Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries

AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.

Autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia

Objective： To study the efficacy and safety of autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia. Methods： Fifty Type 2 diabetic patients with lower limb ischemia were enrolled and randomized to either transplanted group or control group. Patients in both group received the same conventional treatment. Meanwhile, 20 ml bone marrow from each transplanted patient were collected, and the mesenchymal stem cells were separated by density gradient centrifugation and cultured in the medium with autologous serum. After three-weeks adherent culture in vitro, 7.32×10^8-5.61×10^9 mesenchymal stem cells were harvested and transplanted by multiple intramuscular and hypodermic injections into the impaired lower limbs. Results： At the end of 12-week follow-up, 5 patients were excluded from this study because of clinical worsening or failure of cell culture. Main ischemic symptoms, including rest pain and intermittent claudication, were improved significantly in transplanted patients. The ulcer healing rate of the transplanted group （1 5 of 18, 83.33%） was significantly higher than that of the control group （9 of 20, 45.00%, P=0.012）.The mean of resting ankle-brachial index （ABI） in transplanted group significantly was increased from 0.61±0.09 to 0.74±0.11 （P〈0.001）. Magnetic resonance angiography （MRA） demonstrated that there were more patients whose score of new vessels exceeded or equaled to 2 in the transplant patients （11 of 15） than in control patients （2 of 14, P=0.001）. Lower limb amputation rate was significantly lower in transplanted group than in the control group （P=0.040）. No adverse effects was observed in transplanted group. Conclusion： These results indicate that the autologous transplantation of bone marrow mesenchymal stem cells relieves critical lower limb ischemia and promotes ulcers healing in Type 2 diabetic patients.

Hepatocyte growth factor gene transfer effects on the femoral and intramuscular nerve in a canine model of lower limb ischemia

BACKGROUND： Recent advancements in gene therapy have provided new methodology for treating ischemia in lower extremities. Gene transfer of angiogenic factors to ischemic tissues may promote local proliferation of new vessels and form collateral circulation. OBJECTIVE： To observe histopathological changes in the femoral and intramuscular nerve three months after intramuscular injection of hepatocyte growth factor （HGF） into the peripheral skeletal muscle in a canine model of lower limb ischemia. DESIGN： Randomized occlusion modelled and verification animal study. SETTING： Experimental Center, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA. MATERIALS： This study was performed at Animal Experimental Center, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA from September to November 2006. A total of eight male mongrel dogs, weighing 12–15 kg and 1.5–3 years of age, were selected for this study. This experimental study was in accordance with local ethics standards. Recombinant plasmid carrying HGF （pUDKH） and occlusion model plasmid （pUDK） were provided by the Third Laboratory of Radiation Medical Institute, Academy of Military Medical Sciences of PLA. METHODS： Grouping and model establishment： under anesthesia, complete vascular occlusion models were established on the left lower extremities. The experimental dogs were randomly divided into a model group and a pUDKH treatment group, with four dogs in each group. Dogs in the pUDKH group were injected with 0.15 mg/kg pUDKH. Ten minutes later, intramuscular injections were performed at three spots into the peripheral skeletal muscle of the left hind limb, as well as lateral injections at two spots. The injection volume at each spot was 0.2 mL. Dogs in the model group were injected with pUDK, and dosage and injection method were identical to the treatment group. MAIN OUTCOME MEASURES： Histopathological changes in the femoral nerve, as well as internal and external intramuscular nerve tissues in the hind limb of dogs three months after plasmid injection under optic microscope. RESULTS： （1） Histopathological changes in the femoral nerve： tiny nerves from the femoral nerve to the intramuscular nerve exhibited marked degeneration in the model group. The degenerating features included neurites, myelin sheaths, and Schwann cell nuclei. Neuropathy in the pUDKH treatment group was not detected. （2） Histopathological changes of the intramuscular nerve： large and irregular vacuoles were present on several longitudinal sections of intramuscular nerve fibers in the model group, as well as annular-shaped blank regions on transverse sections of peripheral neurites. In the pUDKH treatment group, large, blank regions were present in several segments of partial nerve fibers of the longitudinal intramuscular nerve region, but only a few nerve fibers exhibited annular-shaped blank regions on the transverse section of peripheral neurites. CONCLUSION： Local pUDKH injection may relieve or block femoral and intramuscular nerve tissue injury in a canine mocel of lower limb ischemia.

The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study

Background: Patients with critical limb ischemia (CLI) often suffer from severe pain. A continuous peripheral nerve block has been shown to provide effective analgesia for patients having lower limb surgery. We have been administering continuous sciatic nerve block (CSNB) for patients with CLI whose pain could not be relieved by other analgesic tools. The aim of this retrospective study was to investigate the efficacy and safety of CSNB for patients with CLI. Method: We retrospectively investigated 99 patients who received CSNB for the relief of severe pain in the lower limb associated with CLI. Patient demographics, neurological history, complications, and subjective evaluation of the effectiveness of CSNB were investigated from their clinical records. The distal tips of 108 catheters were cultured. Result: One hundred and seventy-two catheters were placed in 99 patients. More than 90% of the patients enjoyed considerable relief of severe pain. The analgesic effect of CSNB was greater in patients with older age and hemodialysis. Thirty-one catheters had positive bacterial colonization. However, no severe infectious complication was found. There was no relationship between the co-existence of diabetes and positive bacterial colonization. We encountered a patient with ASO and diabetes who suffered from persistent motor weakness and hypesthesia even after 3 months of CSNB placement. Conclusions: CSNB provided good pain control for patients with severe pain caused by CLI. Although catheters were frequently found to be colonized, infection at the catheter site was self-limiting even in patients with diabetes.

H_2S Protecting against Lung Injury following Limb Ischemia-reperfusion by Alleviating Inflammation and Water Transport Abnormality in Rats

Objective To investigate the effect of H2S on lower limb ischemia-reperfusion （LIR） induced lung injury and explore the underlying mechanism. Methods Wistar rats were randomly divided into control group, IR group, IR＋ Sodium Hydrosulphide （NariS） group and IR＋ DL-propargylglycine （PPG） group. IR group as lung injury model induced by LIR were given 4 h reperfusion following 4 h ischemia of bilateral hindlimbs with rubber bands. NariS （0.78 mg/kg） as exogenous H2S donor and PPG （60 mg/kg） which can suppress endogenous H2S production were administrated before LIR, respectively. The lungs were removed for histologic analysis, the determination of wet-to-dry weight ratios and the measurement of mRNA and protein levels of aquaporin-1 （AQP1）, aquaporin-5 （AQP5） as indexes of water transport abnormality, and mRNA and protein levels of Toll-like receptor 4 （TLR4）, myeloid differentiation primary-response gene 88 （MyD88） and p-NF-KB as indexes of inflammation. Results LIR induced lung injury was accompanied with upregulation of TLR4-Myd88-NF-κB pathway and downregulation of AQP1/AQP5. NariS pre-treatment reduced lung injury with increasing AQP1/AQP5 expression and inhibition of TLR4-Myd88-NF-KB pathway, but PPG adjusted AO.PJAO.Ps and TLR4 pathway to the opposite side and exacerbated lung injury. Conclusion Endogenous H2S, TLR4-Myd88-NF-κB pathway and AQP1/AQP5 were involved in LIR induced lung injury. Increased H2S would alleviate lung injury and the effect is at least partially depend on the adjustment of TLR4-Myd88-NF-κB pathway and AQP1/AQP5 expression to reduce inflammatory reaction and lessen pulmonary edema.

Infective endocarditis as a rare cause for acute limb ischemia

Infective endocarditis （IE） occurs at a rate of approximately 1-7/100 000 people per year, and has a high morbidity and mortality despite advances in antibiotic and surgical treatments.

Endovascular Treatment Options of Acute Limb Ischemia

Acute limb ischemia is a urgent condition which occurs when there is an abrupt interruption of blood flow into an extremity usually because of either embolic or thrombotic vascular occlusion. Restoration of perfusion through early intervention can decrease amputation and mortality. Contemporary treatment includes both surgery and endovascular techniques. There is a rapid progress in endovascular intervention therapy. This article aims to make a comprehensive review of the endovascular intervention options of acute limb ischemia.

Reperfusion of Delayed Acute Occlusive Limb Ischemia: Is It Worthwhile?

Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients. The aim of this study was to examine the outcome and risk factors of reperfusion injury in such cases. Patients and Methods: Retrospective review of all cases presented, to King Fahd Hospital of University, with acute occlusive limb ischemia more than 12 hours was performed between June 2004 and November 2012. Grades of ischemia, extremities, comorbidities, morbidities and mortality were recorded. Results: During the study period, 92 patients were included, 47 (51%) were embolic and the rest was thrombotic. On admission, 15 patients had grade III ischemia, 68 had grade IIb, 8 had grade IIa and 1 had grade I. Four patients died (4.3%) and 15 (16%) patients had amputation. The risk factors of amputation were age (p = 0.031), extremity (lower limb 21% vs. Upper limb 0%, p = 0.019), cause of ischemia (thrombotic 24% vs. embolic 8.5%, p = 0.049) and grade of ischemia (p = 0.001). Conclusion: Delayed reperfusion of acute occlusive ischemia carries acceptable morbidity and mortality and could be performed even in irreversible ischemia. The risk factors of amputation are age, lower limb ischemia, thrombosis and grade III ischemia.

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation,?the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro- and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting,?a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large- and medium-sized collaterals, and the arterial-arterial communicants, in an intentional “source artery” and “collateral” topographic foot revascularization. However,?up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.

Superior Mesenteric Arterial Embolism Associated with an Acute Limb Ischemia: A Case Report and Literature Review

Introduction: Acute mesenteric ischemia due to an embolism of the superior mesenteric artery (SMA) is associated with a high mortality rate. Over twenty per cent of acute mesenteric embolism cases consist of multiple emboli. Case Presentation: We present a rare case of a 62-year-old man admitted with acute abdominal pain and signs of intestinal occlusion related to an acute mesenteric ischemia due to superior mesenteric arterial embolism. It was associated with a synchronous acute bilateral lower limb ischemia due to embolic arterial occlusion. He underwent an emergency explorative laparotomy with proximal jejunal resection, and the patient made an excellent recovery. As for the acute limb ischemia, it was treated by efficient anticoagulation allowing limb salvage. Conclusion: When treating a superior mesenteric arterial embolism, the possibility of recurrent or multiple arterial thromboembolic events should be considered. A prompt diagnosis, aggressive surgical treatment and intensive care could improve the prognosis.

Risk of critical limb ischemia in long-term uterine cancer survivors:A population-based study

BACKGROUND The risk of critical limb ischemia(CLI)which causes ischemic pain or ischemic loss in the arteries of the lower extremities in long-term uterine cancer(UC)survivors remains unclear,especially in Asian patients,who are younger at the diagnosis of UC than their Western counterparts.AIM To conduct a nationwide population-based study to assess the risk of CLI in UC long-term survivors.METHODS UC survivors,defined as those who survived for longer than 5 years after the diagnosis,were identified and matched at a 1:4 ratio with normal controls.Stratified Cox models were used to assess the risk of CLI.RESULTS From 2000 to 2005,1889 UC survivors who received surgery alone or surgery combined with radiotherapy(RT)were classified into younger(onset age<50 years,n=894)and older(onset age≥50 years,n=995)groups.While compared with normal controls,the younger patients with diabetes,hypertension,and receiving hormone replacement therapy(HRT)were more likely to develop CLI.In contrast,the risk of CLI was associated with adjuvant RT,obesity,hypertension,and HRT in the older group.Among the UC survivors,those who were diagnosed at an advanced age(>65 years,aHR=2.48,P=0.011),had hypertension(aHR=2.18,P=0.008)or received HRT(aHR=3.52,P=0.020)were at a higher risk of CLI.CONCLUSION In this nationwide study,we found that the risk factors associated with CLI were similar in both cohorts except for adjuvant RT that was negligible in the younger group,but positive in the older group.Among the survivors,hypertension,advanced age,and HRT were more hazardous than RT.Secondary prevention should include CLI as a late complication in UC survivorship programs.

The effectiveness of the mononuclear fraction of autologous bone marrow in the treatment of experimental chronic limb ischemia

Objective To study of the effectiveness of using autologous mononuclear fraction of bone marrow for the treatment of chronic limb ischemia. Methods Results of autologous mononuclear fraction of bone marrow in 90 laboratory Wistar rats on a background of creating chronic limb ischemia was presented. Sampling was carried out from the bone marrow of the femur of the animal. The mononuclear fraction of bone marrow autologous 4 × 106 cells in a volume of 200 microliter were injected into the ischemic limb of the two points,in each of which 100 microliter:(1)Paravessel directly below the inguinal ligament at the level of the sacroiliac joint in the area of the anatomical location of collaterals in the projection of the internal iliac artery and its branches;(2)Intramuscularly in gastrocnemius muscle anterior-lateral surface of the middle third of the leg. Results In the experimental group of rats treated with autologous mononuclear fraction of bone marrow,the level of microcirculation compared with the intact group of animals on day 21 was higher than 6. 1% by day 28% ~ 31. 2%; compared with the control group-day 10 increased by 111% at day 21,85. 7% on day 28% ~ 97%. Conclusion Proposed method of treating pathogenically justified and can be recommended for use in clinical practice in the treatment of patients with chronic obliterating diseases of lower limb arteries.

Long-term effect of autologous progenitor cell therapy to induce neo angiogenesis in patients with critical limb ischemia transplantated via intramuscular vs combined intramuscular and distal retrograde intra venous

Critical limb ischemia is a medical condition that decreases blood flow and limb oxygen supply;this disease in its late stages of progression leads to only two possible options: either surgical bypass revascularization or limb amputation. We investigated a novel method using autologous transplantation of progenitor cells derived from mobilized peripheral blood bone marrow mononuclear cells to evaluate its long-term effect as a cell therapy to induce neo-angiogenesis and restore blood flow in the affected ischemic limbs. A total of 20 ischemic limbs from critical limb ischemia diagnosed patients, non candidates to surgical revascularization were transplanted with autologous progenitor cells by either intramuscular combined with intravenous (group A) or intramuscular (group B) procedure. Patients were monitored during 31 months. Treatment efficacy was evaluated according to the following parameters: ankle brachial index which increased at a range of 0.29-1.0 in group A and 0.40-0.90 in group B;pain-free walking distance which increased at a range of 50-600 m in group A and 50-300 m in group B;and blood perfusion (measured by Laser Doppler) which increased at a range of 48-299 in group A and 135-225 in group B. We achieved 90% treated ischemic limbs free of amputation in both transplanted groups. Results here described provide a safe, efficient and minimally invasive therapy with progenitor cells to induce angiogenesis and preserve limbs from amputation in CLI diagnosed patients.

Oxidative stress and hypoxia-induced factor 1α expression in gastric ischemia

AIM:To investigate the relation of reactive oxygen species (ROS) to hypoxia induced factor 1α (HIF-1α) in gastric ischemia. METHODS:The animal model of gastric ischemia reperfusion was established by placing an elastic rubber band on the proximal part of the bilateral lower limb for ligature for 3 h and reperfusion for 0,1,3,6,12 or 24 h. Ischemic post-conditioning,three cycles of 30-s reperfusion and 30-s femoral aortic reocclusion were conducted before reperfusion. Histological and immunohistochemical methods were used to assess the gastric oxidative damage and the expression of HIF1-α in gastric ischemia. The malondialdehyde (MDA) content and superoxide dismutase (SOD),xanthine oxidase (XOD) and myeloperoxidase (MPO) activities were determined by colorimetric assays. RESULTS:Ischemic post-conditioning can reduce post-ischemic oxidative stress and the expression of HIF-1α of gastric tissue resulting from limb ischemia reperfusion injury. MDA,SOD,XOD and MPO were regarded as indexes for mucosal injuries from ROS,and ROS was found to affect the expression of HIF-1α under gastric ischemic conditions. CONCLUSION:ROS affects HIF-1α expression under gastric ischemic conditions induced by limb ischemia reperfusion injury. Therefore,ROS can regulate HIF-1α expression in gastric ischemia.

Ex vivo limb perfusion for traumatic amputation in military medicine

Background:Limb loss has a drastic impact on a patient’s life.Severe trauma to the extremities is common in current military conflicts.Among other aspects,"life before limb"damage control surgery hinders immediate replantation within the short post-traumatic timeframe,which is limited in part by the ischemic time for successful replantation.Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.Presentation of the hypothesis:The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device,as there are several opportunities present with the introduction of this technique on the horizon.We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time,provide surgical opportunities such as preparation of the stump and limb,allow for spare-part surgery,enable rigorous antibiotic treatment of the limb,reduce ischemiareperfusion injuries,enable a tissue function assessment before replantation,and enable the development of large limb transplant programs.Testing the hypothesis:Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h.In the military setting,notably longer perfusion times need to be realized.Therefore,future animal studies must focus especially on long-term perfusion,since this represents the military setting,considering the time for stabilization of the patient until evacuation to a tertiary treatment center.Implications of the hypothesis:The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members.Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent,lifethreatening situation to a highly methodical,well-prepared starting point for optimal treatment of the wounded service member.With its introduction,the principle of"life before limb"will change to"life before limb before elective replantation/allotransplantation after ex vivo limb perfusion".

Overcoming ischemia in the diabetic foot:Minimally invasive treatment options

As the global burden of diabetes is rapidly increasing,the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances.A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue.Left untreated,chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality;prompt treatment is required.In this review,the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization,stem cells,and gene therapy are examined.

阿司匹林联合利伐沙班在糖尿病合并严重下肢缺血性血管病变患者下肢动脉腔内成形术后的临床效果

目的探讨阿司匹林联合利伐沙班在糖尿病合并严重下肢缺血性血管病变患者下肢动脉腔内成形术后的临床效果。方法选取2019年8月至2021年9月潍坊市人民医院血管外科收治的行下肢动脉腔内成形术的81例糖尿病合并严重下肢缺血性血管病变患者(均为单侧下肢)为研究对象,根据患者术后维持药物治疗方案不同分为对照组(41例)和观察组(40例)。两组患者均行下肢动脉腔内成形术,术后常规行降糖、降压、降脂等基础治疗。对照组口服阿司匹林(每次100 mg、每日1次)治疗;观察组口服阿司匹林(每次100 mg,每日1次)联合利伐沙班(每次2.5 mg,每日2次)治疗。记录两组患者术前和术后6个月踝肱指数(ABI)、C反应蛋白(CRP)、D-二聚体(DD)、糖化血红蛋白(HbA_(1c))、总胆固醇(TC)水平,术后6个月再狭窄发生情况。同时记录两组患者不良反应发生情况。结果术前和术后6个月,两组间ABI比较差异无统计学意义(P>0.05);术后6个月,两组ABI均明显高于术前(P<0.05)。术后6个月,两组再狭窄率比较差异无统计学意义(P>0.05)。术后6个月,两组患者CRP、DD低于术前(P<0.05),且观察组低于对照组(P<0.01),但两组HbA_(1c)、TC与术前比较差异无统计学意义(P>0.05),且两组间HbA 1c、TC比较差异无统计学意义(P>0.05)。两组患者总不良反应发生率比较差异无统计学意义(P>0.05)。结论与单独使用阿司匹林相比,利伐沙班联合阿司匹林对糖尿病合并严重下肢缺血性血管病变患者术后维持治疗有益,可抑制炎症及血管内斑块的发展,改善患者下肢血管情况。

严重下肢缺血患者围手术期的合理用药

严重下肢缺(CLI)血患者常合并多种慢性疾病,血运重建围手术期的药物管理是疾病治疗的重要内容,不合理的多重用药直接影响患者的治疗结局。本研究针对CLI患者围手术期常见的用药问题进行探讨,重点关注围手术期血栓的预防与治疗、基础疾病防治与多重用药管理、镇痛方案制定与调整,以期为临床医师和药师给患者制定个体化用药方案提供参考。

四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床观察

目的观察四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床疗效。方法选取2021年6月—2023年10月期间邢台医学高等专科学校附属二院收治的糖尿病足(Diabetic foot,DF)伴严重下肢缺血(Critial limb ischemia,CLI)患者60例,采用随机数表法分为对照组和观察组,每组各30例,术前WIFI分级评估,进行相应的血管腔内治疗,血运重建成功后,分别行坏疽趾或趾列开放性切除或溃疡清创术,其中对照组术后采用负压封闭引流(VSD)进行治疗,观察组术后采用四妙勇安汤负压滴灌治疗,1周后拆除VSD敷料查看创面情况,创面内组织细菌培养阴性后,行创面修复,直至创面愈合,分别检测治疗1、2周后血清C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT),治疗2周后创面细菌转阴率;检测治疗2周后经皮氧分压(Transcutaneous oxygen pressure,T_(C)PO_(2))及踝肱指数(Ankle-brachialindex,ABI)、创面愈合时间及不良反应。结果治疗后观察组总有效率90.00%(27/30)明显高于对照组80.00%(24/30),差异有统计学意义(P<0.05)。治疗后两组患者CRP、PCT水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组创面细菌转阴率90%(27/30)明显高于对照组70%(21/30),差异有统计学意义(P<0.05)。治疗后两组患者T_(C)PO_(2)水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组T_(C)PO_(2)水平明显高于对照组,差异有统计学意义(P<0.05),观察组ABI指数与对照组比较,治疗前后差异无统计学意义(P>0.05)。治疗后观察组创面愈合时间(28.63±5.30)d明显优于对照组(40.87±5.14)d,差异有统计学意义(P<0.05)。治疗期间,两组患者均无过敏、肿胀、感染加重等不良反应发生。结论四妙勇安汤负压滴灌治疗糖尿病足伴严重下肢缺血腔内治疗术后湿热内蕴型可有效控制感染,改善局部微循环,缩短创面愈合时间,具有临床应用及推广价值。

流变血栓清除装置在老年患者急性下肢缺血治疗中的应用

目的探讨流变血栓清除装置在老年患者急性下肢缺血(ALLI)治疗中的疗效及安全性。方法收集2021年7月至2022年8月南京医科大学附属宿迁第一人民医院/宿迁市第一人民医院收治的13例老年ALLI患者的临床资料及随访结果。观察患者的血栓清除率及再通情况,比较患者手术前后红细胞计数、血红蛋白水平、肌酐水平、尿素氮水平、血钾水平、白细胞计数和白蛋白水平,记录患者术后并发症发生情况。通过随访观察患者的临床症状改善情况及预后。结果13例老年ALLI患者均使用血栓清除装置进行治疗,并辅以球囊扩张术,10例患者进行了支架植入术,平均植入1.5枚支架。平均手术时间为(137.08±48.60)min;平均血栓抽吸时间为180.00(135.00,304.00)s;平均术中失血量为90.00(67.50,159.50)ml。术后,患者的红细胞计数、血红蛋白水平、尿素氮水平和白细胞计数均低于术前,差异均有统计学意义(P﹤0.05),无需输血治疗。所有患者均出现不同程度的血红蛋白尿,平均持续时间为(13.46±2.76)h。所有患者术后即刻临床症状均有所改善,达到临床成功。3例患者术后24 h内血栓复发,其余患者获得至少1个月的随访,2例患者发生心衰,无穿刺部位相关并发症发生,亦无肾功能不全、其他心脑血管意外、胰腺炎等并发症发生,术后30 d内无死亡病例。结论对于老年ALLI患者,流变血栓清除装置具有微创、高效、简单、并发症少的优点,是一种安全、有效的药物机械吸栓装置。做好围手术期管理,可以减少并发症的发生。