系统治疗糖尿病性下肢动脉硬化闭塞症的疗效相关因素及干预作用的实验与临床研究
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摘要
目的
探讨一体化系统治疗(复合术式：取栓+球囊扩张+支架植入、内膜剥脱+球囊扩张+支架植入,腔内血管成形术：球囊扩张+支架植入)复杂型糖尿病性下肢动脉硬化闭塞症(DLASO)的疗效、影响疗效的相关因素及其阿托伐他汀干预作用的研究。
方法
1.选择住院治疗的338例下肢动脉硬化闭塞症患者,随机分为两组,其中糖尿病性下肢动脉硬化闭塞症(diabetes lower extremity arteriosclerosis obliterans DLASO)198例(61例为双侧病变)259侧肢体,非糖尿病性下肢动脉硬化闭塞症(lower extremity atherosclerotic occlusive disease,LEAOD)120例(41例为双侧病变)161侧肢体。根据术前的CTA (CT血管造影)结果制定治疗方案。术前CTA提示病变血管有血栓者先行取栓治疗,股浅动脉开口处狭窄或闭塞者先行局部内膜剥脱术,术中血管造影确定病变血管狭窄部位,再行血管腔内介入治疗。主要操作步骤：术野消毒,局部麻醉成功后,切开皮肤及浅筋膜,游离出股总动脉、股浅动脉及股深动脉,静脉内注射肝素50mg(按每公斤体重0.8mg计算),阻断总动脉、股深动脉及股浅动脉或髂动脉远心端,切开股浅动脉前壁约1.5cm,应用5F的球囊取栓导管插入股浅动脉或髂动脉取出的血栓,股动脉开口处闭塞者行局部内膜剥脱术。造影证实病变部位及程度。选择适当导丝,必要时选择导管导丝配合使导丝通过狭窄或闭塞的病变部位。根据病变部位及长度选择相应的球囊(意大利英泰克公司生产的球囊：球囊直经2.50mm、3.00mm、4.00mm、6.00mm、7.00mm,长度40mm、60mm、80mm、120mm)进行扩张,以标准压力泵扩张,压力为6～12atm,每次扩张1-3min,必要时可重复1～2次,术中经动脉给予5000U～7000U的肝素。术中遇有夹层或扩张效果不佳时植入镊钛合金支架(美国强生公司)。术毕经动脉给予尿激酶100000U。如果术后病变血管出现痉挛,经动脉注射0.1～0.2mg硝酸甘油。术后对于流出道不良的患者,患肢动脉内留置硬膜外导管,持续输入凯时20ug+生理盐水200ml治疗1周。术后皮下注射低分子肝素5000U/12h一次,连用5d,终生口服阿司匹林100mg/d。通过病人复诊和电话联系对出院患者进行6-36个月的随访。观察患者的跛行症状、静息痛的变化,进行阶段性测压、多普勒血流测定；必要时行CTA检查,判断血管的通畅情况,所有数据经Excel录入,SPSS10.0统计软件分析。
2.采用腔内血管成形术治疗160例(DLASO108侧肢体、LEAOD113侧肢体),人工血管旁路移植术治疗68例DLASO33侧肢体、LEAOD35侧肢体,两组在性别、年龄等方面无显著性差异,具有可比性。系统观察其出院后的疗效结果,同时调查并记录每个人的吸烟、高血压、高胆固醇血症、血糖控制不稳等生活习性情况,将所得数据进行统计分析,观察影响疗效的相关因素。
3.将24只新西兰白兔随机分为四组：正常对照组(N组),高脂模型组(Ⅰ组)、高脂+球囊损伤模型组(Ⅱ组)、高脂+球囊损伤+阿托伐他汀组(Ⅲ组)。正常对照组给予普通饲料喂养.其余三组给予含1.3%胆固醇饲料.高脂饮食后一周开始阿托伐他汀5mg/kg/d)7周,第五周末行球囊损伤术,第1周末、第9周末取空腹血标本,测胆固醇(TC)、甘油三酯(TGh TNF-α、 IL-6等炎症因子。实验末取损伤腹主动脉中段动脉行HE染色,β型血小板源性生长因子受体(PDGFR-β)免疫组化染色,组织病理学分析。
4.选择复合术式治疗的糖尿病性下肢动脉硬化闭塞症患者118例,随机分为对照组(60例)和观察组(58例),观察组每日一次口服阿托伐他汀20mg,两组均给予每日一次口服肠溶阿司匹林100mg治疗,观察两组治疗前及治疗后4周、12周、24周、的病变血管的通畅率、C反应蛋白(CRP)、血脂及下肢动脉内-中膜厚度(IMT)变化情况,观察阿托伐他汀对病变血管通畅率的影响。
结果
1.复合术式治疗DLASC、 LEAOD的首次通畅率318例患者中初次治疗成功率分别为,DLAOD初级血管90%,次级血管92%,LEAOD初级血管91%,次级血管94%。随访6～36个月,复诊时患者复查CTA,观察其下肢血管的通畅情况。两组的首次通畅率随随访时间延长而降低,DLAOD组尤为明显。随访24个月后,DLASO次级血管的通畅率显著低于LEAOD (P<0.05)。
2.复合术式治疗DLASO、 LEAOD的累积二次通畅率随访6-36个月,D1ASO初级血管的累积二次通畅89%～67%,次级血管的累积二次通畅率为93%～73%。结果表明DLASO初级血管的通畅率低于LEAOD初级血管的通畅率,但无统计学意义；DLASO与LEAOD患者再狭窄或闭塞后可反复行血管腔内治疗,且疗效满意。
3. DLASO, LEAOD支架植入后狭窄率的比较两组支架植入组的狭窄率显著低于单纯球囊括张组(P<0.05)。单纯球囊扩张与支架植入后的狭窄率DLASO组均高于LEAOD组,但无统计学意义。DLASO与LEAOD组支架植入可有效减低再狭窄的发生。
4.复合术式治疗DLASO与LEAOD的临床疗效LDLASO患者“复合术式”二次治疗成功率高于DLASO患者,DLASO患者的截肢率高于LDLASO患者,但均无统计学意义。
5.腔内血管成形术与人工血管旁路移植术治疗下肢动脉硬化闭塞症的疗效比较及其相关影响因素的研究人工血管旁路移植术治疗DLASO, LEAOD次级血管行腔内后初级血管的通畅率与单纯腔内治疗无差别,即无统计学意义。腔内血管成形术治疗DLASO复发率相关因素分析将单因素分析发现的与DLASO行腔内血管成形术治疗后复发率有关的因素：吸烟、高血压、高胆固醇血症、血糖控制不稳,引入logistic回归模型分析,在多因素水平筛选与复发率相关的因素,吸烟、高血压、血糖控制不稳3个因素是DLASO行复合术式治疗后复发率相关的因素。
6.动物实验表明：高脂模型组(Ⅰ组)、高脂+球囊损伤模型组(Ⅱ组)血胆固醇明显升高,阿托伐他汀可降低血胆固醇。Ⅰ、Ⅱ组兔血IL-6、TNF-a较正常组明显升高(P<0.05)。Ⅲ组(阿托伐他汀干预组)与Ⅱ组(单纯球囊损伤模型组)比较血IL-6、TNF-a含量明显下降(P<0.05)。阿托伐他汀治疗组所有内膜增生轻微。高脂模型组(Ⅰ组)、高脂+球囊损伤模型组免疫组化染色均有表达并高于正常对照组和阿托伐他汀干预组。
7.阿托伐他汀对复合术式治疗下肢动脉硬化闭塞症后再狭窄的干预作用两组病变血管的血管通畅率随随访时间的延长出现不同程度的下降,观察组无明显变化。随访24周后,对照组的血管通畅率明显低于观察组(P<0.05)。表明阿托伐他汀具有干预下肢动脉硬化闭塞症治疗后再狭窄的作用。
结论
1.系统方法治疗下肢动脉硬化闭塞症适应症范围广泛,可解决传统方法不能一次性治疗复杂的病例间题,此术式在局部麻醉进行,最大限度地减少了麻醉带来的并发症的风险,同时也减少了传统手术对患者的过度损伤,相对缩短了治疗的时间,且可重复治疗,疗效肯定。
2.人工血管旁路移植术治疗DLASO、 LEAOD与单纯腔内治疗效果没有差别。吸烟、高血压、血糖控制不稳3个因素与DLASO治疗后再狭窄及闭塞相关。控制相关影响因素,可有效提高下肢动脉硬化闭塞症治疗的疗效。
3.高胆固醇饮食加球囊损伤可造成广泛的内膜的增生,阿托伐汀治疗可减轻内膜增生。球囊损伤造成血管中膜厚度增加,PDGFR-β表达增。阿托伐他汀治疗组血管中表达减少,中膜无明显增厚。
4.阿托伐他汀抑制血管内膜的增生,阻止了病变血管动脉硬化的进程。阿托伐他汀有预防系统治疗后病变血管再狭窄的作用,提高了系统治疗病变血管的通畅率。
Objective
To explore the efficacy and influencing factors of "complex procedures"(embole-ctomy+balloon dilatation+stent implantation, Intimectomy+balloon dilatation+stent implantation) treatment of complex diabetes lower extremity arteriosclerosis obliterans (DLASO).
Methods
1. From August2007to August2010,338hospitalized patients in Baoding Second Hos-pital Vascular Surgery with lower extremity arterial occlusive disease were Chosen and randomly divided into two groups. There are198patients with diabetes lowerext-remity arteriosclerosis obliterans (DLASO)(61cases of bilateral lesions) of259limbs, and120cases non-diabetic lower extremity atherosclerotic occlusive disease (LEAOD)(41cases with bilateral lesions) of161limbs. According to the preoperative CTA (CT angiography) results, we can make treatment strategies. Some patients that preoperative CTA has prompted lesions vascular with thrombosis should take thrombectomy first and others that superficial femoral artery stenosis or occlusion should adopt local endarterectomy first, by intraoperative angiography to determine lesions vascular stenosis location, then intracavitary interention. Major steps:Through the ipsilateral or contralateral femoral artery anterograde puncturing under local anesthesia, angiography can confirme the site and degree of lesion. Select the appropriate godet, if necessary, Cooperating to use the godet and catheter, the godet can through the stenosis or occlusion of the lesion. According to the location and length of the lesion,the appropriate balloon are selected (which is producted by Italian-British tektronix company:Balloon Diameter2.50mm,3.00mm,4.00mm,6.00mm,7.00mm, length of40mm,60mm,80mm,120mm) the appropriate balloon are selected for expansion at the standard pressure pump.The standard pressure is6-12atm and1-3min of each expansion, if necessary, repeat1or2times.5000U-7000U of heparin though artery should be intraoperative given. In case of intraoperative dissection or poorly expansion effect,tweezers alloy titanium stents (Johnson&Johnson) should be implantanted. End of surgery Urokinase200000U was given by arterial. If appears spasm,0.1-0.2mg of nitroglycerin may be given by artery. For patients with poor outflow tract, limb arterial indwelling epidural catheter with continuous infusion of Lipo20ug, safflower20ml and physiological saline200ml treatment1to2weeks. Subcutaneous injection of low molecular weight heparin5000U/8h each time after operation,, contin uously used for5d, and oral intake of aspirin100mg/d life-long. Followed up6to36months through the return visit and telephone contact of discharged patients. Patients were observed limp symptoms, rest pain changes, and measured of the stage pressure and Doppler blood flow; given CTA, if necessary. To judgement the patency of blood vessels and to investigate the daily life habits, medication and all of regularly biochemical test results. All data entered by Excel, SPSS10.0statistical analysis software.
2. There are160patients with lowerext-remity arteriosclerosis obliterans were accepted the cavity forming therapy. There are68patients with lowerext-remity arteriosclerosis obliterans were accepted the artificial blood vessel bypass graft treatment else.We investigated the efficacy of treatment, respectively. We recorded daily life habits of two groups such as smoking, hypertension, high cholesterol, poor blood glucose control at the same time. The data were analyzed to observe the factors influencing efficacy.
3.24New Zealand white rabbits were randomly divided into for group:normal control group,fat model group, balloon-injured modle group, atorvastatin treated group. The control group was fed with ordinary diet,other groups were fed on cholesterol-rich diet, followed an injured by dilated balloon on abdominal artery at the end of the5th week. Blood samples were collected at the end of the first and9th week for Examination of serum lipid levels、TNF-a levels and IL-6levels. The abdominal arteries were harvested for histomorphometic analysis the pathogenic features of the arterial wall were showed by HE stain assay.Immunohistochemistry was employed to detect the expression of PDGFR-β.
4.118patients with lower extremity arterial occlusive disease were accepted "complex procedures" treatment and randomly divided into two groups(60cases in the control group/58cases in the Observation group). Both groups were treated with aspirin100mg daily. Observation group were treated with atorvastatin20mg daily addition. Patients were observed vascular patency rate, CRP, lipids and IMT before treatment and after treatment for4weeks,12weeks,24weeks. We observeded effects of atorvastatin on the patency rate of vascular lesions.
Results
1. First Patency rate for the DLASO, LEAOD with the treatment of complex procedures:The initial treatment success rates in318patients were, DLAOD90%of the primary vessels,92%of the secondary vessels, LEAOD91%of the primary vessels,94%of the secondary vessels respectively. Followed up for6to36months, the patients should be rechecked CTA when they return visit, to observe the patency of lower limb vascular. First Patency rate of the two groups reduces with longer follow-up time, DLAOD group is significantly evident. After24months of follow-up, the secondary vascular patency rate was significantly lower than LEAOD (P<0.05).
2. DLASO, LEAOD with complex procedures treatment of complex cumulative secondary patency rate:Followed up6to36months, cumulative secondary patency rate of primary vascular is93%and of subprime vascular is73%in DLASO. The results show that primary vascular patency rate in DLASO is inferior to LEAOD, which have no statistical significance; DLASO and LEAOD patients with restenosis or occlusion should be given repeated endovascular treatment, and the results were satisfactory.
3. The rate of stenosis after implantation DLASO or LEAOD stent were compared:The rate of stenosis in DLASO or LEAOD group was significantly lower than only balloon dilatation(P<0.05). However, in Simple balloon dilatation with stent implant, the rate of stenosis DLASO group was higher than LEAOD group, but it is not statistically significant. In all, DLASO or LEAOD group with stent implant can effectively reduce the recurrence of stenosis.
4. Clinical effects of "complex procedures" treatment with DLASO and LEAOD:The results show that Secondary treatment success rates in LDLASO Patients was higher than in DLASO Patients. Amputation rate in patients with DLASO was higher than patients with DLASO. They have no statistical significance.
5. The relationship between the recurrence rate after DLASO and associated factors:This is no difference on the primary patency rate in the bypass graft treatment group and endovascular treatment group.The related factors about the recurrence rate after DLASO was analysed in a simple linear regression analysis. The result showed that smoking, hypertension, hype-rcholesterolemia and uncontrol blood glucose were the influential factors for the rec-urrence rate in the model, which were introduced into the logistic regression analys-is and in the level of the multivariate factors screen factors associated with recuren-ce rate. The result showed that smoking, hypertension and uncontrol blood glucosea-re associated with the recurrence rate after DLASO.
6. Animal experiment:Compared with the control group, the serum total cholesterol levels of rabbits fed with high cholesterol diet were higher(P<0.01),Treatment with atovastatin lowed serum lipid levels(P<0.05). The serum levels of IL-6and TNF-a increased in fat model group, and balloon-injured modle group(P<0.05). The serum levels of IL-6and TNF-a lowed in atorvastatin treated group(P<0.05). The intima thickness in atovastatin treated group were much more decreased than injured modle group(P<0.01). Fat model group and balloon-injured modle group had higher level of expression of PDGFR-β compared with control group and atorvastatin treated group.
7. Intervention role of Atorvastatin in LEAOD patients with restenosis:Two patency rate of vascular lesions were decreased to varying degrees With the follow-up time.We have not seen the same change in the observation group. Followed up for24weeks, the patency rate of the control group was significantly lower than the observation group(P<0.05). Atorvastatin may have a Intervention role in patients with restenosis.
Conclusion
1. The "complex procedures" method has a wide range of indications for Treatment arteriosclerosis obliterans and can also be used to treat complex patients who are untreated with the traditional method. The surgical procedures are under local anesthesia that materially minimizes the risk of complications which are caused by anesthesia, reduces the danger of excess injury for patients by traditional surgery and relatively shortens the time of treatment, besides, it can be repeated and it is undoubtedly about its effect.
2. Primary patency rate was not significantly different in the people who were accepted cavity forming therapy or artificial blood vessel bypass graft treatment. Three factors including smoking, hypertension and uncontrol blood glucose are related to the repeated LASO. The efficacious prognosis of patients who had arterial occlusive disease can be improved in control of these related factors. Further research about intervention endovascular treatment for resist restenosis is needed.
3. Atorvastatin can inhibit vascular stenosis in high cholesterol diet plus balloon injured rabbit modle by reducing serum lipids, inflammatory factors. The media thickess were increased in abdominal artery after balloon injury, atorvastatin can protect the abdomal artery from this injury, the expression of PDGFR-β in arterial walls in atorvastatin treated group may contributed to this protective effect.
4. Atorvastatin can restrain the hyperplasia of vascular endothelial, it can prevent the disease process of atherosclerosis at the same time. Atorvastatin can prevent restenosis after systemic treatment of diabetic arteriosclerosis obliterans. Patency rate was increased by atorvastatin
探讨一体化系统治疗(复合术式：取栓+球囊扩张+支架植入、内膜剥脱+球囊扩张+支架植入,腔内血管成形术：球囊扩张+支架植入)复杂型糖尿病性下肢动脉硬化闭塞症(DLASO)的疗效、影响疗效的相关因素及其阿托伐他汀干预作用的研究。
方法
1.选择住院治疗的338例下肢动脉硬化闭塞症患者,随机分为两组,其中糖尿病性下肢动脉硬化闭塞症(diabetes lower extremity arteriosclerosis obliterans DLASO)198例(61例为双侧病变)259侧肢体,非糖尿病性下肢动脉硬化闭塞症(lower extremity atherosclerotic occlusive disease,LEAOD)120例(41例为双侧病变)161侧肢体。根据术前的CTA (CT血管造影)结果制定治疗方案。术前CTA提示病变血管有血栓者先行取栓治疗,股浅动脉开口处狭窄或闭塞者先行局部内膜剥脱术,术中血管造影确定病变血管狭窄部位,再行血管腔内介入治疗。主要操作步骤：术野消毒,局部麻醉成功后,切开皮肤及浅筋膜,游离出股总动脉、股浅动脉及股深动脉,静脉内注射肝素50mg(按每公斤体重0.8mg计算),阻断总动脉、股深动脉及股浅动脉或髂动脉远心端,切开股浅动脉前壁约1.5cm,应用5F的球囊取栓导管插入股浅动脉或髂动脉取出的血栓,股动脉开口处闭塞者行局部内膜剥脱术。造影证实病变部位及程度。选择适当导丝,必要时选择导管导丝配合使导丝通过狭窄或闭塞的病变部位。根据病变部位及长度选择相应的球囊(意大利英泰克公司生产的球囊：球囊直经2.50mm、3.00mm、4.00mm、6.00mm、7.00mm,长度40mm、60mm、80mm、120mm)进行扩张,以标准压力泵扩张,压力为6～12atm,每次扩张1-3min,必要时可重复1～2次,术中经动脉给予5000U～7000U的肝素。术中遇有夹层或扩张效果不佳时植入镊钛合金支架(美国强生公司)。术毕经动脉给予尿激酶100000U。如果术后病变血管出现痉挛,经动脉注射0.1～0.2mg硝酸甘油。术后对于流出道不良的患者,患肢动脉内留置硬膜外导管,持续输入凯时20ug+生理盐水200ml治疗1周。术后皮下注射低分子肝素5000U/12h一次,连用5d,终生口服阿司匹林100mg/d。通过病人复诊和电话联系对出院患者进行6-36个月的随访。观察患者的跛行症状、静息痛的变化,进行阶段性测压、多普勒血流测定；必要时行CTA检查,判断血管的通畅情况,所有数据经Excel录入,SPSS10.0统计软件分析。
2.采用腔内血管成形术治疗160例(DLASO108侧肢体、LEAOD113侧肢体),人工血管旁路移植术治疗68例DLASO33侧肢体、LEAOD35侧肢体,两组在性别、年龄等方面无显著性差异,具有可比性。系统观察其出院后的疗效结果,同时调查并记录每个人的吸烟、高血压、高胆固醇血症、血糖控制不稳等生活习性情况,将所得数据进行统计分析,观察影响疗效的相关因素。
3.将24只新西兰白兔随机分为四组：正常对照组(N组),高脂模型组(Ⅰ组)、高脂+球囊损伤模型组(Ⅱ组)、高脂+球囊损伤+阿托伐他汀组(Ⅲ组)。正常对照组给予普通饲料喂养.其余三组给予含1.3%胆固醇饲料.高脂饮食后一周开始阿托伐他汀5mg/kg/d)7周,第五周末行球囊损伤术,第1周末、第9周末取空腹血标本,测胆固醇(TC)、甘油三酯(TGh TNF-α、 IL-6等炎症因子。实验末取损伤腹主动脉中段动脉行HE染色,β型血小板源性生长因子受体(PDGFR-β)免疫组化染色,组织病理学分析。
4.选择复合术式治疗的糖尿病性下肢动脉硬化闭塞症患者118例,随机分为对照组(60例)和观察组(58例),观察组每日一次口服阿托伐他汀20mg,两组均给予每日一次口服肠溶阿司匹林100mg治疗,观察两组治疗前及治疗后4周、12周、24周、的病变血管的通畅率、C反应蛋白(CRP)、血脂及下肢动脉内-中膜厚度(IMT)变化情况,观察阿托伐他汀对病变血管通畅率的影响。
结果
1.复合术式治疗DLASC、 LEAOD的首次通畅率318例患者中初次治疗成功率分别为,DLAOD初级血管90%,次级血管92%,LEAOD初级血管91%,次级血管94%。随访6～36个月,复诊时患者复查CTA,观察其下肢血管的通畅情况。两组的首次通畅率随随访时间延长而降低,DLAOD组尤为明显。随访24个月后,DLASO次级血管的通畅率显著低于LEAOD (P<0.05)。
2.复合术式治疗DLASO、 LEAOD的累积二次通畅率随访6-36个月,D1ASO初级血管的累积二次通畅89%～67%,次级血管的累积二次通畅率为93%～73%。结果表明DLASO初级血管的通畅率低于LEAOD初级血管的通畅率,但无统计学意义；DLASO与LEAOD患者再狭窄或闭塞后可反复行血管腔内治疗,且疗效满意。
3. DLASO, LEAOD支架植入后狭窄率的比较两组支架植入组的狭窄率显著低于单纯球囊括张组(P<0.05)。单纯球囊扩张与支架植入后的狭窄率DLASO组均高于LEAOD组,但无统计学意义。DLASO与LEAOD组支架植入可有效减低再狭窄的发生。
4.复合术式治疗DLASO与LEAOD的临床疗效LDLASO患者“复合术式”二次治疗成功率高于DLASO患者,DLASO患者的截肢率高于LDLASO患者,但均无统计学意义。
5.腔内血管成形术与人工血管旁路移植术治疗下肢动脉硬化闭塞症的疗效比较及其相关影响因素的研究人工血管旁路移植术治疗DLASO, LEAOD次级血管行腔内后初级血管的通畅率与单纯腔内治疗无差别,即无统计学意义。腔内血管成形术治疗DLASO复发率相关因素分析将单因素分析发现的与DLASO行腔内血管成形术治疗后复发率有关的因素：吸烟、高血压、高胆固醇血症、血糖控制不稳,引入logistic回归模型分析,在多因素水平筛选与复发率相关的因素,吸烟、高血压、血糖控制不稳3个因素是DLASO行复合术式治疗后复发率相关的因素。
6.动物实验表明：高脂模型组(Ⅰ组)、高脂+球囊损伤模型组(Ⅱ组)血胆固醇明显升高,阿托伐他汀可降低血胆固醇。Ⅰ、Ⅱ组兔血IL-6、TNF-a较正常组明显升高(P<0.05)。Ⅲ组(阿托伐他汀干预组)与Ⅱ组(单纯球囊损伤模型组)比较血IL-6、TNF-a含量明显下降(P<0.05)。阿托伐他汀治疗组所有内膜增生轻微。高脂模型组(Ⅰ组)、高脂+球囊损伤模型组免疫组化染色均有表达并高于正常对照组和阿托伐他汀干预组。
7.阿托伐他汀对复合术式治疗下肢动脉硬化闭塞症后再狭窄的干预作用两组病变血管的血管通畅率随随访时间的延长出现不同程度的下降,观察组无明显变化。随访24周后,对照组的血管通畅率明显低于观察组(P<0.05)。表明阿托伐他汀具有干预下肢动脉硬化闭塞症治疗后再狭窄的作用。
结论
1.系统方法治疗下肢动脉硬化闭塞症适应症范围广泛,可解决传统方法不能一次性治疗复杂的病例间题,此术式在局部麻醉进行,最大限度地减少了麻醉带来的并发症的风险,同时也减少了传统手术对患者的过度损伤,相对缩短了治疗的时间,且可重复治疗,疗效肯定。
2.人工血管旁路移植术治疗DLASO、 LEAOD与单纯腔内治疗效果没有差别。吸烟、高血压、血糖控制不稳3个因素与DLASO治疗后再狭窄及闭塞相关。控制相关影响因素,可有效提高下肢动脉硬化闭塞症治疗的疗效。
3.高胆固醇饮食加球囊损伤可造成广泛的内膜的增生,阿托伐汀治疗可减轻内膜增生。球囊损伤造成血管中膜厚度增加,PDGFR-β表达增。阿托伐他汀治疗组血管中表达减少,中膜无明显增厚。
4.阿托伐他汀抑制血管内膜的增生,阻止了病变血管动脉硬化的进程。阿托伐他汀有预防系统治疗后病变血管再狭窄的作用,提高了系统治疗病变血管的通畅率。
Objective
To explore the efficacy and influencing factors of "complex procedures"(embole-ctomy+balloon dilatation+stent implantation, Intimectomy+balloon dilatation+stent implantation) treatment of complex diabetes lower extremity arteriosclerosis obliterans (DLASO).
Methods
1. From August2007to August2010,338hospitalized patients in Baoding Second Hos-pital Vascular Surgery with lower extremity arterial occlusive disease were Chosen and randomly divided into two groups. There are198patients with diabetes lowerext-remity arteriosclerosis obliterans (DLASO)(61cases of bilateral lesions) of259limbs, and120cases non-diabetic lower extremity atherosclerotic occlusive disease (LEAOD)(41cases with bilateral lesions) of161limbs. According to the preoperative CTA (CT angiography) results, we can make treatment strategies. Some patients that preoperative CTA has prompted lesions vascular with thrombosis should take thrombectomy first and others that superficial femoral artery stenosis or occlusion should adopt local endarterectomy first, by intraoperative angiography to determine lesions vascular stenosis location, then intracavitary interention. Major steps:Through the ipsilateral or contralateral femoral artery anterograde puncturing under local anesthesia, angiography can confirme the site and degree of lesion. Select the appropriate godet, if necessary, Cooperating to use the godet and catheter, the godet can through the stenosis or occlusion of the lesion. According to the location and length of the lesion,the appropriate balloon are selected (which is producted by Italian-British tektronix company:Balloon Diameter2.50mm,3.00mm,4.00mm,6.00mm,7.00mm, length of40mm,60mm,80mm,120mm) the appropriate balloon are selected for expansion at the standard pressure pump.The standard pressure is6-12atm and1-3min of each expansion, if necessary, repeat1or2times.5000U-7000U of heparin though artery should be intraoperative given. In case of intraoperative dissection or poorly expansion effect,tweezers alloy titanium stents (Johnson&Johnson) should be implantanted. End of surgery Urokinase200000U was given by arterial. If appears spasm,0.1-0.2mg of nitroglycerin may be given by artery. For patients with poor outflow tract, limb arterial indwelling epidural catheter with continuous infusion of Lipo20ug, safflower20ml and physiological saline200ml treatment1to2weeks. Subcutaneous injection of low molecular weight heparin5000U/8h each time after operation,, contin uously used for5d, and oral intake of aspirin100mg/d life-long. Followed up6to36months through the return visit and telephone contact of discharged patients. Patients were observed limp symptoms, rest pain changes, and measured of the stage pressure and Doppler blood flow; given CTA, if necessary. To judgement the patency of blood vessels and to investigate the daily life habits, medication and all of regularly biochemical test results. All data entered by Excel, SPSS10.0statistical analysis software.
2. There are160patients with lowerext-remity arteriosclerosis obliterans were accepted the cavity forming therapy. There are68patients with lowerext-remity arteriosclerosis obliterans were accepted the artificial blood vessel bypass graft treatment else.We investigated the efficacy of treatment, respectively. We recorded daily life habits of two groups such as smoking, hypertension, high cholesterol, poor blood glucose control at the same time. The data were analyzed to observe the factors influencing efficacy.
3.24New Zealand white rabbits were randomly divided into for group:normal control group,fat model group, balloon-injured modle group, atorvastatin treated group. The control group was fed with ordinary diet,other groups were fed on cholesterol-rich diet, followed an injured by dilated balloon on abdominal artery at the end of the5th week. Blood samples were collected at the end of the first and9th week for Examination of serum lipid levels、TNF-a levels and IL-6levels. The abdominal arteries were harvested for histomorphometic analysis the pathogenic features of the arterial wall were showed by HE stain assay.Immunohistochemistry was employed to detect the expression of PDGFR-β.
4.118patients with lower extremity arterial occlusive disease were accepted "complex procedures" treatment and randomly divided into two groups(60cases in the control group/58cases in the Observation group). Both groups were treated with aspirin100mg daily. Observation group were treated with atorvastatin20mg daily addition. Patients were observed vascular patency rate, CRP, lipids and IMT before treatment and after treatment for4weeks,12weeks,24weeks. We observeded effects of atorvastatin on the patency rate of vascular lesions.
Results
1. First Patency rate for the DLASO, LEAOD with the treatment of complex procedures:The initial treatment success rates in318patients were, DLAOD90%of the primary vessels,92%of the secondary vessels, LEAOD91%of the primary vessels,94%of the secondary vessels respectively. Followed up for6to36months, the patients should be rechecked CTA when they return visit, to observe the patency of lower limb vascular. First Patency rate of the two groups reduces with longer follow-up time, DLAOD group is significantly evident. After24months of follow-up, the secondary vascular patency rate was significantly lower than LEAOD (P<0.05).
2. DLASO, LEAOD with complex procedures treatment of complex cumulative secondary patency rate:Followed up6to36months, cumulative secondary patency rate of primary vascular is93%and of subprime vascular is73%in DLASO. The results show that primary vascular patency rate in DLASO is inferior to LEAOD, which have no statistical significance; DLASO and LEAOD patients with restenosis or occlusion should be given repeated endovascular treatment, and the results were satisfactory.
3. The rate of stenosis after implantation DLASO or LEAOD stent were compared:The rate of stenosis in DLASO or LEAOD group was significantly lower than only balloon dilatation(P<0.05). However, in Simple balloon dilatation with stent implant, the rate of stenosis DLASO group was higher than LEAOD group, but it is not statistically significant. In all, DLASO or LEAOD group with stent implant can effectively reduce the recurrence of stenosis.
4. Clinical effects of "complex procedures" treatment with DLASO and LEAOD:The results show that Secondary treatment success rates in LDLASO Patients was higher than in DLASO Patients. Amputation rate in patients with DLASO was higher than patients with DLASO. They have no statistical significance.
5. The relationship between the recurrence rate after DLASO and associated factors:This is no difference on the primary patency rate in the bypass graft treatment group and endovascular treatment group.The related factors about the recurrence rate after DLASO was analysed in a simple linear regression analysis. The result showed that smoking, hypertension, hype-rcholesterolemia and uncontrol blood glucose were the influential factors for the rec-urrence rate in the model, which were introduced into the logistic regression analys-is and in the level of the multivariate factors screen factors associated with recuren-ce rate. The result showed that smoking, hypertension and uncontrol blood glucosea-re associated with the recurrence rate after DLASO.
6. Animal experiment:Compared with the control group, the serum total cholesterol levels of rabbits fed with high cholesterol diet were higher(P<0.01),Treatment with atovastatin lowed serum lipid levels(P<0.05). The serum levels of IL-6and TNF-a increased in fat model group, and balloon-injured modle group(P<0.05). The serum levels of IL-6and TNF-a lowed in atorvastatin treated group(P<0.05). The intima thickness in atovastatin treated group were much more decreased than injured modle group(P<0.01). Fat model group and balloon-injured modle group had higher level of expression of PDGFR-β compared with control group and atorvastatin treated group.
7. Intervention role of Atorvastatin in LEAOD patients with restenosis:Two patency rate of vascular lesions were decreased to varying degrees With the follow-up time.We have not seen the same change in the observation group. Followed up for24weeks, the patency rate of the control group was significantly lower than the observation group(P<0.05). Atorvastatin may have a Intervention role in patients with restenosis.
Conclusion
1. The "complex procedures" method has a wide range of indications for Treatment arteriosclerosis obliterans and can also be used to treat complex patients who are untreated with the traditional method. The surgical procedures are under local anesthesia that materially minimizes the risk of complications which are caused by anesthesia, reduces the danger of excess injury for patients by traditional surgery and relatively shortens the time of treatment, besides, it can be repeated and it is undoubtedly about its effect.
2. Primary patency rate was not significantly different in the people who were accepted cavity forming therapy or artificial blood vessel bypass graft treatment. Three factors including smoking, hypertension and uncontrol blood glucose are related to the repeated LASO. The efficacious prognosis of patients who had arterial occlusive disease can be improved in control of these related factors. Further research about intervention endovascular treatment for resist restenosis is needed.
3. Atorvastatin can inhibit vascular stenosis in high cholesterol diet plus balloon injured rabbit modle by reducing serum lipids, inflammatory factors. The media thickess were increased in abdominal artery after balloon injury, atorvastatin can protect the abdomal artery from this injury, the expression of PDGFR-β in arterial walls in atorvastatin treated group may contributed to this protective effect.
4. Atorvastatin can restrain the hyperplasia of vascular endothelial, it can prevent the disease process of atherosclerosis at the same time. Atorvastatin can prevent restenosis after systemic treatment of diabetic arteriosclerosis obliterans. Patency rate was increased by atorvastatin
引文
[1]许樟荣.于世界糖尿病日重谈糖尿病的诊治与预防[J].中华内分泌代谢杂志,2005,21(6)：491-493.
[2]Selvin E, Erlinger TP, Prevalence and risk factors for peripheral arterialdisease in theUnites States:results from the NationalHealth and Nutri-tion Examination Survey,1999-2000 (J).Circulation,2004,110(6):738-743.
[3]李小鹰,王洁,王全义,等·周围动脉硬化闭塞症在老年血脂异常人群中的现患率调查(J).中华老年心脑血管病杂志,2005,7(1)：3-6·
[4]汪忠镐近肾动脉腹主动脉闭塞症[J].胸心血管外科杂志,1985,4：206.
[5]Jiang ME,Huang Y,Lu M,et al.Revascularization of severly is chcmic limbs by staged arteriovenous reversal [J] Jap J Cardiovasc Surg,1999,28(4):215-220.
[6]Owens CD, Ho KJ,Conte MS.Lower extremity vein graft failure:a translational approach [J].Vasc Med,2008,13(1):63-74.
[7]Stonebridge PA,Prescott RJ,Ruckley CV. Randomizedtrial comparing infrainguinal polytetrafluoroethylene by-pass grafting with and without vein interposition cuff atthe distal anastomosis.The Joint Vascular ResearchGroup[J].J Vasc Surg,1997,26(4):543-550.
[8]Veith FJ,Gupta SK,Ascer E,et al.Six-year prospectivemulticenter randomized comparison of autologous saphe-nous vein and expanded polytetrafluoroethylene grafts ininfrainguinal arterial reconstructions[J].J Vasc Surg,1986,3(1):104-114.
[9]Oderich GS, Panneton JM,Yagubyan M,et al.Compari-son of precuffed and vein-cuffed expanded polytetrafluoroethylene grafts for infragenicular arterial reconstructions:a case-matched study[J].Ann Vasc Surg,2005,19(1):49-55.
[10]杨庭树.老年闭塞性外周动脉疾病的介入治疗进展[J].解放军保健医学杂志,2007,9(1)：4-7.
[11]GrazianiL, SilvestroA, BertoneV, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer:a new morphologic categorization of disease severity [J]. Eur J Vasc Endovasc Surg,2007,33(4):453-460.
[12]张建勇,于中丽.经皮腔内血管成形术治疗下肢动脉流出道闭塞性硬化症的临床分析[J].新疆医科大学学报,2008,31(8)：1002-1004.
[13]李晓强,桑宏飞.下肢动脉硬化闭塞症的外科手术及介入治疗[J].苏州医学,2005,29(2)：57-59.
[14]姜鑫,汪宁宁,刘丽,等.超声消融结合介入治疗慢性下肢深静脉血栓的临床研究[J].中国医学装备,2008,5(12)：17.
[15]韩冰,张宏光,周晨光等.老年糖尿病性下肢动脉硬化闭塞症的外科治疗[J].中国普通外杂志,2007,16(6)：536-538.
[16]Kawamoto A, Asahara T, LosordoDW. Transplantation of endothelial progenitor cells for therapeutic neovascularization [J]. Cardiovasc Radiat Med,2002,3(3-4):221-225.
[17]韩冰,张宏光,汪忠镐.急性肢体动脉缺血再通术后再灌注损伤的治疗[J].中华急诊医学 杂志.2003,12(11)：771-772.
[18]陈家伟.糖尿病动脉粥样硬化中的炎症机制[J].国外医学内分泌学分册,2004,24(4)：附录2-1-3.
[19]韩冰,王稼祥,王兵.下肢动脉硬化闭塞症合并血栓形成的治疗[J].中国综合临床,2010,26(2)：207-208.
[20]Klinkert P,Schepers A,Burger DH,et al.Vein versus polytetranfluoroethylene in aboveknee femoropopliteal bypass grafting:five-years of a randomized controlled trial[J].j Vase Surg,2003,37(1):149-155.
[21]Schillinger M,Sabeti S,Loewe C,et al.Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery[J].N Engl J Med,2006,354 (18):1879-1888.
[22]Adam DJ,Stonebridge PA,Belch JJ,et al.Antiplateletand anticoagulant therapy to prevent bypass graft thrombosis in patients with lower extremity arterial occlusive disease[J].Int angiol,2001,20(1):90-98.
[23]Mills SJ,Patel ST.Infrainguinal graft duplex surveil-lance:detection and treatment of graft-threatening lesions[M]//Pearce WH,Matsumura JS,Yao JST.Trends in Vascular Surgery. Illinois:Greenwood Academic,2005:51-66.
[24]Adam DJ,Beard JD,Cleveland T,et al.Bypass versus angioplasty in severe ischaemia of the leg(BASIL):multicentre,randomised controlled trial[J].Lancet,2005,366(9501):1925-1934.
[25]Dormandy JA,Rutherford RB. Management of peripheral arterial disease (PAD).TASC Working Group.TransAtlantic Inter-Society Consensus(TASC)[J]. J Vase Surg,2000,31(1 Pt 2):S1-S296.
[26]Matsi PJ,Manninen HI,Soder HK,et al.Percutaneous transluminal angioplasty in femoral artery occlusions:primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques[J].Clin Radiol,1995,50(4):237-244.
[27]Hunink MG, Wong JB, Donaldson MC,et al. Revascularization for femoropopliteal disease. Adecision and cost-effectiveness analysis[J].JAMA,1995,274(2):165-171.
[28]Muradin GS,Bosch JL,Stijnen T,et al.Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease:meta-analysis[J].Radiology,2001,221(1):137-145.
[29]Iida O, Nanto S, Uematsu M, et al.Effect of exercise on frequency of stent fracture in the superficial femoral artery[J].Am J cardio,2006,98(2):272-274.
[30]Saxon RR,Dake MD,Volqelzang RL,et al.Randomized,multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease[J].J Vase IntervRadiol,2008,19(6):823-832.
[31]韩冰,王稼祥,王兵.血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症[J].医学研究与教育,2009,27(6)：22-24.
[1]King H, Aubert RE, Herman WH. Global burden of diabetes,1995-2025:prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.
[2]Eschwege E SimonDBalkau B. The growing burden of diabetes in the world population. International Diabetes Federation Bulletin 1997;42:14-9.
[3]Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients:a comparison of severity and outcome. Diabetes Care 2001;24: 1433-7.
[4]Melliere D, Berrahal D, Desgranges P, Allaire E, Becquemin JP, Perlemuter L, et al. Influence of diabetes on revascularization procedures of the aorta and lower limb arteries: early results. Eur J Vase Endovasc Surg 1999;17:438-41.
[5]Awad S, Karkos CD, Serrachino-Inglott F, Cooper NJ, Butterfield JS, Ashleigh R, et al. The impact of diabetes on current revascularization practice and clinical outcome in patients with critical lower limb ischemia. Eur J Vasc Endovasc Surg 2006;32:51-9.
[6]Schmiedt W, Neufang A, Dorweiler B, Espinola-Klein C, Reinstadler J, Kraus O, et al. Short distal origin vein graft in diabetic foot syndrome. Zentralbl Chir 2003;128:720-5.
[7]Veith FJ, Ascer E, Gupta SK, White-Flores S, Sprayregen S, Scher LA, et al. Tibiotibial vein bypass grafts:a new operation for limb salvage. J Vasc Surg 1985;2:552-7.
[8]King SB 3rd, Kosinski AS, Guyton RA, Lembo NJ, Weintraub WS. Eight-year mortality in the Emory Angioplasty versus Surgery Trial (EAST). J Am Coll Cardiol 2000;35:1116-21.
[9]The BARI Investigators. Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status. J Am Coll Cardiol 2000;35:1122-9.
[10]Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schonberger JP, et al; Arterial Revascularization Therapies Study Group. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001 12;344:1117-24.
[11]Arana-ConejoV, DomingoMendez J. Physiopathology ofVascu-larComplications ofDiabetic Foot [J]. GacMedMex,2003,139(3):255-264.
[12]Dietzek AM, Gupta SK, Kram HB, Wengerter KR, Veith FJ. Limb loss with patent infrainguinal bypasses. Eur J Vase Surg 1990;4:413-7.
[13]Veith FJ, Ascer E, Gupta SK, White-Flores S, Sprayregen S, Scher LA, et al. Tibiotibial vein bypass grafts:a new operation for limb salvage. J Vasc Surg 1985;2:552-7.
[14]沈丽新,袁晓晨.糖尿病和动脉粥样硬化发病机制的交会点-PPARs[J]中国厂矿医学,2007,20(3)：286-287。
[15]任杰,殷瑛,赵兴胜.高血压和糖代谢调节异常对动脉硬化的影响[J].医学综述,2009,15(9)：1358-1360。
[1]Mason RP, Walter Mf, Day CA, et al. Active metabolite of atorvastatin inhibits membrane cholesterol domain formation by an antioxidant mechanism[J]. J Biol Chem, 2006,281(14):9337-9345.
[2]赵振国,江渝.动脉粥样硬化中主要炎症细胞因子的作用[J].国际检验医学杂志,2006,10,27(10)：919-920.
[3]Ma QL, Mo L, Yang TL, et al. Effects of different doses of atorvastatin on adhesion molecules of the patients undergoing percutaneous coronary intervention[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban,2006,31(6):914-916.
[4]郑春华,周胜华,刘启明, 等.阿托伐他汀对大鼠再狭窄血管醛糖还原酶表达及内膜增生的抑制作用[J].中国动脉硬化杂志,2006,14(6)：487-490.
[5]C冯波,王华,赵秀丽.应用基因芯片探讨阿托伐他汀对糖尿病大鼠动脉组织基因谱表达的影响.中华糖尿病杂志,2005,13(6)：465-466.
[6]李振勇.他汀类药物从心血管病到肾脏病.心血管病学进展,2007,28：802-805.
[7]陈书艳,张琼,周卿,等.阿托伐他汀对急性心肌梗死随过氧化物酶的影响.中华老年心血管病杂志,2007,9：551-553.
[8]张京梅.早期应用大剂量阿托伐他汀对老年急性冠脉综合症患者抗炎作用的临床研究[J].中国综合临床,2007,23(3)203-205.
[9]王安才,成蓓,谢晓竟,等.阿托伐他汀对白发性高血压大鼠心室重构的影响.中国临床药理学与治疗学,2004,9：880-884.
[10]徐浩,王安才,杨解人.阿托伐他汀改善心室重构作用及其抗氧化机制研究.心脑血管病防治,2005,5：16-18.
[11]Takemoto M, Liao JK. Pleiotropic effects of 3-hydroxy-3-methylglutaryl coenzyme a Reductase Inhibitors [J]. Arterioscler Thromb Vasc Biol,2001,21(11):1712-1719.
[12]Ortego M, Bustos C, Hernandez-Presa MA, et al. Atorvastatin reduces NF-κB activation and chemokine expression in vascular smooth muscle cells and mononuclear cells[J]. Atherosclerosis,1999,147(2):253-261.
[13]Bellas RE, Lee JS, Sonenshein GE. Expression of a constitutive NF-κB like activity is essential for proliferation of cultured bovine vascular smooth muscle cells[J]. J Clin Invest,1995,96(5):2521-2527
[14]唐梅,章钲,宁金民,等JAK2/STAT3信号通路在阿托伐他汀抗大鼠血管平滑肌细胞增殖凋亡中的作用研究[J].中国分子心脏病学杂志,2006,6(3)：161-165.
[15]Ray KK, Morrow DA, Shui A, et al. Relation between soluble intercellular adhesion molecule-1, statin therapy, and long-term risk of clinical cardiovascular events in patients with previous acute coronary syndrome(from PROVEIT—TIMI22). Am J Cardiol, 2006,98(7):861-865.
[16]杜纪兵,丛洪良,杨万松,等.阿托伐他汀在小鼠颈动脉粥样硬化形成中的作用[J].天津医药,2008,36(4)：285-287.
[17]Ramana KV, Chandra D, Srivastava S, et al. Aldose reductase mediates the mitogenic signals of cytokines[J]. Chem Biol Interact,2003,143-144:587-596.
[18]Meuwissen M, Piek JJ, Van der Wal AC, et al. Recurrent unstable angina after directional coronary atherectomy is related to the extent of intial coronary plaque inflammation [J]. J Am Coll Cardiol,2001,37(5):1271-1276.
[19]Buemi M, Allegra A, Senatore M, et al. Pro-apoptotic effect of fluvastatin on human smooth muscle cells[J]. Eur J Pharmacol,1999,370(2):201-203.
[1]韩冰,张宏光,周晨光等.老年糖尿病性下肢动脉硬化闭塞症的外科治疗[J].中国普通外杂志,2007,16(6)：536-538.
[2]韩冰,王家祥,王兵等.腔内治疗糖尿病合并下肢动脉硬化闭塞症的临床分析[J].中华普通外杂志,2009,24(3)：243-244.
[3]Klinkert P,Schepers A,Burger DH,et al.Vein versus polytetranfluoroethlene in above-knee femoropopliteal bypass grafting:five-years of a randomized controlled trial[J].J Vasc Surg,2003,37(1):149-155.
[4]Muradin GS, Bosch JL.Stijnen T,et al. Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease:meta-analysis[J].Radiology,2001,221(1):137-145.
[5]Iida O,Nanto S,Uematsu M,et al. Effect of lxercise on frequency of stent fracture in the superficial fevnoral artery[J].Am J Cardiol,2006,98(2):272-274.
[6]Schillinger M,Sabeti S,Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery[J].N Engl J Med,2006,354(18):1879-1888.
[7]俞小韵,陈锐,李瑾等.阿托伐他汀对冠心病患者介入治疗的影响[J].世界临床药物,2009,30(1)：30-32.
[8]Monahan TS,Andersen ND,Panossian H,et al.A novel function for cadherin 11/osteoblast-cadherin in vascular smooth muscle cells:modulation of cell migration and proliferation [J].J Vasc Surg.2007,45(3):581-589.
[9]杨永宗.动脉粥样硬化性心血管病基础与临床.北京：科学出版社,2004：51-52.
[10]Raja SG, Dreyfus GD. Statins:much more than just alipid-lowering therapy. Indian Heart J,2004,56 (3):204-209.
[11]Xu YG,Zhou SH,LiYG,et al.The mechanis underlying vaseular smooth muscle cell apoptosis induced by atorvastain may be mainly associated with domn-regu lation of survivin expression [J].Cardiovasc Drugs ther,2007,21(3):145-153.
[12]Poli A,Aeorvastation.Pharmacolog ical characteristics and lipid-lowering effects [J].,Drugs. 2007,67(suppl 1):3-15.
[13]R ubba P. Effects of atorvastatin on the different phases of atherogenesis [J].Drugs, 2007,67(suppl 1):17-27.
[1]韩冰,王稼祥,王兵等.腔内治疗糖尿病合并下肢动脉硬化闭塞症的临床分析[J].中华普通外科,2009,24(3)：243-244.
[2]韩冰,王稼祥,王兵等.下肢动脉硬化闭塞症合并血栓形成的治疗[J].中国综合临床,2010,26(2)：207-208.
[3]韩冰,王稼祥,王兵等.血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症[J].医学研究与教育,2009,26(6)：22-24.
[4]Surowiec SM,Davies MG,Eberly SW,et al. Percutaneous angioplasty and stenting of the superficial femoral artery[J].J Vasc Surg,2005,41(2):269-278.
[5]Conte MS,Bandyk DF,Clowes AW,et al. Results of PREVENT Ⅲ:a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery[J].J Vasc Surg,2006,43(4):742-751.
[6]陈柏南.中西医结合治疗闭塞性动脉硬化症研究概述[J].中国中西医结杂志,1998,18(2)：122-124.
[7]王嘉桔.肢体动脉硬化闭塞症的研究现状和展望[J].辽宁医学杂志,1993,7(4)：170-172.
[8]汪忠镐.近肾动脉腹主动脉闭塞症[J].胸心血管外科杂志,1985,4：206.
[9]Jiang ME, Huang Y, Lu M, et al.Revascularization ofseverly ischcmic limbs by staged arteriovenous reversal [J].Jap J Cardiovasc Surg,1999,28(4):215-220.
[10]Owens CD, Ho KJ,Conte MS.Lower extremity vein graft failure:a translational approach [J].Vasc Med,2008,13(1):63-74.
[11]Stonebridge PA,Prescott RJ,Ruckley CV. Randomized trial comparing infrainguinal polytetrafluoroethylene by-pass grafting with and without vein interposition cuff at the distal anastomosis.The Joint Vascular Research Group[J].J Vasc Surg,1997,26(4):543-550.
[12]Veith FJ, Gupta SK, Ascer E,et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts ininfrainguinal arterial reconstructions[J].J Vasc Surg,1986,3(1):104-114.
[13]Oderich GS, Panneton JM, Yagubyan M,et al.Comparison of precuffed and vein-cuffed expanded polytetrafluoroethylene grafts for infragenicular arterial reconstructions:a case-matched study[J].Ann Vasc Surg,2005,19(1):49-55.
[14]Dotter CT, Judkins MP.Transluminal treatment of arteriosclerotic obstruction.Description of a new technic and a preliminary report of its application[J].Circulation,1964,30:654-670.
[15]Dormandy JA, Rutherford RB. Management of peripheral arterial disease(PAD).TASC Working Group.TransAt-lantic Inter-Society Consensus(TASC)[J].J Vasc Surg,2000,31(1Pt 2):S1-S296.
[16]White CJ, Gray WA.Endovascular therapies for peripheral arterial disease:an evidence-based review[J].Circulation,2007,116(19):2203-2215.
[17]Wildgruber MG,Berger HJ.Cryoplasty for the prevention of arterial restenosis[J]. Cardiovasc Intervent Radiol,2008,31(6):1050-1058.
[18]Adam DJ,Beard JD,Cleveland T,et al.Bypass versus angioplasty in severe ischaemia of the leg(BASIL):multicentre,randomised controlled trial[J].Lancet,2005,366(9501):1925-1934.
[19]Dormandy JA,Rutherford RB.Management of peripheralarterial disease(PAD).TASC Working Group.TransAt-lantic Inter-Society Consensus(TASC)[J].J Vasc Surg,2000,31(l Pt2):Sl-S296.
[20]Matsi PJ,Manninen HI,Soder HK,et al.Percutaneous transluminal angioplasty in femoral artery occlusions:primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques[J].Clin Radiol,1995,50(4):237-244.
[21]Hunink MG,Wong JB,Donaldson MC,et al.Revascularization for femoropopliteal disease.A decision and cost-effectiveness analysis[J].JAMA,1995,274(2):165-171.
[22]Saxon RR,Dake MD,Volqelzang RL,et al.Randomized,multicenter study comparing expan-ded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease [J]. J Vasc Interv Radiol,2008,19(6):823-832.
[23]Bosiers M, Deloose K, Verbist J, et al. First ClinicalApplication of Absorbable Metal Stents in the Treatment ofCritical Limb Ischemia:12-month results. Vasc DiseaseManagement, 2005,2:86-91.
[24]Bolia A,Miles KA,Brennan J,et al.Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection[J]. Cardiovasc Intervent Radiol,1990,13(6):357-363.
[25]陆信武,李维敏,黄英等.内膜下血管成形术治疗下肢动脉硬化闭塞病人的临床评价[J].中华医学杂志,2007,87(43)：3047-3050.
[26]杨广林,黄英,蒋米尔等.内膜下血管成形术在下肢动脉硬化闭塞症中的应用[J].临床外科杂志,2005,13(11)：732-734.
[27]Rogers JH, Laird JR.Overview of new technologies forlower extremity revascularization [J].Circulation,2007,116(18):2072-2085.
[28]Met R, Van Lienden KP, Koelemay MJ,et al.Subintimal angioplasty for peripheral arterial occlusive disease:a systematic review[J].Cardiovasc Intervent Radiol,2008,31(4):687-697.
[29]黄英,陆信武,李维敏,等.内膜下血管成形术治疗下肢动脉硬化闭塞症的初步报道[J].外科理论与实践,2005,10(1)：23-26..
[30]Treiman GS,Whiting JH, Treiman RL, et a.l Treatment of limb-threatening ischemia with percutaneous intentional extraluminalrecanalization:a preliminary evaluation[J]. J Vasc Surg,2003,38(1):29-35.
[31]Scott EC, Biuckians A,Light RE,et al.Subintimal angioplasty forthe treatment of claudication and critical limb ischemia:3-year re-sults[J].J Vasc Surg,2007,46(5): 959-964.
[32]Canaud L,Alric P,Berthet JP,et al.Infrainguinal cutting balloon angioplasty in de novo arterial lesions[J].J Vasc Surg,2008,48(5):1182-1188.
[33]Rogers JH,Laird JR.Overview of new technologies for lower extremity revascularization [J].Circulation,2007,116(18):2072-2085.
[34][34]McCaslin JE, Macdonald S,Stansby G.Cryoplasty for peripheral vascular disease[J/CD]. Cochrane Database Syst Rev,2007,17(4):CD005507.
[35]Wildgruber MG,Berger HJ.Cryoplasty for the prevention of arterial restenosis[J]. Cardiovasc Intervent Radiol,2008,31(6):1050-1058.
[36]Samson RH,Showalter DP,Lepore M Jr,et al.CryoPlasty therapy of the superficial femoral and popliteal arteriesra reappraisal after 44 months'experience[J].J Vasc Surg,2008,48(3): 634-637.
[37]Simpson JB.How atherectomy began:a personal history[J].Am J Cardiol,1993,72(13): 3E-5E.
[38]Keeling WB,Shames ML,Stone PA,et al.Plaque excision with the Silverhawk catheter:early results in patients with claudication or critical limb ischemia[J].J Vasc Surg,2007,45(l): 25-31.
[39]Zeller T,Sixt S,Schwarzwalder U,et al.Two-year results after directional atherectomy of infrapopliteal arteries with the Silver Hawk device[J].J Endovasc Ther,2007,14(2):232-240.
[40]Chung SW,Sharafuddin MJ,Chigurupati R,et al.Midterm patency following atherectomy for infrainguinal occlusive disease:a word of caution[J].Ann Vasc Surg,2008,22(3): 358-365.
[41]韩冰,王稼祥,王兵.杂交术式治疗糖尿病性下肢动脉硬化闭塞症的临床分析[J].医学研究与教育,2010,27(2)：17-19.
[42]DeRubertis BG, Pierce M, Chaer RA,et al. Lesion severity and treatment complexity are associated with outcome after percutaneous infra-inguinal intervention [J]. J Vasc Surg, 2007,4-6(4):709-716.
[43]Cotroneo AR, Iezzi R, Marano G, et al. Hybrid therapy in patients with complex peripheral multifocal steno-obstructive vascular disease:two-year results [J]. Cardiovasc Intervent Radio-1,2007,30(3):355-361.
[44]Klinkert P,Post PN,Breslau PJ,et al.Saphenous vein versus PTFEfor above-knee femoropopliteal bypass. A review of the literature (J).Eur J Vasc Endovasc Surg,2004,27(4): 357-362.
[45]Klein WM, van der Graaf Y, Seegers J,et al.Dutch iliac stent trial:long-term results in patients randomized for primary or selective stent placement (J).Radiology,2006,238(2): 734-744.
[46]周兆熊,张纪蔚,张皓,等.支架植入联合旁路转流术治疗下肢多平面动脉闭塞症(J).外科理论与实践,2004；9(2)：140-143.
[47]Ballotta E,Renon L,De Rossi A,etal.Prospective randomized study on reversed saphenous vein infrapopliteal bypass to treat limb-threatening ischemia:common femoral artery versus superficial femoral or popliteal and tibial arteries as inflow (J).Vase Surg,2004, 40(4):732-740.
[48]Devine C,McCollum C. Heparin-bonded Dacron or polytetrafluorethylene for femoropoplitealbypass:five-year results of a prospective randomized multicenter clinical trial(J).J Vasc Surg,2004; 40(5):924-931.
[49]葛长青,韩冰,张红光等.复合术式治疗下肢动脉硬化闭塞症的疗效观察及其影响冈素的研究[J].中华普通外科文献杂志,2010,4(4)：38-41.
[50]Mannava K, Money SR.Current management of peripheral arterial occlusive disease:a review of pharmacologic agents and other interventions [J].Am J Cardiovasc Drugs,2007, 7(1):59-66.
[51]Sobel M, Verhaeghe R.Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)[J]. Chest,2008,133(6 Suppl):815s-843s.
[52]Monahan TS,Andersen ND,Panossian H,et al.A novel function for cadherin 11/osteoblast-cad-herin in vascular smooth muscle cells:modulation of cell migration and prolife-ratio n [J].J Vasc Surg.2007,45(3):581-589.
[53]韩冰,葛长青,张红光等.阿伐洛他汀干预腔内治疗下肢动脉硬化闭塞症后再狭窄的研究[J].中国综合临床医学,2010年,26(12)：1326-1327.
[54]Xu YG, Zhou SH, LiYG, et al.The mechanis underlying vaseular smooth muscle cell apoptosis induced by atorvatain may be mainly associated with domn-regulation of survivin expression [J].Card iovasc Drugs ther,2007,21(3):145-153.
[55]Gu YQ,Zhang J,Guo LR,et al.Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia[J].Chin Med J(Engl),2008,121(11):963-967.
[56]De Vriese AS, Billiet J,Van Droogenbroeck J,et al.Autologous transplantation of bone marrow mononuclearcells for limb ischemia in a Caucasian population with atherosclerosis obliterans[J].J Intern Med,2008,263(4):395-403.
[57]Kalka C, Baumgartner I.Gene and stem cell therapy in peripheral arterial occlusive disease [J].Vasc Med,2008,13(2):157-172.
[58]Siskin G, DarlingRC, Stainken B,et al.Combined use of iliac artery angioplasty and infrainguinal revascularization for treatment of multilevel atherosclerotic disease (J).Ann VascSurg,1999,13(1):45-51.
[2]Selvin E, Erlinger TP, Prevalence and risk factors for peripheral arterialdisease in theUnites States:results from the NationalHealth and Nutri-tion Examination Survey,1999-2000 (J).Circulation,2004,110(6):738-743.
[3]李小鹰,王洁,王全义,等·周围动脉硬化闭塞症在老年血脂异常人群中的现患率调查(J).中华老年心脑血管病杂志,2005,7(1)：3-6·
[4]汪忠镐近肾动脉腹主动脉闭塞症[J].胸心血管外科杂志,1985,4：206.
[5]Jiang ME,Huang Y,Lu M,et al.Revascularization of severly is chcmic limbs by staged arteriovenous reversal [J] Jap J Cardiovasc Surg,1999,28(4):215-220.
[6]Owens CD, Ho KJ,Conte MS.Lower extremity vein graft failure:a translational approach [J].Vasc Med,2008,13(1):63-74.
[7]Stonebridge PA,Prescott RJ,Ruckley CV. Randomizedtrial comparing infrainguinal polytetrafluoroethylene by-pass grafting with and without vein interposition cuff atthe distal anastomosis.The Joint Vascular ResearchGroup[J].J Vasc Surg,1997,26(4):543-550.
[8]Veith FJ,Gupta SK,Ascer E,et al.Six-year prospectivemulticenter randomized comparison of autologous saphe-nous vein and expanded polytetrafluoroethylene grafts ininfrainguinal arterial reconstructions[J].J Vasc Surg,1986,3(1):104-114.
[9]Oderich GS, Panneton JM,Yagubyan M,et al.Compari-son of precuffed and vein-cuffed expanded polytetrafluoroethylene grafts for infragenicular arterial reconstructions:a case-matched study[J].Ann Vasc Surg,2005,19(1):49-55.
[10]杨庭树.老年闭塞性外周动脉疾病的介入治疗进展[J].解放军保健医学杂志,2007,9(1)：4-7.
[11]GrazianiL, SilvestroA, BertoneV, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer:a new morphologic categorization of disease severity [J]. Eur J Vasc Endovasc Surg,2007,33(4):453-460.
[12]张建勇,于中丽.经皮腔内血管成形术治疗下肢动脉流出道闭塞性硬化症的临床分析[J].新疆医科大学学报,2008,31(8)：1002-1004.
[13]李晓强,桑宏飞.下肢动脉硬化闭塞症的外科手术及介入治疗[J].苏州医学,2005,29(2)：57-59.
[14]姜鑫,汪宁宁,刘丽,等.超声消融结合介入治疗慢性下肢深静脉血栓的临床研究[J].中国医学装备,2008,5(12)：17.
[15]韩冰,张宏光,周晨光等.老年糖尿病性下肢动脉硬化闭塞症的外科治疗[J].中国普通外杂志,2007,16(6)：536-538.
[16]Kawamoto A, Asahara T, LosordoDW. Transplantation of endothelial progenitor cells for therapeutic neovascularization [J]. Cardiovasc Radiat Med,2002,3(3-4):221-225.
[17]韩冰,张宏光,汪忠镐.急性肢体动脉缺血再通术后再灌注损伤的治疗[J].中华急诊医学 杂志.2003,12(11)：771-772.
[18]陈家伟.糖尿病动脉粥样硬化中的炎症机制[J].国外医学内分泌学分册,2004,24(4)：附录2-1-3.
[19]韩冰,王稼祥,王兵.下肢动脉硬化闭塞症合并血栓形成的治疗[J].中国综合临床,2010,26(2)：207-208.
[20]Klinkert P,Schepers A,Burger DH,et al.Vein versus polytetranfluoroethylene in aboveknee femoropopliteal bypass grafting:five-years of a randomized controlled trial[J].j Vase Surg,2003,37(1):149-155.
[21]Schillinger M,Sabeti S,Loewe C,et al.Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery[J].N Engl J Med,2006,354 (18):1879-1888.
[22]Adam DJ,Stonebridge PA,Belch JJ,et al.Antiplateletand anticoagulant therapy to prevent bypass graft thrombosis in patients with lower extremity arterial occlusive disease[J].Int angiol,2001,20(1):90-98.
[23]Mills SJ,Patel ST.Infrainguinal graft duplex surveil-lance:detection and treatment of graft-threatening lesions[M]//Pearce WH,Matsumura JS,Yao JST.Trends in Vascular Surgery. Illinois:Greenwood Academic,2005:51-66.
[24]Adam DJ,Beard JD,Cleveland T,et al.Bypass versus angioplasty in severe ischaemia of the leg(BASIL):multicentre,randomised controlled trial[J].Lancet,2005,366(9501):1925-1934.
[25]Dormandy JA,Rutherford RB. Management of peripheral arterial disease (PAD).TASC Working Group.TransAtlantic Inter-Society Consensus(TASC)[J]. J Vase Surg,2000,31(1 Pt 2):S1-S296.
[26]Matsi PJ,Manninen HI,Soder HK,et al.Percutaneous transluminal angioplasty in femoral artery occlusions:primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques[J].Clin Radiol,1995,50(4):237-244.
[27]Hunink MG, Wong JB, Donaldson MC,et al. Revascularization for femoropopliteal disease. Adecision and cost-effectiveness analysis[J].JAMA,1995,274(2):165-171.
[28]Muradin GS,Bosch JL,Stijnen T,et al.Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease:meta-analysis[J].Radiology,2001,221(1):137-145.
[29]Iida O, Nanto S, Uematsu M, et al.Effect of exercise on frequency of stent fracture in the superficial femoral artery[J].Am J cardio,2006,98(2):272-274.
[30]Saxon RR,Dake MD,Volqelzang RL,et al.Randomized,multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease[J].J Vase IntervRadiol,2008,19(6):823-832.
[31]韩冰,王稼祥,王兵.血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症[J].医学研究与教育,2009,27(6)：22-24.
[1]King H, Aubert RE, Herman WH. Global burden of diabetes,1995-2025:prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.
[2]Eschwege E SimonDBalkau B. The growing burden of diabetes in the world population. International Diabetes Federation Bulletin 1997;42:14-9.
[3]Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients:a comparison of severity and outcome. Diabetes Care 2001;24: 1433-7.
[4]Melliere D, Berrahal D, Desgranges P, Allaire E, Becquemin JP, Perlemuter L, et al. Influence of diabetes on revascularization procedures of the aorta and lower limb arteries: early results. Eur J Vase Endovasc Surg 1999;17:438-41.
[5]Awad S, Karkos CD, Serrachino-Inglott F, Cooper NJ, Butterfield JS, Ashleigh R, et al. The impact of diabetes on current revascularization practice and clinical outcome in patients with critical lower limb ischemia. Eur J Vasc Endovasc Surg 2006;32:51-9.
[6]Schmiedt W, Neufang A, Dorweiler B, Espinola-Klein C, Reinstadler J, Kraus O, et al. Short distal origin vein graft in diabetic foot syndrome. Zentralbl Chir 2003;128:720-5.
[7]Veith FJ, Ascer E, Gupta SK, White-Flores S, Sprayregen S, Scher LA, et al. Tibiotibial vein bypass grafts:a new operation for limb salvage. J Vasc Surg 1985;2:552-7.
[8]King SB 3rd, Kosinski AS, Guyton RA, Lembo NJ, Weintraub WS. Eight-year mortality in the Emory Angioplasty versus Surgery Trial (EAST). J Am Coll Cardiol 2000;35:1116-21.
[9]The BARI Investigators. Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status. J Am Coll Cardiol 2000;35:1122-9.
[10]Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schonberger JP, et al; Arterial Revascularization Therapies Study Group. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001 12;344:1117-24.
[11]Arana-ConejoV, DomingoMendez J. Physiopathology ofVascu-larComplications ofDiabetic Foot [J]. GacMedMex,2003,139(3):255-264.
[12]Dietzek AM, Gupta SK, Kram HB, Wengerter KR, Veith FJ. Limb loss with patent infrainguinal bypasses. Eur J Vase Surg 1990;4:413-7.
[13]Veith FJ, Ascer E, Gupta SK, White-Flores S, Sprayregen S, Scher LA, et al. Tibiotibial vein bypass grafts:a new operation for limb salvage. J Vasc Surg 1985;2:552-7.
[14]沈丽新,袁晓晨.糖尿病和动脉粥样硬化发病机制的交会点-PPARs[J]中国厂矿医学,2007,20(3)：286-287。
[15]任杰,殷瑛,赵兴胜.高血压和糖代谢调节异常对动脉硬化的影响[J].医学综述,2009,15(9)：1358-1360。
[1]Mason RP, Walter Mf, Day CA, et al. Active metabolite of atorvastatin inhibits membrane cholesterol domain formation by an antioxidant mechanism[J]. J Biol Chem, 2006,281(14):9337-9345.
[2]赵振国,江渝.动脉粥样硬化中主要炎症细胞因子的作用[J].国际检验医学杂志,2006,10,27(10)：919-920.
[3]Ma QL, Mo L, Yang TL, et al. Effects of different doses of atorvastatin on adhesion molecules of the patients undergoing percutaneous coronary intervention[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban,2006,31(6):914-916.
[4]郑春华,周胜华,刘启明, 等.阿托伐他汀对大鼠再狭窄血管醛糖还原酶表达及内膜增生的抑制作用[J].中国动脉硬化杂志,2006,14(6)：487-490.
[5]C冯波,王华,赵秀丽.应用基因芯片探讨阿托伐他汀对糖尿病大鼠动脉组织基因谱表达的影响.中华糖尿病杂志,2005,13(6)：465-466.
[6]李振勇.他汀类药物从心血管病到肾脏病.心血管病学进展,2007,28：802-805.
[7]陈书艳,张琼,周卿,等.阿托伐他汀对急性心肌梗死随过氧化物酶的影响.中华老年心血管病杂志,2007,9：551-553.
[8]张京梅.早期应用大剂量阿托伐他汀对老年急性冠脉综合症患者抗炎作用的临床研究[J].中国综合临床,2007,23(3)203-205.
[9]王安才,成蓓,谢晓竟,等.阿托伐他汀对白发性高血压大鼠心室重构的影响.中国临床药理学与治疗学,2004,9：880-884.
[10]徐浩,王安才,杨解人.阿托伐他汀改善心室重构作用及其抗氧化机制研究.心脑血管病防治,2005,5：16-18.
[11]Takemoto M, Liao JK. Pleiotropic effects of 3-hydroxy-3-methylglutaryl coenzyme a Reductase Inhibitors [J]. Arterioscler Thromb Vasc Biol,2001,21(11):1712-1719.
[12]Ortego M, Bustos C, Hernandez-Presa MA, et al. Atorvastatin reduces NF-κB activation and chemokine expression in vascular smooth muscle cells and mononuclear cells[J]. Atherosclerosis,1999,147(2):253-261.
[13]Bellas RE, Lee JS, Sonenshein GE. Expression of a constitutive NF-κB like activity is essential for proliferation of cultured bovine vascular smooth muscle cells[J]. J Clin Invest,1995,96(5):2521-2527
[14]唐梅,章钲,宁金民,等JAK2/STAT3信号通路在阿托伐他汀抗大鼠血管平滑肌细胞增殖凋亡中的作用研究[J].中国分子心脏病学杂志,2006,6(3)：161-165.
[15]Ray KK, Morrow DA, Shui A, et al. Relation between soluble intercellular adhesion molecule-1, statin therapy, and long-term risk of clinical cardiovascular events in patients with previous acute coronary syndrome(from PROVEIT—TIMI22). Am J Cardiol, 2006,98(7):861-865.
[16]杜纪兵,丛洪良,杨万松,等.阿托伐他汀在小鼠颈动脉粥样硬化形成中的作用[J].天津医药,2008,36(4)：285-287.
[17]Ramana KV, Chandra D, Srivastava S, et al. Aldose reductase mediates the mitogenic signals of cytokines[J]. Chem Biol Interact,2003,143-144:587-596.
[18]Meuwissen M, Piek JJ, Van der Wal AC, et al. Recurrent unstable angina after directional coronary atherectomy is related to the extent of intial coronary plaque inflammation [J]. J Am Coll Cardiol,2001,37(5):1271-1276.
[19]Buemi M, Allegra A, Senatore M, et al. Pro-apoptotic effect of fluvastatin on human smooth muscle cells[J]. Eur J Pharmacol,1999,370(2):201-203.
[1]韩冰,张宏光,周晨光等.老年糖尿病性下肢动脉硬化闭塞症的外科治疗[J].中国普通外杂志,2007,16(6)：536-538.
[2]韩冰,王家祥,王兵等.腔内治疗糖尿病合并下肢动脉硬化闭塞症的临床分析[J].中华普通外杂志,2009,24(3)：243-244.
[3]Klinkert P,Schepers A,Burger DH,et al.Vein versus polytetranfluoroethlene in above-knee femoropopliteal bypass grafting:five-years of a randomized controlled trial[J].J Vasc Surg,2003,37(1):149-155.
[4]Muradin GS, Bosch JL.Stijnen T,et al. Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease:meta-analysis[J].Radiology,2001,221(1):137-145.
[5]Iida O,Nanto S,Uematsu M,et al. Effect of lxercise on frequency of stent fracture in the superficial fevnoral artery[J].Am J Cardiol,2006,98(2):272-274.
[6]Schillinger M,Sabeti S,Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery[J].N Engl J Med,2006,354(18):1879-1888.
[7]俞小韵,陈锐,李瑾等.阿托伐他汀对冠心病患者介入治疗的影响[J].世界临床药物,2009,30(1)：30-32.
[8]Monahan TS,Andersen ND,Panossian H,et al.A novel function for cadherin 11/osteoblast-cadherin in vascular smooth muscle cells:modulation of cell migration and proliferation [J].J Vasc Surg.2007,45(3):581-589.
[9]杨永宗.动脉粥样硬化性心血管病基础与临床.北京：科学出版社,2004：51-52.
[10]Raja SG, Dreyfus GD. Statins:much more than just alipid-lowering therapy. Indian Heart J,2004,56 (3):204-209.
[11]Xu YG,Zhou SH,LiYG,et al.The mechanis underlying vaseular smooth muscle cell apoptosis induced by atorvastain may be mainly associated with domn-regu lation of survivin expression [J].Cardiovasc Drugs ther,2007,21(3):145-153.
[12]Poli A,Aeorvastation.Pharmacolog ical characteristics and lipid-lowering effects [J].,Drugs. 2007,67(suppl 1):3-15.
[13]R ubba P. Effects of atorvastatin on the different phases of atherogenesis [J].Drugs, 2007,67(suppl 1):17-27.
[1]韩冰,王稼祥,王兵等.腔内治疗糖尿病合并下肢动脉硬化闭塞症的临床分析[J].中华普通外科,2009,24(3)：243-244.
[2]韩冰,王稼祥,王兵等.下肢动脉硬化闭塞症合并血栓形成的治疗[J].中国综合临床,2010,26(2)：207-208.
[3]韩冰,王稼祥,王兵等.血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症[J].医学研究与教育,2009,26(6)：22-24.
[4]Surowiec SM,Davies MG,Eberly SW,et al. Percutaneous angioplasty and stenting of the superficial femoral artery[J].J Vasc Surg,2005,41(2):269-278.
[5]Conte MS,Bandyk DF,Clowes AW,et al. Results of PREVENT Ⅲ:a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery[J].J Vasc Surg,2006,43(4):742-751.
[6]陈柏南.中西医结合治疗闭塞性动脉硬化症研究概述[J].中国中西医结杂志,1998,18(2)：122-124.
[7]王嘉桔.肢体动脉硬化闭塞症的研究现状和展望[J].辽宁医学杂志,1993,7(4)：170-172.
[8]汪忠镐.近肾动脉腹主动脉闭塞症[J].胸心血管外科杂志,1985,4：206.
[9]Jiang ME, Huang Y, Lu M, et al.Revascularization ofseverly ischcmic limbs by staged arteriovenous reversal [J].Jap J Cardiovasc Surg,1999,28(4):215-220.
[10]Owens CD, Ho KJ,Conte MS.Lower extremity vein graft failure:a translational approach [J].Vasc Med,2008,13(1):63-74.
[11]Stonebridge PA,Prescott RJ,Ruckley CV. Randomized trial comparing infrainguinal polytetrafluoroethylene by-pass grafting with and without vein interposition cuff at the distal anastomosis.The Joint Vascular Research Group[J].J Vasc Surg,1997,26(4):543-550.
[12]Veith FJ, Gupta SK, Ascer E,et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts ininfrainguinal arterial reconstructions[J].J Vasc Surg,1986,3(1):104-114.
[13]Oderich GS, Panneton JM, Yagubyan M,et al.Comparison of precuffed and vein-cuffed expanded polytetrafluoroethylene grafts for infragenicular arterial reconstructions:a case-matched study[J].Ann Vasc Surg,2005,19(1):49-55.
[14]Dotter CT, Judkins MP.Transluminal treatment of arteriosclerotic obstruction.Description of a new technic and a preliminary report of its application[J].Circulation,1964,30:654-670.
[15]Dormandy JA, Rutherford RB. Management of peripheral arterial disease(PAD).TASC Working Group.TransAt-lantic Inter-Society Consensus(TASC)[J].J Vasc Surg,2000,31(1Pt 2):S1-S296.
[16]White CJ, Gray WA.Endovascular therapies for peripheral arterial disease:an evidence-based review[J].Circulation,2007,116(19):2203-2215.
[17]Wildgruber MG,Berger HJ.Cryoplasty for the prevention of arterial restenosis[J]. Cardiovasc Intervent Radiol,2008,31(6):1050-1058.
[18]Adam DJ,Beard JD,Cleveland T,et al.Bypass versus angioplasty in severe ischaemia of the leg(BASIL):multicentre,randomised controlled trial[J].Lancet,2005,366(9501):1925-1934.
[19]Dormandy JA,Rutherford RB.Management of peripheralarterial disease(PAD).TASC Working Group.TransAt-lantic Inter-Society Consensus(TASC)[J].J Vasc Surg,2000,31(l Pt2):Sl-S296.
[20]Matsi PJ,Manninen HI,Soder HK,et al.Percutaneous transluminal angioplasty in femoral artery occlusions:primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques[J].Clin Radiol,1995,50(4):237-244.
[21]Hunink MG,Wong JB,Donaldson MC,et al.Revascularization for femoropopliteal disease.A decision and cost-effectiveness analysis[J].JAMA,1995,274(2):165-171.
[22]Saxon RR,Dake MD,Volqelzang RL,et al.Randomized,multicenter study comparing expan-ded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease [J]. J Vasc Interv Radiol,2008,19(6):823-832.
[23]Bosiers M, Deloose K, Verbist J, et al. First ClinicalApplication of Absorbable Metal Stents in the Treatment ofCritical Limb Ischemia:12-month results. Vasc DiseaseManagement, 2005,2:86-91.
[24]Bolia A,Miles KA,Brennan J,et al.Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection[J]. Cardiovasc Intervent Radiol,1990,13(6):357-363.
[25]陆信武,李维敏,黄英等.内膜下血管成形术治疗下肢动脉硬化闭塞病人的临床评价[J].中华医学杂志,2007,87(43)：3047-3050.
[26]杨广林,黄英,蒋米尔等.内膜下血管成形术在下肢动脉硬化闭塞症中的应用[J].临床外科杂志,2005,13(11)：732-734.
[27]Rogers JH, Laird JR.Overview of new technologies forlower extremity revascularization [J].Circulation,2007,116(18):2072-2085.
[28]Met R, Van Lienden KP, Koelemay MJ,et al.Subintimal angioplasty for peripheral arterial occlusive disease:a systematic review[J].Cardiovasc Intervent Radiol,2008,31(4):687-697.
[29]黄英,陆信武,李维敏,等.内膜下血管成形术治疗下肢动脉硬化闭塞症的初步报道[J].外科理论与实践,2005,10(1)：23-26..
[30]Treiman GS,Whiting JH, Treiman RL, et a.l Treatment of limb-threatening ischemia with percutaneous intentional extraluminalrecanalization:a preliminary evaluation[J]. J Vasc Surg,2003,38(1):29-35.
[31]Scott EC, Biuckians A,Light RE,et al.Subintimal angioplasty forthe treatment of claudication and critical limb ischemia:3-year re-sults[J].J Vasc Surg,2007,46(5): 959-964.
[32]Canaud L,Alric P,Berthet JP,et al.Infrainguinal cutting balloon angioplasty in de novo arterial lesions[J].J Vasc Surg,2008,48(5):1182-1188.
[33]Rogers JH,Laird JR.Overview of new technologies for lower extremity revascularization [J].Circulation,2007,116(18):2072-2085.
[34][34]McCaslin JE, Macdonald S,Stansby G.Cryoplasty for peripheral vascular disease[J/CD]. Cochrane Database Syst Rev,2007,17(4):CD005507.
[35]Wildgruber MG,Berger HJ.Cryoplasty for the prevention of arterial restenosis[J]. Cardiovasc Intervent Radiol,2008,31(6):1050-1058.
[36]Samson RH,Showalter DP,Lepore M Jr,et al.CryoPlasty therapy of the superficial femoral and popliteal arteriesra reappraisal after 44 months'experience[J].J Vasc Surg,2008,48(3): 634-637.
[37]Simpson JB.How atherectomy began:a personal history[J].Am J Cardiol,1993,72(13): 3E-5E.
[38]Keeling WB,Shames ML,Stone PA,et al.Plaque excision with the Silverhawk catheter:early results in patients with claudication or critical limb ischemia[J].J Vasc Surg,2007,45(l): 25-31.
[39]Zeller T,Sixt S,Schwarzwalder U,et al.Two-year results after directional atherectomy of infrapopliteal arteries with the Silver Hawk device[J].J Endovasc Ther,2007,14(2):232-240.
[40]Chung SW,Sharafuddin MJ,Chigurupati R,et al.Midterm patency following atherectomy for infrainguinal occlusive disease:a word of caution[J].Ann Vasc Surg,2008,22(3): 358-365.
[41]韩冰,王稼祥,王兵.杂交术式治疗糖尿病性下肢动脉硬化闭塞症的临床分析[J].医学研究与教育,2010,27(2)：17-19.
[42]DeRubertis BG, Pierce M, Chaer RA,et al. Lesion severity and treatment complexity are associated with outcome after percutaneous infra-inguinal intervention [J]. J Vasc Surg, 2007,4-6(4):709-716.
[43]Cotroneo AR, Iezzi R, Marano G, et al. Hybrid therapy in patients with complex peripheral multifocal steno-obstructive vascular disease:two-year results [J]. Cardiovasc Intervent Radio-1,2007,30(3):355-361.
[44]Klinkert P,Post PN,Breslau PJ,et al.Saphenous vein versus PTFEfor above-knee femoropopliteal bypass. A review of the literature (J).Eur J Vasc Endovasc Surg,2004,27(4): 357-362.
[45]Klein WM, van der Graaf Y, Seegers J,et al.Dutch iliac stent trial:long-term results in patients randomized for primary or selective stent placement (J).Radiology,2006,238(2): 734-744.
[46]周兆熊,张纪蔚,张皓,等.支架植入联合旁路转流术治疗下肢多平面动脉闭塞症(J).外科理论与实践,2004；9(2)：140-143.
[47]Ballotta E,Renon L,De Rossi A,etal.Prospective randomized study on reversed saphenous vein infrapopliteal bypass to treat limb-threatening ischemia:common femoral artery versus superficial femoral or popliteal and tibial arteries as inflow (J).Vase Surg,2004, 40(4):732-740.
[48]Devine C,McCollum C. Heparin-bonded Dacron or polytetrafluorethylene for femoropoplitealbypass:five-year results of a prospective randomized multicenter clinical trial(J).J Vasc Surg,2004; 40(5):924-931.
[49]葛长青,韩冰,张红光等.复合术式治疗下肢动脉硬化闭塞症的疗效观察及其影响冈素的研究[J].中华普通外科文献杂志,2010,4(4)：38-41.
[50]Mannava K, Money SR.Current management of peripheral arterial occlusive disease:a review of pharmacologic agents and other interventions [J].Am J Cardiovasc Drugs,2007, 7(1):59-66.
[51]Sobel M, Verhaeghe R.Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)[J]. Chest,2008,133(6 Suppl):815s-843s.
[52]Monahan TS,Andersen ND,Panossian H,et al.A novel function for cadherin 11/osteoblast-cad-herin in vascular smooth muscle cells:modulation of cell migration and prolife-ratio n [J].J Vasc Surg.2007,45(3):581-589.
[53]韩冰,葛长青,张红光等.阿伐洛他汀干预腔内治疗下肢动脉硬化闭塞症后再狭窄的研究[J].中国综合临床医学,2010年,26(12)：1326-1327.
[54]Xu YG, Zhou SH, LiYG, et al.The mechanis underlying vaseular smooth muscle cell apoptosis induced by atorvatain may be mainly associated with domn-regulation of survivin expression [J].Card iovasc Drugs ther,2007,21(3):145-153.
[55]Gu YQ,Zhang J,Guo LR,et al.Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia[J].Chin Med J(Engl),2008,121(11):963-967.
[56]De Vriese AS, Billiet J,Van Droogenbroeck J,et al.Autologous transplantation of bone marrow mononuclearcells for limb ischemia in a Caucasian population with atherosclerosis obliterans[J].J Intern Med,2008,263(4):395-403.
[57]Kalka C, Baumgartner I.Gene and stem cell therapy in peripheral arterial occlusive disease [J].Vasc Med,2008,13(2):157-172.
[58]Siskin G, DarlingRC, Stainken B,et al.Combined use of iliac artery angioplasty and infrainguinal revascularization for treatment of multilevel atherosclerotic disease (J).Ann VascSurg,1999,13(1):45-51.