cardiovascular-agents and Arteriosclerosis-Obliterans

The "leave nothing behind" strategies have been becoming a popular treatment for femoropopliteal arteriosclerosis obliterans. Atherectomy before drug-coated balloon (DCB) angioplasty may have an advantage in improving the efficiency of drug delivery into the blood vessel wall. This study aimed to compare the therapeutic effects of directional atherectomy combined with DCB angioplasty with DCB angioplasty alone in the treatment of femoropopliteal arteriosclerosis obliterans.. Patients with femoropopliteal arteriosclerosis obliterans who received endovascular therapy from June 2016 to June 2018 in our hospital and presented with life-limiting claudication or severe chronic limb ischemia comprised the study cohort. The patients were randomized to receive directional atherectomy combined with DCB angioplasty (n = 45) or DCB alone (n = 49). Ninety-four patients were enrolled in our study with 72 males, and the mean age was 67 ± 10 years. The mean lesion length was 112 ± 64 mm.. There were no significant differences in the baseline characteristics of patients and lesions between the 2 randomized groups (P > 0.05). Flow-limiting dissections occurred more frequently in the DCB group (n = 12; 24.5%) than in the DA-DCB group (n = 2; 4.4%; P = 0.006). The technical success rate in the DA-DCB group was superior to that in the DCB group (95.6% vs. 75.5%, P = 0.006). The mean follow-up duration was 16.7 ± 6.1 months in the DCB group and 15.3 ± 5.8 months in the DA-DCB group. No amputations were performed. The overall mortality in the DCB group was 4.1% (2/49), while all patients survived in the DA-DCB group. The 12-month and 24-month primary patencies in the DA-DCB group were greater than those in the DCB group (80.5% vs. 75.7% and 67.1% vs. 55.1%, respectively); however, using all available patency data, no significant differences over time were observed (P = 0.377).. In this study, directional atherectomy combined with DCB angioplasty can decrease the flow-limiting dissection rate in the treatment of femoropopliteal arteriosclerosis obliterans compared with DCB angioplasty alone. There was no significant difference between the 2 groups in terms of primary patency rate which was needed to be further clarified.

Topics: Aged; Angioplasty, Balloon; Arteriosclerosis Obliterans; Atherectomy; Beijing; Cardiovascular Agents; Chronic Disease; Coated Materials, Biocompatible; Female; Femoral Artery; Humans; Intermittent Claudication; Ischemia; Male; Middle Aged; Popliteal Artery; Prospective Studies; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency

To evaluate the effect of sarpogrelate for patients with atherosclerotic obliterans (ASO).. Patients with ASO were randomly divided into sarpogrelate group (n = 92) and control group (n = 84). The patients in sarpogrelate group received sarpogrelate (100 mg, tid), whereas in control group aspirin (100 mg, qd) was administered orally. The patients were followed up monthly to observe any side effect of medication. Clinical manifestation, painless walking distance, Rutherford type and ankle brachial Index (ABI) were studied.. In comparison with control group, the severity of pain, Rutherford type 0 and 1 were improved with statistic significance. Incidence of patients with intermittent claudication decreased from 56.6% before treatment to 28.3% after treatment; the painless walking distance was prolonged (116.3 ± 72.3m vs. 243.5 ± 175.3m, P <0.001); ABI values were increased (0.74 ± 0.17 vs. 0.86 ± 0.18; p <0.001). No side effect of medication was observed.. Sarpogrelate has a therapeutic effect on patients with atherosclerotic obliterans.

Topics: Aged; Ankle Brachial Index; Arteriosclerosis Obliterans; Cardiovascular Agents; Chi-Square Distribution; China; Exercise Test; Exercise Tolerance; Female; Hemodynamics; Humans; Intermittent Claudication; Male; Middle Aged; Pain Measurement; Predictive Value of Tests; Prospective Studies; Recovery of Function; Severity of Illness Index; Succinates; Time Factors; Treatment Outcome; Walking

We studied the effects of prostacyclin (PGI2) and its stable analog, iloprost, on blood fibrinolytic activity in 33 patients with peripheral arterial disease. Ten subjects (group A) received three 5-hour infusions of iloprost on three consecutive days. The remaining 23 patients received three different 5-hour infusions (placebo, iloprost 2 ng/kg/min, PGI2 5 ng/kg/min). Tissue plasminogen activator (t-PA), total plasma fibrinolytic activity and euglobulin clot lysis time (ECLT) were determined in patients before and after each infusion, both in freely flowing blood samples and following 10 min venous occlusion. In patients of group A, ECLT at rest was significantly shortened after all three iloprost infusions (on average by about 5-11%). First and third infusions produced also shortening of ECLT after venostasis (by 21 and 32%). Statistically significant rise in t-PA activity (by about 68% on average) accompanied only the first infusion. In patients of the group B iloprost provoked significant fall in ECLT at rest (by about 19% on average) only. PGI2 shortened ECLT both at rest and after venous occlusion (by about 17% and 20% on average, respectively) and led to a rise in t-PA activity after venous occlusion by about 33% on average. Our results indicate that prostacyclin and its stable analog, iloprost, enhance fibrinolytic activity in man by releasing or facilitating the release of tissue plasminogen activator from the vessel wall.

Topics: Adult; Arteriosclerosis Obliterans; Cardiovascular Agents; Epoprostenol; Female; Fibrinogen; Fibrinolysis; Humans; Iloprost; Male; Thromboangiitis Obliterans; Tissue Plasminogen Activator

The effect of pharmacotherapy or supervised exercise training on patients with intermittent claudication was assessed.. One hundred patients with stable intermittent claudication due to arteriosclerosis obliterans were analyzed. We divided the patients into 2 groups: patients treated by pharmacotherapy alone (Group A: 39 claudicants) and patients treated by supervised exercise training and pharmacotherapy (Group B: 61 claudicants). The changes in ankle-brachial pressure index (ABI) and recovery time of ABI after a 40-m walk (RT(40)) and absolute claudication distance (ACD) on a treadmill before and after each treatment were assessed.. In Group A, RT(40) decreased from 9.5 +/- 5.8 min at the baseline to 6.4 +/- 3.5 min after 6 months (P=0.0002). In Group B, it decreased from 9.7+/-5.2 min at the baseline to 6.3+/-4.2 min after 3 weeks (P<0.0001). In Group A, ACD increased from 249+/-177 m at the baseline to 317+/-168 m after 6 months (P=0.0003). In Group B, it increased from 143+/-90 m at the baseline to 257+/-161 m after 3 weeks (P<0.0001).. Hemodynamics and walking ability were improved by either short-term supervised exercise training or midterm pharmacotherapy. RT(40) may be useful for predicting the effect of conservative treatment on intermittent claudication. Greater increases in ACD after treatment can be achieved in claudicants with a shorter RT(40) before conservative treatment.

Topics: Aged; Aged, 80 and over; Ankle Brachial Index; Arteriosclerosis Obliterans; Blood Pressure; Cardiovascular Agents; Combined Modality Therapy; Exercise Test; Exercise Therapy; Exercise Tolerance; Female; Humans; Intermittent Claudication; Male; Middle Aged; Time Factors; Treatment Outcome

We aimed to determine the current status of the medical expenses for the treatment of arteriosclerosis obliterans (ASO) and evaluate the cost effectiveness of the medical practices employed in ASO treatment in Japan.. We performed a prospective observational study using 140 ASO patients. The cost of the medical practices comprised the costs of outpatient treatment, pharmacological agents, and hospitalization. To compare the average monthly costs, the patients were divided into preintervention, postintervention, or conservative-therapy groups. To compare the total costs and effectiveness of each treatment, the patients who had first visited our division during the study period were classified into surgery, endovascular-revascularization (EVR), or conservative-therapy groups. The adverse reactions of the 4 most popular agents for ASO were investigated, and bleeding events were assessed specifically.. The average monthly costs for outpatient treatment and pharmacological agents were yen 168,002 in conservative cases, yen 149,871 in preoperation cases, and yen 128,527 in postoperation cases. The mean total costs were yen 5,407,950 in conservative cases, yen 7,375,290 in surgical cases, and yen 2,631,650 in EVR cases. The average change of the gauge in clinical status was 0.57 in conservative cases, 2.13 in surgical cases, and 2.25 in EVR cases. Warfarin induced more bleeding complications than the other agents.. The costs of pharmacological agents represented much of the medical costs in any treatment groups.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Amputation, Surgical; Angioplasty, Balloon; Arteriosclerosis Obliterans; Cardiovascular Agents; Combined Modality Therapy; Cost-Benefit Analysis; Drug Costs; Female; Health Care Costs; Hospital Costs; Hospitalization; Humans; Japan; Male; Middle Aged; Models, Economic; Outcome and Process Assessment, Health Care; Prospective Studies; Stents; Treatment Outcome; Vascular Surgical Procedures

Topics: Arterial Occlusive Diseases; Arteriosclerosis Obliterans; Cardiovascular Agents; Humans; Ischemic Attack, Transient; Raynaud Disease

Iloprost, a stable analogue of carbaprostacyclin, was infused for 72 h to 9 patients with advanced obliterative arterial disease. Total peripheral and pulmonary vascular resistances and blood pressure were decreased. Cardiac output was elevated with no marked extra cardiac load. The glomerular filtration rate was increased and tubular reabsorption of sodium and water reduced. Consequently, urine excretion increased. The renin-angiotensin system was not activated but excretion of renal kallikrein was augmented. Several patients showed clinical improvement. The drug was well tolerated except for gastrointestinal side-effects with the dose of 4 ng X kg-1 X min-1 or more.

Topics: Adult; Arteriosclerosis Obliterans; Blood Pressure; Cardiac Output; Cardiovascular Agents; Epoprostenol; Female; Glomerular Filtration Rate; Humans; Iloprost; Kallikreins; Kidney; Male; Middle Aged; Pulmonary Circulation; Vascular Resistance

Topics: Aged; Arteriosclerosis Obliterans; Cardiovascular Agents; Drug Evaluation; Epoprostenol; Female; Humans; Iloprost; Infusions, Parenteral; Leg; Male; Middle Aged; Prospective Studies

Topics: Arterial Occlusive Diseases; Arteriosclerosis Obliterans; Cardiovascular Agents; Drug Evaluation; Drug Therapy, Combination; Endarteritis; Humans; Infusions, Intra-Arterial; Leg; Middle Aged

Topics: 1-Propanol; Arteriosclerosis Obliterans; Cardiovascular Agents; Diabetic Angiopathies; Geriatrics; Humans; Isoxsuprine; Muscle Relaxants, Central; Phenethylamines; Raynaud Disease; Thromboangiitis Obliterans; Vasodilator Agents

Topics: Arteriosclerosis Obliterans; Cardiovascular Agents; Drug Therapy; Humans; Raynaud Disease; Tolperisone; Vasodilator Agents

Topics: Arteriosclerosis Obliterans; Cardiovascular Agents; Endarteritis; Humans; Muscle Relaxants, Central; Parasympatholytics; Pharmacology; Vasodilator Agents

Topics: Arteriosclerosis; Arteriosclerosis Obliterans; Cardiovascular Agents; Hexamethonium; Humans; Muscle Relaxants, Central