Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients

ObjectiveThis study aimed to investigate the prevalence and identify predictive factors of asymptomatic carotid artery stenosis (ACAS) in Southern Chinese patients with peripheral arterial disease (PAD).DesignA cross-sectional study.Setting and participantsA total of 653 patients with PAD admitted to the First Affiliated Hospital of Chongqing Medical University from July 2014 to July 2019.Main outcome measuresThe degree of carotid stenosis was assessed by Duplex ultrasound and classified as normal (no stenosis), mild (<50% stenosis), moderate (50%–69% stenosis), severe (≥70% stenosis or near occlusion) and total occlusion. Patients with stenosis ≥50% were classified as having significant ACAS. Multivariable logistic regression analysis was used to calculate the risk associated with concomitant factors of ACAS.ResultsThe mean age was 71.5±5.5 years, and 55.9% of the patients were men. Significant ACAS stenosis accounted for 128 (19.6%) cases, including 68 (10.4%) cases of moderate stenosis (50%–69%), 46 (7.0%) cases of severe stenosis (70%–99%) and 14 (2.1%) cases of total occlusion. Multivariable analysis revealed that age ≥70 years (OR 2.0, 95% CI 1.25 to 3.18), an ankle brachial index (ABI) ≤0.5 (OR 3.39, 95% CI 1.34 to 8.55), an ABI ≤0.4 (OR 3.86, 95% CI 1.47 to 10.06) and Fontaine stage IV (OR 4.53, 95% CI 1.47 to 13.88) are predictive factors of significant ACAS.ConclusionThe prevalence of significant ACAS (stenosis ≥50%) in patients with PAD was approximately 19.6%. Significant ACAS was more common in patients with PAD older than 70 years, particularly in patients with an ABI <0.5 and those classified as Fontaine stage IV. Selective carotid screening may be more worthwhile in these high-risk patients with PAD.

Hyperbaric Oxygen Therapy in the Treatment of Fontaine Stage IV Thromboangiitis Obliterans

Ischemic wounds unresponsive to standard treatment in thromboangiitis obliterans are associated with amputation, morbidity, and mortality. In this study, hyperbaric oxygen therapy was added to standard treatment of 36 patients with thromboangiitis obliterans with ischemic ulcerated wounds in the extremities. Full recovery was observed in 52.7% of cases (25% at discharge, 27.7% during follow-up). Resting pain after treatment decreased significantly compared to pretreatment levels based on visual analog scale scores (7.1 ± 1.7 vs 2.2 ± 3.0, P = .0001). Mean wound area also decreased significantly after treatment (22.6 ± 17.5 vs 13.02 ± 16.5, P = .0001). The number of patients requiring no assistance during routine daily activities increased significantly (25% vs 55.5%, P = .001). All patients were at Fontaine stage IV before hyperbaric oxygen therapy. The number of patients at stage IIB increased significantly after treatment, while that of patients at stage IV decreased significantly (0% vs 47.2%, P = .0001, and 100% vs 47.2%, P = .0001, respectively). None of our patients was able to walk without pain before treatment; however, walking distance was significantly extended in 16 patients who were capable of walking (0 vs 190.6 ± 129.4 meters, P = .0001). In addition, 11.1% of patients underwent major amputation during follow-up.

Is the revascularisation of pedal arteries worthwhile in diabetic gangrene?

The potential of arterial reconstructions at the foot level is a matter of debate. A series of 119 pedal arterial bypass grafts in 114 patients (77 diabetic and 37 non-diabetic patients, mean age 66 years) is reviewed retrospectively, after a mean follow-up 31 months. Of the patients, 91% had foot lesions regarded as Fontaine stage IV, and 97% had occlusions of all crural arteries with patent malleolar or pedal arteries. Autologous vein bypasses were grafted between pedal and either femoral (57%), popliteal (35%), or crural(8%) arteries. Results: the 30-day mortality was 4.4%, and the total mortality after 31 months was 21%. Postoperative graft failure resulted in 22 amputations above the ankle (in 12% of the diabetic, and in 32% of the nondiabetic patients). The one-year primary (secondary) graft patency rates were 67% (69%) in the diabetic patients, and 51% (59%) in the nondiabetic patients. Limb salvage rate was 82% (D) versus 62% (ND) after 1 year, and 64% (D) versus 55% (ND) after 31 months. Conclusion: nearly two thirds of diabetic patients with partial foot gangrene will benefit from timely pedal arterial reconstruction, and more than half of nondiabetic patients.