Objective:The arm of trial is to study to treat serious lower extremity ischemia by low molecule weight heparin(LMWH)cooperated with sarpogrelate.Methods: We conducted a randomized cohort trial,in which 43 patients(experimental group) were assigned to apply LMWH cooperated with sarpogrelate,40 patients(compared group) were assigned to apply cilostazol cooperated with pancreatic kallikrein.To compare their validity and security between 2 groups.Results: The excellent,productive and invalid ratio of the experimental group are respectively 38.5%(30/78),48.7%(38/78)and 12.8%(10/78).Them of the compared group are respectively 10.1%(7/69),14.5%(10/69)and 75.4%(52/69)(P0.001).There is none of bleeding in two groups.Conclusion: LMWH cooperated with sarpogrelate plays a big role in increasing distance of claudication in FontaineⅡ,eliminating or alleviating rest pain in Fontaine Ⅲ or Ⅳ,promoting to form lateral branch artery,and no in increasing blooding.These give expression to validity and security in treatment of LMWH cooperated with sarpogrelate.

OBJECTIVE:To investigate the prevalence and risk factors of peripheral arterial disease (PAD) in male Chinese octogenarians and nonagenarians with hypertension.METHODS:Ankle-brachial index (ABI) was measured in the noninvasive vascular laboratory for hypertensive male octogenarians and nonagenarians enrolled from outpatient and inpatient departments. The baseline conditions were investigated using standard questionnaire and by routine physical examinations. PAD was diagnosed when an ABI≤0.9 in either lower extremity.RESULTS:Totally 290 male Chinese octogenarians and nonagenarians [age: (84.61±4.20) years] with hypertension who were receiving antihypertensive therapy were enrolled in this study, among whom 9 men with missing data except age and ABI measurements. The ABI was 0.948±0.258, with the range of highest frequency of 0.91-1.30, and 106 patients were diagnosed as PAD, 182 as non-PAD, and 2 had ABI>1.3. ABI in hypertensive men with PAD were significantly lower than in those without PAD (P<0.05). On the contrary, age, blood urea nitrogen, white blood cell counts, platelets and aspartic transaminase were significantly higher in PAD patients than in non-PAD patients (all P<0.05). The prevalence of PAD in this study population were 36.5%; more specifically, it significantly differed between different subgroups when stratified by age (28.6% vs. 46.3%, below and above 85 years), with and without hypertension (27.5% vs. 40.1%), stroke (44.7% vs. 27.5%), dyslipidemia (41.4% vs. 33.3%), coronary artery disease (44.1% vs. 13.9%), and diabetes mellitus (53.7% vs. 21.8%) (all P<0.05). The prevalences of PAD in hypertensive patients treated with diuretics, calcium antagonists, beta-blocker, or angiotensin receptor antagonist were 41.4%, 36.1%, 22.4%, and 26.8%, respectively. No association was observed between the prevalence of PAD and smoking/alcohol drinking in these subjects. Multivariate analysis showed that age (OR 1.12, 95%CI 1.014-1.238), blood urea nitrogen (OR 1.15, 95%CI 1.025-1.301), aspartic transaminase (OR 1.05, 95%CI 1.005-1.089), diabetes mellitus (OR 4.02, 95%CI 1.797-9.009), coronary artery disease (OR 6.34, 95%CI 1.734-23.214) were strong risk factors of PAD.CONCLUSION:PAD is highly prevalent among aged Chinese hypertensive men, in which age, blood urea nitrogen, aspartic transaminase, diabetes mellitus, coronary artery disease may be involved in the development of this condition.

Objective:To investigate the clinical value of color Doppler flow imaging(CDFI) in diagonosis of perforating venous insufficiency of the lower extremity.Methods:The clinical data of 64 cases(82 limbs) undergoing high ligation and striping of great saphenous vein and perforator surgery were reviewed retrospectively.The dilated and insufficient perforating venous were diagnosed and located by CDFI.The results were compared with surgery.Results:Total consistent rate,sensitivity,specificity,omission diagonostic rate,mistake diagnositic rate,Youden index,Odd product,positive predictive value,negative predictive value,and Kappa of CDFI in diagnosis of perforating venous insufficiency of the lower extremity was respectively 95.8%、96.5%、88.2%、3.5%、11.8%、0.837、206.5、98.8%、71.4% and 0.766(P0.0001).The CDFI foundings were consistent with operation results very well.Conclusion:CDFI is a useful technique for the diagnosis and locating the dilated and insufficient perforating venous correctly and provide important basis for the operation.

Objective To investigate the clinical value of color Doppler ultrasound examination in the diagonosis of acute and chronic artery occlusion of the extremities. Methods A review was made on 129 extremetiy artery occlusion patients at Anzhen Hospital during 2006 -2010. 85 cases were male, and 44 cases were female. Age was from 17 to 94 years (average: 62 ±9 years). We analyzed two-dimensional and color Doppler flow imagings of 39 acute occlusion arteries and 97 chronic occlusion arteries. We compared factors including the echoes of artery lumens, the vessel wall structures, hemodynamic parameters of inlet and outlet at the occlusion, and collaterals between groups. Results The factors of depths of vessel wall,internal diameters of ccclusion arteries, proximal resistant index and collaterals were significantly different between groups ( P ＜ 0. 05 ). The internal diameters of acute occlusion arteries were wider than chronic occlusion arteries. The depths of vessel wall, proximal resistant index and collaterals were thinner, smaller,and less than chronic occlusion arteries. The total accurate rate of differential diagnosis for acute and chronic artery occlusion by color Doppler ultrasound was 95.6％. Conclusions Color Doppler ultrasound is an effective method for the differential diagnosis of acute and chronic artery occlusion of the extremities.

Objective:To study the evaluation of color doppler flow imaging before and after carotid endarterectomy(CEA).Methods:The clinical and color doppler flow imaging(CDFI)records of 115 patients undergoing CEA for carotid artery stenosis were reviewed retrospectively.Results:After CEA,the diameter and velocity of the stenotic area of extracranial ICA returned to normal(P 0.001).During the period of follow-up,the outcomes are satisfactory.Conclusion:CEA appears to an effective method in treatment of carotid artery stenosis.CDFI can provide reliable objective basis for the operation,and it is an effective way to evaluate the operation result and follow-up.

Objective To examine outcomes of superficial vein stripping for vein varicosis caused by combination of superficial and deep venous reflux and the effect on deep vein reflux. Methods From January 2004 to December 2006, twenty patients (22 lower extremities) with combined superficial and deep venous reflux were enrolled for evaluation, patients with superficial venous reflux alone worked as controls.All patients underwent superficial vein stripping and followed up for 2 years. Venous clinic severity score (VCSS) and color duplex ultrasound test were used to evaluate the change of clinic symptoms and valve reflux of deep veins. Results Preoperative VCSS of superficial and deep vein reflux group and superficial vein reflux group was 7.1 ± 2. 9 and 6. 6 ± 2. 0 respectively (P = 0. 44). At two years after operation the VCSS was 2. 3 ± 1.2 and 1.8 ± 0. 8 respectively without significant statistic differences, whereas comparing postoperative VCSS with individual preoperative parameters there was a significant decrease (P <0. 01). In combined superficial and deep vein group, deep venous reflux reduced in 7 limbs, progressed in 4 limbs, no change in 12 limbs. While in superficial reflux alone group, deep venous reflux occurred in 4 limbs.Conclusions Superficial vein stripping effectively improves symptoms of great saphenous vein varicosis of lower extremity caused by combination of superficial and deep vein reflux without a significant effect on the stares of deep vein reflux.

Objective To explore segmantal blood pressure ratio in Doppler ultrasound in the evaluation of distal outlets in lower extremity atherosclerosis ocllusion patients undergoing blood vessel prosthesis and provide references to surgical indications. Methods A review research was made on 166 lower extremity atherosclerosis ocllusion patients receiving blood vessel prosthesis therapy in Anzhen hospital in 1998--2005. We analyzed related factors including segmantal blood pressure ratio to potency rate, evaluated the difference of segmantal blood pressure ratio between groups in which the blood vessel prosthesis was patent and that it was not. Results The difference of segmantal blood pressure ratio of outlet is one of the highest risk among risk factors. The Mean ± SDs of segmantal blood pressure ratio of outlet in patent and obstructed groups were 0. 12±0. 09 and 0. 24±0. 14 respectively. The difference of segmantal blood pressure ratio of outlet has a significant difference between the two groups ( P = 0. 001 ). The corresponding 95% confidence interval of patent group is (0,0. 27). Conclusion Doppler ultrasound is a quantitative testing method. The confidence interval of the difference of segmantal blood pressure ratio could be used as the primary reference standard for the assessment of the outlet and to expect the potency rate before the vascular surgical procedures.

OBJECTIVE:The purpose of the study was to investigate the relationship between peripheral arterial disease (PAD) and coronary artery disease or stroke in Chinese. At the same time, investigate the prevalence of symptoms, include cold, numb, pain, intermittent claudication and ulcer, then investigate the relationship between abnormal ABI and them.METHODS:Hospitalized patients in department of cardiology, neurology and vascular were enrolled from March 2006 to December 2007 consecutively. ABI was measured and the disease history was collected. Elective Fraction (EF), cardioangiography of coronary artery, and ultrasound examination of cervical artery were recorded too to analyze the relationship between them and ABI. The degree of cold, numb, pain, intermittent claudication and ulcer were recorded in patients with PAD, to analyze the relationship between the prevalence and ABI.RESULTS:In 132 patients of department of cardiology, the prevalence of ABI < 0.9 was 29.5%, In 124 patients of department of neurology, the prevalence of ABI < 0.9 was 17.7%. When ABI decreased, the EF decreased too, and the disease of coronary artery and cervical artery became more serious. In patients of vascular department, when ABI decreased, the symptoms of cold, numb, pain, intermittent claudication and ulcer aggravated.CONCLUSIONS:In Chinese, in patients with coronary artery disease, the prevalence of PAD is 29.5%, and in patients with stroke the prevalence of PAD is 17.7%. 7.2% patients have these three disease. PAD has relationship with the severity of these two diseases. In patients with PAD, the symptoms will aggravate when ABI decreased. When ABI < 0.4, the symptoms all aggravate significantly.

目的:研究外周血白细胞(white blood cell,WBC)计数等指标与下肢动脉硬化性缺血疾病的相关性.方法:用独立样本t检验回顾性分析下肢动脉硬化性缺血疾病组与非下肢动脉硬化性缺血疾病组WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数及血小板计数等的统计学差异.结果:缺血组WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数明显高于非缺血组患者(P＜0.01),分别为(7.15±0.62 vs 4.97±0.8)×109/L,(4.59±1.57 vs 3.10 ±0.72)×109/L,(1.92 ±0.74 vs 1.41±0.60)×109/L,(0.41±0.16 vs 0.30±0.01)×109/L及(224±66.8 vs 189±51.7)G/L.结论:炎性细胞及血小板等参与了下肢动脉硬化性缺血疾病的形成过程.

Objective To evaluate the different value of color Doppler ultrnsonography and Doppler vascular examinations in diagnosis for deep venous thrombosis(DVT)in the lower extremities.Methotis Imaging of color Doppler ultrasound scanning was employed as diagnostic criteria for DVT on 178 lower extremities of 146 suspected patients,as compared to the result by Doppler vascular examinations.Results Color Doppler ultrasonograph showed hish accuracy in diagnosis for DVT,as compared to that by Doppler vascular examination with 97.9 percent(142/145)positive for the femoral and popliteal veins and relatively lower positive diagnostic vallie for thrombosis in the inferior vena cava,iliac vein,anterior tibial vein,posterior tibial vein and calf veins.Conclusions Color Doppler ultrasonography is superior to Doppler vascular examination in determining DVT of the lower extremities and can be used as a main diagnostic method for it.Doppler vasculiar examination can be used as an initial screening method for DVT and deep venous angiography should not be used as a routine diagnostic measure for it.

Objective To evaluate the diagnostic role of color Doppler ultrasonogarphy(CDU),Doppler ultrasound(DU)in the diagnosis of lower extremity deep venous thrombosis(DVT). Methods In this study,84 patients(92 lower extremities)of lower extremity DVT were underwent CDU and DU and lower extremity deep venous angiography respectively. Results Total consistent rate,sensitivity,specificity,omission diagnostic rate,mistake diagnostic rate,Youden index,Odd product.positive predictive value,negative predictive value and Kappa of CDU in diagnosing lower extremity DVT was respectively 96.7%,95.7%,97.8%,4.3%,2.2%,0.935,990.0,97.8%.95.7%and 0.935(P=0.037).As Kappa of CDU(0.935)＞0.75 and its P(0.037)＜0.05.CDU can theoreticallv substitute for deep venous angiography;Above-mentioned indexes of DU were respectively 89.1%,87.2%,91.1%,12.8%,8.9%,0.783,70.0,91.1%,87.2%and 0.783(P=0.065). Conclusion CDU iS becoming preferred and more reliable noninvasive method in diagnosing lower extremitv DVT.

目的 调查动脉硬化闭塞症累及下肢造成的周围动脉性疾病与冠心病和脑卒中发病率的相关性,以及这3种疾病严重程度的相关关系.明确患者是否需要统一进行踝臂指数(ABI)的检查.方法 自2006年3月至2007年12月对心脏科、神经科、血管科患者进行ABI的测量并记录病史、射血分数、冠状动脉造影和颈动脉超声结果 ,计算患者中ABI降低的发生率,并统计ABI与观察指标的相关性.结果 心脏科132例患者,ABI＜0.9者占29.5%;神经科124例患者,ABI＜0.9者占17.7%,其中缺血性脑卒中109例,ABI＜0.9的发生率为14.7%;出血性脑卒中15例,ABI＜0.9者占40%.随着ABI的降低,患者射血分数逐渐降低,冠状动脉和颈动脉病变程度也逐渐加重.结论 周围动脉性疾病,冠状动脉硬化性心脏病和脑卒中都是动脉硬化闭塞症在全身不同部位的表现,周围动脉性疾病的严重程度与冠心病和脑卒中的严重程度相关,无论患者以哪一种疾病为首发症状就诊,对全身血管的全面检查都很重要.