Comparison of the Safety and Effectiveness of Lower Extremity Artery Bypass Grafting and Endovascular Angioplasty in the Treatment of Lower Extremity Arteriosclerosis Obliterans in the Elderly

Objective:To compare the safety and effectiveness of lower extremity artery bypass grafting and endovascular angioplasty in the treatment of lower extremity arteriosclerosis obliterans in the elderly.Methods:The data of 87 elderly patients with lower extremity arteriosclerosis obliterans treated in our hospital from August 2015 to August 2017 were analyzed retrospectively.According to the different treatment methods,they were divided into angioplasty group(n=45,intravascular angioplasty)and bypass grafting group(n=42,lower extremity artery bypass grafting).The success rate,hemodynamics of dorsalis pedis artery and nerve conduction of lower extremity were compared between the two groups Velocity,VAS score,late target vessel lumen loss(LLL),patency rate,restenosis rate,ankle brachial index(ABI)and clinical adverse events.Results:There was no significant difference between angioplasty group and bypass group(P>0.05).One month after operation,the hemodynamics of dorsalis pedis artery and nerve conduction velocity of lower limbs in the two groups were better than those before operation,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).The VAS score of the two groups was significantly lower than that of the preoperative group(P<0.05),but there was no significant difference between the two groups(P>0.05).The ABI of the two groups was significantly improved after operation,the difference was statistically significant(P<0.05),but there was no significant difference between the groups at each time point(P>0.05).There was no significant difference in LLL,patency rate and restenosis rate between the two groups(P>0.05).There was statistical difference in the incidence of complications between the two groups(P<0.05).During the follow-up period,no serious adverse events such as death or amputation occurred in both groups.Conclusion:Endovascular angioplasty and lower extremity artery bypass grafting have the same clinical effect in the treatment of elderly patients with lower extremity arteriosclerosis obliterans,which are safe and feasible.

Effects of Endovascular Brachytherapy with ^(192)Ir Afterloading System on Expression of Type I Collagen after Angioplasty

Objectives To investigate the effect and mechanism of endovascular brachytherapy with 192Ir on expression of type I colla gen, metalloproteinases - 1 (MMP - 1) and the tissue inhibitor (TIMP - 1 ) after angioplasty. Methods Restenotic model of domestic microswine was employed and the iliac arteries were randomized to radiation group (n = 12), which were treated with 20 - 25 Gy of 192Ir, and non - radiation group ( n = 36) after angioplasty. The target vessels were harvested in the end of 3 months and 6 months after angioplasty. Im-munohistochemistry and in situ hybridization were used to detect proteins of type I collagen, MMP - 1 and TIMP -1, and mRNA expression of type I collagen. Results The protein and mRNA of type I collagen, the ratios of TIMP-1/MMP-1 were significantly lower in radiation group than in non - radiation group (P < 0. 05 or 0. 01). The peak of transcription of type I collagen mRNA was at 6 months and 3 months in non - radiation group and radiation group respectively. Conclusions Endovascular brachytherapy with 192Ir might modify the metabolism of extracellular matrix after angioplasty by inhibiting the synthesis of type I collagen and the activities of MMP - 1 and TIMP - 1.