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1.
Adv Ther ; 38(12): 5700-5709, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34676515

RESUMO

INTRODUCTION: Endovascular therapies have not yet had an ideal effect on thromboangiitis obliterans (TAO) and no data have been published about laser-assisted angioplasty (LA) combined with radiofrequency ablation (RFA) for TAO. This study aimed to investigate the outcome of LA combined with RFA for TAO. METHODS: Sixteen consecutive patients underwent LA and RFA procedures between June 2018 and March 2019 in this prospective pilot study. The clinical outcomes and complications were assessed at 6, 12, and 18 months after the procedure. The primary endpoint was defined as the limb salvage rate and freedom of target-lesion revascularization (f-TLR) of the limb, and the effect on the outcome was assessed by the ankle brachial index (ABI), numerical rating scores (NRSs), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). RESULTS: Men accounted for 87.5% of the patients. All patients underwent LA, and following the RFA procedure, two patients received bailout stenting (12.50%). The technique success rate was 100%, and no severe complications occurred. The ABI was significantly higher at the 18-month follow-up than at baseline (P < 0.001). The primary and secondary patency rates were 71.82% and 79.80%, respectively, and the f-TLR and limb salvage rates were 90% and 92.86% based on Kaplan-Meier analysis. The EQ-5D value was higher after the procedure than at baseline (P < 0.001), and the NRS value was lower after the procedure than at baseline (P < 0.001). CONCLUSIONS: Our results confirmed that LA combined with RFA was a feasible procedure that resulted in acceptable limb salvage and f-TLR rates.


Assuntos
Angioplastia com Balão a Laser , Ablação por Radiofrequência , Tromboangiite Obliterante , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Stents , Tromboangiite Obliterante/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(42): e27577, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34678903

RESUMO

RATIONALE: Currently, there is no consensus regarding the best treatment for patients with thromboangiitis obliterans (TAO). Regenerative medicine, such as bone marrow stem cells or adipose-derived stem cell (ASC) transplantation, have proven efficacy in improving tissue perfusion and wound healing in clinical trials. In this case, we used nanofat grafting to treat severe conditions in a patient with TAO, with promising outcomes. PATIENT CONCERNS: This is a case of a 48-year-old smoker who presented with cyanosis in both hands and the right foot, with gangrenous changes. Investigative angiography showed severe vasospasm in the radial and ulnar arteries of the patient's left hand. Progressive cyanosis of the patient's left hand was noted which may eventually require amputation if left untreated. DIAGNOSES: He was diagnosed with TAO under the Shionoya diagnostic criteria. INTERVENTIONS: Fasciotomy and necrotic tissue debridement were performed, followed by centrifuged nanofat grafting. The nanofat graft was prepared using Pallua method and deployed with a MAFT-GUN (Dermato Plastica Beauty Co., Ltd., Kaohsiung, Taiwan). OUTCOMES: Three months later, computed tomography angiography revealed a radial artery patency. The patient's wrist function was preserved with uneventful wound healing. LESSONS: The regenerative ability of centrifuged nanofat grafts not only helps wound healing but also helps reverse vasospasm and preserve remnant tissue perfusion.


Assuntos
Tecido Adiposo/transplante , Mãos/patologia , Mãos/cirurgia , Isquemia/etiologia , Isquemia/cirurgia , Tromboangiite Obliterante/complicações , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade
3.
Int Angiol ; 40(5): 395-408, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34236154

RESUMO

Even today thromboangiitis obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. An international group of experts however came to one conclusion. They all agree that management of TAO needs a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.


Assuntos
Cardiologia , Tromboangiite Obliterante , Humanos , Tromboangiite Obliterante/diagnóstico , Tromboangiite Obliterante/epidemiologia , Tromboangiite Obliterante/terapia
5.
Medicine (Baltimore) ; 100(20): e25659, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011027

RESUMO

ABSTRACT: Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.


Assuntos
Amputação/estatística & dados numéricos , Dedos/irrigação sanguínea , Isquemia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/complicações , Embolia/epidemiologia , Feminino , Dedos/patologia , Dedos/cirurgia , Seguimentos , Humanos , Doença Iatrogênica/epidemiologia , Isquemia/epidemiologia , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Pessoa de Meia-Idade , Necrose/epidemiologia , Necrose/etiologia , Necrose/cirurgia , Neoplasias/complicações , Neoplasias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Taxa de Sobrevida , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/epidemiologia , Trombose/complicações , Trombose/epidemiologia , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia
6.
J Med Case Rep ; 15(1): 215, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892806

RESUMO

BACKGROUND: Thromboangiitis obliterans or Buerger's disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented. CASE PRESENTATION: Our Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery. CONCLUSION: Acute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger's disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.


Assuntos
Abdome Agudo , Perfuração Intestinal , Isquemia Mesentérica , Tromboangiite Obliterante , Humanos , Intestinos , Masculino , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/diagnóstico
8.
Vasa ; 50(4): 301-305, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33739143

RESUMO

Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa's criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.


Assuntos
Cannabis , Tromboangiite Obliterante , Amputação , Humanos , Estudos Retrospectivos
10.
AJR Am J Roentgenol ; 216(2): 421-427, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325735

RESUMO

OBJECTIVE. Thromboangiitis obliterans (TAO) is an occlusive inflammatory disease affecting small- and medium-sized vessels that causes decrease in life quality and eventually limb loss. The only proven treatment method is smoking cessation, but it may be insufficient for limb salvage in patients with critical limb ischemia. In this single-center retrospective study, the feasibility and efficiency of endovascular treatment in TAO were evaluated. MATERIALS AND METHODS. After approval of the local institutional review board, 41 patients who underwent endovascular treatment of TAO between January 2014 and June 2019 were evaluated retrospectively. Technical success and procedure-related complications were recorded. Decrease in Rutherford classification score, relief of pain, and wound healing were evaluated to determine clinical success. Primary patency, limb salvage rate, and amputation-free survival were also evaluated. RESULTS. A total of 45 limbs were treated during the study period. Technical success was achieved in 82.2% of procedures. Mean follow-up was 29.8 months. Clinical improvement was achieved in 35 limbs. Three patients underwent major amputation and 12 patients underwent minor amputation. Amputation-free survival and limb salvage were both 93.3% at both 1 and 2 years. Reintervention was performed in 14 patients because of occlusion and clinical relapsing of the symptoms. CONCLUSION. Endovascular treatment of TAO is feasible, has a potential to prevent limb amputation in patients with critical limb ischemia, and has acceptable technical success and limb salvage rates. Because there is no consensus in treatment of TAO, prospective comparative studies are needed to determine the effectiveness of an endovascular approach.


Assuntos
Procedimentos Endovasculares , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Tromboangiite Obliterante/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/diagnóstico por imagem , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Ann Vasc Surg ; 73: 509.e5-509.e9, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33333192

RESUMO

Thromboangiitis obliterans (TAO) is a rare vasculopathy that is predominantly seen in young male smokers. Recently, new biomarkers have been shown to be useful in distinguishing TAO from acute phase TAO in an Asian study population. The present case study illustrates their application in a European patient during TAO exacerbation and their association with therapeutic performance.


Assuntos
Plaquetas , Leucócitos , Tromboangiite Obliterante/sangue , Adulto , Amputação , Analgésicos/uso terapêutico , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Humanos , Contagem de Linfócitos , Linfócitos , Masculino , Monócitos , Neutrófilos , Contagem de Plaquetas , Abandono do Hábito de Fumar , Tromboangiite Obliterante/diagnóstico , Tromboangiite Obliterante/terapia , Fatores de Tempo , Resultado do Tratamento
12.
Am J Forensic Med Pathol ; 42(3): 297-300, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33346979

RESUMO

ABSTRACT: Thromboangiitis obliterans (TAO, Buerger disease) is a segmental, non-atherosclerotic vasculitis that causes occlusion of the small and medium sized vessels of the distal extremities. In rare cases, it can affect vessels in the gastrointestinal, cerebrovascular, coronary, and renal systems. The etiology of thromboangiitis obliterans is unknown, but there is a strong association with smoking in the development and the progression of the disease. We present the case of a 42-year-old homeless female smoker, who was found dead outdoors. Although originally suspected to be a possible trauma-related death, autopsy revealed a thrombus in her left carotid artery, which caused an acute cerebral infarction. It was concluded that thromboangiitis obliterans, likely precipitated by smoking, was the cause of the thrombosis and subsequent death.


Assuntos
Trombose das Artérias Carótidas/etiologia , Tromboangiite Obliterante/complicações , Adulto , Trombose das Artérias Carótidas/patologia , Infarto Cerebral/etiologia , Infarto Cerebral/patologia , Feminino , Humanos , Fumar/efeitos adversos
13.
J Pediatr Hematol Oncol ; 43(6): e759-e762, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925405

RESUMO

Arterial occlusive disease of the limb is very rare in children. Buerger's disease (BD) is a nonatherosclerotic, segmental inflammatory arteritis affecting the small and medium-sized vessels of the extremities. We report BD in a 16-year-old male presenting with arterial insufficiency of left foot and history of smoking cigarettes and cannabis for 2 years. BD was diagnosed based on history of smoking in combination with clinical, laboratory, and radiologic findings. Pediatric hemato-oncologists should consider BD in the differential diagnosis in adolescents who smoke cigarettes and/or cannabis and present with vascular insufficiency of the hands and/or feet.


Assuntos
Tromboangiite Obliterante/diagnóstico , Adolescente , Anticoagulantes/uso terapêutico , Fumar Cigarros , Humanos , Masculino , Fumar Maconha , Tromboangiite Obliterante/tratamento farmacológico , Tromboangiite Obliterante/patologia
14.
J Clin Ultrasound ; 49(2): 129-134, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32557645

RESUMO

PURPOSE: To evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU). METHODS: We evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology. RESULTS: A total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1-1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as "large snake" images, all type III collaterals on DSA appeared as "small snake" images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small "snake" images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern. DISCUSSION: SMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.


Assuntos
Angiografia Digital , Microvasos/diagnóstico por imagem , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/fisiopatologia , Ultrassonografia Doppler , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Eur Rev Med Pharmacol Sci ; 24(20): 10605-10611, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33155218

RESUMO

OBJECTIVE: The aim of this study was to observe the regulatory effects of micro ribonucleic acid (miR)-223 on thromboangiitis obliterans (TAO) rats, and to explore the potential regulatory mechanism. MATERIALS AND METHODS: Online database TargetScan was used to predict the downstream regulatory targets of miR-223. A total of 45 Sprague Dawley (SD) rats were randomly divided into three groups, including sham operation group (Sham group), Model group, and miR-223 agonist group (miR-223 mimic group). TAO model was successfully established in rats through the injection of lauric acid via the femoral artery. The content of serum thromboxane B2 (TXB2) and endothelin (ET) was measured via enzyme-linked immunosorbent assay (ELISA). The pathological changes in the left hind limb were detected via hematoxylin-eosin (HE) staining. Moreover, the expressions of interleukin-6 (IL-6) and IL-1ß in the tissues of the rat left hind limb were determined via immunohistochemistry. In addition, the protein expression of Nod-like receptor protein 3 (NLRP3) in tissues was determined using Western blotting. RESULTS: TargetScan database predicted that NLRP3 was the downstream target gene of miR-223. Compared with the Sham group, Model group exerted significantly higher content of serum TXB2 and ET, severe lesions in the rat left hind limb, as well as significantly increased expressions of IL-6 and IL-1ß and protein expression of NLRP3 in tissues of the rat left hind limb (p<0.05). Besides, compared with the Model group, miR-223 mimic group showed remarkably lower content of serum TXB2 and ET, improved lesions in the rat left hind limb, as well as decreased expressions of IL-6 and IL-1ß and protein expression of NLRP3 in the tissues of the rat left hind limb (p<0.05). CONCLUSIONS: MiR-223 agonist can alleviate thrombus and inflammatory response in TAO rats. The possible underlying mechanism may be related to targeted regulation on NLRP3 inflammasome expression.


Assuntos
Inflamação/metabolismo , MicroRNAs/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Tromboangiite Obliterante/metabolismo , Trombose/metabolismo , Animais , Inflamação/patologia , Masculino , MicroRNAs/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Ratos , Ratos Sprague-Dawley , Tromboangiite Obliterante/patologia , Trombose/patologia
16.
ANZ J Surg ; 90(12): 2506-2509, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33176048

RESUMO

BACKGROUND: Arterial revascularization is seldom considered as a treatment option in thromboangiitis obliterans (TAO) due to diffuse segmental involvement of medium- and small-sized extremity vessels. Although typical angiographic features include bilaterally symmetrical involvement of infrapopliteal vessels, larger vessels too can be affected. Similarly, there could be distal target vessels feasible for revascularization. This study was conducted to describe the patterns of arterial involvement in TAO and assess the feasibility of revascularization. METHODS: The study was approved by the Institutional Review Board and research ethics committee of Christian Medical College, Vellore (IRB no: 12034). A retrospective study was conducted in the Department of Vascular Surgery, Christian Medical College, Vellore, India, between January 2009 and December 2018. There were 329 patients who fulfilled the clinical criteria for TAO of whom 83 had an angiogram done. These 83 patients formed the study cohort. RESULTS: Large vessel involvement was seen in 56.6% of patients and 79.5% of patients had at least one or more distal target artery feasible for revascularization. The anterior tibial artery and peroneal artery were the most common target vessels that were patent for revascularization. Of the 22 patients who underwent revascularization (16 bypasses and six angioplasties), the patency rate was 64.8% and the limb salvage rate was 80.9% at the end of 6 months. CONCLUSION: The study shows that one-third of our patients with TAO have a distal target artery feasible for revascularization. As most of the affected patients are in the economically productive age group, every attempt should be made to salvage the limb with revascularization for which the use of angiography should be more liberal.


Assuntos
Tromboangiite Obliterante , Artérias/diagnóstico por imagem , Artérias/cirurgia , Estudos de Viabilidade , Humanos , Índia , Isquemia/cirurgia , Salvamento de Membro , Estudos Retrospectivos , Centros de Atenção Terciária , Tromboangiite Obliterante/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
Sci Rep ; 10(1): 16045, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994527

RESUMO

Adipose-derived regenerative cell (ADRC) is a promising alternative source of autologous somatic stem cells for the repair of damaged tissue. This study aimed to assess the safety and feasibility of autologous ADRC implantation for therapeutic angiogenesis in patients with critical limb ischaemia (CLI). A clinical pilot study-Therapeutic Angiogenesis by Cell Transplantation using ADRCs (TACT-ADRC) study-was initiated in Japan. Adipose tissue was obtained by ordinary liposuction method. Isolated ADRCs were injected into the ischaemic limb. We performed TACT-ADRC procedure in five patients with CLI. At 6 months, no adverse events related to the TACT-ADRC were observed. No patients required major limb amputation, and ischaemic ulcers were partly or completely healed during the 6-month follow-up. In all cases, significant clinical improvements were seen in terms of rest pain and 6-min walking distance. Numbers of circulating CD34+ and CD133+ cells markers of progenitor cell persistently increased after ADRC implantation. The ratio of VEGF-A165b (an anti-angiogenic isoform of VEGF) to total VEGF-A in plasma significantly decreased after ADRC implantation. In vitro experiments, cultured with ADRC-conditioned media (CM) resulted in increased total VEGF-A and decreased VEGF-A165b in C2C12 cells, but not in macrophages. ADRC-CM also increased CD206+ cells expression and decreased TNF-α in macrophages. Autologous ADRC implantation was safe and effective in patients with CLI and could repair damaged tissue via its ability to promote angiogenesis and suppress tissue inflammation.


Assuntos
Isquemia/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Transplante Autólogo/métodos , Adipócitos/metabolismo , Tecido Adiposo/metabolismo , Adulto , Idoso , Indutores da Angiogênese/uso terapêutico , Feminino , Humanos , Japão , Masculino , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Neovascularização Fisiológica/fisiologia , Doença Arterial Periférica/complicações , Projetos Piloto , Regeneração/fisiologia , Transplante de Células-Tronco/métodos , Tromboangiite Obliterante/complicações
19.
Khirurgiia (Mosk) ; (8): 55-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869616

RESUMO

OBJECTIVE: To study the immediate results of therapy and indirect revascularization in patients with critical ischemia of the lower limbs. MATERIAL AND METHODS: The results of medication and surgical treatment were analyzed in 210 patients with critical ischemia of the lower limbs. Atherosclerosis obliterans was diagnosed in 142 patients, thromboangiitis obliterans - in 68 patients. Lesion of femoropopliteal segment was observed in 32 (15.2%) cases, popliteal-tibial segment - 68 (32.8%) patients, tibial and foot segment - 62 (29.5%) cases, foot - 31 (14.8%) cases, multiple-level lesion - 17 (8.1%) cases. Survey consisted of Doppler ultrasound, CT angiography, rheovasography with analysis of rheographic index (RI) and pulse oximetry. Circulatory parameters were compared with identical values in 48 almost healthy persons ("reference group"). The results of medication and surgical treatment were evaluated by using of the scale of Rutherford R.B. et al. (1997). RESULTS: Conservative treatment was performed in 48 patients (control group). The following types of indirect revascularization operations were performed to stimulate regional circulation: bone trepanation in 42 patients, lumbar sympathectomy in 51 patients, bone trepanation + lumbar sympathectomy in 38 patients, bone trepanation with intraosseous irradiation in 31 cases. CONCLUSION: Indirect revascularization improves early postoperative outcomes, ensures maintaining support function of the limb and active lifestyle in patients with critical ischemia of the lower limbs. Technical simplicity of these procedures facilitates widespread introduction of indirect revascularization in multi-field hospitals.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/tratamento farmacológico , Arteriosclerose Obliterante/diagnóstico por imagem , Arteriosclerose Obliterante/tratamento farmacológico , Arteriosclerose Obliterante/cirurgia , Osso e Ossos/cirurgia , Tratamento Conservador , Humanos , Isquemia/diagnóstico por imagem , Isquemia/tratamento farmacológico , Salvamento de Membro/métodos , Extremidade Inferior/diagnóstico por imagem , Estudos Retrospectivos , Simpatectomia , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/tratamento farmacológico , Tromboangiite Obliterante/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
20.
Circ J ; 84(10): 1786-1796, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32879220

RESUMO

BACKGROUND: The epidemiology and clinical features of thromboangiitis obliterans (TAO) in Japan have not been updated extensively.Methods and Results:This retrospective study used the Japanese Ministry of Health, Labour and Welfare (JMHLW) medical support system database and associated health insurance data. The number of medical financial support recipients registered as TAO patients and estimated prevalence of TAO decreased from fiscal year (FY) 2000 (10,089 and 7.95 [95% confidence interval, CI: 7.79-8.10] per 100,000 population) to FY 2010 (7,147 and 5.58 [95% Cl: 5.45-5.71] per 100,000) and leveled off until 2014. The prevalence of TAO among patients with peripheral arterial occlusive diseases declined from 7.15% (95% Cl: 7.00-7.31) in FY 2008 to 6.12% (95% Cl: 5.98-6.26) in FY 2014. Clinicodemographic features were obtained from 89 new recipients in FY 2013 and 2014: 12 (13%) women, 36 (40%) aged ≥50 years, 26 (29%) had probable onset age ≥50 years, 7 (8%) were non-smokers, and 12 (13%) had arteriosclerosis-related comorbidities. The symptoms were similar regardless of registration age, smoking history, or sex. Although 40 (45%) had digit ulcers, only 12 (13%) fulfilled Shionoya's criteria. They rarely had infrapopliteal lesions combined with upper extremity involvement or phlebitis. CONCLUSIONS: The prevalence of TAO has decreased in Japan. In the current diagnosis of TAO, various clinical characteristics including late onset, arteriosclerotic factors, non-smoking, or mild symptoms should be considered.


Assuntos
Arteriopatias Oclusivas/epidemiologia , Doença Arterial Periférica/epidemiologia , Tromboangiite Obliterante/epidemiologia , Adulto , Idoso , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Erros de Diagnóstico , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Tromboangiite Obliterante/diagnóstico , Adulto Jovem
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