Potential Arteriovenous Fistula In Some Patients With Arteriosclerosis Obliterans Of Lower Extremities

Objective To summarize the differences between patients with AVF and patients without AVF in arteriosclerosis obliterans of lower extremity,and to explore the pathogenesis of potential arteriovenous fistula in lower extremity arteriosclerosis obliterans.Methods 82 ASO patients with or without AVF were selected from September2015 to November 2018(A total of 82 diseased limbs,the lesion was located in the femoral popliteal artery and beyond).They were divided into arteriovenous fistula group(group A)and non-arteriovenous fistula group(group B).Clinical data of the two groups were collected,Data included gender,age,ASO risk factors(smoking,drinking,hypertension,diabetes),side and duration of disease,preoperative symptoms and were recorded according to Rutherford classification,ASO vascular lesions were recorded according to TASC classification,auxiliary examination results,postoperative recovery.The clinical data of the two groups were statistically analyzed and compared,and the pathogenesis was preliminarily discussed.Results Group A included 10 males(45.5%)and 12 females(54.5%),Group B included 44 males(73.3%)and 16 females(26.7%),There was significant difference in the incidence of AVF between the sexes(P=0.018 <0.05),Female(OR=3.136)is an independent risk factor for AVF in ASO.22 patients in group A were aged from 68 to 85(75.36±3.971)years old.60 patients in group B were aged from 50 to 85(71.53±10.545)years old,and the age difference between the two groups was statistically significant(P=0.019 < 0.05).There were 16 hypertensive patients(72.7%)in group A and 46 hypertensive patients(76.7%)in group B;9 diabetic patients(40.9%)in group A and 29 diabetic patients(48.3%)in group B;7 smoking patients in group A(31.8%)and 26 smoking patients in group B(43.3%);4 cases of drinking patients in group A(18.2%)and15 cases of drinking patients in group B(25.0%).There was no significant difference in the above risk factors between the two groups(P > 0.05).Patients in group A had an average of 368.09±561.546 days of illness,while patients in group B had an average of708.60±1039.329 days of illness,and the difference was not statistically significant(P=0.063 > 0.05).In group A,there were 8 cases of limb swelling and 5 cases of varicose veins,a total of 10 cases(45.5%);In group B,there were 9 cases of limb swelling and 4case of varicose vein,a total of 11 cases(18.3%),and the difference was statistically significant(P=0.013 < 0.05).The affected limbs of 22 patients in group A included 15 patients with right lower limb and 7 patients with left lower limb;The affected limb of 60 patients in group B included 45 patients were right lower limb and 15 patients were leftlower limb,the difference was not statistically significant(P=0.537 > 0.05).Rutherford grading of symptoms and signs between the two groups showed no statistically significant difference(P=0.119 > 0.05).TASC classification of arterial stenosis or occlusion showed statistically significant difference between the two groups(P=0.021 < 0.05),with 17 cases of CD type in group A(77.3%)and 24 cases of CD type in group B(40.0%),CD type(OR=5.377)is an independent risk factor for AVF in ASO.In group A,2 patient underwent the second operation due to acute arterial thrombosis,1 patient underwent toe amputation due to ulcer gangrene,and 2 patient was terminated due to intraoperative difficulty in passing the occlusion segment.In group B,3 patient underwent a second operation due to acute arterial thrombosis,and 3 patients were terminated due to intraoperative difficulty in passing the occlusion segment.Conclusion There was no difference in the occurrence of AVF in both limbs of ASO,it mostly occurs in extremities with TASC type CD of femoral popliteal artery,distal femoral superficial artery and popliteal artery occlusion.Senior female may be an important factor in the occurrence of AVF,and the incidence of AVF is not significantly correlated with time of disease and severity of symptoms.The formation of AVF may lead to varicose veins and swelling of lower limbs,and even aggravate the symptoms of pigmentation,ulceration and gangrene.The occurrence of AVF may be related to the opening of potential communication between arteries and veins,abnormal secretion of many cytokines with collateral angiogenesis,direct erosion of atherosclerotic plaques to accompanying veins.