treatment of chronic arterial occlusion such as ASO and Buerger's disease (thromboangiitis obliterans). The drug was also shown to be of value in supporting the reconstruction of circulation in the lower extremities.

Aged↗
PubMed1994

Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans.

To determine the factors which influence perioperative coagulative and fibrinolytic function, we studied 41 patients who underwent surgical repair of unruptured abdominal aortic aneurysm (AAA) and 30 patients who underwent arterial reconstruction for arteriosclerosis obliterans (ASO). In patients with AAA, the levels of fibrin/fibrinogen degradation products (FDP) (11.4 +/- 20.1 micrograms/ml), thrombin-antithrombin III complex (TAT) (22.0 +/- 21.8 micrograms/l), plasmin-alpha 2 plasmin inhibitor complex (PIC) (2.6 +/- 2.9 micrograms/ml) and d-dimer of cross-linked fibrin degradation products (D-D) (8.4 +/- 10.8 micrograms/ml) were elevated, particularly when the AAAs had a large mural thrombus surface area or were accompanied by aneurysm of the iliac or femoral artery. In arterial aneurysms, blood coagulability and secondary fibrinolytic activity were believed to be enhanced. In patients with ASO, the level of TAT (17.2 +/- 24.8 micrograms/l) was so elevated that they were considered to show chronic hypercoagulability. Among the ASO patients with aorto-iliac lesions, those with concomitant graft occlusion or anastomotic aneurysm had significantly elevated levels of TAT. Proximal arterial occlusion or accompanying aneurysm in the ASO patients was associated with increased levels of PIC and D-D. Postoperative fluctuations in conventional hematological variables did not differ significantly among the surgical procedures. Conventional markers showed a transient decrease due to consumption during surgery, and a subsequent recovery or an actual increase within several days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Diagnosis of arteriosclerosis obliterans by impedance technique with special reference to relative blood flow of the lower extremity.

Simultaneous recordings of impedance cardiography of the chest and impedance plethysmography of the lower extremity were performed on 105 limbs with or without arteriosclerosis obliterans (ASO) documented by angiography. The ratios of blood flow to the lower extremity--leg stroke volume/cardiac stroke volume--(LSV/CSV) were 11.2 +/- 3.3% in normal male subjects, 11.1 +/- 5.5% in normal female subjects, and 3.1 +/- 1.2% in lower extremities with ASO, respectively. The normal value (range) for LSV/CSV calculated from the normal groups by the percentile method was between 4.9% and 17.8%, and the diagnostic accuracy of this value was 100% for sensitivity and 97.5% for specificity. LSV/CSV is a good index for the diagnosis of ASO and makes it possible to minimize error when expressed as an absolute value.

Arteriosclerosis Obliterans↗
PubMed2005

Close association of hypoadiponectinemia with arteriosclerosis obliterans and ischemic heart disease.

Adiponectin is an adipose-derived cytokine, and it is suggested that hypoadiponectinemia increases the prevalence of ischemic heart disease (IHD). The present study was undertaken to determine serum adiponectin levels in patients with arteriosclerosis obliterans (ASO) and IHD. Forty-nine patients with ASO and 49 age-, sex-, and body mass index-matched control subjects were examined. The diagnosis of ASO was derived from an ankle brachial index of less than 0.90 and stenotic or obstructive change in angiogram. Ischemic heart disease was diagnosed by ischemic or stenotic change in ECG, treadmill, or coronary angiogram. Serum adiponectin level was 8.6 +/- 0.9 microg/mL in the patients with ASO, a value significantly less than that of 12.4 +/- 1.0 microg/mL in the control subjects ( P < .01). Next, we subgrouped the subjects into 4 groups according to the presence of ASO and IHD. Serum adiponectin levels were 9.4 +/- 1.5 and 10.2 +/- 1.6 microg/mL in the subjects with ASO (n =23) and those with IHD (n = 13), respectively. It was further reduced to 7.9 +/- 1.2 microg/mL in the subjects having both ASO and IHD (n = 26), a value significantly less than that of 13.2 +/- 1.4 microg/mL in the control subjects (n = 36; P < .05). Serum high-density lipoprotein cholesterol was significantly less in the subjects with ASO than in the control subjects (42.1 +/- 1.7 vs 48.5 +/- 2.0 mg/dL; P < .05), but there were no differences in blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglyceride, and uric acid levels. The present results indicate that a reduction in serum adiponectin level is associated with the prevalence and magnitude of systemic atherosclerosis including IHD and ASO.

Adiponectin↗
PubMed2006

Cost-effectiveness of Liple (LipoPGE1) for arteriosclerosis obliterans patients in Japan: an economic evaluation using the EQ-5D instrument.

AIM: This study was conducted to evaluate the health-related quality of life (HRQOL) and cost-effectiveness of LipoPGE(1) when added to the conventional treatment of arteriosclerosis obliterans (ASO) patients. The research design consisted of a before and after-treatment study without comparison groups. We collected data from May 1999 through July 2001 at 473 institutions located throughout Japan. The subjects were ASO patients who experienced pain at rest or had ulcers of the extremities. METHODS: The observation period was a 2-month period that commenced with the start of administration of LipoPGE1. The HRQOL score (utility value) was obtained from the EQ-5D instrument, and the incremental cost-effectiveness ratio was calculated on the basis of quality-adjusted life years (QALYs). RESULTS: The mean utility value for the 2 months after the start of the administration of LipoPGE(1) was 0.672, and it was a significantly higher (P<0.0001) than the 0.616 before administration of LipoPGE(1). The incremental cost-effectiveness ratio was 18,807 US dollar/QALY assuming that drug efficacy persisted for 1 year after the end of LipoPGE1 therapy, and 75,227 dollar/QALY assuming a duration of just 3 months. CONCLUSIONS: We concluded that when LipoPGE1 is added to the conventional treatment of ASO patients, the HRQOL of the patient improves, and it is highly cost-effective.

Adolescent↗
PubMed1997

Effects of prostaglandin E1 infusion on limb hemodynamics and vasodilatory response in patients with arteriosclerosis obliterans.

It is well known that prostaglandin E1 (PGE1) increases peripheral blood flow. The aim of this study was to investigate the effects of PGE1 infusion on the hemodynamics and vasodilatory response of the leg affected by intermittent claudication in patients with arteriosclerosis obliterans (ASO). Fourteen legs of 8 male patients with ASO were infused intravenously with PGE1 (120 microg/day) for 7 consecutive days. Before the infusion and 5 days after cessation of the infusion, resting skin and skeletal muscle blood flow in the calf and occlusion-induced reactive hyperemic flow were measured using plethysmography and a laser Doppler flowmeter. Clinical symptoms in the legs were assessed by treadmill exercise testing. Resting calf blood flow was found to have increased significantly (skin, from 2.6 +/- 0.1 ml/min/100 g tissue to 2.9 +/- 0.1 ml/min/100 g tissue, p < 0.02; skeletal muscle, from 3.1 +/- 0.2 ml/min/dl tissue to 4.0 +/- 0.5 ml/min/dl tissue, p < 0.02). There was also a significant reduction in the peripheral vascular resistance (-17.8 +/- 7.2%, p < 0.05) 5 days after the cessation of infusion. The time to the half-maximum post peak of hyperemia was significantly elongated (from 34.6 +/- 5.7 sec to 58.6 +/- 9.2 sec, p < 0.01). Borg's score of the legs on exercise testing was markedly reduced, and symptom-free walking distance was increased by an average of 70.9 + 15.6%. In conclusion, PGE1 infusion has vascular effects on not only resting calf blood flow but also hyperemic flow responses. These retentive effects may be due to alteration in vascular functions and/or rheological state as a result of PGE1-induced regular enhancement of blood flow, rather than the direct vasodilatory effect of the agent.

Aged↗
PubMed2003

Effects of LDL apheresis and vitamin E-modified membrane on carotid atherosclerosis in hemodialyzed patients with arteriosclerosis obliterans.

BACKGROUND: Hemodialysis patients manifest accelerated atherosclerosis. Hemodialysis is associated with oxidative stress, which can be partially prevented with the use of a vitamin E-coated dialyzer. Adsorption of low-density lipoprotein (LDL) has been applied in the treatment of arteriosclerosis obliterans (ASO). The aim of the present study was to determine whether the vitamin E-coated dialyzer and/or LDL apheresis affects carotid atherosclerosis in hemodialysis patients with ASO. METHODS: Thirty hemodialysis patients with ASO were divided into four treatment groups: treatment with conventional cellulose or synthetic membranes (group A, n = 12), treatment with vitamin E-coated membrane (group B, n = 7), treatment with conventional membrane and LDL apheresis (group C, n = 6), and treatment with vitamin E-coated membrane and LDL apheresis (group D, n = 5). Carotid artery intima-media thickness (IMT) and arterial stiffness assessed by pulse wave velocity (PWV), plasma C-reactive protein (CRP) and interleukin (IL)-6 were measured before and 10 weeks after treatment and compared between groups. All values were referred to measurements after LDL apheresis. RESULTS: IMT and PWV, plasma CRP and IL-6 showed little change in group A throughout the experimental period. These decreased slightly from the baseline value in group B, but the change was not significant. In group C, IMT decreased from 1.12 +/- 0.24 to 1.02 +/- 0.18 mm (p < 0.05), and PWV decreased from 2,266 +/- 380 to 1,968 +/- 342 cm/s (p < 0.05). Plasma CRP and IL-6 concentrations also decreased significantly compared with baseline (p < 0.05). In group D, IMT decreased from 1.18 +/- 0.26 to 0.92 +/- 0.18 mm (p < 0.01), and PWV decreased from 2,284 +/- 390 to 1,786 +/- 284 cm/s (p < 0.01). Plasma CRP and IL-6 levels also decreased significantly compared with baseline (p < 0.01). CONCLUSION: These data suggest that LDL apheresis and the vitamin E-coated membrane dialysis in combination may prevent further progression of atherosclerosis in hemodialysis patients with ASO.

Anticholesteremic Agents↗
PubMed1999

Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans.

A 73-year-old man with a ruptured distal aortic arch aneurysm into the pericardial space, mediastinum and right pleural space is described. The patient underwent a successful total aortic arch replacement using deep hypothermia, systemic circulatory arrest and selective cerebral perfusion. Extracorporeal circulation was established with right axillar arterial perfusion due to arteriosclerosis obliterans (ASO). Presentation and management are discussed.

Aged↗
PubMed1998

[A case of mild-type myotonic dystrophy with dementia and severe arteriosclerosis obliterans].

A 70-year-old man, with mild-type myotonic dystrophy (MyD) diagnosed by molecular genetic analysis when he was 68 years old, complained of worsening intermittent claudication during the past 2 years. Doppler examination revealed severe stenosis and obstruction in his leg arteries, which we diagnosed as arteriosclerosis obliterans (ASO). We then found him to be suffering from dementia, which was confirmed by dementia scale tests (Mini Mental State, 20/30; Hasegawas' Dementia Scale-Revision, 15/30). Even in mild-type MyD, as MyD is one of the progeria syndromes, the abnormal genes of MyD may accelerate the aging processes.

Aged↗