Current Situation And Thought Of Revascularization Treatment To The Lower Extremities ASO In Our Country

AS is the most common disease in old people. Theincidence rate reaches 79.94% in old people over 60 in China. Insurrounding vessels, the increasingly expanding of thearteriosclerosis materials and the formation of the secondarythrombus cause the narrowing and blockage of the arteries. As aresult, disorder in the limb's blood cycle and the acute or chronicischemia will appear. This is called Arteriosclerosis Obliterans(ASO). ASO often happens in femoral and popliteal arteries, and itis often accompanied by coronary artery disease, hypertension anddiabetes mellitus etc. Its high impairment and mortality ratethreaten people's health and the quality of life. It is common inclinic.The main risk factors of AS are smoking, hypertension,hypertriglyceridemia, hypercholesterolemia, obesity, infection andfamily heredity. It often happens to people over 45, men higherthan women (6-8:1). ASO's etiological factors are not very clear.Many theories coexist at present. Some main theories include lipidinfiltration, intima damage, smooth muscle cell proliferation,hemdynamics and thrombosis. Each theory has some relevantfactors which work etiologically from different angles and periodsto induce ASO.The clinic situations and signs have important bearing withlimb's ischemia. Meanwhile limb's ischemia depends on limbartery's occlusive parts, range and NC's construction.There are three types of the session. I. The occlusive site islocated in the distal end of abdominal aorta and amphi-commoniliac artery. (10%) II. The occlusive site is located in external iliacartery and common femoral artery. (25%-30%) III. The occlusivesite is located in external iliac artery and femoral-popliteal artery.(60%) Type III is called Lower Extremity Multi-level ArterialOcclusive Disease (MLAOD). ASO's manifestation are limbs'muscle pain, contraction, hypodynamia, being cold, intermittentclaudication, the weakness or disappearance of the limb's pulse,disuse amyotrophy and stiffness of joint etc. When the situationturns severe, gangrene and ulcer may gradually appear.Necrobiosis usually happens between the toes, the tips of the toesand the pressed points in the toes.ASO is known as a disease that the chronic disease iscaused by the obstruction in the limb's arteries. According to thedevelopment of the patient's situation, ASO can be controlledthrough giving up smoking, having sports exercise and using drugtherapy. By these methods, the construction of NC and the bloodcirculation can be improved. Drug therapy includes lowerlimpemia, widening blood vessel, anti-fibration, anti-coagulant,anti-aggregation of platelet, improving microcirculation andtreatment by Chinese herbs. With the development of the patient'ssituation, the option of operation project should be adapt topatient's indication according to angiography. And run-in andrunoff should be choosed properly. The united drug therapy shouldbe used to increase the patency of grafting after the operation.Most of the ASO patients are of old age, accompanying bycandiovascular disease or diabetes. Their tolerance in the operationis weak. Thus, Rx should be decided on account of the patient'sG.C, the degree of the pathological changes, the risk in theoperation and the expectation effect. The operation adaptationdisease includes intermittent claudication which worsens rapidlyand the affected limb is in such a state of disability that has seriousimpact on their lives;ischemic rest pain which intensifies at night;the affected limb appears nutrition changes and thinner or palerskin that are the signs before necrosis;skin ulcer or the toenecrobiosis;Doppler blood flowmeter shows the malleolus/humerus index<0.5;deciduous embolism in femoral and poplitealartery which causes embolism at diatal part of the limbs.The surgical operation method includes primarily below a fewaspects. 1.Conventional surgery:Arterial thromboendarterectomy,anatomic bypass reconstruction, extra-anatomic bypassreconstruction etc. 2 . Intravascular interventional treatment:Percutaneous transluminal angioplasty, stent implantation,intravascular ultrasound ablation, laser angioplasty etc.3.Angiogenesis: Gene therapy, Stem Cell transplantation etc.Anatomic bypass reconstruction, including autogenous veintransplantation, artificial blood vessel transplantation, autogenousvein combined with artificial blood vessel transplantation, is themost in common use in our country.In this article, the documents concerning ASO in recent 5years have been collected and various operations within thecountry have been concluded, esp. their postoperative results. Thearticle lays emphasis on the current situation of ASO's arteryconstruction. Along with 22 successful experiment in PTfE bloodvessel transplantation, we discuss the values of artery constructionin ASO treatment. Researches on how to choose the grafting way,prophylexis and treatment on postoperative complications and theunified treatment of operation and drug are the main problems atpresent.In this team, the operative method is choosed responding tothe artery occlusion area in MRA shows and satisfactory inflowand outflow location. 22 cases in this team adopt PTFE bloodvessel transplantation, 3 cases with Y-type protheticaorto-doubleilliac or double femoral artery shunt , 2 cases withaorto-singleilliac or femoral artery shunt , 16 cases withiliac-femoral artery shunt. The operative result is evaluated byclinic situation and Color Ultrasonic Doppler examination.The result shows that 22 patients shunt are all successfulwithout postoperative mortality rate. The incision healed in theprimary stage and the rest pain ameliorated or disappered. 7 caseshad ischemic gangrene or ulcer. The ulcer healed in 3-5 weeksexcept that 3 patients were complicated by diabetes and toe ulcerwhich had toe amputation. 18 cases were in average 1.2 year.Among them, 15 were significantly improved and 3 had nosignificant improvement. None of them become worse. Thepostoperative patency rate in a year is 72.2%, 61.1% in 2 years.Limb salvage rate is 100%.From this, we know prothetic bypass grafting is a proper wayin treatment for ASO on the basis of MRA and the patient'sallowable conditions, which should be attached importanceAlthough artery reconstruction is an important method, theresult of the operation is being affected by the complications of theold people, the choices of indications, technical misoperation,misconduction in the postoperative multiple–organ period andneglection on postoperative continuant drug treatmeat. All thesefactors may endanger the patients' lives, on which are worthconsideration and focus of the doctors.