Lower Extremity Arterial Disease in Patients with Type 2 Diabetes: Prevalence and Associated Factors at the Libreville University Hospital Center

Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]

Observation of the effect of angiojet to treat acute lower extremity arterial embolization

BACKGROUND Through significant advances in the treatment of peripheral arterial occlusive disease,acute ischemia of the lower extremity is still associated with significant morbidity,limb threat and mortality.The two main causes of acute ischemia in lower extremities are arterial embolism and atherosclerotic arteries.Timely recognition and treatment of acute limb ischemia in emergency situations is essential in order to minimize the duration of ischemia.AIM To investigate the application effect of angiojet thrombolysis in the treatment of acute lower extremity arterial embolization.METHODS Sixty-two patients with acute lower extremity arterial embolization admitted to our hospital from May 2018 to May 2020 were selected.Among them,the observation group(twenty-eight cases)had received angiojet thrombolysis,and the control group(thirty-four cases)had received femoral artery incision and thrombectomy.After thrombus clearance,significant residual stenosis of the lumen was combined with balloon dilation and/or stent implantation.When the thrombus removal was not satisfactory,catheter-directed thrombolysis was performed.The incidence of postoperative complications,recurrence rate and recovery of the two groups were compared.RESULTS There were no significant differences in postoperative recurrence(target vessel reconstruction rate),anklebrachial index and the incidence of postoperative complications between the two groups(P>0.05);there were statistically significant differences in postoperative pain score and postoperative rehabilitation between the two groups(P<0.05).CONCLUSION The application of angiojet in the treatment of acute lower limb artery thromboembolism disease is safe and effective,minimally invasive,quicker recovery after operation,less postoperative complications,which is more suitable for the treatment of femoral popliteal arterial thromboembolism lesions.If the thrombus removal is not satisfactory,the combination of coronary artery aspiration catheter and catheterized directed thrombolysis can be used.Balloon dilation and stent implantation can be considered for obvious lumen stenosis.

New Approach to Measuring the Ankle and Toe Brachial Indices as New Markers for Early Detection of Lower Extremity Peripheral Artery Disease

Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.

Epidemiology of Lower Extremity Artery Disease in People Living with HIV Followed at the Departmental University Hospital Center Ouémé-Plateau in 2019

Introduction: Lower extremity artery disease (LEAD) is a serious cardiovascular disease. People living with the human immunodeficiency virus (HIV) are at risk. The aim of the study was to determine the prevalence of LEAD and identify the associated factors among people living with HIV who were followed at the departmental university hospital Ouémé-Plateau in Benin. Methods: This was a cross-sectional study. It included all HIV-infected people who were monitored at the department of medicine of the target hospital during the study period and met the inclusion criteria (followed for at least three months, aged at least 25 years, and having given their written consent to participate). Data were collected during an individual interview, followed by the measurement of parameters. The ankle brachial index ≤ 0.9 was used for the diagnosis of LEAD. Associated factors were searched through a multivariable logistic regression. Results: The prevalence of LEAD was 34.2% among 222 respondents having a mean age was 42.9 ± 10.8 years and a female predominance (77.5%). No significant association was found between the presence of LEAD and sociodemographic factors. The presence of LEAD was significantly associated with hypertension and antiretroviral therapy. Hypertensive patients had a higher risk of LEAD compared to non-hypertensive patients (OR = 1.98, 95% CI [1.04-3.83], p = 0.037). Those who were receiving second-line therapy also had a higher risk of LEAD compared to those on first-line therapy (OR = 2.95, 95% CI [1.14-7.60], p = 0.025). Conclusion: This study showed a high prevalence of LEAD especially among hypertensive patients and those who were receiving second-line antiretroviral therapy. LEAD diagnosis and management should be included in the routine care of people living with HIV in Benin.

The Role of Color Doppler Ultrasound Arterial Mapping for Decision Making in the Treatment of Patients with Lower Extremity Peripheral Arterial Disease

Purpose: To assess the efficacy of color Doppler imaging for decision making in the treatment of patients with lower extremity peripheral arterial disease (PAD) compared to digital subtraction angiography (DSA). Materials and Methods: Color Doppler scan was done on patients suspected for lower limb PAD, a day prior to the DSA which was done by a vascular surgeon. Also, for the patients who were candidates for endovascular intervention based on the color Doppler arterial mapping results, endovascular interventions were performed at the same time if the DSA findings are correlated with the color Doppler map. The grading for evaluated segments was normal, insignificant stenosis (<50%), hemodynamically significant stenosis (≥50%) and occlusion. We yielded the diagnostic efficacy indices of Doppler for detecting arterial stenosis in each 18 different arterial segments below the renal arteries including, infrarenal aorta, common and external iliac, common femoral, superficial femoral (proximal, middle and distal segments), deep femoral, popliteal artery, tibioperoneal trunk, anterior and posterior tibial arteries (proximal, middle and distal segments) and peroneal artery (proximal and distal segments). Then, we yielded the kappa agreement between Doppler and DSA findings considering the grade of stenosis in 18 arterial segments separately. Results: Totally 115 lower extremities (2045 arterial segments) were evaluated in 90 patients [mean age: 60.8 ± 8.9 (range: 47 - 84 years old)] of which 68 (75.6%) were men. The sensitivity of color Doppler for all arterial segments was 90% or higher except for common iliac artery, distal segment of superficial femoral artery and proximal segments of anterior and posterior tibialis and peroneal arteries. However, the specificity was 89% or higher, in all arterial segments. Kappa agreement was 0.72 or higher in all segments (All P-Values 0.001). Conclusion: This study suggests that considering excellent capability of color Doppler sonography in the evaluation of lower extremity arterial disease, color Doppler arterial mapping is sufficient for decision making in the treatment of these patients and can reduce the rate of diagnostic angiography.

Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

BACKGROUND Acute gastrointestinal bleeding is an emergency condition that can lead to significant morbidity and mortality.Embolization is considered the preferred therapy in the treatment of lower gastrointestinal bleeding when it is unrealistic to perform the surgery or vasopressin infusion in this population.Treatment of acute lower gastrointestinal(GI)bleeding(any site below the ligament of Treitz)using this technique has not reached a consensus,because of the belief that the risk of intestinal infarction in this condition is extremely high.The purpose of the study is to evaluate the effectiveness and safety of this technique in a retrospective group of patients who underwent embolization for acute lower GI bleeding.AIM To evaluate the efficacy and safety of super-selective arterial embolization in the management of acute lower GI bleeding.METHODS A series of 31 consecutive patients with angiographically demonstrated small intestinal or colonic bleeding was retrospectively reviewed.The success rate and complication rate of super-selective embolization were recorded.RESULTS Five out of thirty-one patients(16.1%)could not achieve sufficiently selective catheterization to permit embolization.Initial control of bleeding was achieved in 26 patients(100%),and relapsed GI bleeding occurred in 1 of them at 1 wk after the operation.No clinically apparent bowel infarctions were observed in patients undergoing embolization.CONCLUSION Super-selective embolization is a safe therapeutic method for acute lower GI bleeding,and it is suitable and effective for many patients suffering this disease.Importantly,careful technique and suitable embolic agent are essential to the successful operation.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.

Cardiac myxoma shedding leads to lower extremity arterial embolism:A case report

BACKGROUND Left cardiac myxoma(CM)is the most common benign tumor of primary cardiac tumors,but because of its special position caused by pathological physiology change,caused by the complications of the heavier,the surface is often accompanied by blood clots,once fall out,it causes peripheral vascular embolization,such as acute lower limb artery embo-lization,harmfulness is large,high morbidity,and easy to occur repeatedly.CASE SUMMARY A 67-year-old male patient suddenly appeared numbness and weakness of the left lower limb and could not walk without obvious incentive.The patient was finally diagnosed as left CM complicated with acute lower limb arterial embolism after completing cardiac ultrasound,computer tomography angiography,and histopathological analysis,such as hematoxylin-eosin stain staining,immunohistochemistry and special staining including alcian blue staining and periodic acid schiff staining.Arterial thrombosis was removed successfully by femoral artery thrombectomy,postoperative numbness and weakness of the patient’s left lower limb disappeared,skin temperature became warm,and dorsal foot artery pulsation was accessible.The patient was readmitted to the hospital 8 mo after discharge for left atrial mass resection,and was diagnosed as CM by postoperative histopathological examination.CONCLUSION Although CM is rare,it may be considered as the source of embolism in patients with acute limb ischemia.Repeated loss of thrombus on the tumor and its surface may lead to repeated embolism of peripheral vessels.Cardiac ultrasound is helpful for early diagnosis.Here,we use this case report to highlight left CM as an important cause of acute limb ischemia and to report our experience in the diagnosis and treatment of lower limb arterial embolism caused by CM detachment.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

Detection,management,and prevention of diabetes-related foot disease in the Australian context

Diabetes-related foot disease(DFD)is a widely feared complication among people who live with diabetes.In Australia and globally,rates of disability,cardiovascular disease,lower extremity amputation,and mortality are significantly increased in patients with DFD.In order to understand and prevent these outcomes,we analyse the common pathogenetic processes of neuropathy,arterial disease,and infection.The review then summarises important management considerations through the interdisciplinary lens.Using Australian and international guidelines,we offer a stepwise,evidence-based practical approach to the care of patients with DFD.

An evaluation of the arterial occlusions in peripheral arterial disease by 64-detector multi-slice CT angiography: DSA correlation

Objective: Evaluation of peripheral arterial disease with 64-detector multi-slice CT angiography (MDCT- A) and comparison of the results with the results of digital subtraction angiography (DSA), a standard reference. Materials and Method: The written informed consent of the patients and ethics committee approval were obtained. The retrospective study group consisted of 28 patients with a diagnosis of peripheral arterial disease. Using 64-MDCT-A, the arterial tree of the lower extremity was evaluated for the presence of steno-occlusive lesions that might have led to luminal stenosis. The diagnostic reliability of 64-MDCT- A was calculated and compared with that of DSA. Findings: In the segment-based analysis, the sensitivity, specificity, and reliability rates of 64-MDCT angiography in determining significant stenoses were 97.7%, 97%, and 97.3%, respectively. The Kappa co-efficiency for compatibility between 64-MDCT-A and DSA methods in grading stenosis was calculated as 0.896

Pitfalls and sources of error of color duplex ultrasonography in detecting deep vein thrombosis of proximal lower extremities

Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

基于深度学习的图像重建算法在下肢动脉病变CTA诊断中的研究

目的 探讨基于深度学习的图像重建算法对下肢动脉病变CT血管成像(Computed Tomography Angiography,CTA)的诊断价值。方法 回顾性收集2021年6月至2022年2月于我院就诊的51例下肢动脉狭窄或闭塞患者的CTA检查资料(65条下肢动脉)。分别基于深度学习的图像重建(Deep Learning Image Reconstruction,DLIR)算法和混合迭代重建(Hybrid Iterative Reconstruction,HIR)算法对CTA图像进行重建,以HIR法为参照进行质量评估;两位医师在不同重建算法下对血管狭窄的部位和程度进行评估,并采用Kappa检验观察者间一致性;以数字减影血管造影作为“金标准”比较HIR法和DLIR法诊断下肢动脉中度和重度狭窄的效能。结果与HIR法相比,DLIR法图像质量的噪声显著降低(Z膝上动脉=8.36,Z膝下动脉=9.46,Z足背动脉=7.19,均P<0.001),信噪比(Z膝上动脉=-7.32,Z膝下动脉=-7.91,Z足背动脉=-8.45,P<0.001)及对比噪声比(Z膝上动脉=-8.66,Z膝下动脉=-9.21,Z足背动脉=-8.52,均P<0.001)显著提高。DLIR法对动脉狭窄或闭塞程度的识别和评估均显示出更高的观察者间一致性(Kappa=0.86)。与HIR法相比,DLIR法的图像对膝下动脉重度狭窄的敏感度(72.2%vs.94.4%)、特异性(78.7%vs.95.7%),足背动脉中度狭窄的特异性(86.0%vs.97.7%)及重度狭窄的敏感度(50.0%vs.87.5%)均显著提高(P<0.05)。结论 DLIR算法可有效改善下肢动脉的CTA图像质量,并获得更优的诊断效能。

深静脉血栓形成患者下肢深静脉血栓密度、血清cTnI、Hcy水平与合并肺栓塞风险的关系研究

目的探讨深静脉血栓(DVT)形成患者下肢深静脉血栓密度、血清心肌肌钙蛋白I(cTnI)及同型半胱氨酸(Hcy)水平与合并肺栓塞风险的关系。方法回顾性分析2016年1月至2019年1月在秦皇岛市第一医院进行治疗的108例DVT患者,依据是否合并肺栓塞分为对照组(单纯DVT)68例,观察组(DVT合并肺栓塞)40例。收集两组基线资料[年龄、性别、高血压史、高血脂史、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体、受累静脉、下肢深静脉血栓密度比、wells评分、血小板计数(PLT)、中性粒细胞计数(NEUT)、C反应蛋白(CRP)、D二聚体(D-D)、cTnI及Hcy水平]并进行比较,分析DVT合并肺栓塞的影响因素。根据肺栓塞危险程度将DVT合并肺栓塞患者划分为高危组(n=10)、中危组(n=17)、低危组(n=13);比较不同危险程度肺栓塞间下肢深静脉血栓密度、血清cTnI、Hcy水平及wells评分间差异。分析下肢深静脉血栓密度、血清cTnI及Hcy水平与wells评分的关系。结果两组患者年龄、性别、高血压、高血脂、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体及受累静脉比较,差异均无统计学意义(P>0.05);观察组下肢深静脉血栓密度比、wells评分、PLT、NEUT、CRP、D-D、cTnI及Hcy水平分别为(52.37±12.19)%、(5.16±1.07)分、(284.63±90.72)×10^(9)/L、(71.22±10.16)%、(15.29±2.39)mg/L、(1051.27±271.19)ng/mL、(0.33±0.13)ng/mL、(21.27±2.16)μmol/L,均高于对照组[41.67±10.28)%、(3.28±0.94)分、(206.27±86.15)×10^(9)/L、(64.31±8.75)%、(10.33±1.71)mg/L、(739.52±206.34)ng/mL、(0.21±0.06)ng/mL、(10.19±1.75)μmol/L],差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,下肢深静脉血栓密度比、wells评分、cTnI及Hcy为DVT合并肺栓塞的独立预测因子(P<0.05)。肺栓塞低危组下肢深静脉血栓密度比、cTnI、Hcy水平及wells评分均低于中危组、高危组,差异均有统计学意义(P<0.05)。经Spearman相关性分析,下肢深静脉血栓密度比、cTnI、Hcy水平与wells评分呈正相关(P<0.05)。结论DVT患者下肢深静脉血栓密度、血清cTnI、Hcy可有效预测合并肺栓塞,同时可判断患者肺栓塞严重程度。

优化双下肢动脉能谱CT血管造影成像方案

目的优化双下肢动脉能谱CT血管造影(CTA)成像方案。方法回顾性分析30例疑诊双下肢动脉硬化性闭塞症(ASO)患者双下肢动脉能谱CTA资料,经重建获得40~80 keV(间隔5 keV)单能量(共9种)及100 kVp混合能量图像,对比双下肢动脉在不同图像中的CT值、噪声(SD)值、信噪比(SNR)及对比度噪声比(CNR);针对50、60 keV单能量和100 kVp混合能量图像质量及血管节段的可诊断性进行主观评估,观察40、45、50、60 keV单能量和100 kVp混合能量图像的自动去骨能力。结果40~80 keV范围内,随keV升高,各动脉在图像中的CT值、SD值、SNR及CNR均逐渐降低。相比100 kVp,腘动脉(PA)及其近端动脉的CT值、CNR及SNR均在40~55 keV图像中升高(P均<0.05);50~55 keV图像中SD值升高(P均<0.05),而60 keV图像中差异无统计学意义(P>0.05)。50及60 keV图像质量主观评分及可诊断动脉节段数与100 kVp差异均无统计学意义(P均>0.05)。PA以远节段的SNR及CNR在各单能量图像及100 kVp图像中差异均无统计学意义,其CT值在40~45 keV图像中、SD在40 keV图像中均高于100 kVp(P均<0.05),但SD在45 keV与100 kVp图像中差异无统计学意义(P>0.05);50 keV图像中,PA以远节段图像质量主观评分及可诊断节段数均高于60 keV及100 kVp(P均<0.05)。40 keV图像对9例(9/30,30.00%)、45 keV图像对6例(6/30,20.00%)不能自动去骨,50及60 keV、100 kVp对30例(30/30,100%)均可自动去骨。结论行双下肢动脉能谱CTA时,对PA及其近端节段以60 keV单能量成像较佳,对其以远或双下肢全程则以50 keV单能量成像较佳。

血管内冲击波治疗下肢动脉钙化病变的临床疗效

目的探讨血管内冲击波治疗下肢动脉钙化病变的临床疗效及安全性。方法收集2023年1月至2024年1月于国家中医针灸临床医学研究中心/天津中医药大学第一附属医院就诊的60例下肢动脉钙化病变患者的临床资料,所有患者均完成血管内冲击波治疗,比较手术前后所有患者踝肱指数(ABI)、疼痛程度、D-二聚体水平、凝血功能指标,统计手术成功率及术后并发症发生情况。结果术前,ABI为(0.48±0.21),与术后(0.79±0.25)比较,差异有统计学意义(P﹤0.05)。60例患者中45例以疼痛为主要症状,其中,0级疼痛由术前6例增加至术后18例,2级疼痛由术前13例增加至术后17例,4级疼痛由术前15例减少至术后8例,6级疼痛由术前8例减少至术后2例,8级疼痛由术前3例减少至术后0例,无10级疼痛患者。手术前后所有患者凝血功能各项指标、D-二聚体水平比较,差异均无统计学意义(P﹥0.05)。手术成功率为100%,术后均未发生严重夹层、急性血栓等手术并发症。结论血管内冲击波是治疗下肢动脉钙化病变的有效手段,且并发症发生率低,安全、有效。

剖宫产术后使用低分子肝素钠预防血栓形成的护理研究

目的探讨低分子肝素钠联合护理干预对剖宫产术后血栓形成的预防效果。方法将100例剖宫产术产妇随机分为观察组和对照组,每组50例。观察组在综合护理基础上给予低分子肝素钠预防血栓形成的护理措施。比较2组血栓发生风险、护理满意度和并发症发生率,评估低分子肝素钠联合护理干预在剖宫产术后预防血栓形成中的效果和安全性。结果观察组Homan征阳性率、下肢围度显著增加病例数、D-二聚体水平升高病例数、持续性疼痛和肿胀病例数、皮肤温度和颜色变化异常病例数均低于对照组,Wells评分及改良Caprini评分低于对照组,护理满意度评分高于对照组,差异有统计学意义(P<0.05)。2组产妇的并发症发生率比较,差异无统计学意义(P>0.05)。2组产妇的生命体征(体温、脉搏、呼吸频率、血压)在术后第1、3天和出院前均恢复正常,手术切口均愈合良好。结论低分子肝素钠联合护理干预在预防剖宫产术后血栓形成中具有一定的效果,且安全性较高,能够提高产妇的护理满意度和术后康复质量。

彩色多普勒定量分析腘动脉参数在2型糖尿病患者下肢血管病变中的应用研究

目的:分析彩色多普勒定量分析腘动脉参数在2型糖尿病(T2DM)患者下肢血管病变中的应用价值。方法:采用回顾性分析法,将天津市河西医院2019年8月—2022年10月进行健康体检的25例志愿者纳入对照组,将51例T2MD患者纳入观察组。按腘动脉中膜厚度(IMT)情况将观察组分为A组(IMT正常)20例、B组(IMT增厚)6例、C组(斑块形成)25例。对比观察组与对照组患者腘动脉最大管径(R)、峰值血流速(peak systolic velocity,PSV)、壁剪应力(wall shear stress,WSS),对比A组、B组、C组患者病程、年龄、体重指数、血压、血糖等可能影响动脉斑块形成的因素,对比三组患者R、PSV、WSS。分析WSS预测T2DM患者效能以及WSS相关因素。结果:观察组患者PSV、WSS低于对照组,差异有统计学意义(P<0.05)。与A组比较,B组患者年龄更高,病程更长,甘油三酯、WSS更低,差异有统计学意义(P<0.05)。与A组比较,C组患者年龄更高,病程更长,PSV、WSS更低,差异有统计学意义(P<0.05)。与B组比较,C组患者年龄更高,PSV、WSS更低,差异有统计学意义(P<0.05)。WSS取1.82 dyne/cm^(2),预测T2DM患者下肢血管病变的特异度、灵敏度分别为84%、66%。WSS与病程、年龄、腘动脉IMT呈负相关(r=-0.370、-0.570、-0.592,P<0.05),与PSV呈正相关(r=0.601,P<0.05)。结论:彩色多普勒超声定量分析下腘动脉WSS能有效预测T2DM患者下肢血管病变,建议综合患者病程、年龄及腘动脉IMT提高诊断准确性。

不同机械减容装置治疗下肢动脉栓塞及血栓形成的效果对比

目的比较不同机械减容装置治疗下肢动脉栓塞及血栓形成的有效性和安全性。方法收集2016年9月至2020年12月甘肃省人民医院收治的50例下肢动脉栓塞及血栓形成患者的临床资料,根据使用机械减容装置的不同将患者分为A组(采用AngioJet机械减容装置)和B组(采用Rotarex Straub机械减容装置),每组25例。比较两组患者的手术治疗结果、手术相关并发症发生情况及术后不同时间一期血管通畅率,记录两组患者不同时间的下肢缺血分级情况,分析术后靶血管再次闭塞或血栓形成的危险因素。结果两组患者的技术成功率和临床成功率比较,差异均无统计学意义(P﹥0.05)。两组患者住院期间均未发生严重的出血事件,随访期间均未发生手术相关的严重并发症,保肢率为100%。术后3、6、12个月,两组患者的一期血管通畅率比较,差异均无统计学意义(P﹥0.05)。两组患者不同时间下肢缺血分级情况比较,差异均无统计学意义(P﹥0.05)。心房颤动、吸烟均为术后靶血管再次闭塞或血栓形成的危险因素(P﹤0.05)。结论对于下肢动脉栓塞及血栓形成患者,两种机械减容装置的短期疗效相似,中期疗效可能存在差异。心房颤动、吸烟均与术后靶血管再次闭塞或血栓形成有关。

心房颤动继发下肢动脉栓塞的急诊血管内介入治疗

目的探讨机械性血栓抽吸术与导管取栓术对心房颤动继发下肢动脉栓塞的治疗效果。方法收集2021年2月至2023年10月首都医科大学宣武医院收治的186例急诊心房颤动继发下肢动脉栓塞患者的临床资料,按照手术方法的不同将其分为抽吸组(n=89)和取栓组(n=97),比较两组患者术后即刻复查造影的血管再通率、Cooley标准痊愈率、踝臂指数、患者自觉疼痛视觉评分、并发症发生率等。结果两组患者发病至穿刺时间、栓塞部位、术前踝臂指数比较,差异均无统计学意义(P﹥0.05)。抽吸组患者手术时间明显短于取栓组患者,术中出血量明显大于取栓组患者,差异均有统计学意义(P﹤0.01)。术后即刻复查造影的血管再通率为100%(186/186),术后Cooley痊愈率为91.94%(171/186),其中,抽吸组患者Cooley痊愈率为91.01%(81/89),与取栓组患者的92.78%(90/97)比较,差异无统计学意义(P﹥0.05)。取栓组患者术后即刻自觉疼痛视觉评分低于抽吸组患者,出院前踝臂指数高于抽吸组患者,差异均有统计学意义(P﹤0.05)。住院期间共发生21例并发症,其中,抽吸组患者并发症发生率为10.11%(9/89),与取栓组患者的13.40%(13/97)比较,差异无统计学意义(P﹥0.05),所有并发症经对症处理后均可好转。结论机械性血栓抽吸术和导管取栓术均可安全、有效治疗心房颤动继发下肢动脉栓塞,各有优缺点,在临床实践中可根据患者的实际病情进行选择。