Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study.

Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), -6.4±10.9, and -15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.

Blood flow differences in cun-kou (radial) artery and anterior tibial artery: normal people vs patients with chronic gastritis.

OBJECTIVE: To explore the blood flow differences in cun-kou (radial) artery and anterior tibial artery between normal people and patients with chronic gastritis. METHODS: Using doppler ultrasonography, blood flow charts [peak systolic velocity (VP), maximum blood flow velocity in diastole (VD), mean blood flow velocity (VM), pulse index (PI), resistance index (RI), blood vessel diameter (D), vessel volume (SV), circulation blood flow periodic time (ET)] measured by at cun-kou (radial) artery and anterior tibial artery in normal group (n = 30) and chronic gastritis group (n = 30) in department of ultrasound, Beijing Anzhen hospital, capital medical university. RESULTS: In the doppler flow charts of the normal group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts in the chronic gastritis group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts between normal group and chronic gastritis group, there were statistically significant differences in SV, ET between normal group and chronic gastritis group (P < 0.05), and there were more statistically significant differences in PI between normal group and chronic gastritis group (P < 0.01). CONCLUSION: Based on the differences in doppler flow charts between the normal group and the chronic gastritis group, the doppler flow charts of cun-kou artery and anterior tibial artery were not only proved to be significantly different, but also provided quantitative objective indexes for the study of cun-kou artery and anterior tibial artery doppler flow charts of normal people and chronic gastritis patients. This study also proves that the doppler flow chart of the anterior tibial pulse is of great significance for the diagnosis of chronic gastritis.

Augmentation of arterial blood velocity with electrostimulation in patients with critical limb ischemia unsuitable for revascularization.

Aim This pilot study aimed to reveal whether combination of electrostimulation with iloprost treatment achieves better results compared to iloprost alone in patients with critical limb ischemia. Material and methods Patients were randomized into Group 1 ( n = 11, mean age: 65.3 ± 4.2 years, received iloprost infusion protocol alone) or Group 2 ( n = 11, mean age: 62.9 ± 6.7, received iloprost infusion plus standardized protocol of peroneal nerve electrostimulation). Electrostimulation was delivered with 1 Hz frequency, 27 mA current, and 200 ms pulse width. Peak blood flow velocities in the anterior and posterior tibialis arteries were measured with duplex ultrasound. Results There was a slight insignificant increase in blood velocity in anterior tibialis artery in Group 1 (from 17.6 ± 13.0 to 18.6 ± 13.1, p = 0.57), whereas the increase in Group 2 was marked (from 23.8 ± 18.3 to 32.2 ± 19.7, p = 0.01). Blood velocity in posterior tibialis artery also increased in both groups, but it was not of statistical significance. No significant difference was found between two groups in regard to final pulse oximetry oxygen saturation levels. Conclusion Electrostimulation of the peroneal nerve caused a substantial increase in anterior tibialis artery blood velocity when used as an adjunct to medical therapy in patients with critical limb ischemia.

[Effect of tongmal recipe on atherosclerosis in patients with early lower extremity arteriopathy caused by type 2 diabetes mellitus].

OBJECTIVE: To observe the effect of Tongmai Recipe (TMR) on atherosclerosis (AS) in patients with early lower extremity arteriopathy disease (LEAD) caused by type 2 diabetes mellitus (T2DM). METHODS: Patients were randomly assigned to two groups. The 23 patients in the treatment group were treated by TMR and the 22 in the control group were given Cilostazo, all for 3 months. Before and after treatment, lower extremity vascular color Doppler image, blood levels of glucose, insulin, serum matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6) were measured. RESULTS: The thickness of AS plaque and that of arterial intima-media obviously reduced (P < 0.01 and P < 0.05), insulin sensitivity improved noticeably (P < 0.01), and serum levels of MMP-9 and IL-6 lowered obviously (P < 0.05) in the treatment group after treatment, but these indexes were unchanged in the control group statistically. CONCLUSION: TMR has remarkable action in reducing the thickness of AS plaque and intima-media of artery, its mechanism might be related with improving of insulin sensitivity and anti-inflammatory reaction, and reducing of serum MMP-9 level as well in patients.

Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury.

STUDY DESIGN: Repeated measures training intervention. OBJECTIVES: To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define "arterial health" using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range. SETTING: Department of Kinesiology, University of Georgia, USA. METHODS: We assessed five 36+/-5-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 x 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a high-resolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design. RESULTS: FMD improved from 0.08+/-0.11 mm (2.7%) to 0.18+/-0.15 mm (6.6%) (P=0.004), and arterial range improved from 0.36+/-0.28 to 0.94+/-0.40 mm (P=0.001), after 18 weeks of training. Resting diameter did not significantly change. CONCLUSIONS: Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.

An alteration in arterial compliance associated with elevated aerobic fitness.

OBJECTIVE: To identify a nonpharmacologic method of enhancing arterial compliance, a correlate of atherogenesis; to determine the relationship between aerobic fitness levels and arterial compliance; and to identify a characteristic Doppler analog waveform associated with elevated levels of aerobic fitness. DESIGN: A cross-sectional design was used to compare the Doppler studies of sedentary subjects and aerobically trained subjects. The trained subjects were divided into a moderately trained group and a highly trained group. SETTING AND PARTICIPANTS: One hundred subjects consisting of 50 sedentary control subjects and 50 aerobically trained subjects in a university-based setting. The mean age of the total group of subjects was 36.0+/-8.6 years. Each group had an equal number of male and female subjects. Control subjects were sedentary, with normal vascular risk factor profiles and a mean aerobic capacity (maximum oxygen consumption) of 25.8+/-3.0 mL x kg(-1) x min(-1). Trained subjects were divided into a moderately trained group and a highly trained group. The mean aerobic capacity for the moderately trained group was 46.0+/-4.4 mL x kg(-1) x min(-1), and that for the highly trained group was 63.3+/-6.7 mL x kg(-1) x min(-1). A standard Doppler examination, including ankle pressure index was performed on each subject. MAIN OUTCOME MEASURE: Arterial compliance measurements were recorded by using A-mode Doppler ultrasonography and analyzed by diastolic flow analysis. RESULTS: Control subjects had a mean arterial compliance level of 21.1%+/-2.5%. The moderately trained subjects had a mean compliance level of 34.8%+/-4.9%, and the highly trained subjects had a mean compliance level of 46.0%+/-6.7%. An analysis of variance was used for this comparison and was significant at a P value of less than .01. CONCLUSION: These results demonstrate that elevated aerobic fitness levels are associated with an augmentation in arterial compliance. A linear relationship existed in our data between aerobic fitness levels and arterial compliance. This study suggests that enhanced arterial compliance is another beneficial cardioprotective effect associated with aerobic training.

Tibial artery false aneurysm: uncommon result of blunt injury occurring during athletics.

Two young men presented with symptoms following lower extremity injuries sustained in the normal course of participation in sports. One played baseball while the other competed in Tae Kwon Do. One case presented with digital ischemia, the other developed a pulsating hematoma. Each came to angiography, and each proved to have a false aneurysm of a tibial artery. The tibial artery was ligated in each case, without further complications. The patient with digital ischemia was thought to have sustained microemboli, and also underwent lumbar sympathectomy.